BNF for Children 2011-2012

BNFC 2011–2012 4.2.2 Antipsychotic depot injections 181Risperidone (Non-proprietary) TATablets, risperidone 500 micrograms, net price 20-tabpack = 97p; 1 mg, 20-tab pack = £1.18, 60-tab pack =£1.70; 2 mg, 60-tab pack = £2.13; 3 mg, 60-tab pack =£2.71; 4 mg, 60-tab pack = £31.52; 6 mg, 28-tab pack =£24.12. Label: 2Orodispersible tablets, risperidone 0.5 mg, net price28-tab pack = £16.88; 1 mg, 28-tab pack = £20.51;2 mg, 28-tab pack = £37.72; 3 mg, 28-tab pack =£14.39; 4 mg, 28-tab pack = £15.20. Label: 2, counselling,administrationCounselling Tablets should be placed on the tongue,allowed to dissolve and swallowedLiquid, risperidone 1 mg/mL, net price 100-mL pack= £57.40. Label: 2, counselling, use of dose syringeNote Liquid may be diluted with any non-alcoholic drink,except teaRisperdal c (Janssen) TATablets, f/c, scored, risperidone 500 micrograms(brown-red), net price 20-tab pack = £5.08; 1 mg(white), 20-tab pack = £8.36, 60-tab pack = £25.08;2 mg (orange), 60-tab pack = £49.46; 3 mg (yellow),60-tab pack = £72.73; 4 mg (green), 60-tab pack =£96.00; 6 mg (yellow), 28-tab pack = £67.88. Label: 2Orodispersible tablets (Quicklet c ), pink, risperidone500 micrograms, net price 28-tab pack = £8.23; 1 mg,28-tab pack = £17.32; 2 mg, 28-tab pack = £32.65;3 mg, 28-tab pack = £36.24; 4 mg, 28-tab pack =£46.68. Label: 2, counselling, administrationExcipients include aspartame (section 9.4.1)Counselling Tablets should be placed on the tongue,allowed to dissolve and swallowedLiquid, risperidone 1 mg/mL, net price 100-mL pack= £52.87. Label: 2, counselling, use of dose syringeNote Liquid may be diluted with any non-alcoholic drink,except tea4.2.2 Antipsychotic depotinjectionsThere is limited information on the use of antipsychoticdepot injections in children and use should be restrictedto specialist centres.4.2.3 Antimanic drugsAntimanic drugs are used in mania to control acuteattacks and to prevent recurrence of episodes of maniaor hypomania. Long-term treatment of bipolar disordershould continue for at least two years from the lastmanic episode and up to five years if the patient hasrisk factors for relapse.An antidepressant drug (section 4.3) may also berequired for the treatment of co-existing depression,but should be avoided in patients with rapid-cyclingbipolar disorder, recent history of hypomania, or rapidmood fluctuations.BenzodiazepinesUse of benzodiazepines (section 4.1) may be helpful inthe initial stages of treatment for behavioural disturbanceor agitation; they should not be used for longperiods because of the risk of dependence.Antipsychotic drugsAtypical antipsychotic drugs (normally olanzapine,quetiapine, or risperidone) (section 4.2.1) are usefulin acute episodes of mania and hypomania; if theresponse to antipsychotic drugs is inadequate, lithiumor valproate may be added. An antipsychotic drug maybe used concomitantly with lithium or valproate in theinitial treatment of severe acute mania.Atypical antipsychotics are the treatment of choice forthe long-term management of bipolar disorder in childrenand adolescents; if the patient has frequentrelapses or continuing functional impairment, considerconcomitant therapy with lithium or valproate. An atypicalantipsychotic that causes less weight gain anddoes not increase prolactin levels is preferred.When discontinuing antipsychotics, the dose should bereduced gradually over at least 4 weeks if the child iscontinuing on other antimanic drugs; if the child is notcontinuing on other antimanic drugs, or has a history ofmanic relapse, a withdrawal period of up to 3 months isrequired.High doses of haloperidol may be hazardous when usedwith lithium; irreversible toxic encephalopathy has beenreported.CarbamazepineCarbamazepine (section 4.8.1) may be used under specialistsupervision for the prophylaxis of bipolar disorder(manic-depressive disorder) in children unresponsive toa combination of other prophylactic drugs; it is used inthose with rapid-cycling manic-depressive illness (4 ormore affective episodes per year). The dose of carbamazepineshould not normally be increased if an acuteepisode of mania occurs. When stopping treatment withcarbamazepine, reduce the dose gradually over a periodof at least 4 weeks.ValproateValproic acid (as the semisodium salt) is licensed inadults for the treatment of manic episodes associatedwith bipolar disorder. Sodium valproate (section 4.8.1) isunlicensed for the treatment of bipolar disorder.Valproate can be used for the prophylaxis of bipolardisorder [unlicensed use]; however, it should not normallybe prescribed for women of child-bearing potential.In patients with frequent relapse or continuingfunctional impairment, consider switching therapy tolithium or an atypical antipsychotic, or adding lithium oran atypical antipsychotic to valproate. If a patient takingvalproate experiences an acute episode of mania that isnot ameliorated by increasing the valproate dose, considerconcomitant therapy with olanzapine, quetiapine,or risperidone. When stopping valproate reduce thedose gradually over at least 4 weeks.LithiumLithium salts are used in the prophylaxis and treatmentof mania, in the prophylaxis of bipolar disorder (manicdepressivedisorder), as concomitant therapy with antidepressantmedication in children who have had anincomplete response to treatment for acute depressionin bipolar disorder, and in the prophylaxis of recurrentdepression (unipolar illness or unipolar depression).4 Central nervous system