BNF for Children 2011-2012

208 4.7.2 Opioid analgesics BNFC 2011–20124 Central nervous systemreflex, restlessness, seizures, paraesthesia, asthenia,malaise, disorientation, excitation, agitation, delirium,raised intracranial pressure, amenorrhoea, myoclonus,muscle fasciculation, rhabdomyolysis, nystagmusLicensed use Oramorph c solution not licensed foruse in children under 1 year; Oramorph c unit dosevials not licensed for use in children under 6 years;Sevredol c tablets not licensed for use in childrenunder 3 years; MST Continus c preparationslicensed to treat children with cancer pain (agerangenot specified by manufacturer); MXL ccapsules not licensed for use in children under 1year; suppositories not licensed for use in childrenIndication and dosePain. By subcutaneous injectionNeonate initially 100 micrograms/kg every 6hours, adjusted according to responseChild 1–6 months initially 100–200 micrograms/kg every 6 hours, adjusted according to responseChild 6 months–2 years initially 100–200 micrograms/kgevery 4 hours, adjusted according toresponseChild 2–12 years initially 200 micrograms/kgevery 4 hours, adjusted according to responseChild 12–18 years initially 2.5–10 mg every 4hours, adjusted according to response. By intravenous injection over at least 5 minutesNeonate initially 50 micrograms/kg every 6 hours,adjusted according to responseChild 1–6 months initially 100 micrograms/kgevery 6 hours, adjusted according to responseChild 6 months–12 years initially 100 micrograms/kgevery 4 hours, adjusted according toresponseChild 12–18 years initially 5 mg every 4 hours,adjusted according to response. By intravenous administrationNeonate initially by intravenous injection (over atleast 5 minutes) 50 micrograms/kg then by continuousintravenous infusion 5–20 micrograms/kg/hour adjusted according to responseChild 1–6 months initially by intravenous injection(over at least 5 minutes) 100 micrograms/kgthen by continuous intravenous infusion 10–30 micrograms/kg/hour adjusted according toresponseChild 6 months–12 years initially by intravenousinjection (over at least 5 minutes) 100 micrograms/kgthen by continuous intravenous infusion20–30 micrograms/kg/hour adjusted accordingto responseChild 12–18 years initially by intravenous injection(over at least 5 minutes) 5 mg then by continuousintravenous infusion 20–30 micrograms/kg/hour adjusted according to response. By mouth or by rectumChild 1–3 months initially 50–100 micrograms/kg every 4 hours, adjusted according to responseChild 3–6 months 100–150 micrograms/kg every4 hours, adjusted according to responseChild 6–12 months 200 micrograms/kg every 4hours, adjusted according to responseChild 1–2 years initially 200–300 micrograms/kgevery 4 hours, adjusted according to responseChild 2–12 years initially 200–300 micrograms/kg (max. 10 mg) every 4 hours, adjusted accordingto responseChild 12–18 years initially 5–10 mg every 4hours, adjusted according to response. By continuous subcutaneous infusionChild 1–3 months 10 micrograms/kg/hour,adjusted according to responseChild 3 months–18 years 20 micrograms/kg/hour, adjusted according to responseNeonatal opioid withdrawal under specialistsupervision. By mouthNeonate initially 40 micrograms/kg every 4 hoursuntil symptoms controlled, increase dose ifnecessary; reduce frequency gradually over 6–10days, and stop when 40 micrograms/kg once dailyachieved; dose may vary, consult local guidelinesAdministration for continuous intravenous infusion,dilute with Glucose 5% or 10% or Sodium Chloride0.9%Neonatal intensive care, dilute 2.5 mg/kg bodyweightto a final volume of 50 mL with infusion fluid;an intravenous infusion rate of 0.1 mL/hour providesa dose of 5 micrograms/kg/hourOral solutionsNote For advice on transfer from oral solutions of morphine tomodified-release preparations of morphine, see Prescribing inPalliative Care, p. 17Morphine Oral SolutionsA or 2Oral solutions of morphine can be prescribed by writing theformula:Morphine hydrochloride 5 mgChloroform water to 5 mLNote The proportion of morphine hydrochloride may bealtered when specified by the prescriber; if above 13 mg per5 mL the solution becomes 2. For sample prescription seeControlled Drugs and Drug Dependence, p. 9. It is usual toadjust the strength so that the dose volume is 5 or 10 mL.Oramorph c (Boehringer Ingelheim)Oramorph c oral solution A, morphine sulphate10 mg/5 mL, net price 100-mL pack = £1.78; 300-mLpack = £4.95; 500-mL pack = £7.47. Label: 2Oramorph c concentrated oral solution 2, sugarfree,morphine sulphate 100 mg/5 mL, net price 30-mL pack = £4.98; 120-mL pack = £18.59 (both withcalibrated dropper). Label: 2TabletsSevredol c (Napp) 2Tablets, f/c, scored, morphine sulphate 10 mg (blue),net price 56-tab pack = £5.28; 20 mg (pink), 56-tabpack = £10.55; 50 mg (pale green), 56-tab pack =£28.02. Label: 2