BNF for Children 2011-2012

BNFC 2011–2012 1.2 Antispasmodics and other drugs altering gut motility 41Licensed use tablets and liquid not licensed for usein children under 10 years; granules not licensed foruse in children under 12 years; modified-releasecapsules not licensed for use in children under 18yearsIndication and doseAdjunct in gastro-intestinal disorders characterisedby smooth muscle spasm. By mouthChild 3–4 years 25 mg 3 times daily, preferably 20minutes before mealsChild 4–8 years 50 mg 3 times daily, preferably 20minutes before mealsChild 8–10 years 100 mg 3 times daily, preferably20 minutes before mealsChild 10–18 years 135–150 mg 3 times daily,preferably 20 minutes before mealsSide-effects heartburn, perianal irritation; rarely,allergic reactions (including rash, headache, bradycardia,muscle tremor, ataxia)Local irritation Capsules should not be broken or chewedbecause peppermint oil may irritate mouth or oesophagusIndication and doseRelief of abdominal colic and distension, particularlyin irritable bowel syndrome. By mouthChild 15–18 years 1–2 capsules, swallowedwhole with water, 3 times daily for up to 3 monthsif necessaryColpermin c (McNeil)Capsules, e/c, light blue/dark blue, blue band,peppermint oil 0.2 mL. Net price 100-cap pack =£12.05. Label: 5, 25Excipients include arachis (peanut) oilMebeverine Hydrochloride (Non-proprietary) ATablets, mebeverine hydrochloride 135 mg, net price100-tab pack = £4.21Oral suspension, mebeverine hydrochloride (asmebeverine embonate) 50 mg/5 mL, net price 300 mL= £137.00Colofac c (Abbott Healthcare) ATablets, s/c, mebeverine hydrochloride 135 mg, netprice 100-tab pack = £7.52Modified releaseColofac c MR (Abbott Healthcare) ACapsules, m/r, mebeverine hydrochloride 200 mg,net price 60-cap pack = £6.67. Label: 25DoseIrritable bowel syndrome. By mouthChild 12–18 years 1 capsule twice dailyCompound preparations1Fybogel c Mebeverine (Reckitt Benckiser) AGranules, buff, effervescent, ispaghula husk 3.5 g,mebeverine hydrochloride 135 mg/sachet, net price10 sachets = £2.50. Label: 13, 22, counselling, seebelowExcipients include aspartame (section 9.4.1)Electrolytes K + 2.5 mmol/sachetDoseIrritable bowel syndrome. By mouthChild 12–18 years 1 sachet in water, morning andevening 30 minutes before food; an additional sachetmay also be taken before the midday meal if necessaryCounselling Preparations that swell in contact with liquidshould always be carefully swallowed with water and shouldnot be taken immediately before going to bed1. 10-sachet pack can be sold to the public for use in childrenover 12 yearsPEPPERMINT OILCautionssensitivity to mentholPregnancy not known to be harmfulBreast-feeding significant levels of menthol in breastmilk unlikelyMotility stimulantsDomperidone and metoclopramide (section 4.6) aredopamine receptor antagonists which stimulate gastricemptying and small intestinal transit, and enhance thestrength of oesophageal sphincter contraction. Metoclopramideand occasionally domperidone can cause acutedystonic reactions—for further details of this and otherside-effects, see section 4.6.A low dose of erythromycin stimulates gastro-intestinalmotility and may be used on the advice of a paediatricgastroenterologist to promote tolerance of enteral feeds;erythromycin may be less effective as a prokinetic drugin preterm neonates than in older children.DOMPERIDONECautions see under Domperidone (section 4.6)Side-effects see under Domperidone (section 4.6);also QT-interval prolongation reportedLicensed use not licensed for use in gastro-intestinalstasis; not licensed for use in children for gastrooesophagealreflux diseaseIndication and doseGastro-oesophageal reflux disease (but efficacynot proven, see section 1.1), gastro-intestinalstasis. By mouthNeonate 100–300 micrograms/kg 4–6 times dailybefore feedsChild 1 month–12 years 200–400 micrograms/kg (max. 20 mg) 3–4 times daily before foodChild 12–18 years 10–20 mg, 3–4 times dailybefore foodNausea and vomiting section 4.6PreparationsSection 4.6ERYTHROMYCINCautions see section 5.1.5; interactions: Appendix 1(macrolides)Side-effects see section 5.1.51 Gastro-intestinal system