BNF for Children 2011-2012

BNFC 2011–2012 8.2.2 Corticosteroids and other immunosuppressants 437Prophylaxis of graft rejection following heart transplantationfollowing antibody induction, startingwithin 5 days of transplantation. By mouthNeonate initially 50–150 micrograms/kg twice daily,adjusted according to whole-blood concentrationChild 1 month–18 years initially 50–150 micrograms/kg twice daily, adjusted according to whole-blood concentrationAllograft rejection resistant to conventional immunosuppressivetherapy Consult local treatment protocolModigraf c (Astellas) TAGranules, tacrolimus (as monohydrate), 200 micrograms,net price 50-sachet pack = £71.30; 1 mg, 50-sachet pack = £356.65. Label: 13, 23, counselling,skilled tasksDoseProphylaxis of graft rejection following liver transplantation,starting 12 hours after transplantation. By mouthNeonate initially 150 micrograms/kg twice daily,adjusted according to whole-blood concentrationChild 1 month–18 years initially 150 micrograms/kgtwice daily, adjusted according to whole-blood concentrationProphylaxis of graft rejection following kidneytransplantation, starting within 24 hours of transplantation. By mouthNeonate initially 150 micrograms/kg twice daily,adjusted according to whole-blood concentrationChild 1 month–18 years initially 150 micrograms/kgtwice daily, adjusted according to whole-blood concentrationNote A lower initial dose of 100 micrograms/kg twicedaily has been used in adolescents to prevent very high‘trough’ concentrationsProphylaxis of graft rejection following heart transplantationwithout antibody induction starting within12 hours of transplantation. By mouthNeonate initially 150 micrograms/kg twice daily as soonas clinically possible (8–12 hours after discontinuingintravenous infusion), adjusted according to whole-bloodconcentrationChild 1 month–18 years initially 150 micrograms/kgtwice daily as soon as clinically possible (8–12 hours afterdiscontinuing intravenous infusion), adjusted accordingto whole-blood concentrationProphylaxis of graft rejection following heart transplantationfollowing antibody induction startingwithin 5 days of transplantation. By mouthNeonate initially 50–150 micrograms/kg twice daily,adjusted according to whole-blood concentrationChild 1 month–18 years initially 50–150 micrograms/kg twice daily, adjusted according to whole-blood concentrationAllograft rejection resistant to conventional immunosuppressivetherapy Consult local treatment protocolPrograf c (Astellas) ACapsules, tacrolimus (as monohydrate) 500 micrograms(yellow), net price 50-cap pack = £61.88; 1 mg(white), 50-cap pack = £80.28, 100-cap pack =£160.54; 5 mg (greyish-red), 50-cap pack = £296.58.Label: 23, counselling, skilled tasksConcentrate for intravenous infusion, tacrolimus5 mg/mL. To be diluted before use. Net price 1-mLamp = £58.46Excipients include polyoxyl castor oil (risk of anaphylaxis, see Excipients,p. 2)DoseProphylaxis of graft rejection following liver transplantation,starting 12 hours after transplantation. By mouthNeonate initially 150 micrograms/kg twice daily,adjusted according to whole-blood concentrationChild 1 month–18 years initially 150 micrograms/kgtwice daily, adjusted according to whole-blood concentration. By continuous intravenous infusion (only if oral routeinappropriate)Neonate 50 micrograms/kg over 24 hours for up to 7days (then transfer to oral therapy), adjusted according towhole-blood concentrationChild 1 month–18 years 50 micrograms/kg over 24hours for up to 7 days (then transfer to oral therapy),adjusted according to whole-blood concentrationProphylaxis of graft rejection following kidneytransplantation, starting within 24 hours of transplantation. By mouthNeonate initially 150 micrograms/kg twice daily,adjusted according to whole-blood concentrationChild 1 month–18 years initially 150 micrograms/kgtwice daily, adjusted according to whole-blood concentrationNote A lower initial dose of 100 micrograms/kg twicedaily has been used in adolescents to prevent very high‘trough’ concentrations. By continuous intravenous infusion (only if oral routeinappropriate)Neonate 75–100 micrograms/kg over 24 hours for up to7 days (then transfer to oral therapy), adjusted accordingto whole-blood concentrationChild 1 month–18 years 75–100 micrograms/kg over24 hours for up to 7 days (then transfer to oral therapy),adjusted according to whole-blood concentrationProphylaxis of graft rejection following heart transplantationwithout antibody induction, starting within12 hours of transplantation. By mouthNeonate initially 150 micrograms/kg twice daily as soonas clinically possible (8–12 hours after discontinuation ofintravenous infusion), adjusted according to whole-bloodconcentrationChild 1 month–18 years initially 150 micrograms/kgtwice daily as soon as clinically possible (8–12 hours afterdiscontinuation of intravenous infusion), adjustedaccording to whole-blood concentration. By continuous intravenous infusionNeonate 30–50 micrograms/kg over 24 hours for up to 7days (then transfer to oral therapy), adjusted according towhole-blood concentrationChild 1 month–18 years 30–50 micrograms/kg over 24hours for up to 7 days (then transfer to oral therapy),adjusted according to whole-blood concentration8 Malignant disease and immunosuppression