BNF for Children 2011-2012

BNFC 2011–2012 8.1.3 Antimetabolites 425pancreatitis, fever, crystalluria with haematuria, rash,and hyperpigmentation; very rarely lymphomaLicensed use not licensed for use in children foracute lymphoblastic lymphoma or T-cell non-Hodgkins lymphomaIndication and doseAcute lymphoblastic leukaemia, lymphoblasticlymphomas. By mouthConsult local treatment protocol for detailsSevere ulcerative colitis and Crohn’s diseasesection 1.5.3Treatment of early stage Burkitt’s lymphoma,non-Hodgkin’s lymphoma, osteogenic sarcoma,some CNS tumours including infant braintumours, acute lymphoblastic leukaemia. By intravenous injection or infusionConsult local treatment protocol for detailsMeningeal leukaemia, treatment and preventionof CNS involvement of leukaemia. By intrathecal injectionConsult local treatment protocol for detailsSevere Crohn’s disease section 1.5.3Puri-Nethol c (GSK) ATablets, yellow, scored, mercaptopurine 50 mg, netprice 25-tab pack = £22.54MercaptopurineCapsules, mercaptopurine 10 mgAvailable from ‘special-order’ manufacturers or specialistimporting companies, p. 809Extemporaneous formulations available seeExtemporaneous Preparations, p. 6METHOTREXATECautions see section 8.1 and section 10.1.3; monitorrenal and hepatic function; peptic ulceration, ulcerativecolitis, diarrhoea, and ulcerative stomatitis;porphyria (section 9.8.2); interactions: Appendix 1(methotrexate)Hepatic impairment avoid in severe impairment—consult local treatment protocol for detailsRenal impairment reduce dose—risk of nephrotoxicityat high doses; avoid in severe impairmentPregnancy avoid (teratogenic; fertility may be reducedduring therapy but this may be reversible); manufactureradvises effective contraception during and for atleast 3 months after treatment in men or women; seealso Pregnancy and Reproductive Function, p. 416Breast-feeding discontinue breast-feeding—presentin milkSide-effects see section 8.1; also anorexia, abdominaldiscomfort, dyspepsia, gastro-intestinal ulcerationand bleeding, diarrhoea, toxic megacolon, hepatotoxicity(see Cautions above); hypotension, pericarditis,pericardial tamponade, thrombosis; pulmonaryoedema, pleuritic pain, pulmonary fibrosis, interstitialpneumonitis (see also Pulmonary Toxicity, p. 509);anaphylactic reactions, urticaria; dizziness, fatigue,chills, fever, drowsiness, malaise, headache, moodchanges, abnormal cranial sensations, neurotoxicity,confusion, psychosis, paraesthesia, cerebral oedema;precipitation of diabetes; menstrual disturbances,vaginitis, cystitis, reduced libido, impotence; haematuria,dysuria, renal failure; osteoporosis, arthralgia,myalgia, vasculitis; conjunctivitis, blepharitis, visualdisturbances; rash, pruritus, Stevens-Johnsonsyndrome, toxic epidermal necrolysis, photosensitivity,changes in nail and skin pigmentation, telangiectasia,acne, furunculosis, ecchymosis; injectionsitereactionsIndication and doseMaintenance and remission of acute lymphoblasticleukaemia, lymphoblastic lymphoma. By mouthConsult local treatment protocol for detailsRheumatic disease section 10.1.3Psoriasis section 13.5.3Methotrexate (Non-proprietary) AInjection, methotrexate (as sodium salt) 2.5 mg/mL,net price 2-mL vial = £1.68Injection, methotrexate (as sodium salt) 25 mg/mL,net price 2-mL vial = £3.00, 20-mL vial = £30.00Injection, methotrexate 100 mg/mL (not forintrathecal use), net price 10-mL vial = £78.33, 50-mLvial = £380.07Oral preparationsSection 10.1.3NELARABINECautions see section 8.1 and notes above; previous orconcurrent intrathecal chemotherapy or craniospinalirradiation (increased risk of neurotoxicity)Skilled tasks Drowsiness may affect performance of skilledtasks (e.g. cycling or driving)Pregnancy avoid (teratogenic in animal studies);manufacturer advises effective contraception duringand for at least 3 months after treatment in men andwomen; see also Pregnancy and Reproductive Function,p. 416Breast-feeding discontinue breast-feedingSide-effects see section 8.1 and notes above; alsoconstipation, diarrhoea; confusion, seizures, drowsiness,peripheral neurological disorders, demyelination,hypoesthesia, paraesthesia, ataxia, tremor,headache, asthenia, fatigue; pyrexia; hypoglycaemia,electrolyte disturbances; arthralgia; benign andmalignant tumours also reportedIndication and doseT-cell acute lymphoblastic leukaemia, T-celllymphoblastic lymphoma. By intravenous infusionConsult local treatment protocol for detailsAtriance c (GSK) TAIntravenous infusion, nelarabine 5 mg/mL, net price50-mL vial = £222.00Electrolytes Na + 3.75 mmol/vialTIOGUANINE(Thioguanine)Cautions see section 8.1 and notes above; thiopurinemethyltransferase status (see section 8.2.1); monitor8 Malignant disease and immunosuppression