BNF for Children 2011-2012

210 4.7.2 Opioid analgesics BNFC 2011–20124 Central nervous systembeige), 56-cap pack = £22.73; 20 mg (pink/beige), 56-cap pack = £45.47. Label: 2Liquid (= oral solution), sugar-free, oxycodonehydrochloride 5 mg/5 mL, net price 250 mL = £9.66.Label: 2Concentrate (= concentrated oral solution), sugarfree,oxycodone hydrochloride 10 mg/mL, net price120 mL = £46.39. Label: 2Modified releaseOxyContin c (Napp) 2Tablets, f/c, m/r, oxycodone hydrochloride 5 mg(blue), net price 28-tab pack = £12.46; 10 mg (white),56-tab pack = £24.91; 15 mg (grey), 56-tab pack =£37.41; 20 mg (pink), 56-tab pack = £49.82; 30 mg(brown), 56-tab pack = £74.81; 40 mg (yellow), 56-tabpack = £99.66; 60 mg (red), 56-tab pack = £149.66;80 mg (green), 56-tab pack = £199.33; 120 mg (purple),56-tab pack = £299.31. Label: 2, 25DoseModerate to severe pain in palliative care. By mouthChild 8–12 years initially, 5 mg every 12 hours,increased if necessary according to severity of painChild 12–18 years initially, 10 mg every 12 hours,increased if necessary according to severity of painPAPAVERETUM USafe PracticeDo not confuse with papaverineA mixture of 253 parts of morphine hydrochloride, 23parts of papaverine hydrochloride and 20 parts ofcodeine hydrochlorideTo avoid confusion, the figures of 7.7 mg/mL or15.4 mg/mL should be used for prescribing purposesCautions see notes above; supraventricular tachycardiaContra-indications see notes above; heart failuresecondary to 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 hypothermiaIndication and dosePremedication, postoperative analgesia, severechronic pain. By subcutaneous or intramuscular injectionNeonate 115 micrograms/kg repeated every 4hours if necessaryChild 1–12 months 154 micrograms/kg repeatedevery 4 hours if necessaryChild 1–6 years 1.93–3.85 mg repeated every 4hours if necessaryChild 6–12 years 3.85–7.7 mg repeated every 4hours if necessaryChild 12–18 years 7.7–15.4 mg repeated every 4hours if necessary. By intravenous injectionGenerally 25–50% of the corresponding subcutaneousor intramuscular dosePapaveretum (Non-proprietary) 2UInjection, papaveretum 15.4 mg/mL (providing theequivalent of 10 mg of anhydrous morphine/mL), netprice 1-mL amp = £1.64PETHIDINE HYDROCHLORIDECautions see notes above; not suitable for severecontinuing pain; accumulation of metabolites mayresult in neurotoxicity; myasthenia gravis; cardiacarrhythmias, severe cor pulmonaleContra-indications see notes above; phaeochromocytomaHepatic impairment see notes aboveRenal impairment see notes abovePregnancy see notes aboveBreast-feeding present in milk but not known to beharmfulSide-effects see notes above; also restlessness, tremor,and hypothermia; convulsions reported inoverdosageIndication and doseObstetric analgesia. By subcutaneous or by intramuscular injectionChild 12–18 years 1 mg/kg (max. 100 mg),repeated 1–3 hours later if necessary; max. 400 mgin 24 hoursPethidine (Non-proprietary) 2Injection, pethidine hydrochloride 50 mg/mL, netprice 1-mL amp = 48p, 2-mL amp = 51p; 10 mg/mL,5-mL amp = £3.17, 10-mL amp = £2.18TRAMADOL HYDROCHLORIDECautions see notes above; impaired consciousness;excessive bronchial secretions; not suitable as substitutein opioid-dependent patientsGeneral anaesthesia Not recommended for analgesia duringpotentially light planes of general anaesthesia (possiblyincreased intra-operative recall reported)Contra-indications see notes above; uncontrolledepilepsyHepatic impairment see notes aboveRenal impairment see notes abovePregnancy embryotoxic in animal studies—manufactureradvises avoid; see also notes aboveBreast-feeding amount probably too small to beharmful, but manufacturer advises avoidSide-effects see notes above; also diarrhoea, retching,fatigue, paraesthesia; less commonly gastritis, andflatulence; rarely anorexia, syncope, hypertension,bronchospasm, dyspnoea, wheezing, seizures, andmuscle weakness; blood disorders also reportedLicensed use not licensed for use in children under12 yearsIndication and doseModerate to severe pain. By mouthChild 12–18 years 50–100 mg not more oftenthan every 4 hours; total of more than 400 mg dailynot usually required