BNF for Children 2011-2012

198 4.6 Drugs used in nausea and vertigo BNFC 2011–20124 Central nervous systemOral lyophilisates (Zofran Melt c ), ondansetron 4 mg,net price 10-tab pack = £35.97; 8 mg, 10-tab pack =£71.94. Counselling, administrationExcipients include aspartame (section 9.4.1)Counselling Tablets should be placed on the tongue,allowed to disperse and swallowedOral solution, sugar-free, strawberry-flavoured,ondansetron (as hydrochloride) 4 mg/5 mL, net price50-mL pack = £35.97Injection, ondansetron (as hydrochloride) 2 mg/mL,net price 2-mL amp = £5.99; 4-mL amp = £11.99CannabinoidNABILONECautions history of psychiatric disorder; hypertension;heart disease; adverse effects on mental state canpersist for 48–72 hours after stopping; interactions:Appendix 1 (nabilone)Skilled tasks Drowsiness may affect performance of skilledtasks (e.g. driving); effects of alcohol enhancedHepatic impairment avoid in severe impairmentPregnancy avoid unless essentialBreast-feeding avoid—no information availableSide-effects drowsiness, vertigo, euphoria, drymouth, ataxia, visual disturbance, concentration difficulties,sleep disturbance, dysphoria, hypotension,headache and nausea; also confusion, disorientation,hallucinations, psychosis, depression, decreasedcoordination, tremors, tachycardia, decreased appetite,and abdominal painBehavioural effects Children and carers should be madeaware of possible changes of mood and other adversebehavioural effectsLicensed use not licensed for use in childrenIndication and doseNausea and vomiting caused by cytotoxicchemotherapy, unresponsive to conventionalantiemetics (under close observation, preferably inhospital setting). By mouthConsult local treatment protocol for detailsNabilone (Meda) 2Capsules, blue/white, nabilone 1 mg, net price 20-cap pack = £125.84. Label: 2, counselling,behavioural effectsHyoscineHYOSCINE HYDROBROMIDE(Scopolamine Hydrobromide)Cautions section 1.2; also epilepsySkilled tasks Drowsiness may affect performance of skilledtasks (e.g. driving) and may persist for up to 24 hours orlonger after removal of patch; effects of alcohol enhancedContra-indications section 1.2Hepatic impairment use with cautionRenal impairment use with cautionPregnancy use only if potential benefit outweighs risk;injection may depress neonatal respirationBreast-feeding amount too small to be harmfulSide-effects section 1.2Licensed use not licensed for use in excessiverespiratory secretions or hypersalivation associatedwith clozapine therapyIndication and doseMotion sickness. By mouthChild 4–10 years 75–150 micrograms 30 minutesbefore start of journey, repeated every 6 hours ifrequired; max. 3 doses in 24 hoursChild 10–18 years 150–300 micrograms 30 minutesbefore start of journey, repeated every 6 hoursif required; max. 3 doses in 24 hours. By topical applicationChild 10–18 years apply 1 patch (1 mg) to hairlessarea of skin behind ear 5–6 hours beforejourney; replace if necessary after 72 hours, sitingreplacement patch behind the other earExcessive respiratory secretions. By mouth or by sublingual administrationChild 2–12 years 10 micrograms/kg, max.300 micrograms 4 times dailyChild 12–18 years 300 micrograms 4 times daily. By transdermal routeChild 1 month–3 years 250 micrograms every 72hours (quarter of a patch)Child 3–10 years 500 micrograms every 72 hours(half a patch)Child 10–18 years 1 mg every 72 hours (onepatch). By subcutaneous injection, intravenous injection,intravenous infusion, or subcutaneousinfusionSee Prescribing in Palliative Care, p. 19 and p. 20Hypersalivation associated with clozapinetherapy. By mouthChild 12–18 years 300 micrograms up to 3 timesdaily; max. 900 micrograms dailyPremedication section 15.1.3Administration patch applied to hairless area of skinbehind ear; if less than whole patch required eithercut with scissors along full thickness ensuring membraneis not peeled away or cover portion to preventcontact with skinFor administration by mouth, injection solution maybe given orallyJoy-Rides c (GSK Consumer Healthcare)Tablets, chewable, hyoscine hydrobromide 150 micrograms,net price 12-tab pack = £1.49. Label: 2, 24Kwells c (Bayer Consumer Care)Tablets, chewable, hyoscine hydrobromide 150 micrograms(Kwells c Kids), net price 12-tab pack = £1.67;300 micrograms, 12-tab pack = £1.67. Label: 2