BNF for Children 2011-2012

476 9.5.3 Fluoride BNFC 2011–20129 Nutrition and bloodCALCIUM SALTSCautions interactions: Appendix 1 (antacids, calciumsalts)Contra-indications hypercalcaemia, hypercalciuriaSide-effects hypercalcaemiaIndication and dosePhosphate binding in renal failure and hyperphosphataemia. By mouthChild 1 month–1 year 120 mg calcium carbonate3–4 times daily with feeds, adjusted as necessaryChild 1–6 years 300 mg calcium carbonate 3–4times daily prior to or with meals, adjusted asnecessaryChild 6–12 years 600 mg calcium carbonate 3–4times daily prior to or with meals, adjusted asnecessaryChild 12–18 years 1.25 g calcium carbonate 3–4times daily prior to or with meals, adjusted asnecessaryAdcal c Section 9.5.1.1Calcichew c Section 9.5.1.1Calcium-500 Section 9.5.1.1Phosex c (Vitaline)Tablets, yellow, scored, calcium acetate 1 g (calcium250 mg or Ca 2þ 6.2 mmol), net price 180-tab pack =£19.79. Counselling, do not chew, with mealsDosePhosphate-binding agent (with meals) in renal failure,according to the requirements of the patientExtemporaneous formulations available seeExtemporaneous Preparations, p. 6SEVELAMER HYDROCHLORIDECautions gastro-intestinal disorders; interactions:Appendix 1 (sevelamer)Contra-indications bowel obstructionPregnancy manufacturer advises use only if potentialbenefit outweighs riskBreast-feeding manufacturer advises use only ifpotential benefit outweighs riskSide-effects nausea, vomiting, abdominal pain, constipation,diarrhoea, dyspepsia, flatulence; very rarelyintestinal obstruction; also reported intestinal perforation,ileus, diverticulitis, pruritus, and rashLicensed use not licensed for use in children under18 yearsIndication and doseHyperphosphataemia in patients on haemodialysisor peritoneal dialysis. By mouthChild 12–18 years initially 0.8–1.6 g 3 times dailywith meals, then adjusted according to plasmaphosphateconcentrationRenagel c (Genzyme) ATablets, f/c, sevelamer hydrochloride 800 mg, netprice 180-tab pack = £117.97. Label: 25, counselling,with mealsExcipients include propylene glycol (see Excipients, p. 2)9.5.3 FluorideAvailability of adequate fluoride confers significantresistance to dental caries. It is now considered thatthe topical action of fluoride on enamel and plaque ismore important than the systemic effect.When the fluoride content of drinking water is less than700 micrograms per litre (0.7 parts per million), dailyadministration of fluoride tablets or drops provide suitablesupplementation. Systemic fluoride supplementsshould not be prescribed without reference to the fluoridecontent of the local water supply. Infants need notreceive fluoride supplements until the age of 6 months.Dentifrices which incorporate sodium fluoride or monofluorophosphateare also a convenient source of fluoride.Individuals who are either particularly caries prone ormedically compromised may be given additional protectionby use of fluoride rinses or by application offluoride gels. Rinses may be used daily or weekly; dailyuse of a less concentrated rinse is more effective thanweekly use of a more concentrated one. High-strengthgels must be applied regularly under professional supervision;extreme caution is necessary to prevent the childfrom swallowing any excess. Less concentrated gels areavailable for home use. Varnishes are also available andare particularly valuable for young or disabled childrensince they adhere to the teeth and set in the presence ofmoisture.Fluoride mouthwash, oral drops, tablets, and toothpasteare prescribable on form FP10D (GP14 in Scotland,WP10D in Wales; for details see preparations below).There are also arrangements for health authorities tosupply fluoride tablets in the course of pre-school dentalschemes, and they may also be supplied in school dentalschemes.Fluoride gels are not prescribable on form FP10D (GP14in Scotland, WP10D in Wales).FLUORIDESNote Sodium fluoride 2.2 mg provides approx. 1 mg fluorideionContra-indications not for areas where drinking wateris fluoridatedSide-effects occasional white flecks on teeth withrecommended doses; rarely yellowish-brown discolorationif recommended doses are exceededIndication and doseProphylaxis of dental caries—see notes aboveNote Dose expressed as fluoride ion (F ):Water content less than F 300 micrograms/litre (0.3parts per million). By mouthChild 6 months–3 years F 250 micrograms daily