BNF for Children 2011-2012

BNFC 2011–2012 4.7.4 Antimigraine drugs 213naproxen can be considered. Sumatriptan and zolmitriptanare used for migraine in children. They may alsobe of value in cluster headache (see also section 4.7.4.3).Cautions See interactions: Appendix 1 (5HT 1 agonists).SUMATRIPTANCautions see under 5HT 1 -receptor agonists above;pre-existing cardiac disease; history of seizures; sensitivityto sulfonamides; interactions: Appendix 1(5HT 1agonists)Skilled tasks Drowsiness may affect performance of skilledtasks (e.g. driving)Contra-indications vasospasm; previous cerebrovascularaccident or transient ischaemic attack; peripheralvascular disease; moderate and severehypertensionHepatic impairment reduce dose of oral therapy;avoid in severe impairmentRenal impairment use with cautionPregnancy limited experience—avoid unless potentialbenefit outweighs riskBreast-feeding present in milk but amount probablytoo small to be harmful; withhold breast-feeding for12 hoursSide-effects nausea, vomiting; sensations of tingling,heat, heaviness, pressure, or tightness of any part ofthe body (including throat and chest—discontinue ifintense, may be due to coronary vasoconstriction orto anaphylaxis), transient increase in blood pressure,flushing; dyspnoea; drowsiness, dizziness, weakness;myalgia; also reported diarrhoea, ischaemic colitis,hypotension, bradycardia or tachycardia, palpitation,arrhythmias, myocardial infarction, Raynaud’ssyndrome, anxiety, seizures, tremor, dystonia, nystagmus,arthralgia, visual disturbances, sweating;epistaxis with nasal sprayLicensed use tablets and injection not licensed foruse in children; not licensed for treating clusterheadache in childrenIndication and doseTreatment of acute migraine. By mouthChild 6–10 years 25 mg as a single dose, repeatedonce after at least 2 hours if migraine recursChild 10–12 years 50 mg as a single dose,repeated once after at least 2 hours if migrainerecursChild 12–18 years 50–100 mg as a single dose,repeated once after at least 2 hours if migrainerecurs. By subcutaneous injection (using auto-injector)Child 10–18 years 6 mg as a single dose, repeatedonce after at least 1 hour if migraine recurs; max.12 mg in 24 hours. IntranasallyChild 12–18 years 10–20 mg as a single dose,repeated once after at least 2 hours if migrainerecurs; max. 40 mg in 24 hoursTreatment of acute cluster headache (underspecialist supervision). By subcutaneous injection (using auto-injector)Child 10–18 years 6 mg as a single dose, repeatedonce after at least 1 hour if headache recurs; max.12 mg in 24 hours. IntranasallyChild 12–18 years 10–20 mg as a single dose,repeated once after at least 2 hours if headacherecurs; max. 40 mg in 24 hoursNote Child not responding to initial dose should not takesecond dose for same attack1Sumatriptan (Non-proprietary) ATablets, sumatriptan (as succinate) 50 mg, net price 6-tab pack = £1.71, 12-tab pack = £2.49; 100 mg, 6-tabpack = £2.43. Label: 3, 10, patient information leaflet1. Sumatriptan 50 mg tablets can be sold to the public to treatpreviously diagnosed migraine; max. daily dose 100 mgImigran c (GSK) ATablets, sumatriptan (as succinate) 50 mg, net price 6-tab pack = £26.54; 100 mg, 6-tab pack = £42.90.Label: 3, 10, patient information leafletInjection, sumatriptan (as succinate) 12 mg/mL (=6 mg/0.5-mL syringe), net price, treatment pack (2 0.5-mL prefilled syringes and auto-injector) = £42.47;refill pack 2 0.5-mL prefilled cartridges = £40.41.Label: 3, 10, patient information leafletNasal spray, sumatriptan 10 mg/0.1-mL actuation,net price 2 unit-dose spray device = £11.80; 20 mg/0.1-mL actuation, 2 unit-dose spray device = £11.80, 6unit-dose spray device = £35.39. Label: 3, 10, patientinformation leafletImigran Radis c (GSK) ATablets, f/c, sumatriptan (as succinate) 50 mg (pink),net price 6-tab pack = £23.90; 100 mg (white), 6-tabpack = £42.90. Label: 3, 10, patient information leafletZOLMITRIPTANCautions see under 5HT 1 -receptor agonists above;should not be taken within 12 hours of any other5HT 1 -receptor agonist; interactions: Appendix 1(5HT 1agonists)Contra-indications vasospasm; Wolff-Parkinson-White syndrome or arrhythmias associated withaccessory cardiac conduction pathways; previouscerebrovascular accident or transient ischaemicattack; ischaemic heart disease; uncontrolled hypertensionHepatic impairment max. 5 mg in 24 hours in moderateor severe impairmentPregnancy limited experience—avoid unless potentialbenefit outweighs riskBreast-feeding use with caution—present in milk inanimal studiesSide-effects abdominal pain, dry mouth, nausea,vomiting; palpitation, sensations of tingling, heat,heaviness, pressure, or tightness of any part of thebody (including throat and chest—discontinue ifintense, may be due to coronary vasoconstriction orto anaphylaxis); dizziness, drowsiness, headache,paraesthesia, asthenia; myalgia, muscle weakness; lesscommonly tachycardia, transient increase in bloodpressure, polyuria; rarely urticaria; very rarely gastrointestinaland splenic infarction, ischaemic colitis,4 Central nervous system