by Kazeem Olalekan

A BNF and BNFc app convert like myself knows to press the ‘Update Now’ button whenever I am prompted to do so. It is the best way to be up-to-date in clinical decision making. What I thought I would do today is highlight some key updates in the BNF and BNFc in the latest update – November 2013.


BNFc – British National Formulary for Children (Updates)

Use of Codeine in Children

avoid_codeineD id you know that the use of Codeine as an analgesia in children is now restricted! This is because of reports of morphine toxicity. I don’t want to bore you with the intricate details of why this is a problem but it is to do with the variability in codeine metabolised in children. The important take home message is:

Codeine SHOULD only be used to relieve acute moderate pain in children older than 12 years and ONLY if it cannot be relieved by other painkillers such as paracetamol or ibuprofen.

Codeine is contra-indicated in all children (under 18 yrs old) who undergo the removal of tonsils or adenoids for the treatment of obstructive sleep apnoea.

A Drug Safety Update is available on the MHRA Website

Metoclopramide: Risk of neurological adverse effects

Following a risk-benefit analysis by the European Medines Agency’s Committee on Medicinal Products (CHMP) for Human Use, it was concluded that the risks of neurological effects such as extrapyramidal disorders and tardive dyskinesia outweigh the benefits in long-term or high-dose treatment. The following advise was recommended to minimise potential risk:

In children aged 1 – 18yrs, metoclopramide should only be used as second-line option for prevention of delayed chemotherapy-induced nausea and vomiting.

Use of metoclopramide is contra-indicated in children aged under 1 yrs.

Used for short-term use (upto 5 days)

More information available here

Oral Ketoconazole? Forget it!

Oral ketoconazole: do not prescribe or use for fungal infections—risk of liver injury outweighs benefits

More information here and here

...and more

There are more updates relating to:

  • Pertussis
  • Colistimethate
  • Malaria prophylaxis
  • Driving guidance with diabetes
  • Vaccination in children

Please take time out to keep up-to-date.

BNF – British National Formulary (Updates)

Mirabegron for treating symptoms of overactive bladder

NICE recommends mirabegron as a possible treatment for the symptoms of overactive bladder in some people (see below).

Who can have mirabegron?

You should be able to have mirabegron if drugs called ‘antimuscarinics’ do not work, if they are not suitable for you, or their side effects are unacceptable.

Why has NICE said this?

NICE looks at how well treatments work, and also at how well they work in relation to how much they cost the NHS. NICE recommended mirabegron because the benefits it provides justify its cost.

Details available here

A traveller? You need to know about Rabies

Rabies is a very serious viral infection that targets the brain and nervous system. You can catch rabies if you are bitten by an infected animal and haven’t been vaccinated (link). Vaccines are used for pre- and post- exposure prophylaxis.

Want to know your risks?


National Travel Network and Centre;


Health Protection Scotland


  • Like changes to the loading dose of Lacosamide
  • Like new product: Aflibercept: VEGF-A, VEGF-B binder. NICE recommends use for wet AMD.
  • Dapagliflozin in combination therapy for treating type 2 diabetes. NICE

Please take time out to keep up-to-date.






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