Navigating the eBNF, BNFC, eMC, netdoctor and NHSD Medicines Q&As

Use the eBNF, BNFC (if appropriate), eMC and netdoctor to answer the following questions. What are the advantages and disadvantages of these information sources?

1 / What is the starting dose of doxazosin for hypertension? / eBNF: 1mg daily, increased after 1–2 weeks to 2mg once daily, and thereafter to 4mg once daily, if necessary; max. 16mg daily
eMC: Doxazosin is used in a once daily regimen. The dose of Doxazosin should be adjusted according to the patient's response. The initial dose of Doxazosin should be 1 mg per day. Dosage may then be increased in intervals of 1 or 2 weeks to 2 mg and thereafter to 4 mg. If necessary, dosage can be further increased to 8 mg or the maximum recommended dose of 16 mg.
netdoctor: No information.
2 / What active ingredient does Flamatak MR contain and how much? / eBNF: Diclofenac 75mg (difficult to find)
eMC: Diclofenac 75mg.
netdoctor: Diclofenac but no strength.
3 / Can I buy Almogran in the chemist / eBNF: Prescription only medicine (POM).
eMC: Prescription only medicine (POM).
netdoctor: No information.
4 / Name three side effects of Distamine / eBNF: Lots of side effects stated.
eMC: Lots of side effects stated.
netdoctor: Lots of side effects stated.
5 / Can phenelzine and pseudoephedrine be taken together safely? / eBNF: Appendix 1 phenelzine - risk of hypertensive crisis when MAOIs given with phenylpropanolamine.
eMC: Sudafed SPC- Concomitant use of SUDAFED Plus with sympathomimetic agents such as decongestants, tricyclic antidepressants, appetite suppressants and amphetamine-like psychostimulants or with monoamine oxidase inhibitors, which interfere with the catabolism of sympathomimetic amines, may occasionally cause a rise in blood pressure.
netdoctor: Monograph for pseudoephedrine - pseudoephedrine may interact with monoamine oxidase inhibitor antidepressants (MAOIs, eg phenelzine, tranylcypromine) to produce a dangerous increase in blood pressure. For this reason, this medicine should not be taken at the same time as, or within 2 weeks of stopping an MAOI.
6 / Can Ibuprofen and lithium be taken together safetly? / eBNF: Potentially hazardous, ibuprofen reduces excretion of lithium (increased risk of toxicity)
eMC: Serum lithium concentrations may increase during concomitant therapy with non-steroidal anti-inflammatory drugs or tetracycline, possibly resulting in lithium toxicity. Serum lithium concentrations therefore should be monitored more frequently if NSAID or tetracycline therapy is initiated or discontinued.
netdoctor: The following medicines may increase the levels of lithium in the blood, causing an increased risk of lithium side effects: non-steroidal anti-inflammatory drugs (NSAIDs), such as indomethacin, diclofenac, ibuprofen.
7 / Can a 3-month old be given ibuprofen? / eBNF: For post-immunisation pyrexia in an infant aged 2–3 months, the dose of paracetamol is 60mg; the dose of ibuprofen is 50mg (on doctor’s advice). An oral syringe can be obtained from any pharmacy to give the small volume required.

eBNFC: Licensed use: in children over 6 months and body-weight more than 7 kg

eMC Nurofen for Children: Infants 3 - 6 months weighing more than 5kg: One 2.5ml dose may be taken 3 times in 24 hours.
netdoctor: Nurofen for children should not be given to children under three months of age or weighing less than five kilograms, unless recommended by a doctor .
8 / I need to take trimethoprim for a UTI, is it safe as I’m breast-feeding? / eBNF: Appendix 5. Present in milk—short-term use not known to be harmful
eMC: Although trimethoprim is excreted in breast milk, lactation is not a contra-indication for short-term trimethoprim therapy.
netdoctor: This medicine passes into breast milk. Seek medical advice from your doctor before using this medicine during breastfeeding.
9 / Is warfarin safe in pregnancy? / eBNF: Within section before main mongraph. Oral anticoagulants are teratogenic and should not be given in the first trimester of pregnancy. Women at risk of pregnancy should be warned of this danger since stopping warfarin before the sixth week of gestation may largely avoid the risk of fetal abnormality. Oral anticoagulants cross the placenta with risk of placental or fetal haemorrhage, especially during the last few weeks of pregnancy and at delivery. Therefore, if at all possible, oral anticoagulants should be avoided in pregnancy, especially in the first and third trimesters. Difficult decisions may have to be made, particularly in women with prosthetic heart valves or with a history of recurrent venous thrombosis or pulmonary embolism. Appendix 4. First, second, third trimesters: Congenital malformations; fetal and neonatal haemorrhage; see also section 2.8.2
eMC: No monograph.
netdoctor: This medicine is not to be used during pregnancy, especially during the first and third trimesters.
10 / Do Seroquel 300 tablets have lactose in them? / eBNF: No information.
eMC: 6.1 List of excipients. Lactose.
netdoctor: No information.
11 / What antibiotics are used in children for prevention of menningealcoccal menningitis. / eBNF: Rifampicin child 10mg/kg (under 1 year, 5mg/kg) every 12 hours for 2 days or ciprofloxacin [not licensed for this indication] child 5–12 years 250mg or i/m ceftriaxone [not licensed for this indication] child under 12 years 125mg. as a single dose
BNFC: Rifampicin by mouth Neonate 5mg/kg every 12 hours for 2 days Child 1 month–1 year 5mg/kg every 12 hours for 2 days Child 1–12 years 10mg/kg (max. 600mg) every 12 hours for 2 days Child 12 -18 years 600mg every 12 hours for 2 days or Ciprofloxacin by mouth [not licensed for this indication] Child 5–12 years 250mg as a single dose Child 12–18 years 500mg as a single dose or Ceftriaxone by intramuscular injection [not licensed for this indication] (preferred if pregnant)
Child 1 month–12 years 125mg as a single dose
Child 12–18 years 250mg as a single dose
eMC: No information unless know what antibiotics to check.
netdoctor: No information unless know what antibiotics to check.
12 / I’ve just started on methotrexate tablets. Can I still drive? / eBNF: No information. Causes drowsiness.
eMC: Effects on ability to drive and use machines: None known.
netdoctor: No specific information although states drowsiness and burred vision within side effects.

Use the NHSD Medicines Q&As to answer the following questions. Can you find the answers in the eBNF, eMC or netdoctor?

13 / Does cannabis interact with amitriptyline? / NHSD Medicines Q&As: Full referenced answer.
eBNF: No information.
eMC: No information.
netdoctor: No information.
14 / Can I take paracetamol with amoxicillin? / NHSD Medicines Q&As: Full referenced answer.
eBNF: No information.
eMC: No information.
netdoctor: No information.

Handling medicines calls training for NAs & HIAs Sept 2006 V6