BNF for Children 2011-2012

BNFC 2011–2012 2.10 Myocardial infarction and fibrinolysis 121Side-effects bronchospasm; gastro-intestinalhaemorrhage (occasionally major), also otherhaemorrhage (e.g. subconjunctival)Licensed use Not licensed for use in children under16 yearsIndication and doseKawasaki syndrome. By mouthNeonate initially 8 mg/kg 4 times daily for 2 weeksor until afebrile, followed by 5 mg/kg once daily for6–8 weeks; if no evidence of coronary lesions after8 weeks, discontinue treatment or seek expertadviceChild 1 month–12 years initially 7.5–12.5 mg/kg4 times daily for 2 weeks or until afebrile, then 2–5 mg/kg once daily for 6–8 weeks; if no evidenceof coronary lesions after 8 weeks, discontinuetreatment or seek expert adviceAntiplatelet, prevention of thrombus formationafter cardiac surgery. By mouthNeonate 1–5 mg/kg once dailyChild 1 month–12 years 1–5 mg/kg (usual max.75 mg) once dailyChild 12–18 years 75 mg once dailyAspirin (Non-proprietary) ADispersible tablets, aspirin 75 mg, net price 28 =83p; 300 mg, 100-tab pack = £2.88 Label: 13, 21, 32Tablets, e/c, aspirin 75 mg, net price 28-tab pack =93p; 56-tab pack = £1.03; 300 mg, 100-tab pack =£5.29. Label: 5, 25, 32Brands include Micropirin cSuppositories, available from ‘special-order’ manufacturersor specialist importing companies, seep. 809Caprin c (Wockhardt) ATablets, e/c, pink, aspirin 75 mg, net price 28-tabpack = £1.51, 56-tab pack = £2.52. Label: 5, 25, 32Nu-Seals c Aspirin (Alliance) ATablets, e/c, aspirin 75 mg, net price 56-tab pack =£3.12; 300 mg, 100-tab pack = £4.15. Label: 5, 25, 32DIPYRIDAMOLECautions aortic stenosis, left ventricular outflowobstruction, heart failure; may exacerbate migraine;hypotension; myasthenia gravis (risk of exacerbation);concomitant use of drugs that increase risk of bleeding;coagulation disorders; interactions: Appendix 1(dipyridamole)Pregnancy not known to be harmfulBreast-feeding manufacturers advise use only ifessential—small amount present in milkSide-effects gastro-intestinal effects, dizziness, myalgia,throbbing headache, hypotension, hot flushes andtachycardia; hypersensitivity reactions such as rash,urticaria, severe bronchospasm and angioedema;increased bleeding during or after surgery; thrombocytopeniareportedLicensed use not licensed for use in childrenIndication and doseKawasaki syndrome. By mouthChild 1 month–12 years 1 mg/kg 3 times dailyPrevention of thrombus formation after cardiacsurgery. By mouthChild 1 month–12 years 2.5 mg/kg twice dailyChild 12–18 years 100–200 mg 3 times dailyAdministration injection solution can be given orallyDipyridamole (Non-proprietary) ATablets, coated, dipyridamole 25 mg, net price 84 =£3.11; 100 mg, 84 = £2.80. Label: 22Oral suspension, dipyridamole 50 mg/5 ml, net price150 mL = £40.63Persantin c (Boehringer Ingelheim) ATablets, s/c, dipyridamole, 100 mg, net price 84-tabpack = £4.16. Label: 22Injection, dipyridamole 5 mg/mL, net price 2-mLamp = 12p2.10 Myocardial infarction andfibrinolysis2.10.1 Management of myocardial infarction2.10.2 Fibrinolytic drugs2.10.1 Management ofmyocardial infarctionThis section is not included in BNF for Children.2.10.2 Fibrinolytic drugsFibrinolytic drugs act as thrombolytics by activatingplasminogen to form plasmin, which degrades fibrinand so breaks up thrombi.Alteplase, streptokinase, and urokinase are used inchildren to dissolve intravascular thrombi and unblockoccluded arteriovenous shunts, catheters, and indwellingcentral lines blocked with fibrin clots. Treatmentshould be started as soon as possible after a clot hasformed and discontinued once a pulse in the affectedlimb is detected, or the shunt or catheter unblocked.The safety and efficacy of treatment remains uncertain,especially in neonates. A fibrinolytic drug is probablyonly appropriate where arterial occlusion threatensischaemic damage; an anticoagulant may stop the clotgetting bigger. Alteplase is the preferred fibrinolytic inchildren and neonates; there is less risk of adverseeffects including allergic reactions.Cautions Thrombolytic drugs should be used withcaution if there is a risk of bleeding including thatfrom venepuncture or invasive procedures. They should2 Cardiovascular system