BNF for Children 2011-2012

234 4.8.2 Drugs used in status epilepticus BNFC 2011–20124 Central nervous systemIndication and doseStatus epilepticus, febrile convulsions (section4.8.3), convulsions caused by poisoning. By slow intravenous injectionNeonate 100 micrograms/kg as a single dose,repeated once after 10 minutes if necessaryChild 1 month–12 years 100 micrograms/kg(max. 4 mg) as a single dose, repeated once after10 minutes if necessaryChild 12–18 years 4 mg as a single dose, repeatedonce after 10 minutes if necessaryPeri-operative useSection 15.1.4.1Administration for intravenous injection, dilute withan equal volume of Sodium Chloride 0.9% (for neonates,dilute injection solution to a concentration of100 micrograms/mL)PreparationsSection 15.1.4.1MIDAZOLAMCautions see Midazolam, section 15.1.4.1Contra-indications see Midazolam, section 15.1.4.1Hepatic impairment see Midazolam, section 15.1.4.1Renal impairment see Midazolam, section 15.1.4.1Pregnancy see Midazolam, section 15.1.4.1Breast-feeding see Midazolam, section 15.1.4.1Side-effects see Midazolam, section 15.1.4.1Licensed use injection not licensed for use in statusepilepticus or febrile convulsionsIndication and doseStatus epilepticus, febrile convulsions (section4.8.3). By buccal administrationNeonate 300 micrograms/kg, repeated once after10 minutes if necessaryChild 1–6 months 300 micrograms/kg (max.2.5 mg), repeated once after 10 minutes if necessaryChild 6 months–1 year 2.5 mg, repeated onceafter 10 minutes if necessaryChild 1–5 years 5 mg, repeated once after 10minutes if necessaryChild 5–10 years 7.5 mg, repeated once after 10minutes if necessaryChild 10–18 years 10 mg, repeated once after 10minutes if necessary. By intravenous administrationNeonate initially by intravenous injection 150–200 micrograms/kg followed by continuous intravenousinfusion of 60 micrograms/kg/hour(increased by 60 micrograms/kg/hour every 15minutes until seizure controlled); max. 300 micrograms/kg/hourChild 1 month–18 years initially by intravenousinjection 150–200 micrograms/kg followed bycontinuous intravenous infusion of 60 micrograms/kg/hour(increased by 60 micrograms/kg/hour every 15 minutes until seizure controlled);max. 300 micrograms/kg/hourAdministration for intravenous injection, dilute withGlucose 5% or Sodium Chloride 0.9%; rapid intravenousinjection (less than 2 minutes) may causeseizure-like myoclonus in preterm neonateFor buccal administration, injection solution may begiven buccallyNeonatal intensive care, dilute 15 mg/kg body-weightto a final volume of 50 mL with infusion fluid; anintravenous infusion rate of 0.1 mL/hour provides adose of 30 micrograms/kg/hourPreparationsSection 15.1.4PARALDEHYDECautions bronchopulmonary disease; interactions:Appendix 1 (paraldehyde)Contra-indications gastric disorders; rectal administrationin colitisHepatic impairment use with cautionPregnancy avoid unless essential—crosses placentaBreast-feeding avoid unless essential—present inmilkSide-effects rashLicensed use not licensed for use in children as anenemaIndication and doseStatus epilepticus. By rectum (doses expressed as undiluted paraldehyde)Neonate 0.4 mL/kg as a single doseChild 1 month–18 years 0.4 mL/kg (max. 10 mL)as a single doseAdministration for rectal administration, do notadminister paraldehyde undilutedParaldehyde (Non-proprietary) AEnema, 8–50%, available from ‘special-order’ manufacturersor specialist importing companies, seep. 809PHENOBARBITAL SODIUMPhenobarbitone sodiumCautions see Phenobarbital, section 4.8.1; interactions:see p. 215 and Appendix 1 (phenobarbital)Hepatic impairment see Phenobarbital, section 4.8.1Renal impairment see Phenobarbital, section 4.8.1Pregnancy see Pregnancy, p. 216Breast-feeding see Phenobarbital, section 4.8.1Side-effects see Phenobarbital, section 4.8.1Indication and doseStatus epilepticus. By slow intravenous injection (no faster than1 mg/kg/minute)Neonate initially 20 mg/kg then 2.5–5 mg/kgonce or twice dailyChild 1 month–12 years initially 20 mg/kg then2.5–5 mg/kg once or twice dailyChild 12–18 years initially 20 mg/kg (max. 1 g)then 300 mg twice daily