BNF for children 2013 2014

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Medicines information services Information on any aspect of drug therapy can be obtained from Regional and District Medicines Information Services Details regarding the local services provided within your Region can be obtained by telephoning the following numbers England Birmingham Bristol Ipswich Leeds Leicester Liverpool (0121) 424 7298 (0117) 342 2867 (01473) 704 431 (0113) 206 5377 (0116) 255 5779 (0151) 794 8113/4/5/7 (0151) 794 8206 London Guy’s Hospital (020) 7188 8750 (020) 7188 3849 (020) 7188 3855 Northwick Park Hospital (020) 8869 2761 (020) 8869 3973 Newcastle Southampton Wales Cardiff Scotland Aberdeen Dundee Edinburgh Glasgow Northern Ireland Belfast Republic of Ireland Dublin (0191) 282 4631 (023) 8079 6908/9 UK Teratology Information Service Information on drug and chemical exposures in pregnancy 0844 892 0909 Medicines for Children information leaflets Medicines information for parents and carers www.medicinesforchildren.org.uk Patient Information Lines NHS Direct Poisons Information Services UK National Poisons Information Service 0845 4647 0844 892 0111 Travel Immunisation Up-to-date information on travel immunisation requirements may be obtained from: National Travel Health Network and Centre (for healthcare professionals only) 0845 602 6712 (09.00–12.00 and 14.00–16.30 hours weekdays) Travel Medicine Team, Health Protection Scotland (0141) 300 1130 (14.00–16.00 hours weekdays) (029) 2074 2979 (029) 2074 2251 www.travax.nhs.uk (for registered users of the NHS website Travax only) Welsh Assembly Government (029) 2082 1318 (09.00–17.30 hours weekdays) (01224) 552 316 (01382) 632 351 (01382) 660 111 Extn 32351 (0131) 242 2920 (0141) 211 4407 (028) 9063 2032 (028) 9063 3847 Dublin 473 0589 Dublin 453 7941 Extn 2348 Department of Health and Social Services (Belfast) (028) 9052 2118 (weekdays) Information on drug therapy relating to dental treatment can be obtained by telephoning: Liverpool (0151) 794 8206 Sport Information on substances currently permitted or prohibited is provided in a card supplied by UK Anti-Doping Further information regarding medicines in sport is available from: www.ukad.org.uk Tel: (020) 7766 7350 information@ukad.org.uk United Kingdom Medicines Information Pharmacists Group (UKMIPG) website www.ukmi.nhs.uk Telephone numbers and email addresses of manufacturers listed in BNF Publications are shown in the Index of Manufacturers BNF for children 2013–2014 Published by BMJ Group Tavistock Square, London WC1H 9JP, UK Pharmaceutical Press Pharmaceutical Press is the publishing division of the Royal Pharmaceutical Society Lambeth High Street, London, SE1 7JN, UK RCPCH Publications Ltd 5–11 Theobalds Road, London WC1X 8SH, UK Copyright # BMJ Group, the Royal Pharmaceutical Society of Great Britain, and RCPCH Publications Ltd 2013 ISBN: 978 85711 087 Distribution of BNFCs The UK health departments distribute BNFCs to NHS hospitals, doctors, and community pharmacies In England, BNFCs are mailed individually to NHS doctors, pharmacists, and non-medical prescribers who have prescribing responsibility for children; email: nice@nice.org.uk In Scotland, email: nss.psd-bnf@nhs.net In Wales, contact NHS Wales Shared Services Partnership—Contractor Services: Tel: 01792 607 420 In Northern Ireland, email: ni.bnf@hscni.net ISSN: 1747–5503 Printed by GGP Media GmbH, Poăssneck, Germany Typeset by Data Standards Ltd A catalogue record for this book is available from the British Library All rights reserved No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, without the prior written permission of the copyright holder Material published in the BNF for Children (BNFC) may not be used for any form of advertising, sales or publicity without prior written permission Each of the classification and the text are protected by copyright and/or database right Paper copies may be obtained through any bookseller or direct from: Pharmaceutical Press c/o Macmillan Distribution (MDL) Brunel Road Houndmills Basingstoke RG21 6XS UK Tel: +44 (0) 1256 302 699 Fax: +44 (0) 1256 812 521 Email: direct@macmillan.co.uk www.pharmpress.com For all bulk orders of more than 20 copies: Email: pharmpress@rpharms.com Tel: +44 (0) 