British National Formulary August 2023 Update

This update contains 6 significant changes, 1 dose change, 2 new monographs, 1 new preparation, 4 deleted monographs, and 1 deleted preparation.

Significant Changes:

• Direct-acting oral anticoagulants (DOACs): reminder of dose adjustments in patients with renal impairment [MHRA/CHM advice] (advice in apixaban, dabigatran etexilate, edoxaban, and rivaroxaban; see example in dabigatran etexilate).
• Drugs that cause first dose hypotension, drugs that cause peripheral neuropathy, and drugs that cause hyponatraemia: pharmacodynamic effects drug groups revalidated and updated; see Appendix 1 interactions.
• Drugs that cause thromboembolism: pharmacodynamic effects drug group deleted from Appendix 1 interactions.
• Febuxostat: updated advice for the treatment of patients with a history of major cardiovascular disease [MHRA/CHM advice].
• Immunisation schedule: updated guidance for influenza immunisation.
• Influenza vaccine: updated guidance for immunisation.

Dose Change:

• Hydrocortisone [update to dosing for adrenal crisis in children].

New Monographs:

• Filsuvez® [birch bark extract].
• Oxlumo® [lumasiran].

New Preparation:

• Benzydamine hydrochloride 0.3% oromucosal spray.

Deleted Monographs:

• Co-triamterzide.
• Ergotamine tartrate.
• Timolol with amiloride and hydrochlorothiazide.
• Tipranavir.

Deleted Preparation:

• Gyno-Daktarin® [miconazole].