BNF for Children 2011-2012

BNFC 2011–2012 2.11 Antifibrinolytic drugs and haemostatics 123Streptase c (CSL Behring) AInjection, powder for reconstitution, streptokinase,net price 250 000-unit vial = £15.91; 750 000-unit vial= £41.72; 1.5 million-unit vial = £83.44 (hosp. only)UROKINASECautions see notes aboveContra-indications see notes aboveHepatic impairment see notes abovePregnancy see notes aboveSide-effects see notes aboveLicensed use not licensed for use in childrenIndication and doseOccluded arteriovenous shunts, catheters, andindwelling central lines. By injection directly into catheter or central lineNeonate 5000–10 000 units in sodium chloride0.9% to fill catheter dead-space only; leave for 2–4hours then aspirate the lysate; flush with sodiumchloride 0.9%Child 1 month–18 years 5000–10 000 units insodium chloride 0.9% to fill catheter dead-spaceonly; leave for 2–4 hours then aspirate the lysate;flush with sodium chloride 0.9%Administration may be diluted, after reconstitution,with Sodium Chloride 0.9%Syner-KINASE c (Syner-Med) AInjection, powder for reconstitution, urokinase, netprice 10 000-unit vial = £35.95; 25 000-unit vial =£45.95; 100 000-unit vial = £112.95Note 50 000-unit vial and 250 000-unit vial also availablefrom ‘special-order’ manufacturers or specialist importingcompanies, see p. 8092.11 Antifibrinolytic drugs andhaemostaticsFibrin dissolution can be impaired by the administrationof tranexamic acid, which inhibits fibrinolysis. It can beused to prevent bleeding or treat bleeding associatedwith excessive fibrinolysis (e.g. in prostatectomy,bladder surgery, in dental extraction in children withhaemophilia, and in traumatic hyphaema) and in themanagement of menorrhagia, it may also be used inhereditary angioedema (section 3.4.3), epistaxis, andthrombolytic overdose. Tranexamic acid can also beused in cardiac surgery to reduce blood loss and toreduce the need for use of blood products.Desmopressin (section 6.5.2) is used in the managementof mild to moderate haemophilia and von Willebrands’disease. It is also used for testing fibrinolyticresponse.TRANEXAMIC ACIDCautions massive haematuria (avoid if risk of uretericobstruction); not for use in disseminated intravascularcoagulation; before initiating treatment for menorrhagia,exclude structural or histological causes orfibroids causing distortion of uterine cavity; irregularmenstrual bleeding (establish cause before initiatingtherapy); regular liver function tests in long-termtreatment of hereditary angioedemaContra-indications thromboembolic disease; historyof convulsionsRenal impairment reduce dose in mild to moderateimpairment; avoid in severe impairmentPregnancy no evidence of teratogenicity in animalstudies; manufacturer advises use only if potentialbenefit outweighs risk—crosses the placentaBreast-feeding small amount present in milk—antifibrinolyticeffect in infant unlikelySide-effects nausea, vomiting, diarrhoea (reducedose); rarely disturbances in colour vision (discontinue),thromboembolic events, convulsions, allergicskin reactions; dizziness and hypotension on rapidintravenous injectionLicensed use not licensed for reduction of bloodloss during cardiac surgeryIndication and doseInhibition of fibrinolysis, hereditary angioedema. By mouthChild 1 month–18 years 15–25 mg/kg (max.1.5 g) 2–3 times daily. By intravenous injection over at least 10 minutesChild 1 month–18 years 10 mg/kg (max. 1 g) 2–3times daily. By continuous intravenous infusionChild 1 month–18 years 45 mg/kg over 24 hoursPrevention of excessive bleeding after dentalprocedures (e.g. in haemophilia). By intravenous injection pre-operativelyChild 6–18 years 10 mg/kg (max. 1.5 g). By mouth pre-operativelyChild 6–18 years 15–25 mg/kg (max. 1.5 g). By mouth postoperativelyChild 6–18 years 15–25 mg/kg (max. 1.5 g) 2–3times daily for up to 8 days. Mouthwash 5% solution (specialist use only)Child 6–18 years rinse mouth with 5–10 mL 4times daily for 2 days; not to be swallowedNote Mouthwash available only as extemporaneouslyprepared preparation, see Extemporaneous Preparations,p. 6Menorrhagia. By mouthChild 12–18 years 1 g 3 times daily for up to 4days; max. 4 g daily (initiate when menstruationhas started)Reduction of blood loss during cardiac surgeryconsult local protocolAdministration for intravenous administration, dilutewith Glucose 5% or Sodium Chloride 0.9%Tranexamic acid (Non-proprietary) ATablets, tranexamic acid 500 mg, net price 60-tabpack = £5.272 Cardiovascular system