BNF for Children (BNFC) 2018-2019

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
▶Ketamine (Non-proprietary)
Ketamine (as Ketamine hydrochloride) 50 mg per 1 mlKetamine
500 mg/ 10 ml solution for injection vials| 10 vialP£ 70. 00 b
▶Ketalar(Pfizer Ltd)
Ketamine (as Ketamine hydrochloride) 10 mg per 1 mlKetalar
200 mg/ 20 ml solution for injection vials| 1 vialP£ 5. 06 (Hospital
only)b
Ketamine (as Ketamine hydrochloride) 50 mg per 1 mlKetalar
500 mg/ 10 ml solution for injection vials| 1 vialP£ 8. 77 (Hospital
only)b

HYPNOTICS, SEDATIVES AND

ANXIOLYTICS›BENZODIAZEPINES
eiiiiF 218

Temazepam

lINDICATIONS AND DOSE

Premedication before surgery or investigatory procedures

▶BY MOUTH

▶Child 12–17 years: 10 – 20 mg, to be taken 1 hour before

procedure

lUNLICENSED USETablets not licensed for use in children.

lCONTRA-INDICATIONSCNS depression.compromised
airway.hyperkinesis.obsessional state.phobic states.
respiratory depression

lCAUTIONSHypoalbuminaemia.muscle weakness.organic
brain changes
CAUTIONS, FURTHER INFORMATION
▶Paradoxical effectsA paradoxical increase in hostility and
aggression may be reported by patients taking
benzodiazepines. The effects range from talkativeness and
excitement to aggressive and antisocial acts. Adjustment
of the dose (up or down) sometimes attenuates the
impulses. Increased anxiety and perceptual disorders are
other paradoxical effects.

lINTERACTIONS→Appendix 1 : temazepam

lSIDE-EFFECTSDreaming excessive.drug abuse.dry
mouth.hypersalivation.speech slurred

lBREAST FEEDINGBenzodiazepines are present in milk, and
should be avoided if possible during breast-feeding.
lHEPATIC IMPAIRMENTCan precipitate coma. Avoid in
severe impairment.
Dose adjustmentsStart with smaller initial doses or reduce
dose.

lRENAL IMPAIRMENT
Dose adjustmentsStart with small doses in severe
impairment.

lPATIENT AND CARER ADVICE
Driving and skilled tasksMay impair judgement and
increase reaction time, and so affect ability to drive or
operate machinery; they increase the effects of alcohol.
Moreover the hangover effects of a night dose may impair
driving on the following day.
Patients given sedatives and analgesics during minor
outpatient procedures should be very carefully warned
about the risks of undertaking skilled tasks (e.g. driving)
afterwards. Responsible persons should be available to
take patients home afterwards. The dangers of taking
alcoholshould be emphasised.

lPROFESSION SPECIFIC INFORMATION

Dental practitioners’formulary

Temazepam Tablets and Oral Solution may be prescribed.

lMEDICINAL FORMS

There can be variation in the licensing of different medicines

containing the same drug. Forms available from special-order

manufacturers include: oral suspension, oral solution

Oral solution

CAUTIONARY AND ADVISORY LABELS 19

▶Temazepam (Non-proprietary)

Temazepam 2 mg per 1 mlTemazepam 10 mg/ 5 ml oral solution

sugar free sugar-free| 300 mlP£ 184. 50 DT = £ 169. 44 c

Tablet

CAUTIONARY AND ADVISORY LABELS 19

▶Temazepam (Non-proprietary)

Temazepam 10 mgTemazepam 10 mg tablets| 28 tabletP

£ 35. 00 DT = £ 1. 36 c| 500 tabletP£ 24. 29 – £ 624. 82 c

Temazepam 20 mgTemazepam 20 mg tablets| 28 tabletP

£ 35. 00 DT = £ 1. 43 c| 250 tabletP£ 12. 77 – £ 307. 94 c

2 Malignant hyperthermia

MUSCLE RELAXANTS›DIRECTLY ACTING

Dantrolene sodium

lDRUG ACTIONActs on skeletal muscle cells by interfering

with calcium efflux, thereby stopping the contractile

process.

lINDICATIONS AND DOSE

Malignant hyperthermia

▶BY RAPID INTRAVENOUS INJECTION

▶Child:Initially 2 – 3 mg/kg, then 1 mg/kg, repeated if

necessary; maximum 10 mg/kg per course

Chronic severe spasticity of voluntary muscle

▶BY MOUTH

▶Child 5–11 years:Initially 500 micrograms/kg once daily

for 7 days, then increased to 500 micrograms/kg/dose

3 times a day, then increased in steps of

500 micrograms/kg/dose every 7 days (max. per dose

2 mg/kg 3 – 4 times a day) until satisfactory response;

maximum 400 mg per day

▶Child 12–17 years:Initially 25 mg once daily for 7 days,

then increased to 25 mg 3 times a day, then increased

in steps of 500 micrograms/kg/dose every 7 days (max.

per dose 2 mg/kg 3 – 4 times a day) until satisfactory

response; maximum 400 mg per day

lUNLICENSED USENot licensed for use in children.

IMPORTANT SAFETY INFORMATION

Should only be administered by, or under the direct

supervision of, personnel experienced in the use of

dantrolene when used for malignant hyperthermia.

lCONTRA-INDICATIONS

▶With oral useAcute muscle spasm.avoid when spasticity is

useful, for example, locomotion

lCAUTIONS

▶With intravenous useAvoid extravasation (risk of tissue

necrosis)

▶With oral useFemales (hepatotoxicity).history of liver

disorders (hepatotoxicity).if doses greater than 400 mg

daily (hepatotoxicity).impaired cardiac function.

impaired pulmonary function.therapeutic effect may take

a few weeks to develop—discontinue if no response within

6 – 8 weeks

lINTERACTIONS→Appendix 1 : dantrolene

lSIDE-EFFECTS

GENERAL SIDE-EFFECTS

▶Common or very commonAbdominal pain.hepatic

disorders.nausea.respiratory disorders.skin reactions.

speech disorder.vomiting

BNFC 2018 – 2019 Malignant hyperthermia 821

Anaesthesia

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