BNF for Children (BNFC) 2018-2019

lRENAL IMPAIRMENTPossible accumulation of lidocaine
and active metabolite; caution in severe impairment.
lMONITORING REQUIREMENTSMonitor ECG and have
resuscitation facilities available.

lDIRECTIONS FOR ADMINISTRATIONForintravenous
infusion, dilute with Glucose 5 % or Sodium Chloride 0. 9 %.

lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: solution for injection
Solution for injection
▶Lidocaine hydrochloride (Non-proprietary)
Lidocaine hydrochloride 5 mg per 1 mlLidocaine 50 mg/ 10 ml
( 0. 5 %) solution for injection ampoules| 10 ampouleP£ 7. 00
( 1 %) solution for injection Mini-Plasco ampoules| 20 ampouleP
£ 11. 21
Lidocaine 100 mg/ 10 ml ( 1 %) solution for injection ampoules|
10 ampouleP£ 4. 40 DT = £ 4. 40
Lidocaine 100 mg/ 10 ml ( 1 %) solution for injection Sure-Amp ampoules
| 20 ampouleP£ 8. 80
Lidocaine 200 mg/ 20 ml ( 1 %) solution for injection vials| 10 vialP
£ 19. 00
10 ampouleP£ 7. 00 – £ 9. 63 DT = £ 9. 63
10 ampouleP£ 2. 59 – £ 3. 10 DT = £ 2. 59
10 ampouleP£ 3. 50 DT = £ 2. 20
Lidocaine 50 mg/ 5 ml ( 1 %) solution for injection Sure-Amp ampoules|
20 ampouleP£ 6. 00
( 2 %) solution for injection ampoules| 10 ampouleP£ 2. 70 – £ 3. 80
DT = £ 2. 70
Lidocaine 400 mg/ 20 ml ( 2 %) solution for injection vials| 10 vialP
£ 19. 50
Lidocaine 200 mg/ 10 ml ( 2 %) solution for injection Mini-Plasco
ampoules| 20 ampouleP£ 14. 95
10 ampouleP£ 4. 00 DT = £ 2. 37
Lidocaine 100 mg/ 5 ml ( 2 %) solution for injection Sure-Amp ampoules
| 20 ampouleP£ 6. 00
10 ampouleP£ 8. 00 – £ 9. 90 DT = £ 9. 90

ANTIARRHYTHMICS›CLASS IC

Flecainide acetate

lINDICATIONS AND DOSE Supraventricular arrhythmias ▶BY MOUTH USING MODIFIED-RELEASE MEDICINES ▶Child 12–17 years: 200 mg daily Resistant re-entry supraventricular tachycardia| Ventricular ectopic beats or ventricular tachycardia| Arrhythmias associated with accessory conduction pathways (e.g. Wolff-Parkinson-White syndrome)| Paroxysmal atrial fibrillation ▶BY MOUTH USING IMMEDIATE-RELEASE MEDICINES ▶Neonate: 2 mg/kg 2 – 3 times a day, adjusted according to response, also adjust dose according to plasma- flecainide concentration.

▶Child 1 month–11 years: 2 mg/kg 2 – 3 times a day, adjusted according to response, also adjust dose according to plasma-flecainide concentration,; maximum 8 mg/kg per day; maximum 300 mg per day ▶Child 12–17 years:Initially 50 – 100 mg twice daily; increased if necessary up to 300 mg daily, maximum 400 mg daily for ventricular arrhythmias in heavily built children

▶INITIALLY BY SLOW INTRAVENOUS INJECTION, OR BY

INTRAVENOUS INFUSION

▶Neonate:Initially 1 – 2 mg/kg, dose to be given over 10 – 30 minutes, followed by (by continuous intravenous infusion) 100 – 250 micrograms/kg/hour if required until arrhythmia controlled, transfer patient to oral treatment following intravenous treatment.

▶Child 1 month–11 years:Initially 2 mg/kg, dose to be given over 10 – 30 minutes, followed by (by continuous intravenous infusion) 100 – 250 micrograms/kg/hour if required until arrhythmia controlled, maximum cumulative dose of 600 mg in thefirst 24 hours, transfer patient to oral treatment following intravenous treatment ▶Child 12–17 years:Initially 2 mg/kg (max. per dose 150 mg), dose to be given over 10 – 30 minutes, followed by (by continuous intravenous infusion) 1. 5 mg/kg/hour if required for 1 hour, then (by continuous intravenous infusion) reduced to 100 – 250 micrograms/kg/hour until arrhythmia controlled, maximum cumulative dose of 600 mg in the first 24 hours, transfer patient to oral treatment following intravenous treatment DOSE ADJUSTMENTS DUE TO INTERACTIONS ▶Manufacturer advises reduce dose by half with concurrent use of amiodarone. DOSE EQUIVALENCE AND CONVERSION ▶Patients stabilised on 200 mg daily immediate-release flecainide may be transferred to modified-release medicines.

lUNLICENSED USENot licensed for use in children under 12 years. lCONTRA-INDICATIONSAbnormal left ventricular function. atrial conduction defects (unless pacing rescue available). bundle branch block (unless pacing rescue available). control of arrhythmias in acute situations (for modified- release forms only).distal block (unless pacing rescue available).haemodynamically significant valvular heart disease.heart failure.long-standing atrialfibrillation where conversion to sinus rhythm not attempted.second- degree or greater AV block (unless pacing rescue available) .sinus node dysfunction (unless pacing rescue available) lCAUTIONSAtrialfibrillation following heart surgery. patients with pacemakers (especially those who may be pacemaker dependent because stimulation threshold may rise appreciably) lINTERACTIONS→Appendix 1 : antiarrhythmics lSIDE-EFFECTS ▶Common or very commonArrhythmias.asthenia.dizziness .dyspnoea.fever.oedema.vision disorders ▶UncommonAlopecia.appetite decreased.constipation. diarrhoea.flatulence.gastrointestinal discomfort.nausea .skin reactions.vomiting ▶Rare or very rareAnxiety.confusion.corneal deposits. depression.drowsiness.flushing.hallucination. headache.hepatic disorders.hyperhidrosis.insomnia. memory loss.movement disorders.peripheral neuropathy .photosensitivity reaction.respiratory disorders.seizure. sensation abnormal.syncope.tinnitus.tremor.vertigo ▶Frequency not knownAltered pacing threshold. atrioventricular block.cardiac arrest.chest pain.heart failure.hypotension.myocardial infarction.palpitations .QT interval prolongation lPREGNANCYUsed in pregnancy to treat maternal and fetal arrhythmias in specialist centres; toxicity reported in animalstudies; infant hyperbilirubinaemia also reported. lBREAST FEEDINGSignificant amount present in milk but not known to be harmful.

BNFC 2018 – 2019 Arrhythmias 77

Cardiovascular system

2

BNF for Children (BNFC) 2018-2019

▶INITIALLY BY SLOW INTRAVENOUS INJECTION, OR BY

INTRAVENOUS INFUSION

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