BNF for Children 2011-2012

BNFC 2011–2012 1.6.5 Bowel cleansing preparations 65Child 10–18 years on day before procedure, ½–1 sachetat 8 a.m. and ½–1 sachet between 2 and 4 p.m.Counselling One sachet should be reconstituted with200 mL of hot water; the solution should be allowed to coolfor approx. 30 minutes before drinking. Low residue or fluidonly diet (e.g. water, fruit squash, lemonade, clear soup, blacktea or coffee) recommended before procedure (according tohospital advice) and copious intake of clear fluids recommendeduntil procedureSODIUM PICOSULFATE WITHMAGNESIUM CITRATECautions see notes above; also recent gastro-intestinalsurgery; cardiac disease (avoid in congestive cardiacfailure)Contra-indications see notes above; also gastrointestinalulceration; ascites; congestive cardiac failureHepatic impairment avoid in hepatic coma if risk ofrenal failureRenal impairment avoid if estimated glomerular filtrationrate less than 30 mL/minute/1.73 m 2 —risk ofhypermagnesaemiaPregnancy cautionBreast-feeding cautionSide-effects see notes above; also anal discomfort,sleep disturbances, fatigue, and rashIndication and doseSee preparationsPicolax c (Ferring)Oral powder, sugar-free, sodium picosulfate 10 mg/sachet, with magnesium citrate, net price 20-sachetpack = £33.90. Label: 10, patient information leaflet,13, counselling, see belowElectrolytes K + 5 mmol, Mg 2þ 87 mmol/sachetDoseBowel evacuation on day before radiological procedure,endoscopy, or surgery. By mouthChild 1–2 years ¼ sachet before 8 a.m. then ¼ sachet 6–8 hours laterChild 2–4 years ½ sachet before 8 a.m. then ½ sachet 6–8 hours laterChild 4–9 years 1 sachet before 8 a.m. then ½ sachet 6–8 hours laterChild 9–18 years 1 sachet before 8 a.m. then 1 sachet 6–8 hours laterNote Acts within 3 hours of first dose. Low residue dietrecommended on the day before procedure and copiousintake of water or other clear fluids recommended duringtreatmentCounselling One sachet should be reconstituted with150 mL (approx. half a glass) of cold water; children andcarers should be warned that heat is generated duringreconstitution and that the solution should be allowed to coolbefore drinkingAMIDOTRIZOATESDiatrizoatesCautions asthma or history of allergy, latent hyperthyroidism,dehydration and electrolyte disturbance(correct first); in children with oesophageal fistulae(aspiration may lead to pulmonary oedema); benignnodular goitre; enteritis; risk of anaphylactoid reactionsincreased by concomitant administration ofbeta-blockersContra-indications hypersensitivity to iodine, hyperthyroidismPregnancy manufacturer advises cautionSide-effects diarrhoea, nausea, vomiting; alsoreported, abdominal pain, intestinal perforation,bowel necrosis, oral mucosal blistering, hypersensitivityreactions, pyrexia, headache, dizziness, disturbancesin consciousness, hyperthyroidism, electrolytedisturbances, and skin reactions (including toxic epidermalnecrolysis)Licensed use not licensed for use in distal intestinalobstruction syndromeIndication and doseUncomplicated meconium ileus. By rectumNeonate 15–30 mL as a single doseDistal intestinal obstruction syndrome. By mouth or by rectumChild 1 month–2 years 15–30 mL as a single doseChild body-weight 15–25 kg 50 mL as a singledoseChild body-weight over 25 kg 100 mL as a singledoseAdministration Intravenous prehydration is essentialin neonates and infants. Fluid intake should beencouraged for 3 hours after administration. Bymouth, for child bodyweight under 25 kg, dilute Gastrografinc with 3 times its volume of water or fruitjuice; for child bodyweight over 25 kg, dilute Gastrografinc with twice its volume of water or fruit juice.By rectum, administration must be carried out slowlyunder radiological supervision to ensure required siteis reached. For child under 5 years, dilute Gastrografinc with 5 times its volume of water; for child over5 years dilute Gastrografin c with 4 times its volumeof water.Radiological investigations dose to be recommendedby radiologistGastrografin c (Bayer Schering)Solution, sodium amidotrizoate 100 mg, meglumineamidotrizoate 660 mg/mL, net price 100-mL bottle =£14.69Excipients include disodium edetate1 Gastro-intestinal systemAmidotrizoatesGastrografin c is an amidotrizoate radiological contrastmedium with high osmolality; it is used in thetreatment of meconium ileus in neonates and in themanagement of distal intestinal obstruction syndromein children with cystic fibrosis.1.6.6 Peripheral opioidreceptorantagonistsClassification not used in BNF for Children.