BNF for Children 2011-2012

230 4.8.1 Control of the epilepsies BNFC 2011–20124 Central nervous systemChild 1 month–2 years initially 15–20 mg/kgtwice daily increased over 2–3 weeks to usualmaintenance dose 30–40 mg/kg twice daily; max.75 mg/kg twice dailyChild 2–12 years initially 15–20 mg/kg (max.250 mg) twice daily increased over 2–3 weeks tousual maintenance dose 30–40 mg/kg (max. 1.5 g)twice dailyChild 12–18 years initially 250 mg twice dailyincreased over 2–3 weeks to usual maintenancedose 1–1.5 g twice dailyAdministration Tablets may be crushed and dispersed inliquid. By rectumChild 1 month–18 years dose as for oral therapy,see aboveAdministration dissolve contents of sachet in smallamount of water and administer rectallyInfantile spasms as monotherapy. By mouthNeonate initially 15–25 mg/kg twice dailyadjusted according to response over 7 days tousual maintenance dose 40–50 mg/kg twice daily;max. 75 mg/kg twice dailyChild 1 month–2 years initially 15–25 mg/kgtwice daily adjusted according to response over 7days to usual maintenance dose 40–50 mg/kgtwice daily; max. 75 mg/kg twice dailySabril c (Sanofi-Aventis) ATablets, f/c, scored, vigabatrin 500 mg, net price 100-tab pack = £30.84. Label: 3, 8, counselling, driving (seenotes above)Powder, sugar-free, vigabatrin 500 mg/sachet. Netprice 50-sachet pack = £17.08. Label: 3, 8, 13, counselling,driving (see notes above)Note The contents of a sachet should be dissolved in wateror a soft drink immediately before takingBenzodiazepinesClobazam may be used as adjunctive therapy in thetreatment of epilepsy. Clonazepam is occasionally usedin tonic-clonic or focal seizures, but its sedative sideeffectsmay be prominent. The effectiveness of clobazamand clonazepam may decrease significantly afterweeks or months of continuous therapy.Nitrazepam is used for treating infantile spasms.Hepatic impairment Benzodiazepines can precipitatecoma if used in hepatic impairment. Start with smallerinitial doses or reduce dose; avoid in severe impairment.Renal impairment Children with renal impairmenthave increased cerebral sensitivity to benzodiazepines;start with small doses in severe impairment.Pregnancy There is a risk of neonatal withdrawalsymptoms when benzodiazepines are used duringpregnancy. Avoid regular use and use only if there is aclear indication such as seizure control. High dosesadministered during late pregnancy or labour maycause neonatal hypothermia, hypotonia, and respiratorydepression.Breast-feeding Benzodiazepines are present in milk,and should be avoided if possible during breast-feeding.CLOBAZAMCautions see Diazepam, section 4.8.2Contra-indications see Diazepam, section 4.8.2Hepatic impairment see notes aboveRenal impairment see notes abovePregnancy see notes aboveBreast-feeding see notes aboveSide-effects see Diazepam, section 4.8.2Licensed use not licensed for use in children under 3yearsIndication and doseAdjunctive therapy for epilepsy, monotherapyunder specialist supervision for catamenial(menstruation) seizures (usually for 7–10 dayseach month, just before and during menstruation),cluster seizures. By mouthChild 1 month–12 years initially 125 micrograms/kgtwice daily increased every 5 days tousual maintenance dose of 250 micrograms/kgtwice daily; max. 500 micrograms/kg twice daily,not exceeding 15 mg twice dailyChild 12–18 years initially 10 mg twice dailyincreased every 5 days to usual maintenance doseof 10–15 mg twice daily; max. 30 mg twice daily1Clobazam (Non-proprietary) KDTablets, clobazam 10 mg. Net price 30-tab pack =£4.68. Label: 2 or 19, 8, counselling, driving (see notesabove)Brands include Frisium c DTablets, clobazam 5 mg available on a named patientbasis1. D except for epilepsy and endorsed ‘SLS’Extemporaneous formulations available seeExtemporaneous Preparations, p. 6CLONAZEPAMCautions see notes above; respiratory disease; spinalor cerebellar ataxia; myasthenia gravis (avoid ifunstable); history of alcohol or drug abuse, depressionor suicidal ideation; debilitated patients; avoid suddenwithdrawal; acute porphyria (section 9.8.2); interactions:see p. 215 and Appendix 1 (anxiolytics andhypnotics)Driving Drowsiness may affect performance of skilled tasks(e.g. driving); effects of alcohol enhancedContra-indications respiratory depression; acutepulmonary insufficiency; sleep apnoea syndrome;marked neuromuscular respiratory weakness includingunstable myasthenia gravisHepatic impairment see notes aboveRenal impairment see notes abovePregnancy see notes aboveBreast-feeding see notes aboveSide-effects drowsiness, fatigue, dizziness, musclehypotonia, coordination disturbances; also poor concentration,restlessness, confusion, amnesia, dependence,and withdrawal; salivary or bronchial hypersecretionin infants and small children; rarely gastrointestinalsymptoms, respiratory depression, head-