BNF for Children 2011-2012

BNFC 2011–2012 4.7.2 Opioid analgesics 209Modified-release 12-hourly oral preparationsMST Continus c (Napp) 2Tablets, m/r, f/c, morphine sulphate 5 mg (white), netprice 60-tab pack = £3.29; 10 mg (brown), 60-tab pack= £5.16; 15 mg (green), 60-tab pack = £9.61; 30 mg(purple), 60-tab pack = £12.40; 60 mg (orange), 60-tabpack = £24.20; 100 mg (grey), 60-tab pack = £38.30;200 mg (green), 60-tab pack = £76.62. Label: 2, 25Suspension (= sachet of granules to mix with water),m/r, pink, morphine sulphate 20 mg/sachet, net price30-sachet pack = £24.58; 30 mg/sachet, 30-sachetpack = £25.54; 60 mg/sachet, 30-sachet pack =£51.09; 100 mg/sachet, 30-sachet pack = £85.15;200 mg/sachet pack, 30-sachet pack = £170.30.Label: 2, 13Dose. By mouthEvery 12 hours, dose adjusted according to daily morphinerequirements; for further advice on determiningdose, see Prescribing in Palliative Care, p. 17; dosagerequirements should be reviewed if the brand is alteredNote Prescriptions must also specify ‘tablets’ or ‘suspension’(i.e. ‘MST Continus tablets’ or ‘MST Continus suspension’)Modified-release 24-hourly oral preparationsMXL c (Napp) 2Capsules, m/r, morphine sulphate 30 mg (light blue),net price 28-cap pack = £10.91; 60 mg (brown), 28-cappack = £14.95; 90 mg (pink), 28-cap pack = £22.04;120 mg (green), 28-cap pack = £29.15; 150 mg (blue),28-cap pack = £36.43; 200 mg (red-brown), 28-cappack = £46.15. Label: 2, counselling, see belowDose. By mouthEvery 24 hours, dose adjusted according to daily morphinerequirements; for further advice on determiningdose, see Prescribing in Palliative Care, p. 17; dosagerequirements should be reviewed if the brand is alteredCounselling Swallow whole or open capsule and sprinklecontents on soft foodNote Prescriptions must also specify ‘capsules’ (i.e. ‘MXLcapsules’)SuppositoriesMorphine (Non-proprietary) 2Suppositories, morphine hydrochloride or sulphate10 mg, net price 12 = £11.21; 15 mg, 12 = £8.85;20 mg, 12 = £33.22; 30 mg, 12 = £13.47. Label: 2Note Both the strength of the suppositories and the morphinesalt contained in them must be specified by theprescriberMorphine sulphate 5 mg suppositories available from‘special-order’ manufacturers or specialist importingcompanies, see p. 809InjectionsMorphine Sulphate (Non-proprietary) 2Injection, morphine sulphate 10, 15, 20, and 30 mg/mL, net price 1- and 2-mL amp (all) = 72p–£1.40Intravenous infusion, morphine sulphate 1 mg/mL,net price 50-mL vial = £5.00; 2 mg/mL, 50-mL vial =£5.89Injection with antiemeticFor prescribing information on cyclizine, see section4.6Caution Not recommended in palliative care, see Nausea andVomiting, p. 19Cyclimorph c (Amdipharm) 2Cyclimorph-10 c Injection, morphine tartrate 10 mg,cyclizine tartrate 50 mg/mL, net price 1-mL amp =£1.75DoseModerate to severe pain (short-term use only). By subcutaneous, intramuscular, or intravenous injectionChild 12–18 years 1 mL, repeated not more often thanevery 4 hours, max. 3 doses in any 24-hour periodCyclimorph-15 c Injection, morphine tartrate 15 mg,cyclizine tartrate 50 mg/mL, net price 1-mL amp =£1.82DoseModerate to severe pain (short-term use only). By subcutaneous, intramuscular, or intravenous injectionChild 12–18 years 1 mL, repeated not more often thanevery 4 hours, max. 3 doses in any 24-hour periodOXYCODONE HYDROCHLORIDECautions see notes above; also toxic psychosis; pancreatitisContra-indications see notes above; also acuteabdomen; delayed gastric emptying; chronic constipation;cor pulmonale; acute porphyria (section 9.8.2)Hepatic impairment avoid in moderate to severeimpairment; see also notes aboveRenal impairment avoid if estimated glomerular filtrationrate less than 10 mL/minute/1.73m 2 ; see alsonotes abovePregnancy see notes aboveBreast-feeding present in milk—avoidSide-effects see notes above; also diarrhoea, abdominalpain, anorexia, dyspepsia; bronchospasm, dyspnoea,impaired cough reflex; asthenia, anxiety; chills;muscle fasciculation; less commonly paralytic ileus,cholestasis, gastritis, flatulence, dysphagia, taste disturbance,belching, hiccups, vasodilatation, supraventriculartachycardia, syncope, amnesia,hypoaesthesia, restlessness, seizures, pyrexia, amenorrhoea,hypotonia, paraesthesia, disorientation,malaise, agitation, speech disorder, tremor, thirst, anddry skinLicensed use not licensed for use in childrenIndication and doseModerate to severe pain in palliative care (seealso Prescribing in Palliative Care, p. 17). By mouthChild 1 month–12 years initially 200 micrograms/kg(up to 5 mg) every 4–6 hours, doseincreased if necessary according to severity of painChild 12–18 years initially 5 mg every 4–6 hours,dose increased if necessary according to severityof pain4 Central nervous systemMinijet c Morphine Sulphate (UCB Pharma) 2Injection, morphine sulphate 1 mg/mL, net price 10-mL disposable syringe = £15.00Oxynorm c (Napp) 2Capsules, oxycodone hydrochloride 5 mg (orange/beige), net price 56-cap pack = £11.36; 10 mg (white/