BNF for Children 2011-2012

BNFC 2011–2012 9.6.3 Vitamin C 481Indication and doseSee also notes aboveMetabolic diseases including cystathioninuriaand homocystinuria. By mouthNeonate 50–100 mg 1–2 times dailyChild 1 month–18 years 50–250 mg 1–2 timesdailyTreatment of isoniazid-induced neuropathy. By mouthNeonate 5–10 mg dailyChild 1 month–12 years 10–20 mg 2–3 timesdailyChild 12–18 years 30–50 mg 2–3 times dailyPrevention of isoniazid-induced neuropathy. By mouthNeonate 5 mg dailyChild 1 month–12 years 5–10 mg dailyChild 12–18 years 10 mg dailyPrevention of penicillamine-induced neuropathyin Wilson’s disease (see notes above). By mouthChild 1–12 years 5–10 mg dailyChild 12–18 years 10 mg dailyPyridoxine-dependent seizures. By intravenous injection or by mouthNeonate initial test dose 50–100 mg by intravenousinjection, may be repeated; if responsivefollowed by an oral maintenance dose of 50–100 mg once daily, adjusted as necessaryChild 1 month–12 years initial test dose 50–100 mg daily; if responsive followed by an oraldose of 20–50 mg 1–2 times daily, adjusted asnecessary; doses up to 30 mg/kg or 1 g daily havebeen usedPyridoxine (Non-proprietary)Tablets, pyridoxine hydrochloride 10 mg, net price500 = £8.53; 20 mg, 500 = £8.53; 50 mg, 28 = £1.52Injection, 25 mg/mL, 2 mL vialAvailable from ‘special-order’ manufacturers or specialistimporting companies, see p. 809Extemporaneous formulations available seeExtemporaneous Preparations, p. 6Oral vitamin B complex preparationsNote Other multivitamin preparations are in section 9.6.7.Vitamin B Tablets, Compound UTablets, nicotinamide 15 mg, riboflavin 1 mg, thiaminehydrochloride 1 mg, net price 28 = £1.00Vitamin B Tablets, Compound, Strong UTablets, brown, f/c or s/c, nicotinamide 20 mg,pyridoxine hydrochloride 2 mg, riboflavin 2 mg, thiaminehydrochloride 5 mg. Net price 28-tab pack =£2.30Vigranon B c (Wallace Mfg) DUSyrup, thiamine hydrochloride 5 mg, riboflavin 2 mg,nicotinamide 20 mg, pyridoxine hydrochloride 2 mg,panthenol 3 mg/5 mL. Net price 150 mL = £2.41DoseTreatment of deficiency. By mouthChild 1 month–1 year 5 mL 3 times dailyChild 1–12 years 10 mL 3 times dailyChild 12–18 years 10–15mL 3 times dailyProphylaxis of deficiency. By mouthChild 1 month–1 year 5 mL once dailyChild 1–12 years 5 mL twice dailyChild 12–18 years 5 mL 3 times daily9.6.3 Vitamin C(Ascorbic acid)Vitamin C therapy is essential in scurvy, but less floridmanifestations of vitamin C deficiency have beenreported. Vitamin C is used to enhance the excretionof iron one month after starting desferrioxamine therapy(section 9.1.3); it is given separately from food as it alsoenhances iron absorption. Vitamin C is also used in thetreatment of some inherited metabolic disorders, particularlymitochondrial disorders; specialist managementof these conditions is required.Severe scurvy causes gingival swelling and bleedingmargins as well as petechiae on the skin. This is, however,exceedingly rare and a child with these signs ismore likely to have leukaemia. Investigation should notbe delayed by a trial period of vitamin treatment.Claims that vitamin C ameliorates colds or promoteswound healing have not been proved.ASCORBIC ACID(Vitamin C)Cautions interactions: Appendix 1 (vitamins)Contra-indications hyperoxaluriaSide-effects nausea, diarrhoea; headache, fatigue;hyperoxaluriaLicensed use not licensed for metabolic disordersIndication and doseTreatment of scurvy. By mouthChild 1 month–4 years 125–250 mg daily in 1–2divided dosesChild 4–12 years 250–500 mg daily in 1–2divided dosesChild 12–18 years 500 mg–1 g daily in 1–2divided dosesAdjunct to desferrioxamine (see notes above). By mouthChild 1 month–18 years 100–200 mg daily 1 hourbefore food9 Nutrition and blood