BNF for Children 2011-2012

BNFC 2011–2012 2.12 Lipid-regulating drugs 127Indication and doseHyperlipidaemia including familial hypercholesterolaemia. By mouthChild 10–18 years initially 10 mg once daily,increased if necessary at intervals of at least 4weeks to usual max. 20 mg once daily (max. 80 mgonce daily in homozygous familial hypercholesterolaemia)Note Reduced dose required with concomitant ciclosporin,clarithromycin, or itraconazole—seek specialistadviceLipitor c (Pfizer) ATablets, all f/c, atorvastatin (as calcium trihydrate)10 mg, net price 28-tab pack = £13.00; 20 mg, 28-tabpack = £24.64; 40 mg, 28-tab pack = £24.64; 80 mg,28-tab pack = £28.21. Counselling, muscle effects, seenotes aboveFLUVASTATINCautions see notes aboveHepatic impairment see notes aboveRenal impairment manufacturer advises doses above40 mg daily should be initiated with caution if estimatedglomerular filtration rate is less than 30 mL/minute/1.73 m 2Pregnancy see notes aboveBreast-feeding see notes aboveSide-effects see notes above; also very rarely vasculitisIndication and doseHeterozygous familial hypercholesterolaemia. By mouthChild 9–18 years initially 20 mg daily in theevening, adjusted in steps of 20 mg daily at intervalsof at least 6 weeks; max. 80 mg daily (40 mgtwice daily)Fluvastatin (Non-proprietary) ACapsules, fluvastatin (as sodium salt) 20 mg, net price28-cap pack = £5.03; 40 mg, 28-cap pack = £5.36.Counselling, muscle effects, see notes aboveLescol c (Novartis) ACapsules, fluvastatin (as sodium salt) 20 mg (brown/yellow), net price 28-cap pack = £15.26; 40 mg(brown/orange), 28-cap pack = £15.26, 56-cap pack =£30.53. Counselling, muscle effects, see notes aboveModified releaseFluvastatin (Non-proprietary) ATablets, m/r, fluvastatin (as sodium salt) 80 mg, netprice 28-tab pack = £19.20. Label: 25, counselling,muscle effects, see notes aboveDoseChild 9–18 years 80 mg once daily (dose form notappropriate for initial dose titration)Brands include Luvinsta c XL, Stefluvin c XLLescol c XL (Novartis) ATablets, m/r, yellow, fluvastatin (as sodium salt)80 mg, net price 28-tab pack = £19.20. Label: 25,counselling, muscle effects, see notes aboveDoseChild 9–18 years 80 mg once daily (dose form notappropriate for initial dose titration)PRAVASTATIN SODIUMCautions see notes aboveHepatic impairment see notes aboveRenal impairment start with lower doses in moderateto severe impairmentPregnancy see notes aboveBreast-feeding see notes aboveSide-effects see notes above; less commonly abnormalurination (including dysuria, nocturia, and frequency);very rarely fulminant hepatic necrosisIndication and doseHyperlipidaemia including familial hypercholesterolaemia. By mouthChild 8–14 years 10 mg once daily at night,adjusted at intervals of at least 4 weeks to max.20 mg once daily at nightChild 14–18 years 10 mg once daily at night,adjusted at intervals of at least 4 weeks to max.40 mg once daily at nightPravastatin (Non-proprietary) ATablets, pravastatin sodium 10 mg, net price 28-tabpack = £1.72; 20 mg, 28-tab pack = £2.02; 40 mg, 28-tab pack = £2.78. Counselling, muscle effects, seenotes aboveLipostat c (Squibb) ATablets, all yellow, pravastatin sodium 10 mg, netprice 28-tab pack = £14.18; 20 mg, 28-tab pack =£26.01; 40 mg, 28-tab pack = £26.01. Counselling,muscle effects, see notes aboveROSUVASTATINCautions see notes above; children of Asian origin; uselower max. dose in children with risk factors formyopathy or rhabdomyolysis (including personal orfamily history of muscular disorders or toxicity)Hepatic impairment see notes aboveRenal impairment reduce dose if estimated glomerularfiltration rate less than 60 mL/minute/1.73 m 2 ;avoid if estimated glomerular filtration rate less than30 mL/minute/1.73 m 2Pregnancy see notes aboveBreast-feeding see notes aboveSide-effects see notes above; also diabetes mellitus,proteinuria; very rarely haematuria; also reportedoedemaIndication and doseHyperlipidaemia including familial hypercholesterolaemia. By mouthChild 10–18 years initially 5 mg daily, increased ifnecessary at intervals of at least 4 weeks to usualmax. 20 mg once dailyNote Reduced dose required with concomitant fibrate—seek specialist adviceCrestor c (AstraZeneca) ATablets, f/c, rosuvastatin (as calcium salt) 5 mg (yellow),net price 28-tab pack = £18.03; 10 mg (pink), 28-tab pack = £18.03; 20 mg (pink), 28-tab pack = £26.02.Counselling, muscle effects, see notes above2 Cardiovascular system