BNF for Children 2011-2012

420 8.1.1 Alkylating drugs BNFC 2011–20128 Malignant disease and immunosuppressionfibrosis, seizures, aplastic anaemia, visual disturbances,hypersensitivity reactions (including urticaria,erythema); very rarely myasthenia gravis, gynaecomastiaIndication and doseConditioning treatment before haematopoieticstem-cell transplantation. By mouth or by intravenous infusionConsult local treatment protocol for detailsMyleran c (GSK) ATablets, f/c, busulfan 2 mg, net price 25-tab pack =£5.20Busilvex c (Fabre) AConcentrate for intravenous infusion, busulfan6 mg/mL, net price 10-mL vial = £201.25BusulfanCapsules, busulfan 25 mgAvailable from ‘special-order’ manufacturers or specialistimporting companies, p. 809Extemporaneous formulations available seeExtemporaneous Preparations, p. 6CHLORAMBUCILCautions see section 8.1 and notes above; monitor fullblood count regularly throughout treatment;increased seizure risk in children with nephroticsyndrome or history of epilepsy; avoid in acute porphyria(but see section 9.8.2)Hepatic impairment manufacturer advises considerdose reduction in severe impairment—limited informationavailablePregnancy avoid; manufacturer advises effectivecontraception during treatment in men or women; seealso Pregnancy and Reproductive Function, p. 416Breast-feeding discontinue breast-feedingSide-effects see section 8.1 and notes above; also lesscommonly skin rash (possible progression to Stevens-Johnson syndrome and toxic epidermal necrolysis);rarely seizures, hepatotoxicity and jaundice; veryrarely irreversible bone-marrow suppression, pulmonaryfibrosis, tremor, peripheral neuropathy, sterilecystitis, sterility in prepubertal and pubertal malesLicensed use not licensed for use in nephroticsyndromeIndication and doseHodgkin’s disease. By mouthConsult local treatment protocol for detailsNon-Hodgkin’s lymphoma. By mouthConsult local treatment protocol for detailsRelapsing steroid-sensitive nephroticsyndrome; initiated in specialist centres (seealso section 6.3.2, p. 371). By mouthChild 3 months–18 years 200 micrograms/kgonce daily for 8 weeksLeukeran c (GSK) ATablets, f/c, brown, chlorambucil 2 mg, net price 25-tab pack = £8.36Extemporaneous formulations available seeExtemporaneous Preparations, p. 6CYCLOPHOSPHAMIDECautions see section 8.1 and notes above; previous orconcurrent mediastinal irradiation—risk of cardiotoxicity;diabetes mellitus; avoid in acute porphyria(but see section 9.8.2); interactions: Appendix 1(cyclophosphamide)Contra-indications haemorrhagic cystitisHepatic impairment reduce dose—consult localtreatment protocol for detailsRenal impairment reduce dose—consult local treatmentprotocol for detailsPregnancy avoid; manufacturer advises effectivecontraception during and for at least 3 months aftertreatment in men or women; see also Pregnancy andReproductive Function, p. 416Breast-feeding discontinue breast-feeding during andfor 36 hours after stopping treatmentSide-effects see section 8.1 and notes above; alsoanorexia; pancreatitis; cardiotoxicity at high doses;interstitial pulmonary fibrosis; inappropriate secretionof anti-diuretic hormone, disturbances of carbohydratemetabolism; urothelial toxicity; pigmentation ofpalms, nails and soles; rarely hepatotoxicity and renaldysfunctionLicensed use not licensed for use in childrenIndication and doseAcute lymphoblastic leukaemia, non-Hodgkin’slymphoma, retinoblastoma, neuroblastoma,rhabdomyosarcoma, soft-tissue sarcomas,Ewing tumour, neuroectodermal tumours(including medulloblastoma), infant braintumours, ependymona, high-dose conditioningfor bone marrow transplantation, lupusnephritis. By mouth or by intravenous infusionConsult local treatment protocol for detailsSteroid-sensitive nephrotic syndrome see alsosection 6.3.2, p. 371. By mouthChild 3 months–18 years 2–3 mg/kg once dailyfor 8 weeks. By intravenous infusionChild 3 months–18 years 500 mg/m 2 once amonth for 6 monthsAdministration Consult local treatment protocol fordetailsCyclophosphamide (Non-proprietary) ATablets, s/c, cyclophosphamide (anhydrous) 50 mg,net price 100 = £20.20. Label: 25, 27Injection, powder for reconstitution, cyclophosphamide,net price 500-mg vial = £5.66; 1-g vial = £10.66Extemporaneous formulations available seeExtemporaneous Preparations, p. 6