207 572 2266 BNFC is available online through bnfc.org and MedicinesComplete, and as mobile apps; a PDA version is also available In addition, BNFC content can be integrated into a local formulary by using BNFC on FormularyComplete; see bnfc.org for details BNFC is also available on www.evidence.nhs.uk and the NICE BNFC smartphone app can be downloaded with a NHS Athens password in England, Scotland, and Wales; for technical support, email: contactus@evidence.nhs.uk The BNF for Children is for rapid reference by UK health professionals engaged in prescribing, dispensing, and administering medicines to children BNF for Children has been constructed using robust procedures for gathering, assessing and assimilating information on paediatric drug treatment, but may not always include all the information necessary for prescribing and dispensing It is expected that the reader will be relying on appropriate professional knowledge and expertise to interpret the contents in the context of the circumstances of the individual child BNF for Children should be used in conjunction with other appropriate and up-to-date literature and, where necessary, supplemented by expert advice Information is also available from Medicines Information Services (see inside front cover) Special care is required in managing childhood conditions with unlicensed medicines or with licensed medicines for unlicensed uses Responsibility for the appropriate use of medicines lies solely with the individual health professional The print edition of BNF for Children is updated in July each year For the most up-to-date information, please visit bnfc.org which is updated monthly Pharmaid Numerous requests have been received from developing countries for BNFCs The Pharmaid scheme of the Commonwealth Pharmacists Association will dispatch old BNFCs to Commonwealth countries BNFCs will be collected from certain community pharmacies in November For further details check the health press or email: admin@commonwealthpharmacy.org BNFC 2013–2014 iii Contents Preface iv Acknowledgements v BNF Staff vi How BNF for Children is constructed ix How to use BNF for Children xi Changes for this edition xvii General guidance Prescription writing Supply of medicines Emergency supply of medicines Prescribing Controlled Drugs Adverse reactions to drugs 11 Prescribing in hepatic impairment 13 Prescribing in renal impairment 13 Prescribing in pregnancy 15 Prescribing in breast-feeding 15 Prescribing in palliative care 16 Prescribing in dental practice 21 Drugs and sport 22 Emergency treatment of poisoning 23 Notes on drugs and Preparations 1: Gastro-intestinal system 34 2: Cardiovascular system 72 3: Respiratory system 131 4: Central nervous system 168 5: Infections 244 6: Endocrine system 349 7: Obstetrics, gynaecology, and urinary-tract disorders 393 8: Malignant disease and immunosuppression 414 9: Nutrition and blood 443 10: Musculoskeletal and joint diseases 500 11: Eye 519 12: Ear, nose, and oropharynx 537 13: Skin 552 14: Immunological products and vaccines 600 15: Anaesthesia 629 Appendices and indices Appendix 1: Interactions 655 Appendix 2: Borderline substances 757 Appendix 3: Cautionary and advisory labels for dispensed medicines 804 Appendix 4: Intravenous infusions for neonatal intensive care 807 Dental Practitioners’ Formulary 810 Nurse Prescribers’ Formulary 812 Non-medical prescribing 814 Index of manufacturers 815 Index 825 Medical emergencies in the community Inside back cover iv Preface BNF for Children aims to provide prescribers, pharmacists, and other healthcare professionals with sound upto-date information on the use of medicines for treating children A joint publication of the British Medical Association, the Royal Pharmaceutical Society, the Royal College of Paediatrics and Child Health, and the Neonatal and Paediatric Pharmacists Group, BNF for Children (‘BNFC’) is published under the authority of a Paediatric Formulary Committee which comprises representatives of these bodies, the Department of Health for England, and the Medicines and Healthcare products Regulatory Agency Many areas of paediatric practice have suffered from inadequate information on effective medicines BNFC addresses this significant knowledge gap by providing practical