BNF for Children 2011-2012

502 10.1.1 Non-steroidal anti-inflammatory drugs BNFC 2011–201210 Musculoskeletal and joint diseasesSide-effects see notes above; suppositories maycause rectal irritation; injection site reactionsLicensed use not licensed for use in children under 1year; suppositories not licensed for use in childrenunder 6 years except for use in children over 1 yearfor juvenile idiopathic arthritis; solid dose formscontaining more than 25 mg not licensed for use inchildren; injection not licensed for use in childrenIndication and doseInflammation and mild to moderate pain. By mouth or by rectumChild 6 months–18 years 0.3–1 mg/kg (max.50 mg) 3 times dailyPostoperative pain. By rectumChild 6–18 years 0.5–1 mg/kg (max. 75 mg)twice daily for max. 4 days; total daily dose mayalternatively be given in 3 divided doses. By intravenous infusion or deep intramuscularinjection into gluteal muscleChild 2–18 years 0.3–1 mg/kg once or twicedaily for max. 2 days (max. 150 mg daily)Pain and inflammation in rheumatic diseaseincluding juvenile idiopathic arthritis. By mouthChild 6 months–18 years 1.5–2.5 mg/kg (max.75 mg) twice daily; total daily dose may alternativelybe given in 3 divided dosesAdministration for intravenous infusion, dilute 75 mgwith 100–500 mL Glucose 5% or Sodium Chloride0.9% (previously buffered with 0.5 mL SodiumBicarbonate 8.4% solution or with 1 mL SodiumBicarbonate 4.2% solution); give over 30–120 minutesDiclofenac Sodium (Non-proprietary) ATablets, both e/c, diclofenac sodium 25 mg, net price84-tab pack = £1.14; 50 mg, 84-tab pack = £1.31.Label: 5, 25Brands include Defenac c , Dicloflex c , Diclozip c , Fenactol c ,Flamrase cDispersible tablets, sugar-free, diclofenac sodium10 mgAvailable from ‘special-order’ manufacturers or specialistimporting companies, see p. 809Suppositories, diclofenac sodium 100 mg, net price10 = £3.97Brands include Econac cVoltarol c (Novartis) ATablets, e/c, diclofenac sodium 25 mg (yellow), netprice 84-tab pack = £2.94; 50 mg (brown), 84-tab pack= £4.57. Label: 5, 25Dispersible tablets, sugar-free, pink, diclofenac,equivalent to diclofenac sodium 50 mg, net price 21-tab pack = £6.19. Label: 13, 21Injection, diclofenac sodium 25 mg/mL, net price 3-mL amp = 83pExcipients include benzyl alcohol (avoid in neonates, see Excipients,p. 2), propylene glycolSuppositories, diclofenac sodium 12.5 mg, net price10 = 58p; 25 mg, 10 = £1.03; 50 mg, 10 = £1.70;100 mg, 10 = £3.03Modified releaseDiclomax SR c (Galen) ACapsules, m/r, yellow, diclofenac sodium 75 mg, netprice 56-cap pack = £11.40. Label: 21, 25DosePain and inflammation. By mouthChild 12–18 years 1 capsule 1–2 times dailyDiclomax Retard c (Galen) ACapsules, m/r, diclofenac sodium 100 mg, net price28-cap pack = £8.20. Label: 21, 25DosePain and inflammation. By mouthChild 12–18 years 1 capsule once dailyMotifene c 75 mg (Daiichi Sankyo) ACapsules, e/c, m/r, diclofenac sodium 75 mg(enclosing e/c pellets containing diclofenac sodium25 mg and m/r pellets containing diclofenac sodium50 mg), net price 56-cap pack = £8.00. Label: 25Excipients include propylene glycol (see Excipients, p. 2)DosePain and inflammation. By mouthChild 12–18 years 1 capsule 1–2 times dailyVoltarol c 75 mg SR (Novartis) ATablets, m/r, pink, diclofenac sodium 75 mg, net price28-tab pack = £6.46; 56-tab pack = £12.92. Label: 21,25DosePain and inflammation. By mouthChild 12–18 years 1 tablet 1–2 times dailyNote Other brands of modified-release tablets containingdiclofenac sodium 75 mg include Defenac c SR, Dexomon c75 SR, Dicloflex c 75 SR, Fenactol c 75 mg SR, Flamatak c75 MR, Flamrase c SR, Flexotard c MR 75, Rheumatac cRetard 75, Rhumalgan c CR, Slofenac c SR, Volsaid cRetard 75Voltarol c Retard (Novartis) ATablets, m/r, red, diclofenac sodium 100 mg, netprice 28-tab pack = £9.47. Label: 21, 25DosePain and inflammation. By mouthChild 12–18 years 1 tablet once dailyNote Other brands of modified-release tablets containingdiclofenac sodium 100 mg include Defenac c Retard,Dexomon c Retard 100, Dicloflex c Retard, Fenactol cRetard 100 mg, Flamatak c 100 MR, Slofenac c SR,Volsaid c Retard 100ETORICOXIBCautions see notes above; also dehydration; monitorblood pressure before treatment, 2 weeks afterinitiation and periodically during treatmentContra-indications see notes above; inflammatorybowel disease; uncontrolled hypertension (persistentlyabove 140/90 mmHg)Hepatic impairment max. 60 mg daily in mildimpairment; max. 60 mg on alternate days or 30 mgonce daily in moderate impairment; see also notesabove