BNF for Children (BNFC) 2018-2019

lSIDE-EFFECTS

OverdoseMassive overdose can cause rough skin, dry hair,

an enlarged liver, and a raised erythrocyte sedimentation

rate and raised serum calcium and serum alkaline

phosphatase concentrations

lPREGNANCYExcessive doses may be teratogenic. In view
of evidence suggesting that high levels of vitamin A may
cause birth defects, women who are (or may become)
pregnant are advised not to take vitamin A supplements
(including tablets andfish liver oil drops), except on the
advice of a doctor or an antenatal clinic; nor should they
eat liver or products such as liver paté or liver sausage.

lBREAST FEEDINGTheoretical risk of toxicity in infants of
mothers taking large doses.

lMONITORING REQUIREMENTSTreatment is sometimes
initiated with very high doses of vitamin A and the child
should be monitored closely; very high doses are
associated with acute toxicity.

lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: oral drops, solution for injection
Solution for injection
▶Vitamin A (Imported)
Retinol (as Vitamin A palmitate) 50000 unit per 1 mlAquasol A
Parenteral 100 , 000 units/ 2 ml solution for injection vials|
1 vialPs
Nepalm Vitamin A 100 , 000 units/ 2 ml solution for injection ampoules|
6 ampoulePs
Oral drops
▶Arovit (Imported (Italy))
Vitamin A 150000 unit per 1 mlArovit 150 , 000 units/ml drops|
7. 5 mlPs
Combinations available:Vitamins A, C and D,p. 626

VITAMINS AND TRACE ELEMENTS›VITAMIN B

GROUP

Biotin

(Vitamin H)

lINDICATIONS AND DOSE

Isolated carboxylase defects

▶BY MOUTH, OR BY SLOW INTRAVENOUS INJECTION

▶Neonate: 5 mg once daily, adjusted according to

response, maintenance 10 – 50 mg daily, higher doses

may be required.

▶Child: 10 mg once daily, adjusted according to

response; maintenance 10 – 50 mg daily, increased if

necessary up to 100 mg daily

Defects of biotin metabolism

▶BY MOUTH, OR BY SLOW INTRAVENOUS INJECTION

▶Neonate:Initially 10 mg once daily, adjusted according

to response; maintenance 5 – 20 mg daily, higher doses

may be required.

▶Child:Initially 10 mg once daily, adjusted according to

response; maintenance 5 – 20 mg daily, higher doses

may be required

lPREGNANCYNo information available.

lBREAST FEEDINGNo information available.

lDIRECTIONS FOR ADMINISTRATIONFor administrationby
mouth, tablets may be crushed and mixed with food or
drink.

lPATIENT AND CARER ADVICE
Medicines for Children leaflet: Biotin for metabolic disorders
http://www.medicinesforchildren.org.uk/biotin-metabolic-disorders- 0

lMEDICINAL FORMS

There can be variation in the licensing of different medicines

containing the same drug. Forms available from special-order

manufacturers include: tablet, oral suspension, oral solution

Solution for injection

▶Biodermatin (Imported (Italy))

Biotin 5 mg per 1 mlBiodermatin 5 mg/ 1 ml solution for injection

vials| 10 vialPs

Tablet

▶Biotin (Imported)

Biotin 5 mgBiotin-ratiopharm 5 tablets| 30 tabletPs

Biotin 10 mgBiotisan Biotin S 10 mg FORTE tablets| 30 tablets

▶OroB 7 (Rhodes Pharma Ltd)

Biotin 5 mgOroB 75 mg tablets| 30 tablet £ 33. 99

Pyridoxine hydrochloride

(Vitamin B 6 )

lINDICATIONS AND DOSE

Isoniazid-induced neuropathy (prophylaxis)

▶BY MOUTH

▶Neonate: 5 mg daily.

▶Child 1 month–11 years: 5 – 10 mg daily

▶Child 12–17 years: 10 mg daily

Isoniazid-induced neuropathy (treatment)

▶BY MOUTH

▶Neonate: 5 – 10 mg daily.

▶Child 1 month–11 years: 10 – 20 mg 2 – 3 times a day

▶Child 12–17 years: 30 – 50 mg 2 – 3 times a day

Prevention of penicillamine-induced neuropathy in

Wilson’s disease

▶BY MOUTH

▶Child 1–11 years: 5 – 10 mg daily

▶Child 12–17 years: 10 mg daily

Metabolic diseases|Cystathioninuria|Homocystinuria

▶BY MOUTH

▶Neonate: 50 – 100 mg 1 – 2 times a day.

▶Child: 50 – 250 mg 1 – 2 times a day

Pyridoxine-dependent seizures

▶INITIALLY BY INTRAVENOUS INJECTION

▶Neonate:Test dose 50 – 100 mg, repeated if necessary, if

responsive, followed by an oral maintenance dose; (by

mouth) maintenance 50 – 100 mg once daily, dose to be

adjusted as necessary.

▶Child 1 month–11 years:Test dose 50 – 100 mg daily, if

responsive, followed by an oral maintenance dose, (by

mouth) maintenance 20 – 50 mg 1 – 2 times a day, dose

to be adjusted as necessary, (by mouth) increased if

necessary up to 30 mg/kg daily, alternatively (by

mouth) increased if necessary up to 1 g daily

lUNLICENSED USENot licensed for prophylaxis of

penicillamine-induced neuropathy in Wilson’s disease.

Not licensed for use in children.

lCAUTIONS

▶With intravenous userisk of cardiovascular collapse (with

intravenous injection—resuscitation facilities must be

available and monitor closely)

lSIDE-EFFECTSPeripheral neuritis

BNFC 2018 – 2019 Vitamin deficiency 627

Blood and nutrition

9