BNF for Children 2011-2012

170 4.1.1 Hypnotics BNFC 2011–2012Dental procedures Some anxious children may benefitfrom the use of a hypnotic the night before the dentalappointment. Hypnotics do not relieve pain, and if paininterferes with sleep an appropriate analgesic should begiven.Chloral Hydrate (Non-proprietary) ASuppositories, chloral hydrate 25 mg, 50 mg, 60 mg,100 mg, 200 mg, 500 mg. Available from ‘specialorder’manufacturers or specialist importing companies,see p. 8094 Central nervous systemChloral and derivativesChloral hydrate and derivatives were formerly popularhypnotics for children.Chloral hydrate is now mainly used for sedation duringdiagnostic procedures (section 15.1.4). It accumulateson prolonged use.CHLORAL HYDRATECautions reduce dose in debilitated; avoid prolongeduse (and abrupt withdrawal thereafter); avoid contactwith skin and mucous membranes; interactions:Appendix 1 (anxiolytics and hypnotics)Skilled tasks Drowsiness may persist the next day andaffect performance of skilled tasks (e.g. driving); effects ofalcohol enhancedContra-indications severe cardiac disease; gastritis;acute porphyria (section 9.8.2)Hepatic impairment can precipitate coma; reducedose in mild to moderate hepatic impairment; avoid insevere impairmentRenal impairment avoid in severe impairmentPregnancy avoidBreast-feeding risk of sedation in infant—avoidSide-effects gastric irritation (nausea and vomitingreported), abdominal distention, flatulence, headache,tolerance, dependence, excitement, delirium (especiallyon abrupt withdrawal), ketonuria, and rashLicensed use not licensed for sedation for painlessproceduresIndication and doseSedation for painless procedures. By mouth or by rectum (if oral route not available)Neonate 30–50 mg/kg 45–60 minutes beforeprocedure; doses up to 100 mg/kg may be usedwith respiratory monitoringChild 1 month–12 years 30–50 mg/kg (max. 1 g)45–60 minutes before procedure; higher doses upto 100 mg/kg (max. 2 g) may be usedChild 12–18 years 1–2 g 45–60 minutes beforeprocedureAdministration for administration by mouth diluteliquid with plenty of water or juice to mask unpleasanttaste.Chloral Mixture, BP 2000 A(Chloral Oral Solution)Mixture, chloral hydrate 500 mg/5 mL in a suitablevehicle. Available from ‘special-order’ manufacturersor specialist importing companies, see p. 809Chloral Elixir, Paediatric, BP 2000 A(Chloral Oral Solution, Paediatric)Elixir, chloral hydrate 200 mg/5 mL (4%) in a suitablevehicle with a black currant flavour. Available from‘special-order’ manufacturers or specialist importingcompanies, see p. 809Cloral betaineWelldorm c (Alphashow) ATablets, blue-purple, f/c, cloral betaine 707 mg(: chloral hydrate 414 mg), net price 30-tab pack =£12.10. Label: 19, 27DoseShort-term treatment of insomnia. By mouthChild 12–18 years 1–2 tablets with water or milk atbedtime, max. 5 tablets (chloral hydrate 2 g) dailyElixir, red, chloral hydrate 143.3 mg/5 mL, net price150-mL pack = £8.70. Label: 19, 27DoseShort-term treatment of insomnia. By mouthChild 2–12 years 1–1.75 mL/kg (chloral hydrate 30–50 mg/kg) with water or milk at bedtime; max. 35 mL(chloral hydrate 1 g) dailyChild 12–18 years 15–45 mL (chloral hydrate 0.4–1.3 g)with water or milk at bedtime; max. 70 mL (chloralhydrate 2 g) dailyAntihistaminesSome antihistamines (section 3.4.1) such as promethazineare used for occasional insomnia in adults; theirprolonged duration of action can often cause drowsinessthe following day. The sedative effect of antihistaminesmay diminish after a few days of continuedtreatment; antihistamines are associated with headache,psychomotor impairment and antimuscarinic effects.The use of antihistamines as hypnotics in children is notusually justified.PROMETHAZINE HYDROCHLORIDEUCautions see notes in section 3.4.1; also avoid extravasationwith intravenous injectionContra-indications see Promethazine Hydrochloride,section 3.4.1Hepatic impairment see notes in section 3.4.1Renal impairment see Promethazine Hydrochloride,section 3.4.1Pregnancy see notes in section 3.4.1Breast-feeding see notes in section 3.4.1Side-effects see Promethazine Hydrochloride, section3.4.1Licensed use not licensed for use in children under 2yearsIndication and doseSedation (short-term use). By mouthChild 2–5 years 15–20 mgChild 5–10 years 20–25 mgChild 10–18 years 25–50 mg