information on the use of medicines in children of all ages from birth to adolescence Information in BNFC has been validated against emerging evidence, best-practice guidelines, and crucially, advice from a network of clinical experts Drawing information from manufacturers’ literature where appropriate, BNFC also includes a great deal of advice that goes beyond marketing authorisations (product licences) This is necessary because licensed indications frequently not cover the clinical needs of children; in some cases, products for use in children need to be specially manufactured or imported Careful consideration has been given to establishing the clinical need for unlicensed interventions with respect to the evidence and experience of their safety and efficacy; local paediatric formularies, clinical literature and national information resources have been invaluable in this process BNFC has been designed for rapid reference and the information presented has been carefully selected to aid decisions on prescribing, dispensing and administration of medicines Less detail is given on areas such as malignant disease and the very specialist use of medicines generally undertaken in tertiary centres BNFC should be interpreted in the light of professional knowledge and it should be supplemented as necessary by specialised publications Information is also available from Medicines Information Services (see inside front cover) It is important to use the most recent BNFC information for making clinical decisions The print edition of BNF for Children is updated in July each year Monthly updates are provided online via the BNF Publications website bnfc.org, MedicinesComplete, and the NHS Evidence portal The more important changes for this edition are listed on p xvii; changes listed online are cumulative (from one print edition to the next), and can be printed off each month to show the main changes since the last print edition as an aide memoire for those using print copies The website (bnfc.org) includes additional information of relevance to healthcare professionals Other digital formats of BNFC—including versions for mobile devices and integration into local formularies—are also available BNFC 2013–2014 BNF Publications welcomes comments from healthcare professionals Comments and constructive criticism should be sent to: British National Formulary, Royal Pharmaceutical Society, Lambeth High Street, London SE1 7JN bnfc@bnf.org The contact email for manufacturers or pharmaceutical companies wishing to contact BNF Publications is manufacturerinfo@bnf.org BNFC 2013–2014 Acknowledgements The Paediatric Formulary Committee is grateful to individuals and organisations that have provided advice and information to the BNF for Children (BNFC) The principal contributors for this edition were: M.N Badminton, S Bailey, G.D.L Bates, H Bedford, M.W Beresford, R.M Bingham, L Brook, K.G Brownlee, M Burch, I.F Burgess, A Cant, L.J Carr, R Carr, E.A Chalmers, T.D Cheetham, A.G Cleary, A.J Cotgrove, J.B.S Coulter, B.G Craig, S.M Creighton, J.H Cross, A Dhawan, P.N Durrington, A Durward, A.B Edgar, J.A Edge, D.A.C Elliman, N.D Embleton, P.J Goadsby, P.W Golightly, J Gray, J.W Gregory, P Gringras, J.P Harcourt, P.J Helms, C Hendriksz, R.F Howard, R.G Hull, H.R Jenkins, S Jones, B.A Judd, P.T Khaw, J.M.W Kirk, P.J Lee, T.H Lee, E.G.H Lyall, A MacDonald, P.S Malone, S.D Marks, D.F Marsh, P.J McKiernan, L.M Melvin, E Miller, R.E Morton, C Moss, P Mulholland, M.S Murphy, C Nelson-Piercy, J.M Neuberger, K.K Nischal, C.Y Ng, L.P Omerod, J.Y Paton, G.A Pearson, M.M Ramsay, J Rogers, K.E Rogstad, P.C Rubin, J.W Sander, N.J Scolding, M.R Sharland, N.J Shaw, O.F.W Stumper, A.G Sutcliffe, A.M Szarewski, E.A Taylor, S Thomas, A.H Thomson, M.A Thomson, J.A Vale, S Vijay, J.O Warner, D.A Warrell, N.J.A Webb, A.D Weeks, R Welbury, W.P Whitehouse, C.E Willoughby, C Wren, A Wright, M.M Yaqoob, Z Zaiwalla, and S.M Zuberi Members of the British Association of Dermatologists’ Therapy & Guidelines Subcommittee, D.A Buckley, R Davis, E Duarte Williams, J Hughes, N.J Levell, A.J McDonagh, P McHenry, I Nasr, S Punjabi, A Sahota, V Swale, S.E Haveron (Secretariat), and M.F Mohd Mustapa (Secretariat) have provided valuable advice Members of the Advisory Committee