BNF for Children 2011-2012

BNFC 2011–2012 4.1.2 Anxiolytics 171Sedation in intensive care. By mouth or by slow intravenous injection or bydeep intramuscular injectionChild 1 month–12 years 0.5–1 mg/kg (max.25 mg) 4 times daily, adjusted according toresponseChild 12–18 years 25–50 mg 4 times daily,adjusted according to responseAllergy and urticaria section 3.4.1Nausea and vomiting section 4.61Promethazine (Non-proprietary) AInjection, promethazine hydrochloride 25 mg/mL,net price 1-mL amp = 68p, 2-mL amp = £1.201. A restriction does not apply where administration is forsaving life in emergency1Phenergan c (Sanofi-Aventis) AInjection, promethazine hydrochloride 25 mg/mL,net price 1-mL amp = 67p1. A restriction does not apply where administration is forsaving life in emergencyOral preparationsSection 3.4.1MelatoninMelatonin is a pineal hormone that may affect sleeppattern. Clinical experience suggests that when appropriatebehavioural sleep interventions fail, melatoninmay be of value for treating sleep onset insomnia anddelayed sleep phase syndrome in children with conditionssuch as visual impairment, cerebral palsy, attentiondeficit hyperactivity disorder, autism, and learningdifficulties. It is also sometimes used before magneticresonance imaging (MRI), computed tomography (CT),or EEG investigations. Little is known about its longtermeffects in children, and there is uncertainty as tothe effect on other circadian rhythms including endocrineor reproductive hormone secretion. Treatmentwith melatonin should be initiated and supervised by aspecialist, but may be continued by general practitionersunder a shared-care arrangement. The need to continuemelatonin therapy should be reviewed every 6 months.Melatonin is available as a modified-release tablet (Circadinc ) and also as unlicensed formulations. Circadin cis licensed for the short-term treatment of primaryinsomnia in adults over 55 years. Unlicensed immediate-releasepreparations may be more suitable forchildren; the manufacturer should be specified in theshared-care guideline because of variability in clinicaleffect of unlicensed formulations.MELATONINCautions autoimmune disease (manufacturer advisesavoid—no information available); interactions:Appendix 1 (melatonin)Hepatic impairment clearance reduced—manufactureradvises avoidRenal impairment no information available—cautionPregnancy no information available—avoidBreast-feeding present in milk—avoidSide-effects less commonly abdominal pain, dyspepsia,dry mouth, mouth ulceration, weight gain,hypertension, chest pain, malaise, dizziness, restlessness,nervousness, irritability, anxiety, migraine, proteinuria,glycosuria, pruritus, rash, dry skin; rarelythirst, flatulence, halitosis, hypersalivation, vomiting,gastritis, hypertriglyceridaemia, palpitation, syncope,hot flushes, aggression, impaired memory, restlesslegs syndrome, paraesthesia, mood changes, priapism,increased libido, prostatitis, polyuria, haematuria,leucopenia, thrombocytopenia, electrolyte disturbances,muscle spasm, arthritis, lacrimation, visualdisturbances, nail disorderLicensed use not licensed for use in childrenIndication and doseSleep onset insomnia and delayed sleep phasesyndrome (see notes above). By mouthChild 1 month–18 years initially 2–3 mg dailybefore bedtime increased if necessary after 1–2weeks to 4–6 mg daily before bedtime; max. 10 mgdailyCircadin c (Lundbeck) TATablets, m/r, melatonin 2 mg, net price 21-tab pack =£10.77. Label: 2, 21, 25Note Other formulations of melatonin are available from‘special-order’ manufacturers or specialist importing companies,see p. 8094.1.2 AnxiolyticsAnxiolytic treatment should be used in children only torelieve acute anxiety (and related insomnia) caused byfear (e.g. before surgery, section 15.1.4.1).Anxiolytic treatment should be limited to the lowestpossible dose for the shortest possible time (see p. 169).BuspironeBuspirone is thought to act at specific serotonin(5HT 1A ) receptors; safety and efficacy in children haveyet to be determined.4.1.3 BarbituratesClassification not used in BNF for Children.4.2 Drugs used in psychosesand related disorders4.2.1 Antipsychotic drugs4.2.2 Antipsychotic depot injections4.2.3 Antimanic drugsAdvice on doses of antipsychotic drugs above BNFfor Children upper limit1. Consider alternative approaches including adjuvanttherapy.4 Central nervous system