BNF for Children 2011-2012

BNFC 2011–2012 4.6 Drugs used in nausea and vertigo 1975HT 3 -receptor antagonistsGRANISETRONCautions QT-interval prolongation (avoid concomitantuse of drugs that prolong QT interval)Pregnancy use only when compelling reasons—noinformation availableBreast-feeding avoid—no information availableSide-effects constipation, nausea, diarrhoea, vomiting,abdominal pain; headache, drowsiness, asthenia;fever; rarely hepatic dysfunction, chest pain,arrhythmia; very rarely anorexia, dizziness, insomnia,agitation, movement disorders, and rashLicensed use sterile solution not licensed for use inchildren under 2 yearsIndication and doseTreatment and prevention of nausea and vomitinginduced by cytotoxic chemotherapy orradiotherapy. By mouthChild 12–18 years 1–2 mg within 1 hour beforestart of treatment, then 1 mg twice daily duringtreatment (total daily dose may alternatively begiven as a single dose); when intravenous infusionalso used, max. combined total 9 mg in 24 hours. By intravenous infusionChild 1 month–12 years prevention, 40 micrograms/kg(max. 3 mg) before start of cytotoxictherapy; treatment, 40 micrograms/kg (max. 3 mg)repeated within 24 hours if necessary (not lessthan 10 minutes after initial dose). By intravenous injection or by intravenousinfusionChild 12–18 years prevention, 3 mg before startof cytotoxic therapy (up to 2 additional 3-mg dosesmay be given within 24 hours); treatment, 3 mgrepeated if necessary (doses must not be given lessthan 10 minutes apart), max. 9 mg in 24 hoursAdministration for intravenous infusion, dilute up to3 mL in Glucose 5% or Sodium Chloride 0.9% to atotal volume of 10–30 mL; give over 5 minutesGranisetron (Non-proprietary) ATablets, granisetron (as hydrochloride) 1 mg, net price10-tab pack = £51.20Injection, granisetron (as hydrochloride) 1 mg/mL,for dilution before use, net price 1-mL amp = £1.20, 3-mL amp = £4.80Kytril c (Roche) ATablets, f/c, granisetron (as hydrochloride) 1 mg, netprice 10-tab pack = £52.39; 2 mg, 5-tab pack = £52.39Injection, granisetron (as hydrochloride) 1 mg/mL,for dilution before use, net price 1-mL amp = £6.88, 3-mL amp = £20.63ONDANSETRONCautions QT-interval prolongation (avoid concomitantuse of drugs that prolong QT interval); subacuteintestinal obstruction; adenotonsillar surgeryHepatic impairment reduce dose in moderate orsevere impairmentPregnancy no information available; avoid unlesspotential benefit outweighs riskBreast-feeding present in milk in animal studies—avoidSide-effects constipation; headache; flushing; injection-sitereactions; less commonly hiccups, hypotension,bradycardia, chest pain, arrhythmias, movementdisorders, seizures; on intravenousadministration, rarely dizziness, transient visual disturbances(very rarely transient blindness)Licensed use not licensed for radiotherapy-inducednausea and vomiting in childrenIndication and dosePrevention and treatment of chemotherapyandradiotherapy-induced nausea and vomiting. By intravenous infusion over at least 15 minutesChild 6 months–18 years either 5 mg/m 2immediately before chemotherapy (max. singledose 8 mg), then give by mouth, or 150 micrograms/kgimmediately before chemotherapy(max. single dose 8 mg) repeated every 4 hours for2 further doses, then give by mouth; max. totaldaily dose 32 mg. By mouth following intravenous administrationNote Oral dosing can start 12 hours after intravenousadministrationChild 6 months–18 yearsBody surface area less than 0.6 m 2 or bodyweight10 kg or less 2 mg every 12 hours for upto 5 days (max. total daily dose 32 mg)Body surface area 0.6 m 2 or greater or bodyweightover 10 kg 4 mg every 12 hours for up to 5days (max. total daily dose 32 mg)Treatment and prevention of postoperativenausea and vomiting. By slow intravenous injection over at least 30secondsChild 1 month–18 years 100 micrograms/kg(max. 4 mg), as a single dose before, during, orafter induction of anaesthesiaAdministration for intravenous infusion, dilute to aconcentration of 320–640 micrograms/mL with Glucose5% or Sodium Chloride 0.9%; give over at least15 minutesOndansetron (Non-proprietary) ATablets, ondansetron (as hydrochloride) 4 mg, netprice 30-tab pack = £66.85; 8 mg, 10-tab pack =£49.92Brands include Ondemet cOral solution, ondansetron (as hydrochloride) 4 mg/5 mL, net price 50-mL pack = £35.97Brands include Demorem cInjection, ondansetron (as hydrochloride) 2 mg/mL,net price 2-mL amp = £5.39, 4-mL amp = £10.79Brands include Ondemet cZofran c (GSK) ATablets, yellow, f/c, ondansetron (as hydrochloride)4 mg, net price 30-tab pack = £107.91; 8 mg, 10-tabpack = £71.944 Central nervous system