BNF for Children (BNFC) 2023-2024

Extensive content updates in the BNF for Children 2023-2024 edition include:

New monographs for:

• Aklief® [trifarotene] for acne vulgaris
• Aubagio® [teriflunomide] for multiple sclerosis
• Bylvay® [odevixibat] for progressive familial intrahepatic cholestasis
• Drovelis® [drospirenone with estetrol] for contraception
• Epclusa® [sofosbuvir with velpatasvir] for chronic hepatitis C infection
• Forxiga® [dapagliflozin] for type 2 diabetes mellitus
• Imcivree® [setmelanotide] for obesity with underlying genetic aetiology
• Magnesium citrate for treatment and prevention of magnesium deficiency
• Ngenla® [somatrogon] for deficiency of growth hormone
• Oxbryta® [voxelotor] for haemolytic anaemia due to sickle-cell disease
• Rezurock® [belumosudil] for chronic graft-versus-host disease
• Sibnayal® [potassium citrate with potassium bicarbonate] for distal renal tubular acidosis
• Tezspire® [tezepelumab] for severe asthma
• Volibris® [ambrisentan] for pulmonary arterial hypertension
• Zepatier ® [elbasvir with grazoprevir] for chronic hepatitis C infection of genotypes 1 or 4

MHRA advice on:

• Anagrelide: risk of thrombosis, including cerebral infarction, if treatment discontinued abruptly
• Denosumab (Prolia®): should not be used in patients under 18 years due to the risk of serious hypercalcaemia
• Dupilumab (Dupixent®): risk of ocular adverse reactions and need for prompt management
• Metformin hydrochloride: reduced vitamin B12 levels and new advice for monitoring patients at risk
• Methylphenidate hydrochloride long-acting (modified-release) preparations: caution if switching between products due to differences in formulations
• Metolazone (Xaqua®): exercise caution when switching patients between metolazone preparations
• Nebulised asthma rescue therapy in children: home use of nebulisers in paediatric asthma should be initiated and managed only by specialists
• Pholcodine-containing cough and cold medicines: withdrawal from UK market as a precautionary measure
• Topiramate (Topamax®): start of safety review triggered by a study reporting an increased risk of neurodevelopmental disabilities in children with prenatal exposure

Other significant changes include updated guidance on:

• Specialist drug monographs: inclusion of the words “Specialist drug” alongside the monograph title to identify drugs used within specialist settings (such as drugs used for malignancy, and those given via intravitreal injection). These monographs continue to include information to support patient safety and non-specialist patient care (such as important safety information, interactions, side-effects, and contra-indications) but no longer include information which is within the remit of specialist care (such as doses, and directions for administration).
• 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].
• Pre-treatment screening advice on genetic testing for aminoglycoside exposure posing risk to hearing
• Antibacterials for the prevention of secondary cases of diphtheria
• Ceftriaxone: directions for administration
• Contraceptives, interactions
• COVID-19 vaccine
• Cystic fibrosis transmembrane conductance regulator modulators: hepatic impairment advice
• Diphtheria vaccine
• Management of epilepsy
• Management of uncomplicated genital chlamydia and gonorrhoea
• National genomic testing directory
• Post-exposure prophylaxis for herpesvirus infections
• Hydrocortisone: dosing for adrenal crisis
• Ibuprofen: breast-feeding advice
• Management of obesity
• Antibacterial therapy for the management of acute sore throat
• Respiratory system, inhaled drug delivery
• Smallpox and mpox vaccine
• Tacrolimus: pregnancy, breast-feeding and monitoring advice
• Continuous glucose monitoring in type 1 diabetes
• Management of lower urinary-tract infection and acute pyelonephritis
• Valaciclovir: indication and doses in line with UK Health Security Agency recommendations on post-exposure prophylaxis for chickenpox and shingles