lRENAL IMPAIRMENTManufacturer advises use with
caution (preparations contain significant amounts of
sodium).
lDIRECTIONS FOR ADMINISTRATION
▶With oral useOral dose may be mixed with fruit drinks,
milk, or feeds. Granules should be mixed with food before
taking.Pheburane®granules must not be administered by
nasogastric or gastrostromy tubes.
▶With intravenous useForintravenous infusion, dilute to a
maximum concentration of 50 mg/mL with Glucose 10 %.
lPATIENT AND CARER ADVICE
Medicines for Children leaflet: Sodium phenylbutyrate for urea
cycle disorderswww.medicinesforchildren.org.uk/sodium-
phenylbutyrate-for-urea-cycle-disorderslMEDICINAL 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,
solution for infusion
Granules
▶Ammonaps(Swedish Orphan Biovitrum Ltd)
Sodium phenylbutyrate 940 mg per 1 gramAmmonaps 940 mg/g
granules sugar-free| 266 gramP£ 860. 00
▶Pheburane(Lucane Pharma Ltd)
Sodium phenylbutyrate 483 mg per 1 gramPheburane 483 mg/g
granules| 174 gramP£ 331. 00
Tablet
▶Ammonaps(Swedish Orphan Biovitrum Ltd)
Sodium phenylbutyrate 500 mgAmmonaps 500 mg tablets|
250 tabletP£ 493. 003.14Wilson’s disease
ANTIDOTES AND CHELATORS›COPPER
ABSORPTION INHIBITORSZinc acetate
lDRUG ACTIONZinc prevents the absorption of copper in
Wilson’s disease.lINDICATIONS AND DOSE
Wilson’s disease (initiated under specialist supervision)
▶BY MOUTH
▶Child 1–5 years: 25 mg twice daily
▶Child 6–15 years (body-weight up to 57 kg): 25 mg 3 times
a day
▶Child 6–15 years (body-weight 57 kg and above): 50 mg
3 times a day
▶Child 16–17 years: 50 mg 3 times a day
DOSE EQUIVALENCE AND CONVERSION
▶Doses expressed as elemental zinc.
PHARMACOKINETICS
▶Symptomatic Wilson’s disease patients should be
treated initially with a chelating agent because zinc has
a slow onset of action. When transferring from
chelating treatment to zinc maintenance therapy,
chelating treatment should be co-administered for
2 – 3 weeks until zinc produces its maximal effect.lCAUTIONSPortal hypertension (risk of hepatic
decompensation when switching from chelating agent)
lINTERACTIONS→Appendix 1 : zinc
lSIDE-EFFECTS
▶Common or very commonEpigastric discomfort (usually
transient)
▶UncommonLeucopenia.sideroblastic anaemia
SIDE-EFFECTS, FURTHER INFORMATIONTransient gastric
irritation may be reduced iffirst dose is taken mid-
morning or with a little protein.lPREGNANCY
Dose adjustmentsUsual dose 25 mg 3 times daily adjusted
according to plasma-copper concentration and urinary
copper excretion.
lBREAST FEEDINGManufacturer advises avoid; present in
milk—may cause zinc-induced copper deficiency in infant.
lMONITORING REQUIREMENTSMonitor full blood count and
serum cholesterol.
lDIRECTIONS FOR ADMINISTRATIONCapsules may be
opened and the contents mixed with water.lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Capsule
CAUTIONARY AND ADVISORY LABELS 23
▶Wilzin(Orphan Europe (UK) Ltd)
Zinc (as Zinc acetate) 25 mgWilzin 25 mg capsules|
250 capsuleP£ 132. 00
Zinc (as Zinc acetate) 50 mgWilzin 50 mg capsules|
250 capsuleP£ 242. 00ANTIDOTES AND CHELATORS›COPPER
CHELATORSPenicillamine
lDRUG ACTIONPenicillamine aids the elimination of copper
ions in Wilson’s disease (hepatolenticular degeneration).lINDICATIONS AND DOSE
Wilson’s disease
▶BY MOUTH
▶Child 1 month–11 years: 20 mg/kg daily in 2 – 3 divided
doses, to be taken 1 hour before food; maximum 2 g per
day
▶Child 12–17 years:Initially 20 mg/kg daily in 2 – 3 divided
doses. maintenance 0. 75 – 1 g daily, to be taken 1 hour
before food; maximum 2 g per day
Cystinuria
▶BY MOUTH
▶Child: 20 – 30 mg/kg daily in 2 – 3 divided doses, lower
doses may be used initially and increased gradually,
doses to be adjusted to maintain 24 -hour urinary
cystine below 1 mmol/litre, maintain adequatefluid
intake, to be taken 1 hour before food; maximum 3 g
per daylCONTRA-INDICATIONSLupus erythematosus
lCAUTIONSNeurological involvement in Wilson’s disease
lINTERACTIONS→Appendix 1 : penicillamine
lSIDE-EFFECTS
▶Common or very commonProteinuria.thrombocytopenia
▶Rare or very rareAlopecia.breast enlargement (males and
females).connective tissue disorders.haematuria
(discontinue immediately if cause unknown).
hypersensitivity.oral disorders.skin reactions
▶Frequency not knownAgranulocytosis.aplastic anaemia.
appetite decreased.fever.glomerulonephritis.
Goodpasture’s syndrome.haemolytic anaemia.increased
risk of infection.jaundice cholestatic.leucopenia.lupus-
like syndrome.myasthenia gravis.nausea.nephrotic
syndrome.neurological deterioration in Wilson’s Disease.
neutropenia.pancreatitis.polymyositis.pulmonary
haemorrhage.rash (consider dose reduction).respiratory
disorders.Stevens-Johnson syndrome.taste loss (mineral
supplements not recommended).vomiting.yellow nail
syndrome
lALLERGY AND CROSS-SENSITIVITYPatients who are
hypersensitive to penicillin may react rarely to
penicillamine.616 Metabolic disorders BNFC 2018 – 2019
Blood and nutrition9