BNF for Children 2011-2012

BNFC 2011–2012 10.2.2 Skeletal muscle relaxants 515DANTROLENE SODIUMCautions impaired cardiac and pulmonary function;therapeutic effect may take a few weeks to develop—discontinue if no response within 45 days; interactions:Appendix 1 (muscle relaxants)Hepatotoxicity Potentially life-threatening hepatotoxicityreported, usually if doses greater than 400 mg daily used, infemales, if history of liver disorders, or concomitant use ofhepatotoxic drugs; test liver function before and at intervalsduring therapy—discontinue if abnormal liver function testsor symptoms of liver disorder (counselling, see below); reintroduceonly if complete reversal of hepatotoxicityCounselling Children and their carers should be told how torecognise signs of liver disorder and advised to seek promptmedical attention if symptoms such as anorexia, nausea,vomiting, fatigue, abdominal pain, dark urine, or pruritusdevelopSkilled tasks Drowsiness may affect performance of skilledtasks (eg. driving); effects of alcohol enhancedContra-indications acute muscle spasm; avoid whenspasticity is useful, for example, locomotionHepatic impairment avoid—may cause severe liverdamage; injection may be used in an emergency formalignant hyperthermiaPregnancy avoid use in chronic spasticity—embryotoxicin animal studiesBreast-feeding present in milk—manufactureradvises avoid use in chronic spasticitySide-effects diarrhoea (withdraw if severe, discontinuetreatment if recurs on re-introduction), nausea,vomiting, anorexia, hepatotoxicity (see above),abdominal pain; pericarditis; pleural effusion, respiratorydepression; headache, drowsiness, dizziness,asthenia, fatigue, seizures, fever, chills; speech andvisual disturbances; rash; less commonly dysphagia,constipation, exacerbation of cardiac insufficiency,tachycardia, erratic blood pressure, dyspnoea,depression, confusion, nervousness, insomnia,increased urinary frequency, urinary incontinence orretention, haematuria, crystalluria, and increasedsweatingLicensed use not licensed for use in childrenIndication and doseChronic severe spasticity of voluntary muscle. By mouthChild 5–12 years initially 500 micrograms/kgonce daily; after 7 days increase to 500 micrograms/kg/dose3 times daily; every 7 daysincrease by further 500 micrograms/kg/dose untilsatisfactory response; max. 2 mg/kg 3–4 timesdaily (max. total daily dose 400 mg)Child 12–18 years initially 25 mg once daily;increase to 3 times daily after 7 days; every 7 daysincrease by further 500 micrograms/kg/dose untilsatisfactory response; max. 2 mg/kg 3–4 timesdaily (max. total daily dose 400 mg)Malignant hyperthermia section 15.1.8Dantrium c (SpePharm) ACapsules, orange/brown, dantrolene sodium 25 mg,net price 100 = £16.87; 100 mg, 100 = £43.07. Label: 2,counselling, driving, hepatotoxicityDIAZEPAMCautions section 4.8.2Contra-indications section 4.8.2Hepatic impairment section 4.8.2Renal impairment section 4.8.2Pregnancy section 4.8.2Breast-feeding section 4.8.2Side-effects section 4.8.2; also hypotoniaIndication and doseMuscle spasm in cerebral spasticity or inpostoperative skeletal muscle spasm. By mouthChild 1–12 months initially 250 microgram/kgtwice dailyChild 1–5 years initially 2.5 mg twice dailyChild 5–12 years initially 5 mg twice dailyChild 12–18 years initially 10 mg twice daily;max. total daily dose 40 mgTetanus. By intravenous injectionChild 1 month–18 years 100–300 micrograms/kg repeated every 1–4 hours. By intravenous infusion (or by nasoduodenaltube)Child 1 month–18 years 3–10 mg/kg over 24hours, adjusted according to responseStatus epilepticus section 4.8.2Febrile convulsions section 4.8.3Administration for continuous intravenous infusionof diazepam emulsion, dilute to a concentration ofmax. 400 micrograms/mL with Glucose 5% or 10%;max. 6 hours between addition and completion ofinfusion; diazepam adsorbed by plastics of infusionbags and giving setsFor continuous intravenous infusion of diazepamsolution, dilute to a concentration of max. 50 micrograms/mLwith Glucose 5% or Sodium Chloride0.9%; diazepam adsorbed by plastics of infusion bagsand giving setsDiazepam (Non-proprietary) KTablets, diazepam 2 mg, net price 28 = 89p; 5 mg, 28= 90p; 10 mg, 28 = 92p. Label: 2 or 19Brands include Rimapam c D, Tensium c DDental prescribing on NHS Diazepam Tablets may beprescribedOral solution, diazepam 2 mg/5 mL, net price 100 mL= £6.08. Label: 2 or 19Brands include Dialar c DDental prescribing on NHS Diazepam Oral Solution 2 mg/5 mL may be prescribedStrong oral solution, diazepam 5 mg/5 mL, net price100-mL pack = £6.38. Label: 2 or 19DBrands include Dialar c DParenteral preparationsSection 4.8.210 Musculoskeletal and joint diseases