Children Hospital Formulary

THE CHILDREN’S HOSPITAL
FORMULARY
2023-25
The Children’s Hospital & University of Child Health Sciences, Lahore

Specialized Healthcare & Medical Education Department
Government of Punjab, Lahore. Pakistan
CH & UCHS, LAHORE I

FOREWORD
The drug formulary of The Children’s Hospital & the University of Child Health
Sciences, Lahore is a unique source of information for the hospital staff,
pediatricians and all those involved in child health. With the limited time available
to the practitioners the accurate and quickly option for up to date information
about new drug recommendations, their doses and treatment is essential. The
Pharmacy & Therapeutic Committee of The Children’s Hospital & University of
Child Health Sciences, Lahore is dedicated to providing the most accurate
information available in a concise practical format for hospital formulary. This
formulary is bringing together authoritative, independent guidance on best practice
with clinically validated drug information, enabling healthcare professionals to
select safe and effective medicines for individual patients with obvious emphasis
on paediatrics and child health.
The Pharmacy & Therapeutic Committee picked information and advice from
various experts in the field of child health as evident by the lengthy list of
contributors to this formulary. In this edition, suggestions were also made by
individual consultants to improve the presentation and information on specific
drugs and different areas incorporated into this edition. The Children’s Hospital
Formulary (CHF) is a pharmaceutical reference book that contains a wide
spectrum of information and advice on prescribing and pharmacology, along with
specific facts and details about many medicines available in Pakistan.
I admire the dedication and work of the Pharmacy Department whose
commitment to this endeavor is unparalleled. It is also worth mentioning that
some omissions and errors are inevitable in a book of this type. I ask the medical
community in general and paediatric community in particular to assist the
committee actively by suggesting specific ways to improve the quality of future
editions. The Pharmacy & Therapeutic Committee endeavors to provide the most
current, relevant evidence based recommendations in infants, children and
adolescents.
I would like to acknowledge Mr. Usama Sardar Gorsi Deputy Drugs
Controller who played a pivotal role in the compilation of Children Hospital & the
Institute of Child Health drug formulary.
PROF. DR. MASOOD SADIQ FRCP

Tamgha-e-Imtiaz
Professor of Pediatric Cardiology
Vice Chancellor
CH & UCHS, LAHORE II

PREFACE
The Drug Formulary of The Children’s Hospital & University of
Child Health Sciences Lahore aims to provide prescribers,
pharmacists & other health care professionals with sound up-to-date
information on the use of medicines for treating children. Covering
neonates to adolescents, this formulary includes key information on
selection, prescribing, dispensing and administration of medicines in
our own set up.
The purpose of this formulary is to ensure the availability of safe,

effective and cost efficient medication. The formulary is also to help
ensure the availability of medicines, at times there may be external
factors that impact inventory levels of certain medications. The
problems at the level of pharmaceutical manufacturers, importers
and sole agents often impact our ability to procure medications.
Shortages of medications are communicated to medical staff
whenever this occurs.
Usama Sardar Gorsi

