BNF for Children 2011-2012

BNFC 2011–2012 4.8.1 Control of the epilepsies 229sachet pack = £30.00. Label: 8, 21, 25, counselling,administration, pancreatitis, blood, or hepatic disordersymptoms (see above), driving (see notes above)DoseChild as above to the nearest whole 50-mg sachet; totaldaily dose given in 1–2 divided dosesCounselling Granules may be mixed with soft food or drinkthat is cold or at room temperature and swallowed immediatelywithout chewingEpisenta c (Beacon) ACapsules, enclosing m/r granules, sodium valproate150 mg, net price 100-cap pack = £7.00; 300 mg, 100-cap pack = £13.00. Label: 8, 21, 25, counselling,administration, pancreatitis, blood, or hepatic disordersymptoms (see above), driving (see notes above)DoseChild as above, total daily dose given in 1–2 divideddosesCounselling Contents of capsule may be mixed with coldfood or drink and swallowed immediately without chewingGranules, m/r, sodium valproate 500 mg, net price100-sachet pack = £21.00; 1 g, 100-sachet pack =£41.00. Label: 8, 21, 25, counselling, administration,pancreatitis, blood, or hepatic disorder symptoms (seeabove), driving (see notes above)DoseChild as above, total daily dose given in 1–2 divideddosesCounselling Granules may be mixed with cold food or drinkand swallowed immediately without chewingEpival c (Chanelle Medical) ATablets, m/r, scored, sodium valproate 300 mg, netprice 100-tab pack = £12.13; 500 mg 100-tab pack =£20.21. Label: 8, 21, 25, counselling, pancreatitis,blood, or hepatic disorder symptoms (see above),driving (see notes above)DoseChild body-weight over 20 kg as above, total daily dosegiven in 1–2 divided dosesCounselling Tablets may be halved but not crushed orchewedParenteralEpilim c Intravenous (Sanofi-Aventis) AInjection, powder for reconstitution, sodium valproate,net price 400-mg vial (with 4-mL amp waterfor injections) = £11.58Episenta c (Beacon) AInjection, sodium valproate 100 mg/mL, net price 3-mL amp = £7.00Valproic acidConvulex c (Pharmacia) ACapsules, e/c, valproic acid 150 mg, net price 100-cap pack = £3.68; 300 mg, 100-cap pack = £7.35;500 mg, 100-cap pack = £12.25. Label: 8, 21, 25,counselling, pancreatitis, blood, or hepatic disordersymptoms (see above), driving (see notes above)DoseChild as for sodium valproate, total daily dose given in 2–4 divided dosesEquivalence to Sodium valproate Manufacturer advises thatConvulex c has a 1:1 dose relationship with products containingsodium valproate, but nevertheless care is needed inmaking changesVigabatrinVigabatrin can be prescribed in combination with otherantiepileptic treatment for focal epilepsy with or withoutsecondary generalisation. It should not be prescribedunless all other appropriate drug combinations areineffective or have not been tolerated, and it shouldbe initiated and supervised by an appropriate specialist.Vigabatrin can be prescribed as monotherapy in themanagement of infantile spasms in West’s syndrome.About one-third of those treated with vigabatrin havesuffered visual field defects; counselling and carefulmonitoring for this side-effect are required (see alsoVisual Field Defects under Cautions below). Vigabatrinhas prominent behavioural side-effects in some children.VIGABATRINCautions closely monitor neurological function; avoidsudden withdrawal; history of psychosis, depressionor behavioural problems; absence seizures (may beexacerbated); interactions: see p. 215 and Appendix1 (vigabatrin)Visual field defects Vigabatrin is associated with visual fielddefects. The onset of symptoms varies from 1 month toseveral years after starting. In most cases, visual field defectshave persisted despite discontinuation, and further deteriorationafter discontinuation cannot be excluded. Productliterature advises visual field testing before treatment and at6-month intervals. Children and their carers should bewarned to report any new visual symptoms that develop andthose with symptoms should be referred for an urgentophthalmological opinion. Gradual withdrawal of vigabatrinshould be considered.Contra-indications visual field defectsRenal impairment consider reduced dose orincreased dose interval if estimated glomerular filtrationrate less than 60 mL/minute/1.73 m 2Pregnancy see Pregnancy, p. 216Breast-feeding present in milk—manufactureradvises avoid; see also Breast-feeding, p. 217Side-effects nausea, abdominal pain; oedema; drowsiness(rarely encephalopathic symptoms includingmarked sedation, stupor, and confusion with nonspecificslow wave EEG—reduce dose or withdraw),fatigue, excitation, agitation, dizziness, headache,nervousness, depression, aggression, irritability,paranoia, impaired concentration, impaired memory,tremor, paraesthesia, speech disorder, weight gain;visual field defects (see under Cautions), blurredvision, nystagmus, diplopia; less commonly ataxia,psychosis, mania, and rash; occasional increase inseizure frequency (especially if myoclonic); rarelysuicidal ideation and retinal disorders (including peripheralretinal neuropathy); very rarely hepatitis, opticneuritis and optic atrophy; also reported movementdisorders in infantile spasmsIndication and doseAdjunctive treatment of focal seizures with orwithout secondary generalisation not satisfactorilycontrolled with other antiepileptics. By mouthNeonate initially 15–20 mg/kg twice dailyincreased over 2–3 weeks to usual maintenancedose 30–40 mg/kg twice daily; max. 75 mg/kgtwice daily4 Central nervous system