BNF for Children 2011-2012

376 6.3.2 Glucocorticoid therapy BNFC 2011–20126 Endocrine systemChild 6–12 years initially 100 mg 3 times daily,adjusted according to responseChild 12–18 years initially 200 mg 3 times daily,adjusted according to responseHypotension resistant to inotropic treatmentand volume replacement (limited evidence). By intravenous injectionNeonate initially 2.5 mg/kg repeated if necessaryafter 4 hours, then 2.5 mg/kg every 6 hours for 48hours or until blood pressure recovers, then dosereduced gradually over at least 48 hoursChild 1 month–18 years 1 mg/kg (max. 100 mg)every 6 hoursSevere acute asthma p. 134Eye section 11.4.1Haemorrhoids section 1.7.2Rheumatic disease section 10.1.2Shock section 2.7.1Skin section 13.4Administration for intravenous administration, dilutewith Glucose 5% or Sodium Chloride 0.9%; for intermittentinfusion give over 20–30 minutes.For administration by mouth, injection solution maybe swallowed [unlicensed use] but consider phosphatecontent; alternatively Corlan c pellets (section12.3.1) may be swallowed [unlicensed use]—pelletsshould not be cut as may not provide appropriatedoseHydrocortisone c (Non-proprietary) ATablets, scored, hydrocortisone 10 mg, net price 30-tab pack = £44.25; 20 mg, 30-tab pack = £47.17.Label: 10, steroid card, 211Efcortesol c (Sovereign) AUInjection, hydrocortisone 100 mg (as sodium phosphate)/mL,net price 1-mL amp = £1.08, 5-mL amp =£4.89. Label: 10, steroid cardNote Paraesthesia and pain (particularly in the perinealregion) may follow intravenous injection of the phosphateester1. A restriction does not apply where administration is forsaving life in emergency1Solu-Cortef c (Pharmacia) AInjection, powder for reconstitution, hydrocortisone(as sodium succinate). Net price 100-mg vial = 92p,100-mg vial with 2-mL amp water for injections =£1.16. Label: 10, steroid card1. A restriction does not apply where administration is forsaving life in emergencyExtemporaneous formulations available seeExtemporaneous Preparations, p. 6METHYLPREDNISOLONECautions see notes above; rapid intravenous administrationof large doses associated with cardiovascularcollapseContra-indications see notes aboveHepatic impairment see notes aboveRenal impairment see notes abovePregnancy see notes aboveBreast-feeding see notes aboveSide-effects see notes aboveIndication and doseInflammatory and allergic disorders. By mouth, slow intravenous injection or byintravenous infusionChild 1 month–18 years 0.5–1.7 mg/kg daily in2–4 divided doses depending on condition andresponseTreatment of graft rejection reactions. By intravenous injectionChild 1 month–18 years 10–20 mg/kg or 400–600 mg/m 2 (max. 1 g) once daily for 3 daysSevere erythema multiforme, lupus nephritis,systemic onset juvenile idiopathic arthritis. By intravenous injectionChild 1 month–18 years 10–30 mg/kg (max. 1 g)once daily or on alternate days for up to 3 dosesImmunosuppression section 8.2.2Rheumatic disease section 10.1.2Skin section 13.4Administration intravenous injection given over 30minutes; for intravenous infusion may be diluted withsodium chloride intravenous infusion 0.9% or 0.45%,or glucose intravenous infusion 5% or 10%Medrone c (Pharmacia) ATablets, scored, methylprednisolone 2 mg (pink), netprice 30-tab pack = £3.88; 4 mg, 30-tab pack = £6.19;16 mg, 30-tab pack = £17.17; 100 mg (blue), 20-tabpack = £48.32. Label: 10, steroid card, 21Solu-Medrone c (Pharmacia) AInjection, powder for reconstitution, methylprednisolone(as sodium succinate) (all with solvent).Net price 40-mg vial = £1.58; 125-mg vial = £4.75;500-mg vial = £9.60; 1-g vial = £17.30; 2-g vial =£32.86. Label: 10, steroid cardIntramuscular depotDepo-Medrone c (Pharmacia) AInjection (aqueous suspension), methylprednisoloneacetate 40 mg/mL. Net price 1-mL vial = £2.87; 2-mLvial = £5.15; 3-mL vial = £7.47. Label: 10, steroid cardDose. By deep intramuscular injection into gluteal muscleseek specialist advicePREDNISOLONECautions see notes above; also Duchenne’s musculardystrophy (possible transient rhabdomyolysis andmyoglobinuria following strenuous physical activity)Contra-indications see notes aboveHepatic impairment see notes aboveRenal impairment see notes abovePregnancy see notes above