BNF for Children 2011-2012

BNFC 2011–2012 4.4 CNS stimulants and other drugs for ADHD 189should be sought in case of abdominal pain, unexplainednausea, malaise, darkening of the urine or jaundiceSuicidal ideation Following reports of suicidal thoughts andbehaviour, children and carers should be informed about therisk and told to report clinical worsening, suicidal thoughts orbehaviour, irritability, agitation, or depressionHepatic impairment halve dose in moderate impairment;quarter dose in severe impairment; see alsoHepatic Disorders abovePregnancy no information available; avoid unlesspotential benefit outweighs riskBreast-feeding avoid—present in milk in animalstudiesSide-effects anorexia, dry mouth, nausea, vomiting,abdominal pain, constipation, dyspepsia, flatulence;palpitation, tachycardia, increased blood pressure,postural hypotension, hot flushes; sleep disturbance,dizziness, headache, fatigue, lethargy, depression,psychotic or manic symptoms, aggression, hostility,emotional lability, drowsiness, anxiety, irritability,tremor, rigors; urinary retention, prostatitis, sexualdysfunction, menstrual disturbances; mydriasis, conjunctivitis;dermatitis, pruritus, rash, sweating; lesscommonly suicidal ideation (see Suicidal Ideation,above), cold extremities; very rarely hepatic disorders(see Hepatic Disorders, above), seizures, Raynaud’sphenomenon, and angle-closure glaucomaLicensed use doses above 100 mg daily not licensedIndication and doseAttention deficit hyperactivity disorder initiatedby specialist. By mouthChild over 6 years (body-weight under 70 kg)initially 500 micrograms/kg daily for 7 days,increased according to response; usual maintenancedose 1.2 mg/kg daily, but may be increasedto 1.8 mg/kg daily (max. 120 mg daily) under thedirection of a specialistChild over 6 years (body-weight over 70 kg)initially 40 mg daily for 7 days, increased accordingto response; usual maintenance dose 80 mg daily,but may be increased to max. 120 mg daily underthe direction of a specialistNote Total daily dose may be given either as a single dose inthe morning or in 2 divided doses with last dose no later thanearly eveningStrattera c (Lilly) TACapsules, atomoxetine (as hydrochloride) 10 mg(white), net price 7-cap pack = £15.62, 28-cap pack =£62.46; 18 mg (gold/white), 7-cap pack = £15.62, 28-cap pack = £62.46; 25 mg (blue/white), 7-cap pack =£15.62, 28-cap pack = £62.46; 40 mg (blue), 7-cappack = £15.62, 28-cap pack = £62.46; 60 mg (blue/gold), 28-cap pack = £62.46; 80 mg (brown/white),28-cap pack = £83.28. Label: 3DEXAMFETAMINE SULPHATE(Dexamphetamine sulphate)Cautions see notes above; also anorexia; mild hypertension(contra-indicated if moderate or severe);psychosis or bipolar disorder; monitor for aggressivebehaviour or hostility during initial treatment; historyof epilepsy (discontinue if convulsions occur); tics andTourette syndrome (use with caution)—discontinue iftics occur; susceptibility to angle-closure glaucoma;avoid abrupt withdrawal; data on safety and efficacyof long-term use not complete; acute porphyria (seesection 9.8.2); interactions: Appendix 1 (sympathomimetics)Growth restriction Monitor height and weight as growthrestriction may occur during prolonged therapy (drug-freeperiods may allow catch-up in growth but withdraw slowly toavoid inducing depression or renewed hyperactivity).Contra-indications cardiovascular disease includingmoderate to severe hypertension, structural cardiacabnormalities, hyperexcitability or agitated states,hyperthyroidism, history of drug or alcohol abuseSkilled tasks May affect performance of skilled tasks (e.g.driving); effects of alcohol unpredictableRenal impairment use with cautionPregnancy avoid (retrospective evidence of uncertainsignificance suggesting possible embryotoxicity)Breast-feeding significant amount in milk—avoidSide-effects nausea, diarrhoea, dry mouth, abdominalcramps, anorexia (increased appetite also reported),weight loss, taste disturbance, ischaemic colitis, palpitation,tachycardia, chest pain, hypertension, hypotension,cardiomyopathy, myocardial infarction, cardiovascularcollapse, cerebral vasculitis, stroke,headache, restlessness, depression, hyperreflexia,hyperactivity, impaired concentration, ataxia, anxiety,aggression, dizziness, confusion, sleep disturbances,dysphoria, euphoria, irritability, nervousness, malaise,obsessive-compulsive behaviour, paranoia, psychosis,panic attack, tremor, convulsions (see also Cautions),neuroleptic malignant syndrome, anhedonia, growthrestriction in children (see also Cautions and notesabove), hyperpyrexia, renal impairment, sexual dysfunction,acidosis, rhabdomyolysis, mydriasis, visualdisturbances, alopecia, rash, sweating, urticaria; centralstimulants have provoked choreoathetoid movementsand dyskinesia, tics and Tourette syndrome inpredisposed individuals (see also Cautions); veryrarely angle-closure glaucoma; overdosage: seeEmergency Treatment of Poisoning, p. 31Indication and doseRefractory attention deficit hyperactivity disorderinitiated by specialist. By mouthChild 6–18 years initially 2.5 mg 2–3 times daily,increased if necessary at weekly intervals by 5 mg;usual max. 1 mg/kg daily, up to 20 mg (40 mg dailyhas been required in some children); maintenancedose given in 2–4 divided dosesAdministration tablets can be halvedDexamfetamine (Non-proprietary) 2Tablets, scored, dexamfetamine sulphate 5 mg, netprice 28-tab pack = £15.60. Counselling, drivingMETHYLPHENIDATEHYDROCHLORIDECautions see notes above; also monitor for psychiatricdisorders; anxiety or agitation; tics or a family historyof Tourette syndrome; drug or alcohol dependence;epilepsy (discontinue if increased seizure frequency);avoid abrupt withdrawal; interactions: Appendix 1(sympathomimetics)Contra-indications severe depression, suicidal ideation;anorexia nervosa; psychosis; uncontrolled bipolardisorder; hyperthyroidism; cardiovascular disease(including heart failure, cardiomyopathy, severehypertension, and arrhythmias), structural cardiac4 Central nervous system