on Malaria Prevention, R.H Behrens, D Bell, P.L Chiodini, S Clarke, V.Field, F Genasi, L Goodyer, A Green, J Jones, G Kassianos, D.G Lalloo, G Pasvol, M Powell, D.V Shingadia, N.O Subair, C.J.M Whitty, M Blaze (Secretariat), and V Smith (Secretariat) have provided valuable advice Members of the UK Ophthalmic Pharmacy Group have also provided valuable advice R Suvarna and colleagues at the MHRA have provided valuable assistance Correspondents in the pharmaceutical industry have provided information on new products and commented on products in BNFC NHS Prescription Services has supplied the prices of products in the BNFC Numerous doctors, pharmacists, nurses, and others have sent comments and suggestions Invaluable contribution to BNFC interactions provided by C.L Preston, S.Z Khan, D.M McGuirk, J.M Sharp, and N Virani v The BNFC has valuable access to the Martindale data banks by courtesy of A Brayfield and staff F Gibson and staff provided valuable technical assistance A Holmes and E Laughton provided considerable assistance during the production of this edition of BNFC Typesetting services were provided by Data Standards Ltd vi BNF Staff BNFC 2013–2014 Terminologist Sarah Peck BSc Managing Editor Suhas Khanderia BPharm, MSc, MBA, MRPharmS Production Manager Tamsin Cousins BSc Managing Editor: Knowledge Creation Rachel S M Ryan BPharm, MRPharmS (acting until April 2013) Senior Production Editor Linda Paulus MA Lead Editors Bryony Jordan BSc, DipPharmPract, MRPharmS BNF Publishing Director John Martin BPharm, PhD, MRPharmS Duncan S T Enright MA, PGCE, MInstP Shama M S Wagle BPharm, DipPharmPract, MRPharmS Managing Director, Pharmaceutical Press Senior Clinical Writers Alina Lourie B.Ed, MSc Sejal Amin BPharm, MSc Susan E Clarke BPharm, DipClinPharm, MRPharmS Senior Medical Adviser Derek G Waller BSc, MB, BS, DM, FRCP Clinical Writers Kristina Fowlie MPharm, CertPharmPract, MRPharmS Bele´n Granell Ville´n BSc, DipClinPharm Manjula Halai BScChem, MPharm Angela M G McFarlane BSc, DipClinPharm, MRPharmS Sarah Mohamad MPharm, MRPharmS Heenaben Patel MPharm, DipClinPharm, MRPharmS Barbara Schneider MPharm, DipClinPharm, MRPharmS Vinaya K Sharma BPharm, MSc, DipPIM, MRPharmS Anna Sparshatt MPharm, CertPharmPract, CertPsychTherap Kate Towers BPharm (AU), GCClinPharm Katie E Walters MPharm, CertPharmPract, MRPharmS Editorial Assistants Rhiannon Howe BMedSc Cristina Lopez-Bueno BA Senior BNF Administrator Heidi Homar BA Clinical Decision Support Product Manager Ferenc P Wo´rum MD (HU), MSc vii BNFC 2013–2014 Paediatric Formulary Committee 2012–2013 Dental Advisory Group 2012–2013 Chair Chair Warren Lenney MD, FRCP, FRCPCH, DCH David Wray MD, BDS, MB ChB, FDSRCPS, FDSRCS Ed, F MedSci Committee Members Committee Members Indraneel Banerjee MB BS, MD, FRCPCH Christine Arnold BDS, DDPHRCS, MCDH Neil A Caldwell BSc, MSc, MRPharmS Andrew K Brewer BSc, BchD Martin G Duerden BMedSci, MB BS, DRCOG, MRCGP, DipTher, DPH Barry Cockcroft BDS, FFDS (Eng) Julia Dunne BA, MB BS, FRCP Duncan S.T Enright MA, PGCE, MInstP James H Larcombe MB, ChB, FRCGP, DipAdvGP Lesley P Longman BSc, BDS, FDSRCS Ed, PhD John Marriott BSc, PhD, MRPharmS, FHEA Sarah Manton BDS, FDSRCS Ed, FHEA, PhD E David G McIntosh MB BS, MPH, PhD, FAFPHM, FRACP, FRCPCH, FFPM, DRCOG, DCH, DipPharmMed John Martin BPharm, PhD, MRPharmS Neena Modi MB, ChB, MD, FRCP, FRCPCH Michelle Moffat BDS, MFDS RCS Ed, M Paed Dent RPCS, FDS (Paed Dent) RSC Ed Julia Simmons BSc, MRPharmS Sarah Mohamad MPharm, MRPharmS Adam Sutherland MPharm, MSc Rachel S.M Ryan BPharm, MRPharmS David Tuthill MB, BCh, FRCPCH Edward R Wozniack BSc, MB BS, FRCP, FRCPCH, DCH Secretary Arianne J Matlin MA, MSc, PhD Executive Secretary Heidi Homar BA Executive Secretary Heidi Homar BA Advice on dental practice The British Dental Association has contributed to the advice on medicines for dental practice through its representatives on the Dental Advisory Group viii Nurse Prescribers’ Advisory Group 2012–2013 Chair Molly Courtenay PhD, MSc, Cert Ed, BSc, RGN Committee Members Duncan S.T Enright MA, PGCE, MInstP Penny M Franklin RN, RCN, RSCPHN(HV), MA, PGCE Bele´n Granell Villen BSc, PGDipClinPharm Tracy Hall BSc, MSc, RGN, DN, Dip N, Cert N Margaret F Helliwell MB, BS, BSc, MFPHM FRCP (Edin) Jill Hill