BNF for Children (BNFC) 2018-2019

▶Child 3 months–17 years (body-weight 13–27 kg): 30 mg

3 times a day until diarrhoea stops; maximum duration

of treatment 7 days

▶Child 3 months–17 years (body-weight 28 kg and

above): 60 mg 3 times a day until diarrhoea stops;

maximum duration of treatment 7 days

lCONTRA-INDICATIONSAntibiotic-associated diarrhoea

lSIDE-EFFECTS

▶UncommonSkin reactions.tonsillitis

▶Frequency not knownAngioedema.erythema nodosum.

eyelid oedema.face oedema.oral disorders

SIDE-EFFECTS, FURTHER INFORMATIONSevere skin

reactions have been reported—discontinue treatment

immediately.

lPREGNANCYManufacturer advises avoid—no information

available.

lBREAST FEEDINGManufacturer advises avoid—no

information available.

lHEPATIC IMPAIRMENTManufacturer advises avoid.

lRENAL IMPAIRMENTManufacturer advises avoid.

lDIRECTIONS FOR ADMINISTRATIONGranules may be added

to food or mixed with water or bottle feeds and then taken

immediately.

lPATIENT AND CARER ADVICEPatients and carers should be

given advice on how to administer racecadotril granules.

lNATIONAL FUNDING/ACCESS DECISIONS

Scottish Medicines Consortium (SMC) Decisions

TheScottish Medicines Consortium, has advised (July 2014 )

that racecadotril (Hidrasec®)isnotrecommended for use

within NHS Scotland for the treatment of acute diarrhoea

in children because there is insufficient evidence that it

improves the recovery rate.

lMEDICINAL FORMS

There can be variation in the licensing of different medicines

containing the same drug.

Granules

EXCIPIENTS:May contain Sucrose

▶Hidrasec(Lincoln Medical Ltd)

Racecadotril 10 mgHidrasec Infants 10 mg granules sachets|

20 sachetP£ 8. 42

Racecadotril 30 mgHidrasec Children 30 mg granules sachets|

20 sachetP£ 8. 42

4 Disorders of gastric acid

and ulceration

4.1 Dyspepsia

Dyspepsia

Overview

Dyspepsia covers upper abdominal pain, fullness, early

satiety, bloating, and nausea. It can occur with gastric and

duodenal ulceration, gastro-oesophageal reflux disease,

gastritis, and upper gastro-intestinal motility disorders, but

most commonly it is of uncertain origin.

Patients with dyspepsia should be advised about lifestyle

changes (avoidance of excess alcohol and of aggravating

foods such as fats); other measures include weight reduction,

smoking cessation, and raising the head of the bed. Some

medications may cause dyspepsia—these should be stopped,

if possible.

A compound alginate preparation may provide relief from

dyspepsia; persistent dyspepsia requires investigation.

Treatment with a H 2 -receptor antagonist or a proton pump

inhibitor should be initiated only on the advice of a hospital

specialist.

Helicobacter pylorimay be present in children with

dyspepsia.H. pylorieradication therapy should be considered

for persistent dyspepsia if it is ulcer-like. However, most

children with functional (investigated, non-ulcer) dyspepsia

do not benefit symptomatically fromH. pylorieradication.

ANTACIDS

Antacids

Overview

Antacids (usually containing aluminium or magnesium

compounds) can often relieve symptoms inulcer dyspepsia

and innon-erosive gastro-oesophageal reflux; they are also

sometimes used in functional (non-ulcer) dyspepsia but the

evidence of benefit is uncertain.

Aluminium- andmagnesium-containing antacids, being

relatively insoluble in water, are long-acting if retained in

the stomach. They are suitable for most antacid purposes.

Magnesium-containing antacids tend to be laxative whereas

aluminium-containing antacids may be constipating;

antacids containing both magnesium and aluminium may

reduce these colonic side-effects.

Complexes such ashydrotalciteconfer no special

advantage.

Calcium-containingantacids can induce rebound acid

secretion; with modest doses the clinical significance of this

is doubtful, but prolonged high doses also cause

hypercalcaemia and alkalosis.

Simeticone

Simeticone (activated dimeticone p. 728 ) is used to treat

infantile colic, but the evidence of benefit is uncertain.

Simeticone is added to an antacid as an antifoaming agent

to relieveflatulence. These preparations may be useful for

the relief of hiccup in palliative care.

Alginates

Alginatestaken in combination with an antacid increases

the viscosity of stomach contents and can protect the

oesophageal mucosa from acid reflux. Some alginate-

containing preparations form a viscous gel (‘raft’) thatfloats

on the surface of the stomach contents, thereby reducing

symptoms of reflux. Alginate-containing preparations are

used in the management of mild symptoms of dyspepsia and

gastro-oesophageal reflux disease.

The amount of additional ingredient or antacid in

individual preparations varies widely, as does their sodium

content, so that preparations may not be freely

interchangeable.

ANTACIDS›ALGINATE

Alginic acid

lINDICATIONS AND DOSE

GAVISCON INFANT®POWDER SACHETS

Management of gastro-oesophageal reflux disease

▶BY MOUTH

▶Neonate (body-weight up to 4.5 kg): 1 dose as required, to

be mixed with feeds (or water, for breast-fed infants);

maximum 6 doses per day.

▶Neonate (body-weight 4.5 kg and above): 2 doses as

required, to be mixed with feeds (or water, for breast-fed

infants); maximum 12 doses per day.

50 Disorders of gastric acid and ulceration BNFC 2018 – 2019

Gastro-intestinal system

1