BNF for Children 2011-2012

200 4.7.1 Non-opioid analgesics BNFC 2011–20124 Central nervous systemCompound analgesic preparationsCompound analgesic preparations that contain a simpleanalgesic (such as aspirin or paracetamol) with anopioid component reduce the scope for effective titrationof the individual components in the management ofpain of varying intensity.Compound analgesic preparations containing paracetamolor aspirin with a low dose of an opioid analgesic(e.g. 8 mg of codeine phosphate per compound tablet)may be used in older children but the advantages havenot been substantiated. The low dose of the opioid maybe enough to cause opioid side-effects (in particular,constipation) and can complicate the treatment of overdosage(see p. 28) yet may not provide significantadditional relief of pain.A full dose of the opioid component (e.g. 60 mg codeinephosphate) in compound analgesic preparations effectivelyaugments the analgesic activity but is associatedwith the full range of opioid side-effects (includingnausea, vomiting, severe constipation, drowsiness, respiratorydepression, and risk of dependence on long-termadministration). For details of the side-effects of opioidanalgesics, see p. 203.PARACETAMOL(Acetaminophen)Cautions alcohol dependence; max. daily infusiondose 3 g in patients with hepatocellular insufficiency,chronic alcoholism, chronic malnutrition, or dehydration;high risk of liver toxicity with high doses;interactions: Appendix 1 (paracetamol)Hepatic impairment dose-related toxicity—avoidlarge doses; see also CautionsRenal impairment increase infusion dose interval toevery 6 hours if estimated glomerular filtration rateless than 30 mL/minute/1.73m 2Pregnancy not known to be harmfulBreast-feeding amount too small to be harmfulSide-effects side-effects rare, but rashes, blood disorders(including thrombocytopenia, leucopenia,neutropenia) reported; hypotension, flushing, andtachycardia also reported on infusion; important:liver damage (and less frequently renal damage) followingoverdosage, see Emergency Treatment ofPoisoning, p. 26Licensed use not licensed for use in children under 2months by mouth; not licensed for use in pretermneonates by intravenous infusion; doses for severesymptoms not licensed; co-codamol 8/500 tabletsnot licensed for use in children under 12 yearsIndication and dosePain; pyrexia with discomfort. By mouthNeonate 28–32 weeks postmenstrual age20 mg/kg as a single dose then 10–15 mg/kgevery 8–12 hours as necessary; max. 30 mg/kgdaily in divided dosesNeonate over 32 weeks postmenstrual age20 mg/kg as a single dose then 10–15 mg/kgevery 6–8 hours as necessary; max. 60 mg/kgdaily in divided dosesChild 1–3 months 30–60 mg every 8 hours asnecessaryChild 3–12 months 60–120 mg every 4–6 hours(max. 4 doses in 24 hours)Child 1–6 years 120–250 mg every 4–6 hours(max. 4 doses in 24 hours)Child 6–12 years 250–500 mg every 4–6 hours(max. 4 doses in 24 hours)Child 12–18 years 500 mg every 4–6 hours. By rectumNeonate 28–32 weeks postmenstrual age20 mg/kg as a single dose then 15 mg/kg every 12hours as necessary; max. 30 mg/kg daily individed dosesNeonate over 32 weeks postmenstrual age30 mg/kg as a single dose then 20 mg/kg every 8hours as necessary; max. 60 mg/kg daily individed dosesChild 1–3 months 30–60 mg every 8 hours asnecessaryChild 3–12 months 60–125 mg every 4–6 hoursas necessary (max. 4 doses in 24 hours)Child 1–5 years 125–250 mg every 4–6 hours asnecessary (max. 4 doses in 24 hours)Child 5–12 years 250–500 mg every 4–6 hours asnecessary (max. 4 doses in 24 hours)Child 12–18 years 500 mg every 4–6 hours. By intravenous infusion over 15 minutesPreterm neonate over 32 weeks postmenstrualage 7.5 mg/kg every 8 hours; max. 25 mg/kg dailyNeonate 10 mg/kg every 4–6 hours; max. 30 mg/kg dailyChild body-weight under 50 kg 15 mg/kg every4–6 hours; max. 60 mg/kg dailyChild body-weight over 50 kg 1 g every 4–6hours; max. 4 g dailySevere postoperative pain (but see Cautions). By mouthChild 1 month–6 years 20–30 mg/kg as a singledose then 15–20 mg/kg every 4–6 hours; max.90 mg/kg daily in divided dosesChild 6–12 years 20–30 mg/kg (max. 1 g) as asingle dose then 15–20 mg/kg every 4–6 hours;max. 90 mg/kg (max. 4 g) daily in divided dosesChild 12–18 years 1 g every 4–6 hours (max. 4doses in 24 hours). By rectumChild 1–3 months 30 mg/kg as a single dose then15–20 mg/kg every 4–6 hours; max. 90 mg/kgdaily in divided dosesChild 3 months–6 years 30–40 mg/kg as a singledose then 15–20 mg/kg every 4–6 hours; max.90 mg/kg daily in divided dosesChild 6–12 years 30–40 mg/kg (max. 1 g) as asingle dose then 15–20 mg/kg every 4–6 hours;max. 90 mg/kg (max. 4 g) daily in divided dosesChild 12–18 years 1 g every 4–6 hours (max. 4doses in 24 hours)