RGN, BSc Bryony Jordan BSc, DipPharmPract, MRPharmS Sandra Lawton RN, RN Dip (Child), ENB 393, MSc Joan Myers MSc, BSc, RGN, RSCN, Dip DN Wendy J Nicholson BSc, MA, Cert Ed, RGN, RSCN Rachel S.M Ryan BPharm, MRPharmS Jill M Shearer BSc, RGN, RM Vicky Vidler MA, RGN, RSCN John Wright Executive Secretary Heidi Homar BA BNFC 2013–2014 BNFC It’s It’s easiest easiest to to report report online online at at www.mhra.gov.uk/yellowcard www.mhra.gov.uk/yellowcard IfIf you you suspect suspect an an adverse adverse reaction reaction may may be be related related to to one one or or more more drugs/vaccines/complementary drugs/vaccines/complementary remedies, remedies, please please complete complete this this Yellow www.mhra.gov.uk/yellowcardfor forguidance guidance.Do Donot notbe beput putoff off Yellow Card Card See See ‘Adverse ‘Adverse reactions reactions to to drugs’ drugs’ section section in in BNFC BNF ororwww.mhra.gov.uk/yellowcard reporting reporting because because some some details details are are not not known known It’s easiest to report online at www.mhra.gov.uk/yellowcard BNFC It’s It’s easiest easiest to to report report online online at at www.mhra.gov.uk/yellowcard www.mhra.gov.uk/yellowcard IfIf you you suspect suspect an an adverse adverse reaction reaction may may be be related related to to one one or or more more drugs/vaccines/complementary drugs/vaccines/complementary remedies, remedies, please please complete complete this this Yellow www.mhra.gov.uk/yellowcardfor forguidance guidance.Do Donot notbe beput putoff off Yellow Card Card See See ‘Adverse ‘Adverse reactions reactions to to drugs’ drugs’ section section in in BNFC BNF ororwww.mhra.gov.uk/yellowcard reporting reporting because because some some details details are are not not known known It’s easiest to report online at www.mhra.gov.uk/yellowcard Child 5–12 years 5–10 mg every 20–30 minutes or as necessary Child 12–18 years 10 mg every 20–30 minutes or as necessary Medical emergencies in the community Drug treatment outlined below is intended for use by community healthcare professionals Only drugs that are used for immediate relief are shown; advice on supporting care is not given Where the child’s condition requires investigation and further treatment, the child should be transferred to hospital promptly Plus (in all cases) Either prednisolone tablets (or prednisolone soluble tablets) (5 mg) Anaphylaxis (section 3.4.3) Adrenaline injection (1 mg/mL (1 in 1000)) By intramuscular injection Child under years 150 micrograms (0.15 mL), repeated every minutes if necessary Child 6–12 years 300 micrograms (0.3 mL), repeated every minutes if necessary Child 12–18 years 500 micrograms (0.5 mL), repeated every minutes if necessary; 300 micrograms (0.3 mL) should be given if child is small or prepubertal High-flow oxygen (section 3.6) and intravenous fluids should be given as soon as available Chlorphenamine injection by intramuscular or intravenous injection (section 3.4.1) may help counter histamine-mediated vasodilation and bronchoconstriction Hydrocortisone (preferably as sodium succinate) by intravenous injection (section 6.3.2) has delayed action but it should be given to severely affected children to prevent further deterioration Asthma: acute or hydrocortisone (preferably as sodium succinate) Monitor response 15 to 30 minutes after nebulisation; if any signs of acute asthma persist, arrange hospital admission While awaiting ambulance, repeat nebulised beta2 agonist (as above) and give with ipratropium nebuliser solution (250 micrograms/mL) Regard each emergency consultation as being for severe acute asthma until shown otherwise; failure to respond adequately at any time requires immediate transfer to hospital By aerosol inhalation via large-volume spacer (and a close-fitting face mask if child under years) Child under 18 years 2–10 puffs each inhaled separately, repeated at 10–20 minute intervals or as necessary By inhalation of nebulised solution (via oxygendriven nebuliser if available) Child under years 2.5 mg every 20–30 minutes or as necessary Child 5–12 years 2.5–5 mg every 20–30 minutes or as necessary Child 12–18 years mg every 20–30 minutes or as necessary or terbutaline nebulised solution (2.5 mg/mL) By inhalation of