BNF for Children 2011-2012

44 1.3.3 Chelates and complexes BNFC 2011–20121 Gastro-intestinal systemChild 1–6 months 1 mg/kg 3 times daily; max.3 mg/kg 3 times dailyChild 6 months–3 years 2–4 mg/kg twice dailyChild 3–12 years 2–4 mg/kg (max. 150 mg) twicedaily; increased up to 5 mg/kg (max. 300 mg)twice daily in severe gastro-oesophageal refluxdiseaseChild 12–18 years 150 mg twice daily or 300 mgat night; increased if necessary, to 300 mg twicedaily or 150 mg 4 times daily for up to 12 weeks inmoderate to severe gastro-oesophageal refluxdiseaseNote In fat malabsorption syndrome, give 1–2 hoursbefore food to enhance effects of pancreatic enzymereplacement. By slow intravenous injectionNeonate 0.5–1 mg/kg every 6–8 hoursChild 1 month–18 years 1 mg/kg (max. 50 mg)every 6–8 hours (may be given as an intermittentinfusion at a rate of 25 mg/hour)Administration For slow intravenous injection diluteto a concentration of 2.5 mg/mL with Glucose 5% orSodium Chloride 0.9%; give over at least 3 minutesRanitidine (Non-proprietary) ATablets, ranitidine (as hydrochloride) 150 mg, netprice 60-tab pack = £1.97; 300 mg, 30-tab pack =£2.17Brands include Ranitic cEffervescent tablets, ranitidine (as hydrochloride)150 mg, net price 60-tab pack = £18.04; 300 mg, 30-tab pack = £17.03. Label: 13Excipients may include sodium (check with supplier)Oral solution, ranitidine (as hydrochloride) 75 mg/5 mL, 100 mL = £7.44, 300 mL = £19.61Excipients may include alcohol (check with supplier)Note Ranitidine can be sold to the public for children over 16years (provided packs do not contain more than 2 weeks’supply) for the short-term symptomatic relief of heartburn,dyspepsia, and hyperacidity, and for the prevention of thesesymptoms when associated with consumption of food or drink(max. single dose 75 mg, max. daily dose 300 mg)Injection, ranitidine (as hydrochloride) 25 mg/mL,net price 2-mL amp = 57pZantac c (GSK) ATablets, f/c, ranitidine (as hydrochloride) 150 mg, netprice 60-tab pack = £1.30; 300 mg, 30-tab pack =£1.30Syrup, sugar-free, ranitidine (as hydrochloride)75 mg/5 mL. Net price 300 mL = £20.76Excipients include alcohol 8%Injection, ranitidine (as hydrochloride) 25 mg/mL.Net price 2-mL amp = 57p1.3.2 Selective antimuscarinicsClassification not used in BNF for Children.1.3.3 Chelates and complexesSucralfate is a complex of aluminium hydroxide andsulphated sucrose that appears to act by protecting themucosa from acid-pepsin attack; it has minimal antacidproperties. Sucralfate can be used to prevent stressulceration in children receiving intensive care. It shouldbe used with caution in this situation (important:reports of bezoar formation, see Bezoar Formationbelow).SUCRALFATECautions administration of sucralfate and enteralfeeds should be separated by 1 hour; interactions:Appendix 1 (sucralfate)Bezoar formation Following reports of bezoar formationassociated with sucralfate, caution is advised in seriously illpatients, especially those receiving concomitant enteralfeeds or those with predisposing conditions such as delayedgastric emptyingRenal impairment use with caution; aluminium isabsorbed and may accumulatePregnancy no evidence of harm; absorption fromgastro-intestinal tract negligibleBreast-feeding amount probably too small to beharmfulSide-effects constipation; less frequently diarrhoea,nausea, indigestion, flatulence, gastric discomfort,back pain, dizziness, headache, drowsiness, bezoarformation (see above), dry mouth, and rashLicensed use not licensed for use in children under15 years; tablets not licensed for prophylaxis ofstress ulcerationIndication and doseProphylaxis of stress ulceration in child underintensive care. By mouthChild 1 month–2 years 250 mg 4–6 times dailyChild 2–12 years 500 mg 4–6 times dailyChild 12–15 years 1 g 4–6 times dailyChild 15–18 years 1 g 6 times daily; max. 8 gdailyBenign gastric and duodenal ulceration. By mouthChild 1 month–2 years 250 mg 4–6 times dailyChild 2–12 years 500 mg 4–6 times dailyChild 12–15 years 1 g 4–6 times dailyChild 15–18 years 2 g twice daily (on rising and atbedtime) or 1 g 4 times daily (1 hour before mealsand at bedtime) taken for 4–6 weeks, or in resistantcases up to 12 weeks; max. 8 g dailyAdministration for administration by mouth, sucralfateshould be given 1 hour before meals, see alsoCautions, above; oral suspension blocks fine-borefeeding tubes; crushed tablets may be dispersed inwater.Antepsin c (Chugai) ATablets, scored, sucralfate 1 g, net price 50-tab pack =£5.77. Label: 5Suspension, sucralfate, 1 g/5 mL, net price 250 mL(aniseed- and caramel-flavoured) = £5.77. Label: 51.3.4 Prostaglandin analoguesClassification not used in BNF for Children.