BNF for Children 2011-2012

108 2.6.2 Calcium-channel blockers BNFC 2011–20122 Cardiovascular systemModified releaseNote Different versions of modified-release preparations maynot have the same clinical effect. To avoid confusion betweenthese different formulations of nifedipine, prescribers shouldspecify the brand to be dispensed. Modified-release formulationsmay not be suitable for dose titration in hepatic diseaseAdalat c LA (Bayer Schering) ALA 20 tablets, m/r, f/c, pink, nifedipine 20 mg, netprice 28-tab pack = £4.97. Label: 25LA 30 tablets, m/r, f/c, pink, nifedipine 30 mg, netprice 28-tab pack = £6.85. Label: 25LA 60 tablets, m/r, f/c, pink, nifedipine 60 mg, netprice 28-tab pack = £9.03. Label: 25Counselling Tablet membrane may pass through gastrointestinaltract unchanged, but being porous has no effect onefficacyCautions dose form not appropriate for use in hepaticimpairment or where there is a history of oesophageal orgastro-intestinal obstruction, decreased lumen diameter ofthe gastro-intestinal tract, or inflammatory bowel disease(including Crohn’s disease)DoseGive once dailyAdalat c Retard (Bayer Schering) ARetard 10 tablets, m/r, f/c, grey-pink, nifedipine10 mg, net price 56-tab pack = £7.34. Label: 25Retard 20 tablets, m/r, f/c, grey-pink, nifedipine20 mg, net price 56-tab pack = £8.81. Label: 25DoseGive twice dailyAdipine c MR (Chiesi) ATablets, m/r, nifedipine 10 mg (pink), net price 56-tabpack = £3.73; 20 mg (pink), 56-tab pack = £5.21.Label: 25DoseGive twice dailyAdipine c XL (Chiesi) ATablets, m/r, red, nifedipine 30 mg, net price 28-tabpack = £4.70; 60 mg, 28-tab pack = £7.10. Label: 25DoseGive once dailyCoracten SR c (UCB Pharma) ACapsules, m/r, nifedipine 10 mg (grey/pink, enclosingyellow pellets), net price 60-cap pack = £3.90;20 mg (pink/brown, enclosing yellow pellets), 60-cappack = £5.41. Label: 25DoseGive twice dailyCoracten XL c (UCB Pharma) ACapsules, m/r, nifedipine 30 mg (brown), net price28-cap pack = £4.89; 60 mg (orange), 28-cap pack =£7.34. Label: 25DoseGive once dailyFortipine LA 40 c (Goldshield) ATablets, m/r, red, nifedipine 40 mg, net price 30-tabpack = £9.60. Label: 21, 25DoseGive 1–2 times dailyHypolar c Retard 20 (Sandoz) ATablets, m/r, red, f/c, nifedipine 20 mg, net price 56-tab pack = £5.75. Label: 25DoseGive twice dailyNifedipress c MR (Dexcel) ATablets, m/r, pink, nifedipine 10 mg, net price 56-tabpack = £9.23; 20 mg, 56-tab pack = £10.06. Label: 25DoseGive twice dailyNote Also available as Calchan c MRTensipine MR c (Genus) ATablets, m/r, pink-grey, nifedipine 10 mg, net price56-tab pack = £4.30; 20 mg, 56-tab pack = £5.49.Label: 21, 25DoseGive twice dailyValni XL c (Winthrop) ATablets, m/r, red, nifedipine 30 mg, net price 28-tabpack = £7.29; 60 mg, 28-tab pack = £9.13. Label: 25Cautions dose form not appropriate for use in hepaticimpairment, or where there is a history of oesophageal orgastro-intestinal obstruction, decreased lumen diameter ofthe gastro-intestinal tract, inflammatory bowel disease, orileostomy after proctocolectomyDoseGive once dailyNIMODIPINECautions cerebral oedema or severely raised intracranialpressure; hypotension; avoid concomitantadministration of nimodipine tablets and infusion,other calcium-channel blockers, or beta-blockers;concomitant nephrotoxic drugs; avoid grapefruit juice(may affect metabolism); interactions: Appendix 1(calcium-channel blockers, alcohol (infusion only))Contra-indications acute porphyria (section 9.8.2)Hepatic impairment elimination reduced in cirrhosis—monitorblood pressureRenal impairment manufacturer advises monitorrenal function closely with intravenous administrationPregnancy manufacturer advises use only if potentialbenefit outweighs risksBreast-feeding manufacturer advises avoid—presentin milkSide-effects hypotension, variation in heart-rate,flushing, headache, gastro-intestinal disorders,nausea, sweating and feeling of warmth; thrombocytopeniaand ileus reportedLicensed use not licensed for use in childrenIndication and doseTreatment of vasospasm following subarachnoidhaemorrhage under specialist advice only. By intravenous infusionChild 1 month–12 years initially 15 micrograms/kg/hour (max. 500 micrograms/hour) or initially7.5 micrograms/kg/hour if blood pressureunstable; increase after 2 hours to 30 micrograms/kg/hour (max. 2 mg/hour) if no severe decrease inblood pressure; continue for at least 5 days (max.14 days)Child 12–18 years initially 500 micrograms/hour(up to 1 mg/hour if body-weight over 70 kg and