nebulised solution (via oxygendriven nebuliser if available) Child under years mg every 20–30 minutes or as necessary By inhalation of nebulised solution (via oxygendriven nebuliser if available) Child under 12 years 250 micrograms repeated every 20–30 minutes for the first hours, then every 4–6 hours as necessary Child 12–18 years 500 micrograms every 4–6 hours as necessary Convulsive (including febrile) seizures lasting longer than minutes (section 4.8.2 and section 4.8.3) Midazolam buccal solution or salbutamol nebuliser solution (1 mg/mL, mg/ mL) By intravenous injection Child up to 18 years mg/kg (max 100 mg) every hours, until conversion to oral prednisolone is possible; alternative dose if weight unavailable, Child under years 25 mg, 2–5 years 50 mg, 5–18 years 100 mg High-flow oxygen (section 3.6) should be given if available (via face mask) (section 3.1) Either salbutamol aerosol inhaler (100 micrograms/ metered inhalation) By mouth Child under 12 years 1–2 mg/kg (max 40 mg) once daily for up to days or longer if necessary; if the child has been taking an oral corticosteroid for more than a few days, give prednisolone mg/kg (max 60 mg) once daily Child 12–18 years 40–50 mg once daily for at least days By buccal administration, repeated once after 10 minutes if necessary Neonate 300 micrograms/kg Child 1–3 months 300 micrograms/kg (max 2.5 mg) Child months–1 year 2.5 mg Child 1–5 years mg Child 5–10 years 7.5 mg Child 10–18 years 10 mg or diazepam rectal solution (2 mg/mL, mg/mL) By rectum, repeated once after 10 minutes if necessary Neonate 1.25–2.5 mg Child month–2 years mg Child 2–12 years 5–10 mg Child 12–18 years 10–20 mg Croup Meningococcal disease (section 3.1) (Table 1, section 5.1) Dexamethasone oral solution (2 mg/5 mL) By mouth Child month–2 years 150 micrograms/kg as a single dose Benzylpenicillin sodium injection (600 mg, 1.2 g) Diabetic hypoglycaemia (section 6.1.4) Note A single dose should be given before urgent transfer to hospital, so long as this does not delay the transfer Glucose or sucrose By mouth Child 2–18 years approx 10–20 g (55–110 mL Lucozade ® Energy Original or 100–200 mL CocaCola ®—both non-diet versions or 2–4 teaspoonfuls of sugar or 3–6 sugar lumps), repeated after 10–15 minutes if necessary or if history of allergy to penicillin Cefotaxime injection (1 g) or if hypoglycaemia unresponsive or if oral route cannot be used Glucagon injection (1 mg/mL) By subcutaneous, intramuscular or intravenous injection Child body-weight under 25 kg 500 micrograms (0.5 mL) Child body-weight over 25 kg mg (1 mL) or if hypoglycaemia prolonged or unresponsive to glucagon after 10 minutes Glucose intravenous infusion (10%) By intravenous injection into large vein Child month–18 years mL/kg (glucose 500 mg/ kg) By intravenous injection (or by intramuscular injection if venous access not available) Neonate 300 mg Child month–1 year 300 mg Child 1–10 years 600 mg Child 10–18 years 1.2 g By intravenous injection (or by intramuscular injection if venous access not available) Neonate 50 mg/kg Child month–12 years 50 mg/kg (max g) Child 12–18 years g Note A single dose can be given before urgent transfer to hospital, so long as this does not delay the transfer or if history of immediate hypersensitivity reaction (including anaphylaxis, angioedema, urticaria, or rash immediately after administration) to penicillin or to cephalosporins Chloramphenicol injection (1 g) By intravenous injection Child month–18 years 12.5–25 mg/kg Note A single dose can be given before urgent transfer to hospital, so long as this does not delay the transfer Approximate conversions and units lb 10 11 12 13 14 kg 0.45 0.91 1.36 1.81 2.27 2.72 3.18 3.63 4.08 4.54 4.99 5.44 5.90 6.35 stones 10 11 12 13 14 15 kg 6.35 12.70 19.05 25.40 31.75 38.10 44.45 50.80 57.15 63.50 69.85 76.20 82.55 88.90 95.25 mL 50 100 150 200 500 1000 fl oz 1.8 3.5 5.3 7.0 17.6 35.2 Prescribing for children Weight, height, and gender The table below shows the mean values for weight, height and gender by age; these values have been derived from the UK-WHO growth charts 2009 and UK1990 standard centile charts, by extrapolating the 50th centile, and may be used to calculate doses in the absence of actual measurements However, the child’s actual