BNF for Children 2011-2012

BNFC 2011–2012 2.6.2 Calcium-channel blockers 107Hepatic impairment half-life prolonged in severeimpairment—may need dose reductionRenal impairment start with smaller dosePregnancy may inhibit labour; toxicity in animal studies;manufacturer advises avoid, but risk to fetusshould be balanced against risk of uncontrolledmaternal hypertensionBreast-feeding manufacturer advises avoid—noinformation availableSide-effects dizziness, headache, peripheral oedema,flushing, palpitation, nausea; also gastro-intestinaldisturbances, drowsiness, insomnia, tinnitus, hypotension,rashes, dyspnoea, paraesthesia, frequency ofmicturition; thrombocytopenia, depression andimpotence reportedLicensed use not licensed for use in childrenIndication and doseHypertensive crisis. By continuous intravenous infusionNeonate initially 500 nanograms/kg/minute,adjusted according to response; usual maintenanceof 1–4 micrograms/kg/minuteChild 1 month–18 years initially 500 nanograms/kg/minute, adjusted according to response; usualmaintenance of 1–4 micrograms/kg/minute (max.250 micrograms/minute)Administration for intravenous infusion, dilute to aconcentration of 100 micrograms/mL with Glucose5% or Sodium Chloride 0.9%; to minimise peripheralvenous irritation, change site of infusion every 12hoursCardene IV c AInjection, nicardipine 2.5 mg/mL (10-mL ampoule)Available from ‘special-order’ manufacturers or specialistimporting companies, see p. 809NIFEDIPINECautions see notes above; also poor cardiac reserve;heart failure or significantly impaired left ventricularfunction (heart failure deterioration observed); severehypotension; diabetes mellitus; avoid grapefruit juice(may affect metabolism); acute porphyria (but seesection 9.8.2); interactions: Appendix 1 (calciumchannelblockers)Contra-indications cardiogenic shock; significantaortic stenosisHepatic impairment dose reduction may be requiredin severe liver diseasePregnancy may inhibit labour; manufacturer advisesavoid before week 20, but risk to fetus should bebalanced against risk of uncontrolled maternalhypertension; use only if other treatment options arenot indicated or have failedBreast-feeding amount too small to be harmful butmanufacturer advises avoidSide-effects gastro-intestinal disturbance; hypotension,oedema, vasodilatation, palpitation; headache,dizziness, lethargy, asthenia; less commonlytachycardia, hypotension, syncope, chills, nasal congestion,dyspnoea, anxiety, sleep disturbance, vertigo,migraine, paraesthesia, tremor, polyuria, dysuria,nocturia, erectile dysfunction, epistaxis, myalgia, jointswelling, visual disturbance, sweating, and hypersensitivityreactions (including angioedema, jaundice,pruritus, urticaria, and rash); rarely anorexia, gumhyperplasia, mood disturbances, hyperglycaemia,male infertility, purpura, and photosensitivity reactions;also reported dysphagia, intestinal obstruction,intestinal ulcer, bezoar formation, gynaecomastia,agranulocytosis, and anaphylaxisLicensed use not licensed for use in childrenIndication and doseHypertensive crisis, acute angina in Kawasakidisease or progeria. By mouth (see Administration, below)Child 1 month–18 years 250–500 micrograms/kg (max. 20 mg) as a single doseHypertension, angina in Kawasaki disease orprogeria. By mouthChild 1 month–12 years 200–300 micrograms/kg 3 times daily; max. 3 mg/kg daily or 90 mg dailyChild 12–18 years 5–20 mg 3 times daily; max.90 mg dailyNote Dose frequency depends on preparation usedRaynaud’s syndrome. By mouthChild 2–18 years 2.5–10 mg 2–4 times daily; startwith low doses at night and increase gradually toavoid postural hypotensionNote Dose frequency depends on preparation usedPersistent hyperinsulinaemic hypoglycaemiasee also section 6.1.4. By mouthNeonate 100–200 micrograms/kg (max.600 micrograms/kg) 4 times dailyAdministration for rapid effect in hypertensive crisisor acute angina, bite capsules and swallow liquid oruse liquid preparation if 5-mg or 10-mg dose inappropriate;if liquid unavailable, extract contents ofcapsule via a syringe and use immediately—coversyringe with foil to protect contents from light; capsulecontents may be diluted with water if necessary.Modified-release tablets may be crushed—this mayalter the release profile; crushed tablets should beadministered within 30–60 seconds to avoid significantloss of potency of drugNifedipine (Non-proprietary) ACapsules, nifedipine 5 mg, net price 84-cap pack =£2.97; 10 mg, 84-cap pack = £4.00DoseGive 3 times dailyOral liquid, available from ‘special-order’ manufacturersor specialist importing companies, see p. 809Adalat c (Bayer Schering) ACapsules, orange, nifedipine 5 mg, net price 90-cappack = £5.73; 10 mg, 90-cap pack = £7.30Note Adalat liquid gel capsules contain 5 mg nifedipine in0.17 mL and 10 mg nifedipine in 0.34 mLDoseGive 3 times daily2 Cardiovascular system