BNF for Children (BNFC) 2018-2019

▶Martapan(Martindale Pharmaceuticals Ltd)

Dexamethasone (as Dexamethasone sodium phosphate)

400 microgram per 1 mlMartapan 2 mg/ 5 ml oral solution sugar-

free| 150 mlP£ 35. 96 DT = £ 42. 30

eiiiiF 436

Fludrocortisone acetate 21-Dec-2017

lINDICATIONS AND DOSE

Mineralocorticoid replacement in adrenocortical

insufficiency

▶BY MOUTH

▶Neonate:Initially 50 micrograms once daily, adjusted

according to response; usual dose 50 – 200 micrograms

once daily, higher doses may be required, dose

adjustment may be required if salt supplements are

administered.

▶Child:Initially 50 – 100 micrograms once daily;

maintenance 50 – 300 micrograms once daily, adjusted

according to response, dose adjustment may be

required if salt supplements are administered

lINTERACTIONS→Appendix 1 : corticosteroids

lSIDE-EFFECTSConjunctivitis.exophthalmos.fatigue.

idiopathic intracranial hypertension.muscle atrophy.

muscle weakness.petechiae

lHEPATIC IMPAIRMENT

MonitoringMonitor patient closely in hepatic impairment.

lPATIENT AND CARER ADVICE

Medicines for Children leaflet: Fludrocortisone for hormone

replacementwww.medicinesforchildren.org.uk/fludrocortisone-

for-hormone-replacement

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

Tablet

CAUTIONARY AND ADVISORY LABELS 10

▶Fludrocortisone acetate (Non-proprietary)

Fludrocortisone acetate 100 microgramFludrocortisone

100 microgram tablets| 30 tabletP£ 13. 60 DT = £ 13. 60

eiiiiF 436

Hydrocortisone 21-Dec-2017

lINDICATIONS AND DOSE

Acute adrenocortical insufficiency (Addisonian crisis)

▶INITIALLY BY SLOW INTRAVENOUS INJECTION

▶Neonate:Initially 10 mg, then (by continuous

intravenous infusion) 100 mg/m^2 daily, alternatively (by

intravenous infusion) 100 mg/m^2 daily in divided doses,

to be given every 6 – 8 hours; adjusted according to

response, when stable reduce over 4 – 5 days to oral

maintenance dose.

▶BY SLOW INTRAVENOUS INJECTION, OR BY INTRAVENOUS

INFUSION

▶Child 1 month–11 years:Initially 2 – 4 mg/kg, then

2 – 4 mg/kg every 6 hours, adjusted according to

response, when stable reduce over 4 – 5 days to oral

maintenance dose

▶Child 12–17 years: 100 mg every 6 – 8 hours

Congenital adrenal hyperplasia

▶BY MOUTH USING IMMEDIATE-RELEASE MEDICINES

▶Neonate: 9 – 15 mg/m^2 in 3 divided doses, adjusted

according to response.

▶Child: 9 – 15 mg/m^2 in 3 divided doses, adjusted

according to response

Adrenal hypoplasia|Addison’s disease, chronic

maintenance or replacement therapy

▶BY MOUTH USING IMMEDIATE-RELEASE MEDICINES

▶Neonate: 8 – 10 mg/m^2 daily in 3 divided doses, the larger

dose to be given in the morning and the smaller in the

evening, higher doses may be needed.

▶Child: 8 – 10 mg/m^2 daily in 3 divided doses, the larger

dose to be given in the morning and the smaller in the

evening, higher doses may be needed

Inflammatory bowel disease—induction of remission

▶BY INTRAVENOUS INJECTION

▶Child 2–17 years: 2. 5 mg/kg every 6 hours (max. per dose

100 mg)

▶BY CONTINUOUS INTRAVENOUS INFUSION

▶Child 2–17 years: 10 mg/kg daily; maximum 400 mg per

day

Ulcerative colitis|Proctitis|Proctosigmoiditis

▶BY RECTUM USING RECTAL FOAM

▶Child 2–17 years:Initially 1 metered application

1 – 2 times a day for 2 – 3 weeks, then reduced to

1 metered application once daily on alternate days, to

be inserted into the rectum

Acute hypersensitivity reactions|Angioedema

▶BY INTRAMUSCULAR INJECTION, OR BY INTRAVENOUS

INJECTION

▶Child 1–5 months:Initially 25 mg 3 times a day, adjusted

according to response

▶Child 6 months–5 years:Initially 50 mg 3 times a day,

adjusted according to response

▶Child 6–11 years:Initially 100 mg 3 times a day, adjusted

according to response

▶Child 12–17 years:Initially 200 mg 3 times a day,

adjusted according to response

Hypotension resistant to inotropic treatment and volume

replacement (limited evidence)

▶BY INTRAVENOUS INJECTION

▶Neonate:Initially 2. 5 mg/kg, then 2. 5 mg/kg after

4 hours if required, followed by 2. 5 mg/kg every 6 hours

for 48 hours or until blood pressure recovers, dose to

then be reduced gradually over at least 48 hours.

▶Child: 1 mg/kg every 6 hours (max. per dose 100 mg)

Severe acute asthma|Life-threatening acute asthma

▶BY INTRAVENOUS INJECTION

▶Child 1 month–1 year: 4 mg/kg every 6 hours (max. per

dose 100 mg), alternatively 25 mg every 6 hours until

conversion to oral prednisolone is possible, dose given,

preferably, as sodium succinate

▶Child 2–4 years: 4 mg/kg every 6 hours (max. per dose

100 mg), alternatively 50 mg every 6 hours until

conversion to oral prednisolone is possible, dose given,

preferably, as sodium succinate

▶Child 5–11 years: 4 mg/kg every 6 hours (max. per dose

100 mg), alternatively 100 mg every 6 hours until

conversion to oral prednisolone is possible, dose given,

preferably, as sodium succinate

▶Child 12–17 years: 4 mg/kg every 6 hours (max. per dose

100 mg), alternatively 100 mg every 6 hours until

conversion to oral prednisolone is possible, dose given,

preferably, as sodium succinate

lUNLICENSED USEUse of injection by mouth is unlicensed.

lCONTRA-INDICATIONS

▶With rectal useBowel perforation.extensivefistulas.

intestinal obstruction.recent intestinal anastomoses

lCAUTIONS

▶With rectal useSystemic absorption may occur

lINTERACTIONS→Appendix 1 : corticosteroids

440 Corticosteroid responsive conditions BNFC 2018 – 2019

Endocrine system

6