BNF for Children 2011-2012

BNFC 2011–2012 5.3.1 HIV infection 315Indication and doseHIV infection in combination with other antiretroviraldrugs. By mouthChild 1 month–18 years 180 mg/m 2 (max.300 mg) twice dailyorBody-weight 4–9 kg 12 mg/kg twice dailyBody-weight 9–30 kg 9 mg/kg twice dailyBody-weight over 30 kg 250–300 mg twice dailyorBody-weight 8–14 kg 100 mg twice dailyBody-weight 14–21 kg 100 mg in the morningand 200 mg in the eveningBody-weight 21–28 kg 200 mg twice dailyBody-weight 28–30 kg 200–250 mg twice daily. By intravenous infusion over 1 hour in childrentemporarily unable to take zidovudine bymouthChild 3 months–12 years 60–80 mg/m 2 every 6hours (approximating to 9–12 mg/kg twice dailyby mouth) usually for not more than 2 weeksChild 12–18 years 0.8–1 mg/kg every 4 hours(approximating to 1.2–1.5 mg/kg every 4 hours bymouth) usually for not more than 2 weeksPrevention of maternal-fetal HIV transmissionseek specialist advice (combination therapy preferred)Administration for intermittent intravenous infusion,dilute to a concentration of 2 mg/mL or 4 mg/mLwith Glucose 5% and give over 1 hour.For administration by mouth, Combivir c tablets maybe crushed and mixed with semi-solid food or liquidjust before administrationZidovudine (Non-proprietary) ACapsules, zidovudine 100 mg, net price 60-cap pack= £50.17; 250 mg, 60-cap pack = £125.44Retrovir c (ViiV) ACapsules, zidovudine 100 mg (white/blue band), netprice 100-cap pack = £104.54; 250 mg (blue/white/dark blue band), 40-cap pack = £104.54Oral solution, sugar-free, strawberry-flavoured,zidovudine 50 mg/5 mL, net price 200-mL pack with10-mL oral syringe = £20.91Injection, zidovudine 10 mg/mL. For dilution and useas an intravenous infusion. Net price 20-mL vial =£10.50With lamivudineFor cautions, contra-indications, and side-effectssee under individual drugsCombivir c (ViiV) ATablets, f/c, zidovudine 300 mg, lamivudine 150 mg,net price 60-tab pack = £300.12DoseHIV infection in combination with other antiretrovirals. By mouthChild body-weight 14–21 kg half a tablet twice dailyChild body-weight 21–30 kg half a tablet in the morningand one tablet in the eveningChild body-weight over 30 kg one tablet twice dailyWith abacavir and lamivudineSee under AbacavirProtease inhibitorsCautionsProtease inhibitors should be used withcaution in diabetes (see also Lipodystrophy Syndrome,p. 310). Caution is also needed in children with haemophiliawho may be at increased risk of bleeding.Contra-indications Protease inhibitors should not begiven to patients with acute porphyria (but see section9.8.2).Hepatic impairment Protease inhibitors should beused with caution in children with chronic hepatitis B orC (increased risk of hepatic side-effects).Pregnancy See p. 310Breast-feeding See p. 310Side-effects Side-effects of the protease inhibitorsinclude gastro-intestinal disturbances (including diarrhoea,nausea, vomiting, abdominal pain, flatulence),anorexia, hepatic dysfunction, pancreatitis; blood disordersincluding anaemia, neutropenia, and thrombocytopenia;sleep disturbances, fatigue, headache, dizziness,paraesthesia, myalgia, myositis, rhabdomyolysis;taste disturbances; rash, pruritus, Stevens-Johnsonsyndrome, hypersensitivity reactions including anaphylaxis;see also Lipodystrophy Syndrome (p. 310) andOsteonecrosis (p. 311).ATAZANAVIRCautions see notes above; concomitant use with drugsthat prolong PR interval; cardiac conduction disorders;predisposition to QT interval prolongation(including electrolyte disturbances, concomitant useof drugs that prolong QT interval); interactions:Appendix 1 (atazanavir)Contra-indications see notes aboveHepatic impairment see notes above; also use withcaution in mild impairment; avoid in moderate tosevere impairmentPregnancy manufacturer advises use only if potentialbenefit outweighs risk; theoretical risk of hyperbilirubinaemiain neonate if used at termBreast-feeding see p. 310Side-effects see notes above; also AV block; lesscommonly mouth ulcers, dry mouth, hypertension,syncope, chest pain, dyspnoea, peripheral neuropathy,abnormal dreams, amnesia, disorientation, depression,anxiety, weight changes, increased appetite,gynaecomastia, nephrolithiasis, urinary frequency,haematuria, proteinuria, arthralgia, and alopecia;rarely hepatosplenomegaly, oedema, palpitation, andabnormal gait; also reported cholelithiasis, cholecystitis,and torsade de pointes5 Infections