BNF for Children 2011-2012

BNFC 2011–2012 2.2.4 Potassium-sparing diuretics with other diuretics 81Indication and doseOedema in heart failure and in ascites,nephrotic syndrome, reduction of hypokalaemiainduced by diuretics or amphotericin. By mouthNeonate 1–2 mg/kg daily in 1–2 divided doses; upto 7 mg/kg daily in resistant ascitesChild 1 month–12 years 1–3 mg/kg daily in 1–2divided doses; up to 9 mg/kg daily in resistantascitesChild 12–18 years 50–100 mg daily in 1–2divided doses; up to 9 mg/kg daily (max. 400 mgdaily) in resistant ascitesSpironolactone (Non-proprietary) ATablets, spironolactone 25 mg, net price 28 = £1.50;50 mg, 28 = £2.11; 100 mg, 28 = £2.46. Label: 21Oral suspensions, spironolactone 5 mg/5 mL,10 mg/5 mL, 25 mg/5 mL, 50 mg/5 mL, and 100 mg/5 mLAvailable from ‘special-order’ manufacturers or specialistimporting companies, see p. 809Aldactone c (Pharmacia) ATablets, f/c, spironolactone 25 mg (buff), net price100-tab pack = £8.89; 50 mg (white), 100-tab pack =£17.78; 100 mg (buff), 28-tab pack = £9.96. Label: 21POTASSIUM CANRENOATECautions potential metabolic products carcinogenic inrodents; monitor electrolytes (discontinue if hyperkalaemia);hypotension; acute porphyria (section9.8.2); interactions: Appendix 1 (diuretics)Contra-indications hyperkalaemia; hyponatraemiaRenal impairment use with caution and monitorplasma-potassium concentration if estimated glomerularfiltration rate 30–60 mL/minute/1.73 m 2 ; avoidif estimated glomerular filtration rate less than 30 mL/minute/1.73 m 2Pregnancy crosses placenta; feminisation and undescendedtestes in male fetus in animal studies—manufactureradvises avoidBreast-feeding present in breast milk—manufactureradvises avoidSide-effects drowsiness, headache, ataxia; menstrualirregularities; hyperuricaemia; pain at injection site onrapid administration; less commonly thrombocytopenia,eosinophilia, and hyperkalaemia; rarely hepatotoxicity,agranulocytosis, osteomalacia, hoarsenessand deepening of voice, hypersensitivity reactions(including urticaria and erythema), and alopecia; alsogastro-intestinal disturbances, hypotension, transientconfusion with high doses, hyponatraemia, hypochloraemicacidosis, mastalgia, gynaecomastia, andhirsutismLicensed use not licensed for use in the UKIndication and doseShort-term diuresis for oedema in heart failureand in ascites. By intravenous injection over at least 3 minutesor intravenous infusionNeonate 1–2 mg/kg twice dailyChild 1 month–12 years 1–2 mg/kg twice dailyChild 12–18 years 1–2 mg/kg (max. 200 mg)twice dailyNote To convert to equivalent oral spironolactone dose,multiply potassium canrenoate dose by 0.7Administration consult product literaturePreparationsPotassium canrenoate injection is available from ‘special-order’manufacturers or specialist importing companies,see p. 8092.2.4 Potassium-sparingdiuretics with otherdiureticsAlthough it is preferable to prescribe diuretics separatelyin children, the use of fixed combinations maybe justified in older children if compliance is a problem.The most commonly used preparations are listed below(but they may not be licensed for use in children—consult product literature), for other preparations seethe BNF. For interactions, see Appendix 1 (diuretics).Amiloride with thiazidesCo-amilozide (Non-proprietary) ATablets, co-amilozide 2.5/25 (amiloride hydrochloride2.5 mg, hydrochlorothiazide 25 mg), net price28-tab pack = £3.73Brands include Moduret 25 cAmiloride with loop diureticsCo-amilofruse (Non-proprietary) ATablets, co-amilofruse 2.5/20 (amiloride hydrochloride2.5 mg, furosemide 20 mg). Net price 28-tabpack = £1.18, 56-tab pack = £1.83Brands include Frumil LS cTablets, co-amilofruse 5/40 (amiloride hydrochloride5 mg, furosemide 40 mg). Net price 28-tab pack =£1.17, 56-tab pack = £1.42Brands include Frumil cTablets, co-amilofruse 10/80 (amiloride hydrochloride10 mg, furosemide 80 mg), net price 28-tabpack = £11.512.2.5 Osmotic diureticsMannitol is used to treat cerebral oedema, raised intraocularpressure, peripheral oedema, and ascites.MANNITOLCautions extravasation causes inflammation andthrombophlebitis; monitor fluid and electrolyte balance,serum osmolality, and pulmonary and renalfunction; assess cardiac function before and duringtreatment; interactions: Appendix 1 (mannitol)Contra-indications severe heart failure; severe pulmonaryoedema; intracranial bleeding (except duringcraniotomy); anuria; severe dehydrationRenal impairment use with caution in severe impairmentPregnancy manufacturer advises avoid unless essential—noinformation available2 Cardiovascular system