BNF for Children 2011-2012

BNFC 2011–2012 4.7.2 Opioid analgesics 207= £17.76; ‘25’ patch (releasing approx. 25 micrograms/hourfor 72 hours), 5 = £25.38; ‘50’ patch(releasing approx. 50 micrograms/hour for 72 hours),5 = £47.40; ‘75’ patch (releasing approx. 75 micrograms/hourfor 72 hours), 5 = £66.08; ‘100’ patch(releasing approx. 100 micrograms/hour for 72hours), 5 = £81.45. Label: 2, counselling, administrationBrands include Fentalis c , Matrifen c , Mezolar c , Osmanil c ,Tilofyl c , Victanyl cDurogesic DTrans c (Janssen) 2Patches, self-adhesive, transparent, fentanyl, ‘12’patch (releasing approx. 12 micrograms/hour for 72hours), net price 5 = £17.76; ‘25’ patch (releasingapprox. 25 micrograms/hour for 72 hours), 5 =£25.38; ‘50’ patch (releasing approx. 50 micrograms/hour for 72 hours), 5 = £47.40; ‘75’ patch (releasingapprox. 75 micrograms/hour for 72 hours), 5 =£66.08; ‘100’ patch (releasing approx. 100 micrograms/hourfor 72 hours), 5 = £81.45. Label: 2,counselling, administrationHYDROMORPHONEHYDROCHLORIDECautions see notes above; also pancreatitis; toxicpsychosisContra-indications see notes above; also acuteabdomenHepatic impairment see notes aboveRenal impairment see notes abovePregnancy see notes aboveBreast-feeding avoid—no information availableSide-effects see notes above; also paralytic ileus,peripheral oedema, seizures, asthenia, dyskinesia,agitation, and tremorIndication and doseSevere pain in cancer. By mouthChild 12–18 years 1.3 mg every 4 hours,increased if necessary according to severity of painAdministration Swallow whole capsule or sprinklecontents on soft foodPalladone c (Napp) 2Capsules, hydromorphone hydrochloride 1.3 mg(orange/clear), net price 56-cap pack = £8.82; 2.6 mg(red/clear), 56-cap pack = £17.64. Label: 2, counselling,see belowModified releasePalladone c SR (Napp) 2Capsules, m/r, hydromorphone hydrochloride 2 mg(yellow/clear), net price 56-cap pack = £20.98; 4 mg(pale blue/clear), 56-cap pack = £28.75; 8 mg (pink/clear), 56-cap pack = £56.08; 16 mg (brown/clear),56-cap pack = £106.53; 24 mg (dark blue/clear), 56-cap pack = £159.82. Label: 2, counselling, see belowDoseSevere pain in cancer. By mouthChild 12–18 years 4 mg every 12 hours, increased ifnecessary according to severity of painCounselling Swallow whole or open capsule and sprinklecontents on soft foodMETHADONE HYDROCHLORIDECautions see notes above; also myasthenia gravis;history of cardiac conduction abnormalities, familyhistory of sudden death (ECG monitoring recommended;see also QT Interval Prolongation, below)QT interval prolongation Children with the following riskfactors for QT interval prolongation should be carefullymonitored while taking methadone: heart or liver disease,electrolyte abnormalities, or concomitant treatment withdrugs that can prolong QT interval; children requiring morethan 100 mg daily should also be monitoredContra-indications see notes above; also phaeochromocytomaHepatic impairment see notes aboveRenal impairment see notes abovePregnancy see notes aboveBreast-feeding withdrawal symptoms in infant;breast-feeding permissible during maintenance butdose should be as low as possible and infant monitoredto avoid sedationSide-effects see notes above; also QT interval prolongation;torsade de pointes, hypothermia, restlessness,raised intracranial pressure, dysmenorrhoea, dryeyes, and hyperprolactinaemiaLicensed use not licensed for use in childrenIndication and doseNeonatal opioid withdrawal dose may vary, consultlocal guidelines. By mouthNeonate initially 100 micrograms/kg increased by50 micrograms/kg every 6 hours until symptomsare controlled; for maintenance, total daily dosethat controls symptoms given in 2 divided doses;to withdraw, reduce dose over 7–10 daysMethadone (Non-proprietary) 2Oral solution 1 mg/mL, methadone hydrochloride1 mg/mL, net price 30 mL = 62p, 50 mL = £1.04,100 mL = £1.27, 500 mL = £11.34. Label: 2Brands include Eptadone c ,Metharose c (sugar-free), Physeptone(also as sugar-free)Safe PracticeThis preparation is 2½ times the strength of MethadoneLinctus; many preparations of this strength arelicensed for opioid dependence only but some are alsolicensed for analgesia in severe painMORPHINE SALTSCautions see notes above; also pancreatitis, myastheniagravis, cardiac arrhythmias, severe cor pulmonaleContra-indications see notes above; also delayedgastric emptying, acute abdomen; heart failure secondaryto chronic lung disease; 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 paralytic ileus,abdominal pain, anorexia, dyspepsia, exacerbation ofpancreatitis, taste disturbance, hypertension, hypothermia,syncope, bronchospasm, inhibition of cough4 Central nervous system