BNF for Children 2011-2012

BNFC 2011–2012 2.6.2 Calcium-channel blockers 109blood pressure stable), increase after 2 hours to 1–2 mg/hour if no severe fall in blood pressure;continue for at least 5 days (max. 14 days)Prevention of vasospasm following subarachnoidhaemorrhage. By mouthChild 1 month–18 years 0.9–1.2 mg/kg (max.60 mg) 6 times daily, starting within 4 days ofhaemorrhage and continued for 21 daysAdministration for continuous intravenous infusion,administer undiluted via a Y-piece on a centralvenous catheter connected to a running infusion ofGlucose 5%, or Sodium Chloride 0.9%; not to beadded to an infusion container; incompatible withpolyvinyl chloride giving sets or containers; protectinfusion from light.For administration by mouth, tablets may be crushedor halved but are light sensitive—administer immediatelyNimotop c (Bayer Schering) ATablets, yellow, f/c, nimodipine 30 mg, net price 100-tab pack = £33.60Intravenous infusion, nimodipine 200 micrograms/mL; also contains ethanol 20% and macrogol ‘400’17%. Net price 50-mL vial (with polyethylene infusioncatheter) = £11.46Note Polyethylene, polypropylene, or glass apparatus shouldbe used; PVC should be avoidedVERAPAMIL HYDROCHLORIDECautions first-degree AV block; patients taking betablockers(important: see below); avoid grapefruitjuice (may affect metabolism); interactions: Appendix1 (calcium-channel blockers)Verapamil and beta-blockers Verapamil injection shouldnot be given to patients recently treated with beta-blockersbecause of the risk of hypotension and asystole. The suggestionthat when verapamil injection has been given first, aninterval of 30 minutes before giving a beta-blocker is sufficienthas not been confirmed.It may also be hazardous to give verapamil and a betablockertogether by mouth (should only be contemplated ifmyocardial function well preserved).Contra-indications hypotension, bradycardia, second-and third-degree AV block, sick sinus syndrome,cardiogenic shock, sino-atrial block; history of heartfailure or significantly impaired left ventricular function,even if controlled by therapy; atrial flutter orfibrillation complicating syndromes associated withaccessory conducting pathways (e.g. Wolff-Parkinson-White syndrome); acute porphyria (section 9.8.2)Hepatic impairment oral dose may need to bereducedPregnancy may reduce uterine blood flow with fetalhypoxia; manufacturer advises avoid during first trimesterunless absolutely necessary; may inhibitlabourBreast-feeding amount too small to be harmfulSide-effects constipation; less commonly nausea,vomiting, flushing, headache, dizziness, fatigue, ankleoedema; rarely allergic reactions (erythema, pruritus,urticaria, angioedema, Stevens-Johnson syndrome);myalgia, arthralgia, paraesthesia, erythromelalgia;increased prolactin concentration; gynaecomastiaand gingival hyperplasia after long-term treatment;after intravenous administration or high doses, hypotension,heart failure, bradycardia, heart block, andasystole; hypersensitivity reactions involving reversiblyraised liver function testsLicensed use Modified release preparation notlicensed for use in childrenIndication and doseHypertension, prophylaxis of supraventriculararrhythmias under specialist advice only. By mouthChild 1–2 years 20 mg 2–3 times dailyChild 2–18 years 40–120 mg 2–3 times dailyTreatment of supraventricular arrhythmias. By intravenous injection over 2–3 minutes(with ECG and blood-pressure monitoring andunder specialist advice)Child 1–18 years 100–300 micrograms/kg (max.5 mg) as a single dose, repeated after 30 minutes ifnecessaryAdministration for intravenous injection, may bediluted with Glucose 5% or Sodium Chloride 0.9%;incompatible with solutions of pH greater than 6Verapamil (Non-proprietary) ATablets, coated, verapamil hydrochloride 40 mg, netprice 84-tab pack = £1.55; 80 mg, 84-tab pack = £1.91;120 mg, 28-tab pack = £1.54; 160 mg, 56-tab pack =£28.20Oral solution, verapamil hydrochloride 40 mg/5 mL,net price 150 mL = £36.90Brands include Zolvera cCordilox c (Dexcel) ATablets, yellow, f/c, verapamil hydrochloride 40 mg,net price 84-tab pack = £1.50; 80 mg, 84-tab pack =£2.05; 120 mg, 28-tab pack = £1.15; 160 mg, 56-tabpack = £2.80Injection, verapamil hydrochloride 2.5 mg/mL, netprice 2-mL amp = £1.11Securon c (Abbott) AInjection, verapamil hydrochloride 2.5 mg/mL, netprice 2-mL amp = £1.08Extemporaneous formulations available seeExtemporaneous Preparations, p. 6Modified releaseHalf Securon SR c (Abbott) ATablets, m/r, f/c, verapamil hydrochloride 120 mg,net price 28-tab pack = £7.71. Label: 25DoseGive once daily (doses above 240 mg daily, give 2–3times daily)Securon SR c (Abbott) ATablets, m/r, pale green, f/c, scored, verapamilhydrochloride 240 mg, net price 28-tab pack = £5.00.Label: 25DoseGive once daily (doses above 240 mg daily, give 2–3times daily)2 Cardiovascular system