BNF for Children 2011-2012

BNFC 2011–2012 4.2.1 Antipsychotic drugs 179bocythaemia, hypertriglyceridaemia, hypercholesterolaemia,hyperlipidaemia, fulminant hepaticnecrosis, angle-closure glaucoma, and skin reactionsLicensed use not licensed for use in children under16 yearsIndication and doseSchizophrenia in children unresponsive to, orintolerant of, conventional antipsychotic drugs(under specialist supervision). By mouthChild 12–18 years 12.5 mg once or twice on firstday then 25–50 mg on second day then increasedgradually (if well tolerated) in steps of 25–50 mgdaily over 14–21 days up to 300 mg daily in divideddoses (larger dose at night, up to 200 mg daily maybe taken as a single dose at bedtime); if necessarymay be further increased in steps of 50–100 mgonce (preferably) or twice weekly; usual dose 200–450 mg daily (max. 900 mg daily)Note Restarting after interval of more than 2 days,12.5 mg once or twice on first day (but may be feasible toincrease more quickly than on initiation)—extreme cautionif previous respiratory or cardiac arrest with initialdosingClozaril c (Novartis) ATablets, yellow, clozapine 25 mg (scored), net price28-tab pack = £5.40, 84-tab pack (hosp. only) =£16.18, 100-tab pack (hosp. only) = £19.26; 100 mg,28-tab pack = £21.56, 84-tab pack (hosp. only) =£64.68, 100-tab pack (hosp. only) = £77.00. Label: 2,10, patient information leafletNote Child, prescriber, and supplying pharmacist must beregistered with the Clozaril Patient Monitoring Service—takes several days to do thisDenzapine c (Merz) ATablets, yellow, scored, clozapine 25 mg, net price 84-tab pack = £16.64, 100-tab pack = £19.80; 50 mg, 50-tab pack = £19.80; 100 mg, 84-tab pack = £66.53, 100-tab pack = £79.20; 200 mg, 50-tab pack = £79.20.Label: 2, 10, patient information leafletSuspension, clozapine 50 mg/mL, net price 100 mL= £39.60. Label: 2, 10, patient information leaflet,counselling, administrationCounselling Shake well for 90 seconds when dispensing or ifvisibly settled; otherwise shake well for 10 seconds beforeuseNote May be diluted in waterNote Child, prescriber, and supplying pharmacist must beregistered with the Denzapine Patient Monitoring Service—takes several days to do thisZaponex c (TEVA UK) ATablets, yellow, scored, clozapine 25 mg, net price 84-tab pack = £8.28; 100 mg, 84-tab pack = £33.88.Label: 2, 10, patient information leafletNote Child, prescriber, and supplying pharmacist must beregistered with the Zaponex Treatment Access System—takes several days to do thisHepatic impairment initial dose 5 mg daily, increasedslowlyRenal impairment initial dose 5 mg daily, increasedslowlyPregnancy use only if potential benefit outweighs risk;neonatal lethargy, tremor and hypertonia reportedwhen used in third trimesterBreast-feeding avoid—present in milkSide-effects see notes above; also mild, transientantimuscarinic effects; drowsiness, speech difficulty,abnormal gait, hallucinations, akathisia, asthenia,increased appetite, increased body temperature,raised triglyceride concentration, oedema, hyperprolactinaemia(but clinical manifestations uncommon);eosinophilia; less commonly hypotension, bradycardia,QT interval prolongation, urinary incontinence,and photosensitivity; rarely seizures, leucopenia,and rash; very rarely hepatitis, pancreatitis,hypercholesterolaemia, hypothermia, urinary retention,priapism, thrombocytopenia, neutropenia, rhabdomyolysis,and angle-closure glaucoma; with injection,sinus pause and hypoventilationLicensed use not licensed for use in childrenIndication and doseSchizophrenia, combination therapy for mania(under specialist supervision). By mouthChild 12–18 years initially 5–10 mg dailyadjusted to usual range of 5–20 mg daily; dosesgreater than 10 mg daily only after reassessment;max. 20 mg dailyMonotherapy for mania (under specialist supervision). By mouthChild 12–18 years 15 mg daily adjusted to usualrange of 5–20 mg daily; doses greater than 15 mgonly after reassessment; max. 20 mg dailyNote When one or more factors present that might result inslower metabolism (e.g. female gender, non-smoker) considerlower initial dose and more gradual dose increaseZyprexa c (Lilly) ATablets, f/c, olanzapine 2.5 mg, net price 28-tab pack= £21.85; 5 mg, 28-tab pack = £43.70; 7.5 mg, 56-tabpack = £131.10; 10 mg, 28-tab pack = £87.40, 15 mg(blue), 28-tab pack = £119.18; 20 mg (pink), 28-tabpack = £158.90. Label: 2Orodispersible tablet (Velotab c ), yellow, olanzapine5 mg, net price 28-tab pack = £48.07; 10 mg, 28-tabpack = £87.40; 15 mg, 28-tab pack = £131.10; 20 mg,28-tab pack = £174.79. Label: 2, counselling, administrationExcipients include aspartame (section 9.4.1)Counselling Velotab c may be placed on the tongue andallowed to dissolve, or dispersed in water, orange juice, applejuice, milk, or coffee4 Central nervous systemOLANZAPINECautions see notes above; also susceptibility to angleclosureglaucoma, paralytic ileus, diabetes mellitus(risk of exacerbation or ketoacidosis), low leucocyteor neutrophil count, bone-marrow depression, hypereosinophilicdisorders, myeloproliferative disease;dose adjustment may be necessary if smoking startedor stopped during treatmentQUETIAPINECautions see notes above; cerebrovascular disease;children at risk of aspiration pneumoniaHepatic impairment for immediate-release tablets,initially 25 mg daily, increased daily in steps of 25–50 mgPregnancy use only if potential benefit outweighs riskBreast-feeding avoid—no information available