BNF for Children 2011-2012

BNFC 2011–2012 2.7.2 Vasoconstrictor sympathomimetics 113Administration for intravenous infusion, dilute to aconcentration of 30–200 micrograms/mL with Glucose5% or Sodium Chloride 0.9% and give through acentral venous catheterMetaraminol (Non-proprietary) AInjection, metaraminol 10 mg (as tartrate)/mL.Available from ‘special-order’ manufacturers or specialistimporting companies, see p. 809NORADRENALINE/NOREPINEPHRINECautions coronary, mesenteric, or peripheral vascularthrombosis; following myocardial infarction; Prinzmetal’svariant angina, hyperthyroidism, diabetesmellitus; hypoxia or hypercapnia; uncorrected hypovolaemia;extravasation at injection site may causenecrosis; susceptibility to angle-closure glaucomainteractions: Appendix 1 (sympathomimetics)Contra-indications hypertension (monitor bloodpressure and rate of flow frequently)Pregnancy avoid—may reduce placental perfusionSide-effects anorexia, nausea, vomiting, hypoxia,arrhythmias, peripheral ischaemia, palpitation,hypertension, bradycardia, tachycardia, dyspnoea,headache, insomnia, confusion, anxiety, psychosis,weakness, tremor, urinary retention, angle-closureglaucomaLicensed use not licensed for use in childrenIndication and doseAcute hypotension (septic shock) or shocksecondary to excessive vasodilation (asnoradrenaline). By continuous intravenous infusionNeonate 20–100 nanograms (base)/kg/minuteadjusted according to response; max. 1 microgram(base)/kg/minuteChild 1 month–18 years 20–100 nanograms(base)/kg/minute adjusted according toresponse; max. 1 microgram (base)/kg/minuteNote 500 micrograms of noradrenaline base is equivalentto 1 mg of acid tartrate. Dose expressed as the baseAdministration for continuous intravenous infusion,dilute to a max. concentration of noradrenaline (base)40 micrograms/mL (higher concentrations can beused if fluid-restricted) with Glucose 5% or SodiumChloride and Glucose. Infuse through central venouscatheter; discard if discoloured. Incompatible withbicarbonate or alkaline solutions.Neonatal intensive care, dilute 600 micrograms(base)/kg body-weight to a final volume of50 mL with infusion fluid; an intravenous infusion rateof 0.1 mL/hour provides a dose of 20 nanograms(base)/kg/minuteNoradrenaline/Norepinephrine (Non-proprietary) AInjection, noradrenaline base 1 mg/mL (equivalent tonoradrenaline acid tartrate 2 mg/mL). For dilutionbefore use. Net price 2-mL amp = £2.40, 4-mL amp =£4.40, 20-mL amp = £6.35Note For a period of time preparations on the UK marketmay be described as either noradrenaline base ornoradrenaline acid tartrate; doses above are expressed as thebasePHENYLEPHRINE HYDROCHLORIDECautions see under Noradrenaline; longer duration ofaction than noradrenaline (norepinephrine), seebelow; coronary diseaseHypertensive response Phenylephrine has a longer durationof action than noradrenaline, and an excessive vasopressorresponse may cause a prolonged rise in bloodpressureContra-indications see under Noradrenaline; severehyperthyroidismPregnancy avoid if possible; malformations reportedfollowing use in first trimester; fetal hypoxia andbradycardia reported in late pregnancy and labourSide-effects see under Noradrenaline; tachycardia orreflex bradycardiaLicensed use not licensed for use in children byintravenous infusion or injectionIndication and doseAcute hypotension. By subcutaneous or intramuscular injection(but intravenous injection preferred, see below)Child 1–12 years 100 micrograms/kg every 1–2hours as needed (max. 5 mg)Child 12–18 years 2–5 mg, followed if necessaryby further doses of 1–10 mg (max. initial dose5 mg). By slow intravenous injectionChild 1–12 years 5–20 micrograms/kg (max.500 micrograms) repeated as necessary after atleast 15 minutesChild 12–18 years 100–500 micrograms repeatedas necessary after at least 15 minutes. By intravenous infusionChild 1–16 years 100–500 nanograms/kg/minute,adjusted according to responseChild 16–18 years initially up to 180 micrograms/minutereduced to 30–60 micrograms/minute according to responseAdministration for intravenous injection, dilute to aconcentration of 1 mg/mL with Water for Injectionsand administer slowly.For intravenous infusion, dilute to a concentration of20 micrograms/mL with Glucose 5% or SodiumChloride 0.9% and administer as a continuous infusionvia a central venous catheter using a controlledinfusion devicePhenylephrine (Sovereign) AInjection, phenylephrine hydrochloride 10 mg/mL(1%), net price 1-mL amp = £5.50ADRENALINE/EPINEPHRINECautions ischaemic heart disease, severe angina,obstructive cardiomyopathy, hypertension, arrhythmias,cerebrovascular disease; occlusive vasculardisease, monitor blood pressure and ECG; cor pulmonale;organic brain damage, psychoneurosis;phaeochromocytoma; diabetes mellitus, hyperthyroidism;hypokalaemia, hypercalcaemia; susceptibilityto angle-closure glaucoma; interactions:Appendix 1 (sympathomimetics)Renal impairment manufacturers advise use withcaution in severe impairment2 Cardiovascular system