BNF for Children 2011-2012

BNFC 2011–2012 4.7.2 Opioid analgesics 205Codeine Phosphate (Non-proprietary)Tablets A, codeine phosphate 15 mg, net price 28-tab pack = £1.14; 30 mg, 28-tab pack = £1.22; 60 mg,28-tab pack = £1.84. Label: 2Syrup A, codeine phosphate 25 mg/5 mL, net price100 mL = 93p. Label: 2Injection 2, codeine phosphate 60 mg/mL, netprice 1-mL amp = £2.44With paracetamolSection 4.7.1DIAMORPHINE HYDROCHLORIDE(Heroin Hydrochloride)Cautions see notes above; also severe diarrhoea; toxicpsychosis, CNS depression; severe cor pulmonaleContra-indications see notes above; also delayedgastric emptying; phaeochromocytomaHepatic impairment see notes aboveRenal impairment see notes abovePregnancy see notes aboveBreast-feeding therapeutic doses unlikely to affectinfant; withdrawal symptoms in infants of dependentmothers; breast-feeding not best method of treatingdependence in offspringSide-effects see notes above; also anorexia, tastedisturbance; syncope; asthenia, raised intracranialpressure; myocardial infarction also reportedLicensed use intranasal route not licensedIndication and doseAcute or chronic pain. By mouthChild 1 month–12 years 100–200 micrograms/kg (max. 10 mg) every 4 hours, adjusted accordingto responseChild 12–18 years 5–10 mg every 4 hours,adjusted according to response. By intravenous administrationNeonate (ventilated) initially by intravenousinjection over 30 minutes, 50 micrograms/kg thenby continuous intravenous infusion, 15 micrograms/kg/hour,adjusted according to responseNeonate (non-ventilated) by continuous intravenousinfusion 2.5–7 micrograms/kg/hour,adjusted according to responseChild 1 month–12 years by continuous intravenousinfusion 12.5–25 micrograms/kg/hour,adjusted according to response. By intravenous injectionChild 1–3 months 20 micrograms/kg every 6hours, adjusted according to responseChild 3–6 months 25–50 micrograms/kg every 6hours, adjusted according to responseChild 6–12 months 75 micrograms/kg every 4hours, adjusted according to responseChild 1–12 years 75–100 micrograms/kg (max.5 mg) every 4 hours, adjusted according toresponseChild 12–18 years 2.5–5 mg every 4 hours,adjusted according to response. By continuous subcutaneous infusionSee Prescribing in Palliative Care, p. 17. By subcutaneous or by intramuscular injectionChild 12–18 years 5 mg every 4 hours, adjustedaccording to responseAcute pain in an emergency setting; shortpainful procedures. Intranasally (but see p. 203)Child over 10 kg 100 micrograms/kg, max. 10 mgAdministration for intravenous infusion, dilute inGlucose 5% or Sodium Chloride 0.9%; Glucose 5% ispreferableFor intranasal administration, diamorphine powdershould be dissolved in sufficient volume of Water forInjections to provide the requisite dose in 0.2 mL ofsolution; use solution immediately after preparationDiamorphine (Non-proprietary) 2Tablets, diamorphine hydrochloride 10 mg, net price100-tab pack = £16.42. Label: 2Injection, powder for reconstitution, diamorphinehydrochloride, net price 5-mg amp = £2.57, 10-mgamp = £3.59, 30-mg amp = £3.82, 100-mg amp =£9.34, 500-mg amp = £42.07Extemporaneous formulations available seeExtemporaneous Preparations, p. 6DIHYDROCODEINE TARTRATECautions see notes above; also pancreatitis; severe corpulmonaleContra-indications see notes aboveHepatic impairment see notes aboveRenal impairment see notes abovePregnancy see notes aboveBreast-feeding use only if potential benefit outweighsriskSide-effects see notes above; also paralytic ileus,abdominal pain, diarrhoea, seizures, and paraesthesiaLicensed use most preparations not licensed for usein children under 4 yearsIndication and doseModerate to severe pain. By mouth or by intramuscular injection or bysubcutaneous injectionChild 1–4 years 500 micrograms/kg every 4–6hoursChild 4–12 years 0.5–1 mg/kg (max. 30 mg)every 4–6 hoursChild 12–18 years 30 mg (max. 50 mg by intramuscularor deep subcutaneous injection) every 4–6 hoursDihydrocodeine (Non-proprietary)Tablets A, dihydrocodeine tartrate 30 mg, net price28-tab pack = £1.58. Label: 2Dental prescribing on NHS Dihydrocodeine Tablets 30 mgmay be prescribedOral solution A, dihydrocodeine tartrate 10 mg/5 mL, net price 150 mL = £3.50. Label: 2Injection 2, dihydrocodeine tartrate 50 mg/mL, netprice 1-mL amp = £3.174 Central nervous system