BNF for Children 2011-2012

BNFC 2011–2012 2.4 Beta-adrenoceptor blocking drugs 91. By intravenous injectionChild 1 month–12 years 250–500 micrograms/kg as a single dose; max. 20 mgChild 12–18 years 50 mg over at least 1 minute,repeated after 5 minutes if necessary; max. totaldose 200 mgNote Excessive bradycardia can be countered with intravenousinjection of atropine sulphate; for overdosage seep. 29Administration for intravenous infusion, dilute to aconcentration of 1 mg/mL in Glucose 5% or SodiumChloride and Glucose 5%; if fluid restricted may begiven undiluted, preferably through a central venouscatheter.For administration by mouth, injection may be givenorally with squash or juiceLabetalol Hydrochloride (Non-proprietary) ATablets, f/c, labetalol hydrochloride 100 mg, net price56 = £7.85; 200 mg, 56 = £11.49; 400 mg, 56 = £20.60.Label: 8, 21Trandate c (UCB Pharma) ATablets, all orange, f/c, labetalol hydrochloride 50 mg,net price 56-tab pack = £3.64; 100 mg, 56-tab pack =£4.01; 200 mg, 56-tab pack = £6.51; 400 mg, 56-tabpack = £9.05. Label: 8, 21Injection, labetalol hydrochloride 5 mg/mL, net price20-mL amp = £2.04Extemporaneous formulations available seeExtemporaneous Preparations, p. 6METOPROLOL TARTRATECautions see under Propranolol HydrochlorideContra-indications see under Propranolol HydrochlorideHepatic impairment reduce dose in severe impairmentPregnancy see notes aboveBreast-feeding see notes aboveSide-effects see under Propranolol HydrochlorideLicensed use not licensed for use in childrenIndication and doseHypertension. By mouthChild 1 month–12 years initially 1 mg/kg twicedaily, increased if necessary to max. 8 mg/kg(max. 400 mg) daily in 2–4 divided dosesChild 12–18 years initially 50–100 mg dailyincreased if necessary to 200 mg daily in 1–2divided doses; max. 400 mg daily (but high dosesrarely necessary)Arrhythmias. By mouthChild 12–18 years usually 50 mg 2–3 times daily;up to 300 mg daily in divided doses if necessaryMetoprolol Tartrate (Non-proprietary) ATablets, metoprolol tartrate 50 mg, net price 28-tabpack = £1.31, 56-tab pack = £1.74; 100 mg, 28-tabpack = £1.59, 56-tab pack = £2.51. Label: 8Lopresor c (Recordati) ATablets, f/c, scored, metoprolol tartrate 50 mg (pink),net price 56-tab pack = £2.57; 100 mg (blue), 56-tabpack = £6.68. Label: 8Modified releaseLopresor SR c (Recordati) ATablets, m/r, yellow, f/c, metoprolol tartrate 200 mg,net price 28-tab pack = £9.80. Label: 8, 25DoseHypertension. By mouthChild 12–18 years 200 mg once dailyExtemporaneous formulations available seeExtemporaneous Preparations, p. 6SOTALOL HYDROCHLORIDECautions see under Propranolol Hydrochloride; correcthypokalaemia, hypomagnesaemia, or otherelectrolyte disturbances; severe or prolonged diarrhoea;reduce dose or discontinue if corrected QTinterval exceeds 550 msecContra-indications see under Propranolol Hydrochloride;congenital or acquired long QT syndrome;torsade de pointesRenal impairment halve normal dose if estimatedglomerular filtration rate 30–60 mL/minute/1.73 m 2 ;use one-quarter normal dose if estimated glomerularfiltration rate 10–30 mL/minute/1.73 m 2 ; avoid ifestimated glomerular filtration rate less than 10 mL/minute/1.73 m 2Pregnancy see notes aboveBreast-feeding see notes aboveSide-effects see under Propranolol Hydrochloride;arrhythmogenic (pro-arrhythmic) effect (torsade depointes—increased risk in females)Licensed use not licensed for use in children under12 yearsIndication and doseVentricular arrhythmias, life-threateningventricular tachyarrhythmia and supraventriculararrhythmias initiated under specialist supervisionand ECG monitoring and measurement ofcorrected QT interval. By mouthNeonate initially 1 mg/kg twice daily, increased asnecessary every 3–4 days to max. 4 mg/kg twicedailyAtrial flutter, ventricular arrhythmias, lifethreateningventricular tachyarrhythmia andsupraventricular arrhythmias initiated underspecialist supervision and ECG monitoring andmeasurement of corrected QT interval. By mouthChild 1 month–12 years initially 1 mg/kg twicedaily, increased as necessary every 2–3 days tomax. 4 mg/kg twice daily (max. 80 mg twice daily)Child 12–18 years initially 80 mg once daily or40 mg twice daily, increased gradually at intervalsof 2–3 days to usual dose 80–160 mg twice daily;higher doses of 480–640 mg daily for life-threateningventricular arrhythmias under specialistsupervision2 Cardiovascular system