BNF for Children 2011-2012

BNFC 2011–2012 9.1.3 Drugs used in hypoplastic, haemolytic, renal anaemias 447Macrocytic anaemia with neurological involvement. By intramuscular injectionChild 1 month–18 years initially 1 mg on alternatedays until no further improvement, then 1 mgevery 2 monthsProphylaxis of macrocytic anaemias associatedwith vitamin B 12 deficiency. By intramuscular injectionChild 1 month–18 years 1 mg every 2–3 monthsLeber’s optic atrophy. By intramuscular injectionInitially 1 mg daily for 2 weeks, then 1 mg twiceweekly until no further improvement, thereafter1 mg every 1–3 monthsCongenital transcobalamin II deficiency. By intramuscular injectionNeonate 1 mg 3 times a week, reduce after 1 yearto 1 mg once weekly or as appropriateChild 1 month–18 years 1 mg 3 times a week,reduce after 1 year to 1 mg once weekly or asappropriateMethylmalonic acidaemia and homocystinuria. By intramuscular injectionChild 1 month–18 years initially 1 mg daily for 5–7 days, reduce according to response to maintenancedose of up to 1 mg once or twice weeklyMethylmalonic acidaemia, maintenance onceintramuscular response established. By mouthChild 1 month–18 years 5–10 mg once or twiceweeklyNote Some children do not respond to the oral routeCyanide poisoningSee Emergency Treatment of Poisoning, p. 32Hydroxocobalamin (Non-proprietary) AInjection, hydroxocobalamin 1 mg/mL. Net price 1-mL amp = 74pBrands include Cobalin-H c D, Neo-Cytamen c DInjection, hydroxocobalamin 2.5 mg/mL, 2 mLAvailable from ‘special-order’ manufacturers or specialistimporting companies, see p. 809Administration For administration by mouth, injection solutionmay be given orally; it will not have prolonged effect via this routeNote The BP directs that when Vitamin B 12 injection isprescribed or demanded hydroxocobalamin injection shallbe dispensed or suppliedPowder available from specialist importing companiesIndication and doseFolate supplementation in neonates (see notesabove). By mouthNeonate 50 micrograms once daily or 500 microgramsonce weeklyMegaloblastic anaemia due to folate deficiency(see notes above). By mouthNeonate initially 500 micrograms/kg once dailyfor up to 4 monthsChild 1 month–1 year initially 500 micrograms/kg once daily (max. 5 mg) for up to 4 months; up to10 mg daily may be required in malabsorptionstatesChild 1–18 years 5 mg daily for 4 months (untilterm in pregnant women); up to 15 mg daily maybe required in malabsorption statesHaemolytic anaemia; metabolic disorders. By mouthChild 1 month–12 years 2.5–5 mg once dailyChild 12–18 years 5–10 mg once dailyProphylaxis of folate deficiency in dialysis. By mouthChild 1 month–12 years 250 microgram/kg(max. 10 mg) once dailyChild 12–18 years 5–10 mg once dailyPrevention of methotrexate side-effects injuvenile idiopathic arthritis. By mouthChild 2–18 years 1 mg daily or 5 mg once weekly,adjusted according to local guidelinesPrevention of methotrexate side-effects insevere Crohn’s disease or severe psoriasis. By mouthSee section 1.5.3 and section 13.5.3Prevention of neural tube defects. By mouthSee notes above1Folic Acid (Non-proprietary) ATablets, folic acid 400 micrograms, net price 90-tabpack = £2.37; 5 mg, 28-tab pack = £1.00Syrup, folic acid 2.5 mg/5 mL, net price 150 mL =£9.16; 400 micrograms/5 mL, 150 mL = £1.40Brands include Folicare c , Lexpec c (sugar-free)1. Can be sold to the public provided daily doses do not exceed500 micrograms9 Nutrition and bloodFOLIC ACIDCautions should never be given alone for vitamin B 12deficiency states (may precipitate subacute combineddegeneration of the spinal cord); interactions:Appendix 1 (folates)Side-effects rarely gastro-intestinal disturbancesLicensed use unlicensed for limiting methotrexatetoxicity9.1.3 Drugs used inhypoplastic, haemolytic,and renal anaemiasAnabolic steroids (see BNF, section 6.4.3), pyridoxine,antilymphocyte immunoglobulin, and various corticos-