BNF for Children 2011-2012

450 9.1.3 Drugs used in hypoplastic, haemolytic, renal anaemias BNFC 2011–20129 Nutrition and bloodweeks; maintenance dose, body-weight under 10 kgusually 75–150 units/kg 3 times weekly, body-weight 10–30 kg usually 60–150 units/kg 3 times weekly, bodyweight30–60 kg usually 30–100 units/kg 3 times weekly,body-weight over 60 kg usually 75–300 units/kg weekly(as a single dose or in divided doses)Note Reduce dose by approximately 25% if rise in haemoglobinconcentration exceeds 2 g/100 mL over 4 weeks or ifhaemoglobin concentration exceeds 12 g/100 mL; if haemoglobinconcentration continues to rise, despite dosereduction, suspend treatment until haemoglobin concentrationdecreases and then restart at a dose approximately 25%lower than the previous doseEpoetin betaNeoRecormon c (Roche) AInjection, prefilled syringe, epoetin beta, net price500 units = £3.75; 2000 units = £14.98; 3000 units =£22.47; 4000 units = £29.96; 5000 units = £37.47;6000 units = £44.94; 10 000 units = £70.14;20 000 units = £140.28; 30 000 units = £224.69Excipients include phenylalanine up to 300 micrograms/syringe (section9.4.1)DoseSymptomatic anaemia associated with chronic renalfailure (see also notes above). By subcutaneous injectionNeonate initially 20 units/kg 3 times weekly for 4 weeks,increased according to response at intervals of 4 weeks insteps of 20 units/kg 3 times weekly; total weekly dosemay be divided into daily doses; maintenance dose,initially reduce dose by half then adjust according toresponse at intervals of 1–2 weeks; total weekly maintenancedose may be given as a single dose or in 3 or 7divided doses; max. 720 units/kg weeklyChild 1 month–18 years initially 20 units/kg 3 timesweekly for 4 weeks, increased according to response atintervals of 4 weeks in steps of 20 units/kg 3 timesweekly; total weekly dose may be divided into dailydoses; maintenance dose, initially reduce dose by halfthen adjust according to response at intervals of 1–2weeks; total weekly maintenance dose may be given as asingle dose or in 3 or 7 divided doses; max. 720 units/kgweekly. By intravenous injection over 2 minutesNeonate initially 40 units/kg 3 times weekly for 4 weeks,increased according to response to 80 units/kg 3 timesweekly after 4 weeks, with further increases if needed atintervals of 4 weeks in steps of 20 units/kg 3 timesweekly; maintenance dose, initially reduce dose by halfthen adjust according to response at intervals of 1–2weeks; max. 720 units/kg weeklyChild 1 month–18 years initially 40 units/kg 3 timesweekly for 4 weeks, increased according to response to80 units/kg 3 times weekly after 4 weeks, with furtherincreases if needed at intervals of 4 weeks in steps of20 units/kg 3 times weekly; maintenance dose, initiallyreduce dose by half then adjust according to response atintervals of 1–2 weeks; max. 720 units/kg weeklyNote Subcutaneous route preferred in patients not onhaemodialysis. Reduce dose by approximately 25% if rise inhaemoglobin concentration exceeds 2 g/100 mL over 4weeks or if haemoglobin concentration approaches orexceeds 12 g/100 mL; if haemoglobin concentration continuesto rise, despite dose reduction, suspend treatmentuntil haemoglobin concentration decreases and then restartat a dose approximately 25% lower than the previous dose.Prevention of anaemias of prematurity in neonateswith birth-weight of 0.75–1.5 kg and gestational ageunder 34 weeks. By subcutaneous injection (of single-dose, unpreservedinjection)Neonate 250 units/kg 3 times weekly preferably startingwithin 3 days of birth and continued for 6 weeksMultidose injection, powder for reconstitution,epoetin beta, net price 50 000-unit vial = £374.48(with solvent)Excipients include phenylalanine up to 5 mg/vial (section 9.4.1), benzylalcohol (avoid in neonates, see Excipients p. 2)Note Avoid contact of reconstituted injection with glass; useonly plastic materialsDoseSymptomatic anaemia associated with chronic renalfailure (see also notes above). By subcutaneous injectionChild 3–18 years initially 20 units/kg 3 times weekly for4 weeks, increased according to response at intervals of 4weeks in steps of 20 units/kg 3 times weekly; total weeklydose may be divided into daily doses; maintenance dose,initially reduce dose by half then adjust according toresponse at intervals of 1–2 weeks; total weekly maintenancedose may be given as a single dose or in 3 or 7divided doses; max. 720 units/kg weekly. By intravenous injection over 2 minutesChild 3–18 years initially 40 units/kg 3 times weekly for4 weeks, increased according to response to 80 units/kg3 times weekly after 4 weeks, with further increases ifneeded at intervals of 4 weeks in steps of 20 units/kg 3times weekly; maintenance dose, initially reduce dose byhalf then adjust according to response at intervals of 1–2weeks; max. 720 units/kg weeklyNote Subcutaneous route preferred in patients not onhaemodialysis. Reduce dose by approximately 25% if rise inhaemoglobin concentration exceeds 2 g/100 mL over 4weeks or if haemoglobin concentration approaches orexceeds 12 g/100 mL; if haemoglobin concentration continuesto rise, despite dose reduction, suspend treatmentuntil haemoglobin concentration decreases and then restartat a dose approximately 25% lower than the previous dose.Epoetin zetaRetacrit c (Hospira) TAInjection, prefilled syringe, epoetin zeta, net price1000 units = £5.66; 2000 units = £11.31; 3000 units =£16.97; 4000 units = £22.63; 5000 units = £28.28;6000 units = £33.94; 8000 units = £45.25; 10 000 units= £56.57; 20 000 units = £203.64; 30 000 units =£305.46; 40 000 units = £407.27Excipients include phenylalanine up to 500 micrograms/syringe (section9.4.1)Note Biosimilar Medicine, p. 2DoseSymptomatic anaemia associated with chronic renalfailure in children on haemodialysis (see also notesabove). By intravenous injection over 1–5 minutesChild 1 month–18 years initially 50 units/kg 3 timesweekly adjusted according to response in steps of25 units/kg 3 times weekly at intervals of at least 4weeks; maintenance dose, body-weight under 10 kgusually 75–150 units/kg 3 times weekly, body-weight 10–30 kg usually 60–150 units/kg 3 times weekly, bodyweightover 30 kg usually 30–100 units/kg 3 timesweeklyNote Avoid increasing haemoglobin concentration at a rateexceeding 2 g/100 mL over 4 weeksSickle-cell diseaseSickle-cell disease is caused by a structural abnormalityof haemoglobin resulting in deformed, less flexible redblood cells. Acute complications in the more severeforms include sickle-cell crisis, where infarction of themicrovasculature and blood supply to organs results insevere pain. Sickle-cell crisis requires hospitalisation,intravenous fluids, analgesia (section 4.7), and treatmentof any concurrent infection. Chronic complica-