BNF for Children 2011-2012

166 3.8 Aromatic inhalations BNFC 2011–20123 Respiratory systemChild 12–18 years initially 2.25 g daily in divideddoses, then 1.5 g daily in divided doses as conditionimprovesCarbocisteine (Sanofi-Aventis) ACapsules, carbocisteine 375 mg, net price 120-cappack = £16.03Brands include Mucodyne cOral liquid, carbocisteine 125 mg/5 mL, net price300 mL = £4.39; 250 mg/5 mL, 300 mL = £5.61Brands include Mucodyne c Paediatric 125 mg/5 mL (cherry- andraspberry-flavoured) and Mucodyne c 250 mg/5 mL (cinnamonandrum-flavoured)DORNASE ALFAPhosphorylated glycosylated recombinanthuman deoxyribonuclease 1 (rhDNase)Pregnancy no evidence of teratogenicity; manufactureradvises use only if potential benefit outweighsriskBreast-feeding amount probably too small to beharmful—manufacturer advises cautionSide-effects pharyngitis, voice changes, chest pain;occasionally laryngitis, rashes, urticaria, conjunctivitisIndication and doseManagement of cystic fibrosis patients with aforced vital capacity (FVC) of greater than 40%of predicted to improve pulmonary function. By inhalation of nebulised solution (by jetnebuliser)Child 5–18 years 2500 units (2.5 mg) once dailyPulmozyme c (Roche) ANebuliser solution, dornase alfa 1000 units (1 mg)/mL. Net price 2.5-mL (2500 units) vial = £16.55Note For use undiluted with jet nebulisers only; ultrasonicnebulisers are unsuitableMECYSTEINE HYDROCHLORIDE(Methyl Cysteine Hydrochloride)Cautions history of peptic ulcerationPregnancy manufacturer advises avoidBreast-feeding manufacturer advises avoidIndication and doseReduction of sputum viscosity. By mouthChild 5–12 years 100 mg 3 times dailyChild 12–18 years 200 mg 4 times daily for 2days, then 200 mg 3 times daily for 6 weeks, then200 mg twice dailyVisclair c (Ranbaxy)Tablets, yellow, s/c, e/c, mecysteine hydrochloride100 mg, net price 100= £17.65. Label: 5, 22, 25Hypertonic sodium chlorideNebulised hypertonic sodium chloride solution (3–7 %)is used to mobilise lower respiratory tract secretions inmucous consolidation (e.g. cystic fibrosis). Temporaryirritation, such as coughing, hoarseness, or reversiblebronchoconstriction may occur; an inhaled bronchodilatorcan be used before treatment with hypertonicsodium chloride to reduce the risk of these adverseeffects.MucoClear c 3% (Pari)Nebuliser solution, sodium chloride 3%, net price 20 4 mL = £12.98; 60 4 mL = £27.00Dose. By inhalation of nebulised solutionChild 4 mL 2–4 times dailyMucoClear c 6% (Pari)Nebuliser solution, sodium chloride 6%, net price 20 4 mL = £12.98; 60 4 mL = £27.00Dose. By inhalation of nebulised solutionChild 4 mL twice dailyNebusal c 7% (Forest)Nebuliser solution, sodium chloride 7%, net price 60 4 mL = £27.00Dose. By inhalation of nebulised solutionChild 4 mL up to twice daily3.8 Aromatic inhalationsInhalations containing volatile substances such aseucalyptus oil are traditionally used to relieve congestionand ease breathing. Although the vapour maycontain little of the additive, it encourages deliberateinspiration of warm moist air which is often comforting.Boiling water should not be used for inhalations owingto the risk of scalding.Strong aromatic decongestants (applied as rubs or topillows) are not recommended for infants under the ageof 3 months. Sodium chloride 0.9% solution given asnasal drops can be used to liquefy mucous secretionsand relieve nasal congestion in infants and young children.Benzoin Tincture, Compound, BP(Friars’ Balsam)Tincture, balsamic acids approx. 4.5%. Label: 15DoseNasal congestion. By inhalationAdd one teaspoonful to a pint of hot, not boiling, waterand inhale the vapourMenthol and Eucalyptus Inhalation, BP 1980Inhalation, racementhol or levomenthol 2 g,eucalyptus oil 10 mL, light magnesium carbonate 7 g,water to 100 mLDoseNasal congestion. By inhalationAdd one teaspoonful to a pint of hot, not boiling, waterand inhale the vapourDental prescribing on the NHS May be prescribed asMenthol and Eucalyptus Inhalation BP, 1980