Haemolytic anaemia|Metabolic disorders
▶BY MOUTH
▶Child 1 month–11 years: 2. 5 – 5 mg once daily
▶Child 12–17 years: 5 – 10 mg once daily
Prevention of methotrexate side-effects in juvenile
idiopathic arthritis
▶BY MOUTH
▶Child: 1 mg daily, alternatively 5 mg once weekly, dose
to be adjusted according to local guidelines, weekly
dose to be taken on a different day to methotrexate
doselUNLICENSED USEUnlicensed for limiting methotrexate
toxicity.
lCAUTIONSShould never be given alone for pernicious
anaemia (may precipitate subacute combined
degeneration of the spinal cord)
lINTERACTIONS→Appendix 1 : folates
lSIDE-EFFECTSAbdominal distension.appetite decreased.
flatulence.nausea.vitamin B 12 deficiency exacerbated
lPATIENT AND CARER ADVICE
Medicines for Children leaflet: Folic acid for megaloblastic anaemia
caused by folate deficiency and haemolytic anaemia
http://www.medicinesforchildren.org.uk/folic-acid-megaloblastic-
anaemia-caused-folate-deficiency-and-haemolytic-anaemia
lEXCEPTIONS TO LEGAL CATEGORY
▶With oral useCan be sold to the public provided daily doses
do not exceed 500 micrograms.
lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: capsule, oral suspension, oral solution
Tablet
▶Folic acid (Non-proprietary)
Folic acid 400 microgramFolic acid 400 microgram tablets|
90 tabletGsDT = £ 2. 71 | 90 tabletPsDT = £ 2. 71 |
90 tabletsDT = £ 2. 71 | 90 tabletp£ 2. 71 – £ 13. 77 DT = £ 2. 71
Folic acid 5 mgFolic acid 5 mg tablets| 28 tabletP£ 2. 00 DT =
£ 0. 47 | 1000 tabletP£ 16. 79 – £ 20. 00
▶Preconceive(G.R. Lane Health Products Ltd)
Folic acid 400 microgramPreconceive 400 microgram tablets|
90 tabletG£ 2. 70 DT = £ 2. 71
Oral solution
▶Folic acid (Non-proprietary)
Folic acid 500 microgram per 1 mlFolic acid 2. 5 mg/ 5 ml oral
solution sugar free sugar-free| 150 mlP£ 9. 16 DT = £ 9. 16 sugar-
free| 150 ml £ 9. 16 DT = £ 9. 16
Folic acid 1 mg per 1 mlFolic acid 5 mg/ 5 ml oral solution sugar free
sugar-free| 150 mlP£ 13. 74 – £ 23. 49 DT = £ 22. 13
▶Lexpec(Rosemont Pharmaceuticals Ltd)
Folic acid 500 microgram per 1 mlLexpec Folic Acid 2. 5 mg/ 5 ml
oral solution sugar-free| 150 mlP£ 9. 16 DT = £ 9. 16
VITAMINS AND TRACE ELEMENTS›VITAMIN B
GROUP
Cyanocobalamin 20-Jul-2017
lINDICATIONS AND DOSE
Vitamin B 12 deficiency of dietary origin
▶BY MOUTH
▶Child: 50 – 105 micrograms daily in 1 – 3 divided doseslPRESCRIBING AND DISPENSING INFORMATIONCurrently
available brands of the tablet may not be suitable for
vegans.
lNATIONAL FUNDING/ACCESS DECISIONS
NHS restrictionsCyanocobalaminsolution is not
prescribable in NHS primary care.
lLESS SUITABLE FOR PRESCRIBINGCyanocobalamin is less
suitable for prescribing.
lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: tablet
Tablet
▶Cyanocobalamin (Non-proprietary)
Cyanocobalamin 50 microgramCyanocobalamin 50 microgram
tablets| 50 tabletsDT = £ 9. 79 | 50 tabletp£ 9. 84 DT = £ 9. 79
Cyanocobalamin 1 mgBehepan 1 mg tablets| 100 tabletPs
Oral solution
▶Cyanocobalamin (Non-proprietary)
Cyanocobalamin 7 microgram per 1 mlCyanocobalamin
35 micrograms/ 5 ml oral solution| 200 mlp£ 8. 75Hydroxocobalamin 20-Jul-2017
lINDICATIONS AND DOSE
Macrocytic anaemia without neurological involvement
▶BY INTRAMUSCULAR INJECTION
▶Child:Initially 0. 25 – 1 mg 3 times a week for 2 weeks,
then 0. 25 mg once weekly until blood count normal,
then 1 mg every 3 months
Macrocytic anaemia with neurological involvement
▶BY INTRAMUSCULAR INJECTION
▶Child:Initially 1 mg once daily on alternate days until
no further improvement, then 1 mg every 2 months
Prophylaxis of macrocytic anaemias associated with
vitamin B 12 deficiency
▶BY INTRAMUSCULAR INJECTION
▶Child: 1 mg every 2 – 3 months
Leber’s optic atrophy
▶BY INTRAMUSCULAR INJECTION
▶Child:Initially 1 mg daily for 2 weeks, then 1 mg twice
weekly until no further improvement, then 1 mg every
1 – 3 months
Congenital transcobalamin II deficiency
▶BY INTRAMUSCULAR INJECTION
▶Neonate: 1 mg 3 times a week for 1 year, then reduced to
1 mg once weekly, adjusted as appropriate.▶Child: 1 mg 3 times a week for 1 year, then reduced to
1 mg once weekly, adjusted as appropriate
Methylmalonic acidaemia and homocystinuria
▶BY INTRAMUSCULAR INJECTION
▶Child:Initially 1 mg daily for 5 – 7 days, then adjusted
according to response to up to 1 mg 1 – 2 times a week,
this is the maintenance dose
Methylmalonic acidaemia, maintenance once
intramuscular response established
▶BY MOUTH
▶Child: 5 – 10 mg 1 – 2 times a week, some children do not
respond to oral route
CYANOKIT®
Poisoning with cyanides
▶BY INTRAVENOUS INFUSION
▶Child (body-weight 5 kg and above):Initially 70 mg/kg
(max. per dose 5 g), to be given over 15 minutes, then
70 mg/kg (max. per dose 5 g) if required, this second
dose can be given over 15 minutes– 2 hours depending
on severity of poisoning and patient stabilitylUNLICENSED USE
▶With intramuscular use or oral useLicensed for use in children
(age not specified by manufacturers). Not licensed for use
in inborn errors of metabolism.
lCAUTIONS
▶With intramuscular use or oral useShould not be given before
diagnosis fully establishedBNFC 2018 – 2019 Megaloblastic anaemia 575
Blood and nutrition9