BNF for Children 2011-2012

BNFC 2011–2012 4.8.2 Drugs used in status epilepticus 233Child 1 month–12 years 300–400 micrograms/kg (max. 10 mg) repeated once after 10 minutes ifnecessaryChild 12–18 years 10 mg repeated once after 10minutes if necessary. By rectum (as rectal solution)Neonate 1.25–2.5 mg repeated once after 10minutes if necessaryChild 1 month–2 years 5 mg repeated once after10 minutes if necessaryChild 2–12 years 5–10 mg repeated once after 10minutes if necessaryChild 12–18 years 10–20 mg repeated once after10 minutes if necessaryMuscle spasm section 10.2.2Diazepam (Non-proprietary) KInjection (solution), diazepam 5 mg/mL, net price 2-mL amp = 45pExcipients include benzyl alcohol (avoid in neonates, see Excipients,p. 2), ethanol, propylene glycolInjection (emulsion), diazepam 5 mg/mL (0.5%), netprice 2-mL amp = 91pBrands include Diazemuls cRectal tubes (= rectal solution), diazepam 2 mg/mL,net price 1.25-mL (2.5-mg) tube = 90p, 2.5-mL (5-mg)tube = £1.41; 4 mg/mL, 2.5-mL (10-mg) tube = £1.88Brands include Diazepam Rectubes c , Stesolid cOral preparationsSection 10.2.2FOSPHENYTOIN SODIUMNote Fosphenytoin is a pro-drug of phenytoinCautions see Phenytoin Sodium; resuscitation facilitiesmust be available; interactions: see p. 215 andAppendix 1 (phenytoin)Contra-indications see Phenytoin SodiumHepatic impairment consider 10–25% reduction indose or infusion rate (except initial dose for statusepilepticus)Renal impairment consider 10–25% reduction indose or infusion rate (except initial dose for statusepilepticus)Pregnancy see Phenytoin (section 4.8.1) andPregnancy, p. 216Breast-feeding see Phenytoin (section 4.8.1)Side-effects see Phenytoin Sodium; also dry mouth,taste disturbance, vasodilatation, asthenia, euphoria,incoordination, chills, visual disturbances, tinnitus,pruritus, ecchymosis; less commonly dysarthria,hypoaesthesia, increased or decreased reflexes, stupor,muscle weakness, pain, hypoacusis; also reportedextrapyramidal disorder, twitching, confusion, hyperglycaemiaImportant Intravenous infusion of fosphenytoin has beenassociated with severe cardiovascular reactions includingasystole, ventricular fibrillation, and cardiac arrest. Hypotension,bradycardia, and heart block have also beenreported. The following are recommended:. monitor heart rate, blood pressure, and respiratoryfunction for duration of infusion;. observe patient for at least 30 minutes after infusion;. if hypotension occurs, reduce infusion rate or discontinue;. reduce dose or infusion rate in renal or hepatic impairment.Indication and doseExpressed as phenytoin sodium equivalent (PE);fosphenytoin sodium 1.5 mg : phenytoin sodium1 mgStatus epilepticus. By intravenous infusion (at a rate of 2–3 mg(PE)/kg/minute, max. 150 mg(PE)/minute)Child 5–18 years initially 20 mg(PE)/kg, then (ata rate of 1–2 mg(PE)/kg/minute, max.100 mg(PE)/minute) 4–5 mg(PE)/kg; total dailydose may be given in 1–4 divided doses; adjustedaccording to response and trough plasma-phenytoinconcentrationProphylaxis or treatment of seizures associatedwith neurosurgery or head injury. By intravenous infusion (at a rate of 1–2 mg(PE)/kg/minute, max. 100 mg(PE)/minute)Child 5–18 years initially 10–15 mg(PE)/kg then4–5 mg(PE)/kg daily; total daily dose may be givenin 1–4 divided doses; adjusted according toresponse and trough plasma-phenytoin concentrationTemporary substitution for oral phenytoin. By intravenous infusion (at a rate of 1–2 mg(PE)/kg/minute, max. 100 mg (PE)/minute)Child 5–18 years same dose and dosing frequencyas oral phenytoin therapyNote Fosphenytoin sodium doses in BNFC may differ fromthose in product literatureNote Prescriptions for fosphenytoin sodium should statethe dose in terms of phenytoin sodium equivalent (PE)Administration for intermittent intravenous infusion,dilute to a concentration of 1.5–25 mg (PE)/mL withGlucose 5% or Sodium Chloride 0.9%Pro-Epanutin c (Pfizer) AInjection, fosphenytoin sodium 75 mg/mL (equivalentto phenytoin sodium 50 mg/mL), net price 10-mLvial = £40.00Electrolytes phosphate 3.7 micromol/mg fosphenytoin sodium (phosphate5.6 micromol/mg phenytoin sodium)LORAZEPAMCautions see Diazepam; facilities for reversing respiratorydepression with mechanical ventilation must beavailableContra-indications see DiazepamHepatic impairment see Benzodiazepines, section4.8.1Renal impairment see Benzodiazepines, section 4.8.1Pregnancy see Benzodiazepines, section 4.8.1Breast-feeding see Benzodiazepines, section 4.8.1Side-effects see Diazepam; hypotension and apnoeaLicensed use not licensed for use in febrile convulsionsor convulsions caused by poisoning4 Central nervous system