BNF for Children 2011-2012

174 4.2.1 Antipsychotic drugs BNFC 2011–20124 Central nervous systemPrescribing of more than one antipsychotic drug at thesame time is not recommended; it may constitute ahazard and there is no significant evidence that sideeffectsare minimised.Chlorpromazine is associated with a wide range ofadverse effects, including marked sedation.Pimozide is less sedating than chlorpromazine.Although pimozide is licensed for use in children, it isnot used because of the risk of serious cardiac sideeffects(see ECG Monitoring, p. 176).Sulpiride in high doses controls florid positive symptoms,but in lower doses it has an alerting effect onpatients with apathetic withdrawn schizophrenia.Haloperidol and trifluoperazine are also licensed foruse in children but their use is limited by the highincidence of extrapyramidal symptoms. Haloperidolmay be preferred for the rapid control of hyperactivepsychotic states; it causes less hypotension than chlorpromazine.Other uses Nausea and vomiting (section 4.6), choreas,motor tics, and intractable hiccup.Equivalent doses of oral antipsychotic drugsThese equivalences are intended only as an approximateguide; individual dosage instructions should alsobe checked; children should be carefully monitoredafter any change in medicationAntipsychotic drugChlorpromazineClozapineHaloperidolPimozideRisperidoneSulpirideTrifluoperazineDaily dose100 mg50 mg2–3 mg2 mg0.5–1 mg200 mg5 mgImportant These equivalences must not be extrapolatedbeyond the max. dose for the drug. Higher doses requirecareful titration in specialist units and the equivalencesshown here may not be appropriateDosageAfter an initial period of stabilisation, the total dailyoral dose of antipsychotic drugs can be given as asingle dose in most children. For advice on dosesabove the BNF for Children upper limit, see p. 171.CHLORPROMAZINEHYDROCHLORIDEWarning Owing to the risk of contact sensitisation, pharmacists,nurses, and other health workers should avoid directcontact with chlorpromazine; tablets should not be crushedand solutions should be handled with careCautions see notes above; also diabetes; childrenshould remain supine, with blood pressure monitoringfor 30 minutes after intramuscular injection; doseadjustment may be necessary if smoking started orstopped during treatmentContra-indications see notes above; hypothyroidismHepatic impairment see notes aboveRenal impairment see notes abovePregnancy see notes aboveBreast-feeding see notes aboveSide-effects see notes above; also hyperglycaemiaIndication and doseChildhood schizophrenia and other psychoses(under specialist supervision). By mouthChild 1–6 years 500 micrograms/kg every 4–6hours adjusted according to response (max. 40 mgdaily)Child 6–12 years 10 mg 3 times daily, adjustedaccording to response (max. 75 mg daily)Child 12–18 years 25 mg 3 times daily (or 75 mgat night), adjusted according to response, to usualmaintenance dose of 75–300 mg daily (but up to1 g daily may be required)Relief of acute symptoms of psychoses (underspecialist supervision) but see also Cautions andSide-effects. By deep intramuscular injectionChild 1–6 years 500 micrograms/kg every 6–8hours (max. 40 mg daily)Child 6–12 years 500 micrograms/kg every 6–8hours (max. 75 mg daily)Child 12–18 years 25–50 mg every 6–8 hoursChlorpromazine (Non-proprietary) ATablets, coated, chlorpromazine hydrochloride25 mg, net price 28-tab pack = £1.77; 50 mg, 28-tabpack = £2.37; 100 mg, 28-tab pack = £2.31. Label: 2,11Brands include Chloractil cOral solution, chlorpromazine hydrochloride 25 mg/5 mL, net price 150 mL = £1.79; 100 mg/5 mL,150 mL = £4.28. Label: 2, 11Injection, chlorpromazine hydrochloride 25 mg/mL,net price 1-mL amp = 60p, 2-mL amp = 63pLargactil c (Sanofi-Aventis) AInjection, chlorpromazine hydrochloride 25 mg/mL,net price 2-mL amp = 60pHALOPERIDOLCautions see notes above; also subarachnoidhaemorrhage and metabolic disturbances such ashypokalaemia, hypocalcaemia, or hypomagnesaemia;dose adjustment may be necessary if smoking startedor stopped during treatmentContra-indications see notes above; QT-intervalprolongation (avoid concomitant administration ofdrugs that prolong QT interval); bradycardiaHepatic impairment see notes aboveRenal impairment see notes abovePregnancy see notes aboveBreast-feeding see notes aboveSide-effects see notes above, but less sedating andfewer antimuscarinic or hypotensive symptoms; pigmentationand photosensitivity reactions rare;depression; weight loss; less commonly dyspnoea,oedema; rarely bronchospasm, hypoglycaemia, andinappropriate antidiuretic hormone secretion; Stevens-Johnsonsyndrome and toxic epidermal necrolysisalso reportedLicensed use not licensed for use in children fornausea and vomiting in palliative care