BNF for Children 2011-2012

BNFC 2011–2012 5.3.2 Herpesvirus infections 321Indication and doseHIV infection in combination with other antiretroviraldrugs for resistant infection or forchildren intolerant to other antiretroviral regimens. By subcutaneous injectionChild 6–16 years 2 mg/kg (max. 90 mg) twicedailyChild 16–18 years 90 mg twice dailyAdministration for subcutaneous injection, reconstitutewith 1.1 mL Water for Injections and allow tostand (for up to 45 minutes) to dissolve; do not shakeor invert vialFuzeon c (Roche) AInjection, powder for reconstitution, enfuvirtide108 mg (= enfuvirtide 90 mg/mL when reconstitutedwith 1.1 mL Water for Injections), net price 108-mgvial = £18.03 (with solvent, syringe, and alcoholswabs). Counselling, hypersensitivity reactionsMARAVIROCCautions cardiovascular disease; chronic hepatitis Bor C; interactions: Appendix 1 (maraviroc)Hepatic impairment use with cautionRenal impairment if estimated glomerular filtrationrate less than 80 mL/minute/1.73 m 2 , consult productliteraturePregnancy manufacturer advises use only if potentialbenefit outweighs risk—toxicity in animal studiesBreast-feeding see p. 310Side-effects nausea, vomiting, abdominal pain, dyspepsia,constipation, diarrhoea; cough; dizziness,paraesthesia, asthenia, sleep disturbances, headache,weight loss; muscle spasms, back pain; taste disturbances;rash, pruritus; less commonly pancreatitis,hepatic cirrhosis, rectal bleeding, myocardial infarction,myocardial ischaemia, bronchospasm, seizures,hallucinations, loss of consciousness, polyneuropathy,pancytopenia, neutropenia, lymphadenopathy, renalfailure, polyuria, and myositis; see also Osteonecrosis,p. 311Licensed use not licensed for use in childrenIndication and doseCCR5–tropic HIV infection in combination withother antiretroviral drugs in children previouslytreated with antiretroviralsFor dose, consult Guidelines (see notes above)Celsentri c (ViiV) TATablets, blue, f/c, maraviroc 150 mg, net price 60-tabpack = £519.14; 300 mg, 60-tab pack = £519.14RALTEGRAVIRCautions risk factors for myopathy or rhabdomyolysis;interactions: Appendix 1 (raltegravir)Hepatic impairment chronic hepatitis B or C (greaterrisk of hepatic side-effects); use with caution in severeimpairment—no information availablePregnancy manufacturer advises avoid—toxicity inanimal studiesBreast-feeding see p. 310Side-effects diarrhoea, nausea, vomiting, abdominalpain, flatulence, hypertriglyceridaemia, dizziness,headache, insomnia, abnormal dreams, asthenia, rash(Stevens-Johnson syndrome reported); less commonlygastritis, hepatitis, pancreatitis, dry mouth,gastro-oesophageal reflux, taste disturbances, pain onswallowing, peptic ulcer, constipation, rectal bleeding,lipodystrophy (see Lipodystrophy Syndrome, p. 310),palpitation, ventricular extrasystoles, bradycardia,hypertension, flushing, chest pain, oedema, dysphonia,epistaxis, nasal congestion, drowsiness, anxiety,appetite changes, confusion, impaired memory andattention, depression, pyrexia, chills, carpal tunnelsyndrome, tremor, peripheral neuropathy, erectiledysfunction, gynaecomastia, menopausal symptoms,osteopenia, renal failure, nocturia, polydipsia, anaemia,thrombocytopenia, neutropenia, arthralgia,myalgia, rhabdomyolysis, visual disturbances, tinnitus,gingivitis, glossitis, acne, pruritus, hyperhidrosis,dry skin, skin papilloma, and alopecia; also reportedsuicidal ideation; see also Osteonecrosis, p. 311Indication and doseIn combination with other antiretroviral drugsfor HIV infection resistant to multiple antiretrovirals. By mouthChild 16–18 years 400 mg twice dailyIsentress c (MSD) TATablets, pink, f/c, raltegravir (as potassium salt)400 mg, net price 60-tab pack = £616.22. Label: 255.3.2 Herpesvirus infections5.3.2.1 Herpes simplex and varicella–zosterinfection5.3.2.2 Cytomegalovirus infection5.3.2.1 Herpes simplex and varicella–zoster infectionThe two most important herpesvirus pathogens areherpes simplex virus (herpesvirus hominis) and varicella–zostervirus.Herpes simplex infections Herpes infection of themouth and lips and in the eye is generally associatedwith herpes simplex virus serotype 1 (HSV-1); otherareas of the skin may also be infected, especially inimmunodeficiency. Genital infection is most often associatedwith HSV-2 and also HSV-1. Treatment of herpessimplex infection should start as early as possible andusually within 5 days of the appearance of the infection.In individuals with good immune function, mild infectionof the eye (ocular herpes, section 11.3.3) and of thelips (herpes labialis or cold sores, section 13.10.3) istreated with a topical antiviral drug. Primary herpeticgingivostomatitis is managed by changes to diet andwith analgesics (section 12.3.2). Severe infection, neonatalherpes infection or infection in immunocompromisedindividuals requires treatment with a systemicantiviral drug. Primary or recurrent genital herpes simplexinfection is treated with an antiviral drug given bymouth. Persistance of a lesion or recurrence in animmunocompromised child may signal the developmentof resistance.5 Infections