British National Formulary July 2023 Update

This update contains 7 significant changes, 5 dose changes, 1 new monograph, and 1 deleted preparation.

Significant Changes:

Adrenaline/epinephrine: recall of Emerade® 500 micrograms and Emerade® 300 micrograms auto-injectors, due to the potential for device failure [National Patient Safety Alert advice].
Baricitinib: new indication for alopecia areata.
Janus kinase (JAK) inhibitors: new measures to reduce risks of major cardiovascular events, malignancy, venous thromboembolism, serious infections and increased mortality [MHRA/CHM advice] (advice in abrocitinib, baricitinib, filgotinib, tofacitinib, upadacitinib; see example in tofacitinib).
Nitrofurantoin: reminder of the risks of pulmonary and hepatic adverse drug reactions [MHRA/CHM advice].
Rabies vaccine: updated guidance for immunisation.
Varicella-zoster vaccine: new indication for post-exposure prophylaxis against varicella infection (chickenpox) during co-circulating group A streptococcal infection (e.g. scarlet fever).
Varicella-zoster vaccines: updated guidance for varicella (chickenpox) immunisation.

Dose Changes:

Baricitinib [update to dosing for rheumatoid arthritis and atopic eczema].
Filgotinib [update to dosing for rheumatoid arthritis and ulcerative colitis].
Rabies vaccine [update to pre-exposure immunisation booster dose in patients who may have frequent, unrecognised exposures e.g. bat handlers].
Upadacitinib [update to dosing for atopic eczema and ulcerative colitis].
Varicella-zoster vaccine [update to immunisation against varicella infection (chickenpox)].

New Monograph:

Deleted Preparations: