BNF for Children 2011-2012

180 4.2.1 Antipsychotic drugs BNFC 2011–20124 Central nervous systemSide-effects see notes above; also drowsiness, dyspepsia,constipation, dry mouth, hypertension, mildasthenia, rhinitis, tachycardia, irritability; leucopenia,neutropenia and occasionally eosinophilia reported;elevated plasma-triglyceride and cholesterol concentrations,hypothyroidism; possible QT interval prolongation;restless legs syndrome; rarely oedema;very rarely priapismLicensed use not licensed for use in childrenIndication and doseSchizophrenia (under specialist supervision). By mouthChild 12–18 years initially 25 mg twice dailyadjusted in steps of 25–50 mg according toresponse; max. 750 mg dailyTreatment of mania in bipolar disorder (underspecialist supervision). By mouthChild 12–18 years 25 mg twice daily on day 1,then 50 mg twice daily on day 2, then 100 mg twicedaily on day 3, then 150 mg twice daily on day 4,then 200 mg twice daily on day 5; thereafter doseadjusted according to response in steps no greaterthan 100 mg daily, usual dose 400–600 mg daily in2 divided dosesSeroquel c (AstraZeneca) TATablets, f/c, quetiapine (as fumarate) 25 mg (peach),net price 60-tab pack = £33.83; 100 mg (yellow), 60-tab pack = £113.10; 150 mg (pale yellow), 60-tab pack= £113.10; 200 mg (white), 60-tab pack = £113.10;300 mg (white), 60-tab pack = £170.00. Label: 2Modified releaseSeroquel c XL (AstraZeneca) TATablets, m/r, quetiapine (as fumarate) 50 mg (peach),net price 60-tab pack = £67.66; 150 mg (white), 60-tabpack = £113.10; 200 mg (yellow), 60-tab pack =£113.10; 300 mg (pale yellow), 60-tab pack = £170.00;400 mg (white), 60-tab pack = £226.20. Label: 2, 23,25DoseSchizophrenia (under specialist supervision). By mouthChild 12–18 years initially 50 mg once daily adjusted insteps of 50 mg daily according to response, usual dose400–800 mg once daily; max. 800 mg once dailyNote Patients can be switched from immediate-release tomodified-release tablets at the equivalent daily dose; tomaintain clinical response, dose titration may be requiredRISPERIDONECautions see notes above; hyperprolactinaemia, prolactin-dependenttumours; dehydration; family historyof sudden cardiac death (perform ECG); avoid in acuteporphyria (section 9.8.2)Hepatic impairment initial and subsequent oral dosesshould be halvedRenal impairment initial and subsequent oral dosesshould be halvedPregnancy use only if potential benefit outweighs risk;extrapyramidal effects reported in neonate whentaken in third trimesterBreast-feeding use only if potential benefit outweighsrisk—small amount present in milkSide-effects see notes above; also gastro-intestinaldisturbances (including diarrhoea, constipation,nausea and vomiting, dyspepsia, abdominal pain), drymouth; dyspnoea; drowsiness, asthenia, tremor, sleepdisturbances, agitation, anxiety, headache; urinaryincontinence; hyperprolactinaemia (less commonlygalactorrhoea, menstrual disturbances, gynaecomastia);arthralgia, myalgia; abnormal vision; epistaxis;rash; less commonly anorexia, ECG changes,hypoaesthesia, impaired concentration, sexual dysfunction,blood disorders, tinnitus, angioedema; rarelyintestinal obstruction, pancreatitis, jaundice, seizures,hyponatraemia, abnormal temperature regulation;oedema and priapism also reportedLicensed use not licensed for use in children forpsychosis, mania, or autismIndication and doseAcute and chronic psychosis (under specialistsupervision). By mouthChild 12–18 years 2 mg in 1–2 divided doses onfirst day then 4 mg in 1–2 divided doses on secondday (slower titration appropriate in some children);usual dose range 4–6 mg daily; doses above 10 mgdaily only if benefit considered to outweigh risk(max. 16 mg daily)Short-term monotherapy of mania in bipolardisorder (under specialist supervision). By mouthChild 12–18 years initially 500 micrograms oncedaily adjusted in steps of 0.5–1 mg daily accordingto response; usual dose 2.5 mg daily in 1–2 divideddoses, max. 6 mg dailyShort-term treatment (up to 6 weeks) of persistentaggression in conduct disorder (underspecialist supervision). By mouthChild 5–18 years and body-weight under 50 kginitially 250 micrograms once daily increasedaccording to response in steps of 250 microgramson alternate days; usual dose 500 micrograms daily(up to 750 micrograms once daily has beenrequired)Child 5–18 years and body-weight over 50 kginitially 500 micrograms once daily increasedaccording to response in steps of 500 microgramson alternate days; usual dose 1 mg daily (up to1.5 mg once daily has been required)Short-term treatment of severe aggression inautism (under specialist supervision). By mouthChild over 5 years and 15–20 kg 250 microgramsdaily increased if necessary after at least 4days to 500 micrograms daily; thereafter increasedby 250 micrograms daily at 2-week intervals tomax. 1 mg dailyChild over 5 years and over 20 kg 500 microgramsdaily increased if necessary after at least 4days to 1 mg daily; thereafter increased by500 micrograms daily at 2-week intervals; max.daily dose 2.5 mg if under 45 kg; max. daily dose3 mg if over 45 kg