BNF for Children 2011-2012

480 9.6.2 Vitamin B group BNFC 2011–20129 Nutrition and blood(section 9.1.2). Pyridoxine is also used in sideroblasticanaemia (section 9.1.3). Rarely, seizures in the neonatalperiod or during infancy respond to pyridoxine treatment;pyridoxine should be tried in all cases of earlyonsetintractable seizures and status epilepticus. Pyridoxinehas been tried for a wide variety of other disorders,but there is little sound evidence to support theclaims of efficacy, and overdosage induces toxic effects.A number of mitochondrial disorders may respond totreatment with certain B vitamins but these disordersrequire specialist management. Thiamine is used in thetreatment of maple syrup urine disease, mitochondrialrespiratory chain defects and, together with riboflavin,in the treatment of congenital lactic acidosis; riboflavinis also used in glutaric acidaemias and cytochromeoxidase deficiencies; biotin (section 9.8.1) is used incarboxylase defects.Folic acid and vitamin B 12 are used in the treatment ofmegaloblastic anaemia (section 9.1.2). Folinic acid(available as calcium folinate) is used in associationwith cytotoxic therapy (section 8.1).RIBOFLAVIN(Riboflavine, vitamin B 2 )Cautions see notes abovePregnancy crosses the placenta but no adverse effectsreported, information at high doses limitedBreast-feeding present in breast milk but no adverseeffects reported, information at high doses limitedSide-effects bright yellow urineLicensed use not licensed in childrenIndication and doseSee also notes aboveMetabolic diseases. By mouthNeonate 50 mg 1–2 times daily, adjusted accordingto responseChild 1 month–18 years 50–100 mg 1–2 timesdaily, adjusted according to response, up to 400 mgdaily has been usedRiboflavin (Non-proprietary)Tablets, 10 mg, 50 mg and 100 mgAvailable from ‘special-order’ manufacturers or specialistimporting companies, see p. 809Oral vitamin B complex preparationsSee belowExtemporaneous formulations available seeExtemporaneous Preparations, p. 6THIAMINE(Vitamin B 1 )Cautions anaphylactic shock may occasionally followinjection (see MHRA/CHM advice below)MHRA/CHM advice (September 2007)Although potentially serious allergic adverse reactionsmay rarely occur during, or shortly after, parenteraladministration, the CHM has recommended that:1. This should not preclude the use of parenteralthiamine in patients where this route of administrationis required, particularly in patients atrisk of Wernicke-Korsakoff syndrome wheretreatment with thiamine is essential;2. Intravenous administration should be by infusionover 30 minutes;3. Facilities for treating anaphylaxis (including resuscitationfacilities) should be available whenparenteral thiamine is administered.Breast-feeding severely thiamine-deficient mothersshould avoid breast-feeding as toxic methyl-glyoxalpresent in milkSide-effects hypersensitivity reactions to injectionLicensed use not licensed in childrenIndication and doseSee also notes aboveMaple syrup urine disease. By mouthNeonate 5 mg/kg daily, adjusted as necessaryChild 1 month–18 years 5 mg/kg daily, adjustedas necessaryMetabolic disorders including congenital lacticacidosis. By mouth or by intravenous infusion over 30minutesNeonate 50–200 mg once daily (total dose mayalternatively be given in 2–3 divided doses),adjusted as necessaryChild 1 month–18 years 100–300 mg once daily(total dose may alternatively be given in 2–3divided doses), adjusted as necessary; up to 2 gdaily may be necessaryThiamine (Non-proprietary)Tablets, thiamine hydrochloride 50 mg, net price 100= £5.19; 100 mg, 100 = £8.04Brands include Benerva c DInjection, 50 mg/mL, 2-mL vial; 100 mg/mL, 2-mLvialInjection (intramuscular), 100 mg/mL, 5-mL vialAvailable from ‘special-order’ manufacturers or specialistimporting companies, see p. 809Note Some preparations may contain phenol as a preservativeOral vitamin B complex preparationsSee belowPYRIDOXINE HYDROCHLORIDE(Vitamin B 6 )Cautions see notes above; risk of cardiovascular collapsewith intravenous injection—resuscitation facilitiesmust be available, monitor closely; interactions:Appendix 1 (vitamins)Side-effects sensory neuropathy reported with highdoses given for extended periodsLicensed use not licensed for use in children