BNF for Children 2011-2012

BNFC 2011–2012 9.1.2 Drugs used in megaloblastic anaemias 445Anaphylactic reactions can occur with parenteral ironcomplexes; facilities for cardiopulmonary resuscitationmust be available. Depending on the preparation, asmall test dose may be required. If children complainof acute symptoms particularly nausea, back pain,breathlessness, or develop hypotension, the infusionshould be stopped.FERRIC CARBOXYMALTOSEA ferric carboxymaltose complex containing 5%(50 mg/mL) of ironCautions hypersensitivity can occur with parenteraliron and facilities for cardiopulmonary resuscitationmust be available; oral iron should not be givenconcomitantly; allergic disorders including asthmaand eczema; infection (discontinue if ongoing bacteraemia)Hepatic impairment use with caution; avoid in conditionswhere iron overload increases risk of impairmentPregnancy avoid in first trimester; crosses the placentain animal studies; may influence skeletaldevelopmentSide-effects gastro-intestinal disturbances; headache,dizziness; rash; injection-site reactions; less commonlyhypotension, flushing, chest pain, peripheral oedema,hypersensitivity reactions (including anaphylaxis),fatigue, paraesthesia, malaise, pyrexia, rigors, myalgia,arthralgia, back pain, pruritus, and urticaria; rarelydyspnoeaLicensed use not licensed for use in children under14 yearsIndication and doseIron-deficiency anaemia see notes above. By slow intravenous injection or by intravenousinfusionCalculated according to body-weight and irondeficit, consult product literatureFerinject c (Vifor) TAInjection, iron (as ferric carboxymaltose) 50 mg/mL,net price 2-mL vial = £21.75, 10-mL vial = £108.75Electrolytes Na + 0.24 mmol/mLIRON DEXTRANA complex of ferric hydroxide with sucrose containing5% (50 mg/mL) of ironCautions oral iron not to be given until 5 days after lastinjectionAnaphylaxis Anaphylactic reactions can occur with parenteraliron and a test dose is recommended before eachdose; the patient should be carefully observed for 60 minutesafter the first test dose and for 15 minutes after subsequenttest doses. Facilities for cardiopulmonary resuscitation mustbe available; risk of allergic reactions increased in immune orinflammatory conditionsContra-indications history of allergic disordersincluding asthma, and eczema; infection; activerheumatoid arthritisHepatic impairment avoid in severe impairmentRenal impairment avoid in acute renal failurePregnancy avoid in first trimesterSide-effects less commonly nausea, vomiting, abdominalpain, flushing, dyspnoea, anaphylactic reactions(see Anaphylaxis above), numbness, cramps, blurredvision, pruritus, and rash; rarely diarrhoea, chest pain,hypotension, angioedema, arrhythmias, tachycardia,dizziness, restlessness, fatigue, seizures, tremor,impaired consciousness, myalgia, arthralgia, sweating,and injection-site reactions; very rarely hypertension,palpitation, headache, paraesthesia, haemolysis,and transient deafnessLicensed use not licensed for use in children under14 yearsIndication and doseIron-deficiency anaemia see notes above. By slow intravenous injection or by intravenousinfusionCalculated according to body-weight and irondeficit, consult product literatureCosmoFer c (Vitaline) AInjection, iron (as iron dextran) 50 mg/mL, net price2-mL amp = £7.97; 10-mL amp = £39.85IRON SUCROSEA complex of ferric hydroxide with sucrose containing2% (20 mg/mL) of ironCautions oral iron therapy should not be given until 5days after last injection; infection (discontinue ifongoing bacteraemia)Anaphylaxis Anaphylactic reactions can occur with parenteraliron and a test dose is recommended before the firstdose; the patient should be carefully observed for 15 minutes.Facilities for cardiopulmonary resuscitation must beavailableContra-indications history of allergic disordersincluding asthma, eczema, and anaphylaxisHepatic impairment use with caution; avoid in conditionswhere iron overload increases risk of impairmentPregnancy avoid in first trimesterSide-effects taste disturbances; less commonlynausea, vomiting, abdominal pain, diarrhoea, hypotension,tachycardia, flushing, palpitation, chest pain,bronchospasm, dyspnoea, headache, dizziness, fever,myalgia, pruritus, rash, and injection-site reactions;rarely peripheral oedema, anaphylactic reactions (seeAnaphylaxis above), fatigue, asthenia, and paraesthesia;confusion, arthralgia, and increased sweatingalso reportedLicensed use not licensed for use in childrenIndication and doseIron-deficiency anaemia see notes above. By slow intravenous injection or by intravenousinfusionCalculated according to body-weight and irondeficit, consult product literatureVenofer c (Vifor) AInjection, iron (as iron sucrose) 20 mg/mL, net price5-mL vial = £9.359.1.2 Drugs used inmegaloblastic anaemiasMegaloblastic anaemias are rare in children; they mayresult from a lack of either vitamin B 12 or folate, and it isessential to establish in every case which deficiency ispresent and the underlying cause. In emergencies, whendelay might be dangerous, it is sometimes necessary to9 Nutrition and blood