weight and height might vary considerably from the values in the table and it is important to see the child to ensure that the value chosen is appropriate In most cases the child’s actual measurement should be obtained as soon as possible and the dose re-calculated Age Length metre (m) centimetre (cm) inch (in) foot (ft) 12 inches = = = = = 1000 millimetres (mm) 10 mm 25.4 mm 12 inches 304.8 mm Mass kilogram (kg) gram (g) milligram (mg) = 1000 grams (g) = 1000 milligrams (mg) = 1000 micrograms microgram nanogram = 1000 nanograms = 1000 picograms Volume litre = 1000 millilitres (mL) millilitre (1 mL) pint = 1000 microlitres & 568 mL Other units kilocalorie (kcal) 1000 kilocalories (kcal) megajoule (MJ) millimetre of mercury (mmHg) kilopascal (kPa) = = = = = 4186.8 joules (J) 4.1868 megajoules (MJ) 238.8 kilocalories (kcal) 133.3 pascals (Pa) 7.5 mmHg (pressure) Plasma-drug concentrations in BNF for Children are expressed in mass units per litre (e.g mg/litre) The approximate equivalent in terms of amount of substance units (e.g micromol/litre) is given in brackets Weight kg Height cm Full term neonate 3.5 51 month months months 4.3 5.4 6.1 55 58 61 months months year years years years 10 years 6.7 7.6 14 18 23 32 63 67 75 96 109 122 138 12 years 14 year-old boy 14 year-old girl Adult male Adult female 39 49 50 68 58 149 163 159 176 164 Recommended wording of cautionary and advisory labels For details see Appendix 3 10 11 12 13 14 15 16 17 18 19 21 22 23 24 25 26 27 28 29 30 32 Warning: This medicine may make you sleepy Warning: This medicine may make you sleepy If this happens, not drive or use tools or machines Do not drink alcohol Warning: This medicine may make you sleepy If this happens, not drive or use tools or machines Warning: Do not drink alcohol Do not take indigestion remedies hours before or after you take this medicine Do not take indigestion remedies, or medicines containing iron or zinc, hours before or after you take this medicine Do not take milk, indigestion remedies, or medicines containing iron or zinc, hours before or after you take this medicine Warning: Do not stop taking this medicine unless your doctor tells you to stop Space the doses evenly throughout the day Keep taking this medicine until the course is finished, unless you are told to stop Warning: Read the additional information given with this medicine Protect your skin from sunlight—even on a bright but cloudy day Do not use sunbeds Do not take anything containing aspirin while taking this medicine Dissolve or mix with water before taking This medicine may colour your urine This is harmless Caution: flammable Keep your body away from fire or flames after you have put on the medicine Dissolve the tablet under your tongue—do not swallow Store the tablets in this bottle with the cap tightly closed Get a new supply weeks after opening Do not take more than in 24 hours Do not take more than in 24 hours Also, not take more than in any one week Warning: This medicine makes you sleepy If you still feel sleepy the next day, not drive or use tools or machines Do not drink alcohol Take with or just after food, or a meal Take 30 to 60 minutes before food Take this medicine when your stomach is empty This means an hour before food or hours after food Suck or chew this medicine Swallow this medicine whole Do not chew or crush Dissolve this medicine under your tongue Take with a full glass of water Spread thinly on the affected skin only Do not take more than at any one time Do not take more than in 24 hours Contains paracetamol Do not take anything else containing paracetamol while taking this medicine Contains aspirin Do not take anything else containing aspirin while taking this medicine Abbreviations and symbols Internationally recognised units and symbols are used in the BNF for Children where possible ACBS ACE ADHD AIDS approx AV BAN BMI BP BPC CAPD K L CHM CHMP CNS CSM d c DMARD DPF e/c ECG EEG f/c G6PD HIV HRT i/m i/v INR MAOI max MHRA m/r NCL NHS D NICE NPF NSAID PGD PHE A ® rINN RSV s/c Advisory Committee on Borderline Substances, see Appendix Angiotensin-converting enzyme attention deficit hyperactivity disorder Acquired immunodeficiency syndrome approximately atrioventricular British Approved Name body mass index British