BNF for Children 2011-2012

86 2.3.2 Drugs for arrhythmias BNFC 2011–20122 Cardiovascular systemLicensed use not licensed for use in children under12 yearsIndication and doseResistant re-entry supraventricular tachycardia,ventricular ectopic beats or ventriculartachycardia, arrhythmias associated withaccessory conduction pathways (e.g. Wolff-Parkinson-White syndrome), paroxysmal atrialfibrillation. By mouthNeonate 2 mg/kg 2–3 times daily adjustedaccording to response and plasma-flecainide concentrationChild 1 month–12 years 2 mg/kg 2–3 times dailyadjusted according to response and plasma-flecainideconcentration (max. 8 mg/kg/day or300 mg daily)Child 12–18 years initially 50–100 mg twicedaily; max. 300 mg daily (max. 400 mg daily forventricular arrhythmias in heavily built children). By slow intravenous injection or intravenousinfusionNeonate 1–2 mg/kg over 10–30 minutes; ifnecessary followed by continuous infusion at a rateof 100–250 micrograms/kg/hour until arrhythmiacontrolled; transfer to oral treatment as aboveChild 1 month–12 years 2 mg/kg over 10–30minutes; if necessary followed by continuousinfusion at a rate of 100–250 micrograms/kg/houruntil arrhythmia controlled (max. cumulative dose600 mg in 24 hours); transfer to oral treatment asaboveChild 12–18 years 2 mg/kg (max. 150 mg) over10–30 minutes; if necessary followed by continuousinfusion at a rate of 1.5 mg/kg/hour for 1 hour,then reduced to 100–250 micrograms/kg/houruntil arrhythmia controlled (max. cumulative dose600 mg in first 24 hours); transfer to oral treatmentas aboveAdministration for administration by mouth, milk,infant formula, and dairy products may reduceabsorption of flecainide—separate doses from feeds.Liquid has a local anaesthetic effect and should begiven at least 30 minutes before or after food. Do notstore liquid in refrigerator as precipitation occurs.For intravenous administration, give initial dose over30 minutes in children with sustained ventriculartachycardia or cardiac failure.Dilute injection using Glucose 5%; concentrations ofmore than 300 micrograms/mL are unstable inchloride-containing solutionsFlecainide (Non-proprietary) ATablets, flecainide acetate 50 mg, net price 60-tabpack = £6.04; 100 mg, 60-tab pack = £8.95Liquid, available from ‘special-order’ manufacturersor specialist importing companies, see p. 809Tambocor c (3M) ATablets, flecainide acetate 50 mg, net price 60-tabpack = £11.57; 100 mg (scored), 60-tab pack = £16.53Injection, flecainide acetate 10 mg/mL, net price 15-mL amp = £4.40Modified releaseTambocor c XL (Meda) ACapsules, m/r, grey/pink, flecainide acetate 200 mg,net price 30-cap pack = £14.77. Label: 25DoseSupraventricular arrhythmias. By mouthChild 12–18 years 200 mg once dailyNote Not to be used to control arrhythmias in acutesituations; children stabilised on 200 mg daily ofimmediate-release flecainide may be transferred toTambocor c XLLIDOCAINE HYDROCHLORIDE(Lignocaine hydrochloride)Cautions lower doses in congestive heart failure andfollowing cardiac surgery; monitor ECG; resuscitationfacilities should be available; interactions: Appendix1 (lidocaine)Contra-indications sino-atrial disorders, all grades ofatrioventricular block, severe myocardial depression;acute porphyria (section 9.8.2)Hepatic impairment caution—increased risk of sideeffectsRenal impairment possible accumulation of lidocaineand active metabolite; caution in severe impairmentPregnancy crosses the placenta but not known to beharmful in animal studies—use if benefit outweighsriskBreast-feeding present in milk but amount too smallto be harmfulSide-effects dizziness, paraesthesia, or drowsiness(particularly if injection too rapid); other CNS effectsinclude confusion, respiratory depression and convulsions;hypotension and bradycardia (may lead tocardiac arrest); rarely hypersensitivity reactionsincluding anaphylaxisLicensed use not licensed for use in children under 1yearIndication and doseVentricular arrhythmias, pulseless ventriculartachycardia or ventricular fibrillation. By intravenous or intraosseous injection, andintravenous infusionNeonate 0.5–1 mg/kg by injection followed byinfusion of 0.6–3 mg/kg/hour; if infusion notimmediately available following initial injection,injection of 0.5–1 mg/kg may be repeated atintervals of not less than 5 minutes (to max. totaldose 3 mg/kg) until infusion can be initiatedChild 1 month–12 years 0.5–1 mg/kg by injectionfollowed by infusion of 0.6–3 mg/kg/hour; ifinfusion not immediately available following initialinjection, injection of 0.5–1 mg/kg may berepeated at intervals of not less than 5 minutes (tomax. total dose 3 mg/kg) until infusion can beinitiatedChild 12–18 years 50–100 mg by injection followedby infusion of 120 mg over 30 minutes then240 mg over 2 hours then 60 mg/hour; reducedose further if infusion continued beyond 24 hours;if infusion not immediately available followinginitial injection, injection of 50–100 mg may berepeated at intervals of not less than 5 minutes (tomax. 300 mg in 1 hour) until infusion can beinitiated