BNF for Children 2011-2012

BNFC 2011–2012 8.2.4 Other immunomodulating drugs 441required during treatment and for up to 3 months afterlast doseBreast-feeding consider if benefit outweighs risk—not known if present in human milkSide-effects vertigo, increased susceptibility to infection,injection-site reactionsIndication and doseCryopyrin-associated periodic syndromes. By subcutaneous injectionChild 4–18 yearsBody-weight 15–40 kg 2 mg/kg every 8 weeks. Ifclinical response not achieved 7 days after startingtreatment, a repeat dose of 2 mg/kg can be considered;if a full response is then achieved, subsequentdosing should be 4 mg/kg every 8 weeksBody-weight over 40 kg 150 mg every 8 weeks. Ifclinical response not achieved 7 days after startingtreatment, a repeat dose of 150 mg can be considered;if a full response is then achieved, subsequentdosing should be 300 mg every 8 weeksIlaris c (Novartis) TAInjection, powder for reconstitution, canakinumab,net price 150-mg vial = £9927.80Indication and doseSee notes above. By intravenous infusion (over 1 hour)Consult local treatment protocols for detailsMepact c (Takeda) TAIntravenous infusion, powder for reconstitution,mifamurtide, net price 4-mg vial = £2375.008.3 Sex hormones andhormone antagonists inmalignant diseaseClassification not used in BNF for Children.MifamurtideMifamurtide is licensed in children and adolescents forthe treatment of high-grade, resectable, non-metastaticosteosarcoma after complete surgical resection. It isused in combination with chemotherapy.MIFAMURTIDECautions asthma and chronic obstructive pulmonarydisease—consider prophylactic bronchodilator therapy;history of autoimmune, inflammatory, or collagendisease; monitor renal function, hepatic functionand clotting parameters; monitor patients withhistory of venous thrombosis, vasculitis, or unstablecardiovascular disorders for persistent or worseningsymptoms during administration—consult productliterature interactions: Appendix 1 (mifamurtide)Hepatic impairment use with caution—no informationavailableRenal impairment use with caution—no informationavailablePregnancy avoid; effective contraception requiredBreast-feeding avoid—no information availableSide-effects gastro-intestinal disturbances (includinganorexia, nausea, vomiting, diarrhoea, constipation,abdominal pain, dyspepsia); tachycardia, hypertension,palpitations, hypotension, phlebitis; oedema,respiratory disorders (including dyspnoea, epistaxis,cough, tachypnoea, haemoptysis, pleural effusion);confusion, depression, insomnia, headache, dizziness,paraesthesia, hypoaesthesia, tremor, drowsiness,anxiety; hypokalaemia, anaemia, leucopenia, thrombocytopenia,granulocytopenia; haematuria, dysuria,pollakiuria; musculoskeletal pain; blurred vision;vertigo, tinnitus, hearing loss; sweating, alopecia, rash,dry skin, flushing8 Malignant disease and immunosuppression