Pharmacopoeia 2010, unless otherwise stated British Pharmaceutical Codex 1973 and Supplement 1976, unless otherwise stated Continuous ambulatory peritoneal dialysis preparation in Schedule of the Misuse of Drugs Regulations 2001 (and subsequent amendments) For regulations see Prescribing Controlled Drugs preparation in Schedule of the Misuse of Drugs Regulations 2001 (and subsequent amendments) For regulations see Prescribing Controlled Drugs preparation in Schedule (Part I) of the Misuse of Drugs Regulations 2001 (and subsequent amendments) For regulations see Prescribing Controlled Drugs preparation in Schedule (Part II) of the Misuse of Drugs Regulations 2001 (and subsequent amendments) For regulations see Prescribing Controlled Drugs Commission on Human Medicines Committee for Medicinal Products for Human Use central nervous system Committee on Safety of Medicines (now subsumed under Commission on Human Medicines) direct current Disease-modifying antirheumatic drug Dental Practitioners’ Formulary enteric-coated (termed gastro-resistant in BP) electrocardiogram electro-encephalogram film-coated glucose 6-phosphate dehydrogenase Human immunodeficiency virus Hormone replacement therapy intramuscular intravenous international normalised ratio Monoamine-oxidase inhibitors maximum Medicines and Healthcare products Regulatory Agency modified-release no cautionary labels, see Appendix National Health Service not prescribable under National Health Service (NHS) National Institute for Health and Care Excellence Nurse Prescribers’ Formulary non-steroidal anti-inflammatory drug patient group direction Public Health England (formerly Health Protection Agency (HPA)) prescription-only medicine, see Fig 1, How to use BNF for Children trade mark Recommended International Non-proprietary Name respiratory syncytial virus sugar-coated SLS SMC SPC spp SSRI UK Units WHO T U Selected List Scheme Scottish Medicines Consortium Summary of Product Characteristics species Selective serotonin reuptake inhibitors United Kingdom for SI units see Prescription Writing World Health Organization limited experience of the use of this product and the CHM requests that all suspected adverse reactions should be reported, see Adverse Reactions to Drugs considered by the Paediatric Formulary Committee to be less suitable for prescribing, see Fig 1, How to use BNF for Children Latin abbreviations Directions should be in English without abbreviation However, Latin abbreviations have been used when prescribing The following is a list of appropriate abbreviations It should be noted that the English version is not always an exact translation a c b d o d o m o n p c p r n q d s = ante cibum (before food) = bis die (twice daily) = omni die (every day) = omni mane (every morning) = omni nocte (every night) = post cibum (after food) = pro re nata (when required) = quater die sumendum (to be taken four times daily) q q h = quarta quaque hora (every four hours) stat = immediately t d s = ter die sumendum (to be taken three times daily) t.i.d = ter in die (three times daily) E numbers The following is a list of common E numbers and the inactive ingredients to which they correspond E211 E102 Tartrazine E104 Quinoline Yellow E223 E320 E110 Sunset Yellow FCF E321 E123 Amaranth E124 Ponceau 4R E127 Erythrosine BS E322 E132 Indigo Carmine E420 E421 E142 Green S E171 Titanium Dioxide E422 E172 Iron oxides, Iron E901 hydroxides E1520 E200 Sorbic Acid Sodium Benzoate Sodium Metabisulphite Butylated Hydroxyanisole Butylated Hydroxytoluene Lecithins Sorbitol Mannitol Glycerol Beeswax (white and yellow) Propylene Glycol ... RSCN John Wright Executive Secretary Heidi Homar BA BNFC 2013 2014 ix BNFC 2013 2014 How BNF for Children is constructed BNF for Children (BNFC) is unique in bringing together authoritative,... been made in the following sections for BNF for Children 2013 2014: Influenza vaccine, p 612 Prices in BNFC [No price update for print edition of BNFC 2013 2014] Lipantil ®, p 129 Palliative Care... 7JN bnfc @bnf. org The contact email for manufacturers or pharmaceutical companies wishing to contact BNF Publications is manufacturerinfo @bnf. org BNFC 2013 2014 Acknowledgements The Paediatric Formulary
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