BNF for Children 2011-2012

BNFC 2011–2012 6.3.2 Glucocorticoid therapy 375Indication and doseInflammatory and allergic disorders. By mouthChild 1 month–18 years 10–100 micrograms/kgdaily in 1–2 divided doses, adjusted according toresponse; up to 300 micrograms/kg daily may berequired in emergency situations. By intramuscular injection or slow intravenousinjection or infusionChild 1 month–12 years 83–333 micrograms/kgdaily in 1–2 divided doses; max. 20 mg dailyChild 12–18 years initially 0.4–20 mg dailyLife-threatening cerebral oedema. By intravenous injectionChild under 35 kg body-weight initially 16.7 mg,then 3.3 mg every 3 hours for 3 days, then 3.3 mgevery 6 hours for 1 day, then 1.7 mg every 6 hoursfor 4 days, then decrease by 0.8 mg dailyChild over 35 kg body-weight initially 20.8 mg,then 3.3 mg every 2 hours for 3 days, then 3.3 mgevery 4 hours for 1 day, then 3.3 mg every 6 hoursfor 4 days, then decrease by 1.7 mg dailyBacterial meningitis (see section 5.1). By slow intravenous injectionChild 3 months–18 years 150 micrograms/kg(max. 10 mg) every 6 hours for 4 days startingbefore or with first dose of antibacterialPhysiological replacement. By mouth or by slow intravenous injectionChild 1 month–18 years 250–500 micrograms/m 2 every 12 hours, adjusted according to responseCroup section 3.1Nausea and vomiting with chemotherapy section8.1Rheumatic disease section 10.1.2Eye section 11.4.1Administration for administration by mouth tabletsmay be dispersed in water or injection solution givenby mouthFor intravenous infusion dilute with Glucose 5% orSodium Chloride 0.9%; give over 15–20 minutesDexamethasone (Non-proprietary) ATablets, dexamethasone 500 micrograms, net price28-tab pack = £38.00; 2 mg, 50-tab pack = £7.46, 100-tab pack = £13.85. Label: 10, steroid card, 21Oral solution, sugar-free, dexamethasone (as sodiumphosphate) 2 mg/5 mL, net price 150-mL = £42.30.Label: 10, steroid card, 21Brands include Dexsol cInjection, dexamethasone (as sodium phosphate)3.3 mg/mL, net price 1-mL amp = 83p. Label: 10,steroid cardInjection, dexamethasone (as sodium phosphate)4 mg/mL, net price 1-mL amp = 83p, 2-mL vial =£1.27. Label: 10, steroid cardHYDROCORTISONECautions see notes aboveContra-indications see notes aboveHepatic impairment see notes aboveRenal impairment see notes abovePregnancy see notes aboveBreast-feeding see notes aboveSide-effects see notes above; also phosphate esterassociated with paraesthesia and pain (particularly inthe perineal region)Indication and doseCongenital adrenal hyperplasia see also section6.3.1. By mouthNeonate 9–15 mg/m 2 in 3 divided doses, adjustedaccording to responseChild 1 month–18 years 9–15 mg/m 2 in 3divided doses, adjusted according to responseAcute adrenocortical insufficiency (Addisoniancrisis) see also notes above and section 6.3.1. By slow intravenous administrationNeonate initially 10 mg by slow intravenousinjection then 100 mg/m 2 daily by continuousintravenous infusion or in divided doses every 6–8hours; adjusted according to response; when stablereduce over 4–5 days to oral maintenance doseChild 1 month–12 years initially 2–4 mg/kg byslow intravenous injection or infusion then 2–4 mg/kg every 6 hours; adjusted according toresponse; when stable reduce over 4–5 days to oralmaintenance doseChild 12–18 years 100 mg every 6 to 8 hours byslow intravenous injection or infusionAdrenal hypoplasia, Addison’s disease, chronicmaintenance or replacement therapy. By mouthNeonate 8–10 mg/m 2 daily in 3 divided doses;higher doses may be neededChild 1 month–18 years 8–10 mg/m 2 daily in 3divided doses; higher doses may be neededNote Give larger doses in the morning and smaller dosesin the eveningInflammatory bowel disease—induction ofremission see also section 1.5.2. By intravenous injectionChild 2–18 years 2.5 mg/kg (max. 100 mg) every6 hours. By continuous intravenous infusionChild 2–18 years 10 mg/kg daily (max. 400 mgdaily)Acute hypersensitivity reactions, angioedemasee also section 3.4.3. By intramuscular or intravenous injectionChild under 6 months initially 25 mg 3 timesdaily, adjusted according to responseChild 6 months–6 years initially 50 mg 3 timesdaily, adjusted according to response6 Endocrine system