BNF for Children 2011-2012

70 1.9.2 Bile acid sequestrants BNFC 2011–20121 Gastro-intestinal systemChenofalk (Non-proprietary) ACapsules, chenodeoxycholic acid 250 mgAvailable from ‘special-order’ manufacturers or specialistimporting companies, see p. 809CHOLESTEROLCautions consult product literatureContra-indications consult product literatureLicensed use not licensedIndication and doseSmith-Lemli-Opitz syndrome. By mouthNeonate 5–10 mg/kg 3–4 times dailyChild 1 month–18 years 5–10 mg/kg 3–4 timesdaily (doses up to 15 mg/kg 4 times daily havebeen used)Administration cholesterol powder can be mixed witha vegetable oil before administrationCholesterol Powder (Non-proprietary)Available from ‘special-order’ manufacturers or specialistimporting companies, see p. 8091.9.2 Bile acid sequestrantsColestyramine is an anion-exchange resin that formsan insoluble complex with bile acids in the gastro-intestinaltract; it is used to relieve diarrhoea associated withsurgical procedures such as ileal resection, or followingradiation therapy. Colestyramine is also used in thetreatment of familial hypercholesterolaemia (see section2.12), and to relieve pruritus in children with partialbiliary obstruction, (for treatment of pruritus, see section3.4.1). Colestyramine is not absorbed from thegastro-intestinal tract, but will interfere with the absorptionof a number of drugs, so timing of administration isimportant.COLESTYRAMINE(Cholestyramine)Cautions section 2.12Contra-indications section 2.12Pregnancy section 2.12Breast-feeding section 2.12Side-effects section 2.12Licensed use not licensed for use in children under 6yearsIndication and dosePruritus associated with partial biliaryobstruction and primary biliary cirrhosis,diarrhoea associated with Crohn’s disease,ileal resection, vagotomy, diabetic vagalneuropathy, and radiation. By mouthChild 1 month–1 year 1 g once daily in a suitableliquid, adjusted according to response; total dailydose may alternatively be given in 2–4 divideddoses (max. 9 g daily)Child 1–6 years 2 g once daily in a suitable liquid,adjusted according to response; total daily dosemay alternatively be given in 2–4 divided doses(max. 18 g daily)Child 6–12 years 4 g once daily in a suitableliquid, adjusted according to response; total dailydose may alternatively be given in 2–4 divideddoses (max. 24 g daily)Child 12–18 years 4–8 g once daily in a suitableliquid, adjusted according to response; total dailydose may alternatively be given in 2–4 divideddoses (max. 36 g daily)Counselling Other drugs should be taken at least 1 hourbefore or 4–6 hours after colestyramine to reduce possibleinterference with absorptionNote For treatment of diarrhoea induced by bile acidmalabsorption, if no response within 3 days an alternativetherapy should be initiatedHypercholesterolaemia section 2.12Administration The contents of one sachet should bemixed with at least 150 mL of water or other suitableliquid such as fruit juice, skimmed milk, thin soups, orpulpy fruits with a high moisture contentPreparationsSection 2.121.9.3 AprotininClassification not used in BNF for Children.1.9.4 PancreatinPancreatin, containing a mixture of protease, lipase andamylase in varying proportions, aids the digestion ofstarch, fat, and protein. Supplements of pancreatin aregiven by mouth to compensate for reduced or absentexocrine secretion in cystic fibrosis, and following pancreatectomy,total gastrectomy, or chronic pancreatitis.The dose of pancreatin is adjusted according to size,number, and consistency of stools, and the nutritionalstatus of the child; extra allowance will be needed ifsnacks are taken between meals. Daily dose should notexceed 10 000 lipase units per kg body-weight per day,(important: see advice on Higher-strength preparationsbelow).Pancreatin preparationsPreparationProteaseunitsAmylaseunitsLipaseunitsCreon c 10 000 capsule, e/c 600 8000 10 000granulesCreon c Micro e/c granules 200 3600 5000(per 100 mg)Nutrizym 10 c capsule, e/c 500 9000 10 000minitabletsPancrex c granules (per 300 4000 5000gram)Pancrex V c capsule, powder 430 9000 8000Pancrex V ‘125’ c capsule, 160 3300 2950powderPancrex V c e/c tablet 110 1700 1900Pancrex V c Forte e/c tablet 330 5000 5600Pancrex V c powder (pergram)1400 30 000 25 000