BNF for Children 2011-2012

90 2.4 Beta-adrenoceptor blocking drugs BNFC 2011–20122 Cardiovascular systempressure, renal impairment, ischaemic heart disease,or diffuse vascular diseaseContra-indications see under Propranolol Hydrochloride;acute or decompensated heart failurerequiring intravenous inotropesHepatic impairment avoidPregnancy see notes aboveBreast-feeding see notes aboveSide-effects postural hypotension, dizziness, headache,fatigue, gastro-intestinal disturbances, bradycardia;occasionally diminished peripheral circulation,peripheral oedema and painful extremities, drymouth, dry eyes, eye irritation or disturbed vision,impotence, disturbances of micturition, influenza-likesymptoms; rarely angina, AV block, exacerbation ofintermittent claudication or Raynaud’s phenomenon;allergic skin reactions, exacerbation of psoriasis, nasalstuffiness, wheezing, depressed mood, sleep disturbances,paraesthesia, heart failure, changes in liverenzymes, thrombocytopenia, leucopenia alsoreportedLicensed use not licensed for use in children under18 yearsIndication and doseAdjunct in heart failure (limited informationavailable). By mouthChild 2–18 years initially 50 micrograms/kg(max. 3.125 mg) twice daily, double dose at intervalsof at least 2 weeks up to 350 micrograms/kg(max. 25 mg) twice dailyCarvedilol (Non-proprietary) ATablets, carvedilol 3.125 mg, net price 28-tab pack =£1.10; 6.25 mg, 28-tab pack = £1.25; 12.5 mg, 28-tabpack = £1.37; 25 mg, 28-tab pack = £1.84. Label: 8Eucardic c (Roche) ATablets, scored, carvedilol 3.125 mg (pink), net price28-tab pack = £7.13; 6.25 mg (yellow), 28-tab pack =£7.92; 12.5 mg (peach), 28-tab pack = £8.81; 25 mg,28-tab pack = £11.00. Label: 8ESMOLOL HYDROCHLORIDECautions see under Propranolol HydrochlorideContra-indications see under Propranolol HydrochlorideRenal impairment manufacturer advises cautionPregnancy see notes aboveBreast-feeding see notes aboveSide-effects see under Propranolol Hydrochloride;infusion causes venous irritation and thrombophlebitisLicensed use not licensed for use in childrenIndication and doseArrhythmias, hypertensive emergencies (seealso notes above and section 2.5). By intravenous administrationChild 1 month–18 years initially by intravenousinjection over 1 minute 500 micrograms/kg thenby intravenous infusion 50 micrograms/kg/minutefor 4 minutes (rate reduced if low blood pressureor low heart rate); if inadequate response,repeat loading dose and increase maintenanceinfusion by 50 micrograms/kg/minute increments;repeat until effective or max. infusion of200 micrograms/kg/minute reached; doses over300 micrograms/kg/minute not recommendedTetralogy of Fallot. By intravenous administrationNeonate initially by intravenous injection over 1–2minutes 600 micrograms/kg then if necessary byintravenous infusion 300–900 micrograms/kg/minuteAdministration give through a central venous catheter;incompatible with bicarbonateBrevibloc c (Baxter) AInjection, esmolol hydrochloride 10 mg/mL, net price10-mL vial = £7.79, 250-mL infusion bag = £89.69LABETALOL HYDROCHLORIDECautions see under Propranolol Hydrochloride; interfereswith laboratory tests for catecholamines; liverdamage (see below)Liver damage Severe hepatocellular damage reported afterboth short-term and long-term treatment. Appropriatelaboratory testing needed at first symptom of liver dysfunctionand if laboratory evidence of damage (or if jaundice)labetalol should be stopped and not restartedContra-indications see under Propranolol HydrochlorideRenal impairment dose reduction may be requiredPregnancy see notes aboveBreast-feeding see notes aboveSide-effects postural hypotension (avoid uprightposition during and for 3 hours after intravenousadministration), tiredness, weakness, headache,rashes, scalp tingling, difficulty in micturition, epigastricpain, nausea, vomiting; liver damage (seeabove); rarely lichenoid rashLicensed use not licensed for use in childrenIndication and doseHypertensive emergencies see also section 2.5. By intravenous infusionNeonate 500 micrograms/kg/hour adjusted atintervals of at least 15 minutes according toresponse; max. 4 mg/kg/hourChild 1 month–12 years initially 0.5–1 mg/kg/hour adjusted at intervals of at least 15 minutesaccording to response; max. 3 mg/kg/hourChild 12–18 years 30–120 mg/hour adjusted atintervals of at least 15 minutes according toresponseNote Consult local guidelines. In hypertensiveencephalopathy reduce blood pressure to normotensivelevel over 24–48 hours (more rapid reduction may lead tocerebral infarction, blindness, and death). If child fitting,reduce blood pressure rapidly, but not to normal levelsHypertension. By mouthChild 1 month–12 years 1–2 mg/kg 3–4 times adayChild 12–18 years initially 50–100 mg twice dailyincreased if required at intervals of 3–14 days tousual dose of 200–400 mg twice daily (3–4 divideddoses if higher); max. 2.4 g daily