BNF for Children 2011-2012

196 4.6 Drugs used in nausea and vertigo BNFC 2011–20124 Central nervous systemHepatic impairment avoidRenal impairment reduce dose in renal impairmentPregnancy use only if potential benefit outweighs riskBreast-feeding amount too small to be harmfulSide-effects rarely gastro-intestinal disturbances(including cramps), and hyperprolactinaemia; veryrarely ventricular arrhythmias, agitation, drowsiness,nervousness, seizures, extrapyramidal effects, headache,and rashes; also reported QT-interval prolongationIndication and doseNausea and vomiting. By mouthChild over 1 month and body-weight up to35 kg 250–500 micrograms/kg 3–4 times daily;max. 2.4 mg/kg in 24 hoursBody-weight 35 kg and over 10–20 mg 3–4 timesdaily, max. 80 mg daily. By rectumBody-weight 15–35 kg 30 mg twice dailyBody-weight over 35 kg 60 mg twice dailyGastro-intestinal stasis section 1.21Domperidone (Non-proprietary) ATablets, 10 mg (as maleate), net price 30-tab pack =£1.12; 100-tab pack = £1.90Suspension, domperidone 5 mg/5 mL, net price 200-mL pack = £12.001. Domperidone can be sold to the public for children over 16years (provided packs do not contain more than 200 mg) forthe relief of postprandial symptoms of excessive fullness,nausea, epigastric bloating and belching occasionallyaccompanied by epigastric discomfort and heartburn, andfor the relief of nausea and vomiting of less than 48 hours’duration (max. single dose 10 mg, max. daily dose 40 mg)Motilium c (Sanofi-Aventis) ATablets, f/c, domperidone 10 mg (as maleate), netprice 30-tab pack = £2.71; 100-tab pack = £9.04Suppositories, domperidone 30 mg, net price 10 =£3.06METOCLOPRAMIDEHYDROCHLORIDECautions atopic allergy (including asthma); cardiacconduction disturbances (and concomitant use ofother drugs affecting cardiac conduction); may maskunderlying disorders such as cerebral irritation; epilepsy;acute porphyria (section 9.8.2); interactions:Appendix 1 (metoclopramide)Contra-indications gastro-intestinal obstruction, perforationor haemorrhage; 3–4 days after gastro-intestinalsurgery; phaeochromocytomaHepatic impairment reduce doseRenal impairment avoid or use small dose in severeimpairment; increased risk of extrapyramidal reactionsPregnancy not known to be harmfulBreast-feeding small amount present in milk; avoidSide-effects extrapyramidal effects (see p. 192),hyperprolactinaemia, occasionally tardive dyskinesiaon prolonged administration; also reported, dyspnoea,anxiety, confusion, drowsiness, dizziness, tremor,restlessness, diarrhoea, depression, neurolepticmalignant syndrome, visual disturbances, rashes,pruritus, oedema; cardiac conduction abnormalitiesreported following intravenous administration; rarelymethaemoglobinaemia (more severe in G6PD deficiency)Licensed use not licensed for use in neonates as aprokineticIndication and doseSevere intractable vomiting of known cause,vomiting associated with radiotherapy andcytotoxics, aid to gastro-intestinal intubation,as a prokinetic in neonates. By mouth, or by intramuscular injection or byintravenous injection over 1–2 minutesNeonate 100 micrograms/kg every 6–8 hours (bymouth or by intravenous injection only)Child 1 month–1 year and body-weight up to10 kg 100 micrograms/kg (max. 1 mg) twice dailyChild 1–3 years and body-weight 10–14 kg1 mg 2–3 times dailyChild 3–5 years and body-weight 15–19 kg2 mg 2–3 times dailyChild 5–9 years and body-weight 20–29 kg2.5 mg 3 times dailyChild 9–18 years and body-weight 30–60 kg5 mg 3 times dailyChild 15–18 years and body-weight over 60 kg10 mg 3 times dailyNote Daily dose of metoclopramide should not normallyexceed 500 micrograms/kgPremedication in diagnostic procedures. By mouth as a single dose 5–10 minutes beforeexaminationChild 1 month–3 years and body-weight up to14 kg 100 micrograms/kg, max. 1 mgChild 3–5 years and body-weight 15–19 kg2 mgChild 5–9 years and body-weight 20–29 kg2.5 mgChild 9–15 years and body-weight 30–60 kg5 mgChild 15–18 years and body-weight over 60 kg10 mgMetoclopramide (Non-proprietary) ATablets, metoclopramide hydrochloride 10 mg, netprice 28-tab pack = £1.01Oral solution, metoclopramide hydrochloride 5 mg/5 mL, net price 150-mL pack = £6.51. Counselling, useof pipetteNote Sugar-free versions are available and can be ordered byspecifying ‘sugar-free’ on the prescriptionInjection, metoclopramide hydrochloride 5 mg/mL,net price 2-mL amp = 26pMaxolon c (Amdipharm) ATablets, scored, metoclopramide hydrochloride10 mg, net price 84-tab pack = £5.24Injection, metoclopramide hydrochloride 5 mg/mL,net price 2-mL amp = 27pCompound preparations (for migraine)Section 4.7.1