The BNF: Each edition a new gold bar

I recently rescued an almost entire collection of the British National Formulary (BNF). The rescue was a close thing. The condemned collection wasn’t quite in the skip, but was pretty close. Poignantly, the rescue took place in Penarth, South Wales, four hundred metres from the early family home of Professor Owen Wade. Acknowledged as one of the founding fathers of clinical pharmacology and therapeutics in the UK, Professor Wade oversaw the modernisation and relaunch of the BNF in 1981.

As I introduced the BNFs to their new home, I noticed that there in front of me was 45 years’ worth of prescribing and therapeutics history. Colours and designs side by side, including anniversary editions:  “25” in silver on the cover & spine , “50” in gold on the cover & spine , and 80 with the NHS Rainbow and “Thank You” on the cover & spine.

Then, I did what any self-respecting pharmacist would do. I started to measure them and weigh them. Of course. I will share the results in a moment.

First, let’s have a quick recap of the BNF and its place in the world of medicines, prescribing and therapeutics. The BNF, first published in 1949, was a direct descendant of the National War Formulary - a formulary developed for wartime use in 1939. Writing in the British Medical Journal in 1993, Wade commented that this original BNF did a good job for about 20 years, then sickened and died in 1976. The new format we recognise today, was reborn in 1981. Professor Wade devotes a chapter to the BNF in his fascinating autobiography, When I Dropped the Knife.

The BNF is a comprehensive register of all the medicines that are currently available to the National Health Service. It is the gold standard source of guidance for prescribers and dispensers, predominantly, but not solely, in the UK. Published jointly by the British Medical Association and Pharmaceutical Press, (the publishing arm of The Royal Pharmaceutical Society). It is updated every March and September. Each edition is a new gold bar.

Originally designed to fit in the white coat pockets of junior doctors. The first edition (BNF No.1) of the new British National Formulary was bound in ultramarine cloth and was distributed throughout the NHS in February 1981. The bespoke ‘pocket’ size (215mm x 130mm) BNF was changed to a standard A5 size (210mm x 148mm) in 2015, together with the introduction of a bright new colour palette , producing the award-winning iconic design we recognise today. At its peak, half a million copies were printed.

Wade highlighted that it was a problem to keep the BNF as a handbook, as the pressure to include more information fitted more with the production of a textbook. In his 1993 BMJ reflective account, Wade commented that “the 25th edition may not have increased much in girth...but has grown in stature”.  He was correct. It had increased in size by just 5 mm. BNF No.25 weighed 0.464 Kg and had a girth of 20 mm compared to BNF No. 1 (0.331 Kg and 15 mm).

Everyone has a favourite BNF. Don’t they? A BNF that transports you back to a time and place. An edition and colour that takes you back to that hospital ward, that dispensary or that clinic. Or perhaps connected to a training moment, a ward round, a patient, or a colleague. Or even a prescribing or dispensing error. Those editions and colours are memorable for a reason. The colour of each book reassured clinicians that they were using the most up-to-date drug information available at the time. I still have my orange BNF No.18, issued to me as a first-year pharmacy student at the Welsh School of Pharmacy in 1989.

So, back to the rescued collection. That gold. What does the data look like? About that girth. The 89th edition of the BNF was published in March 2025. It weighs 1.15 Kg. Its girth is 47 mm. The 2nd edition, published in September 1981, weighs 0.344 Kg and has a girth of 16 mm. The 25th edition referred to by Wade weighs 0.464 kg and has a girth of 20 mm. For completeness, BNF No. 1 (not part of the rescued collection) weighs 0.331 Kg and is 15 mm wide. STC , of course , had a copy!

Measured using a Salter Kitchen Digital Scale – not calibrated or validated, but I did use new batteries

Special notes:

BNF 69 was the final edition of the pocket-sized version measuring 215mm x 130mm

BNF 70 was the first of the A5 size, measuring  210 mm x 148 mm

BNF 78 was the first BNF to weigh more than 1 kg

The 5^th Apothecary, Jonathan Underhill , also told us from his job at NICE , that there are only two printers in the whole of Europe who can print the current BNF with so many pages of text. This is because it requires really really thin paper that's also really really strong, so it has to be the printers of The Bible!!

The collection is missing some copies (1,12,20,21, and 79) - if you can help complete the collection, please contact me.

Jamie

References

Wade, O.L. British National Formulary: its birth, death, and rebirth. British Medical Journal 1993;306:1051-4

Kendall, M. & Enright, D. British Journal of Clinical Pharmacology 2012; 73:6 934-938. Agenda for UK clinical pharmacology. Provision of medicines information: the example of the British National Formulary.

Baxter, K. British National Formulary. Modern Human For The Royal Pharmaceutical Society. Design Business Effectiveness Awards, 2018.

Wade, O. When I Dropped The Knife. The Pentland Press Ltd. 1996.