Deputy Drugs Controller
CH & UCHS, LAHORE III

TABLE OF CONTENTS
PHARMACY SERVICES IN CHILDREN HOSPITAL LAHORE 2
PHARMACY & THERAPEUTIC COMMITTEE 3
GUIDELINE FOR PRESCRIBERS 4
NOTES ON DRUGS & PREPARATIONS
1. DRUGS ACTING ON GASTROINTESTINAL SYSTEM 5
2. DRUGS ACTING ON CARDIOVASCULAR SYSTEM 11
3. DRUGS ACTING ON RESPIRATORY SYSTEM 43
4. DRUGS ACTING ON CENTRAL NERVOUS SYSTEM 53
5. DRUGS USED IN THE TREATMENT OF INFECTIONS 81
6. DRUGS ACTING ON ENDOCRINE SYSTEM 132
7. MALIGNANT DISEASE AND IMMUNOSUPPRESSION 142
8. NUTRITION AND BLOOD 154
9. DRUGS USED IN MUSCULOSKELETAL AND JOINT DISEASES 171
10. DRUGS ACTING ON EYE 178
11. DRUGS ACTING ON EAR, NOSE AND OROPHARYNX 180
12. DRUGS ACTING ON SKIN 182
13. MMUNOLOGICAL PRODUCTS AND VACCINES 194
14. DRUGS USED IN ANAESTHESIA 191
15. CONTRAST MEDIA USED IN RADIOLOGY 203
16. ANTIDOTES & OTHER SUBSTANCES USED IN POISONING 204
DISPOSABLES / MEDICINES ITEMS 209
SUTURES AND LIGATURES MATERIAL 210
SURGICAL GAUZE AND BANANDAGE 212
ANASTHESIA DISPOSABLE ITEMS 213
CARDIAC SURGERY DISPOSABLE ITEMS 214
ANGIOGRAPHY DISPOSABLE ITEMS 215
RECONSTRUCTIVE SURGERY DISPOSABLE ITEMS 217
OTHER SPECIALSED DISPOSABLE ITEMS 218
CHEMICALS 222
PERFORMAS USED IN HOSPITAL
ADVERSE DRUG REACTION REPORTING FORM 223
DRUG INFORMATION PERFORMA 226
PRODUCT RECALL FORM 227
SPECIAL MEDICINES APPROVAL FORM 228
NARCOTICS APPROVAL FORM 229
INDEX 230
CH & UCHS, LAHORE 1

PHARMACY SERVICES IN CHILDREN HOSPITAL LAHORE
INTRODUCTION
Over the past decade The Children Hospital and University of Child Health Sciences has
established itself as a center of excellence providing comprehensive care, free of cost to
thousands of pediatric patients. The Foundation stone of Children Hospital was laid down in
1990, OPD block was operationalized in May, 1995 and Emergency services were started in
October, 1996. The Children’s Hospital has been providing inpatient services since
December, 1998. The Hospital provides wide range of services both inpatient and
outpatient, with full backup of Diagnostic services.
The Department of Pharmaceutical services strives to provide Modern Pharmaceutical
Services to masses through following Pharmacies
1. Central Pharmacy
2. Indoor Pharmacy
3. OPD Pharmacy
4. Accidental & Emergency Pharmacy
5. Drug Information & Pharmacovigilance Center
6. Inpatient / Clinical Services
7. Aseptic and Extemporaneous Dispensing Section
8. Model Pharmacy
MISSION
The mission of Department of Pharmaceutical Services CH & UCHS is To Serve. This
mission is fulfilled through commitment to following standards of practices.
 Department will serve patients by providing pharmaceutical care.
 Department will serve other health care professionals by treating them as customers and
ensure that their needs are met with in content of good pharmacy practice.
 Management team will serve by maintaining environment that foster professional
growth.
 Department will serve hospital by becoming regionally and nationally recognized leader
in hospital pharmacy by stabilizing itself as source of pride for hospital.
 Department will serve schools of pharmacy and its faculty by providing environment
conductive to teaching, practicing and conducting research.
 Department will serve pharmacy student and resident by providing environment
conductive to learning all aspects of pharmacy practice.
 Department will serve profession of pharmacy by developing programmes and
processes that continuously advances practice and improves patient care.
 Department will serve hospital by fulfilling vision, mission and values of institution.
CH & UCHS, LAHORE 2

PHARMACY & THERAPEUTIC COMMITTEE
Sr No Name Status
1 Prof. Dr Masood Sadiq Chairman
Vice Chancellor
2 Prof. Dr. Muhammad Saleem Co Chairman
Medical Director
3 Dr Faeza Hasnain (Ph.D) Secretary
Drugs Controller / Chief Pharmacist
4 Prof. Dr. Shazia Maqbool Member
Prof of Developmental & Behavioural Paediatrics
5 Prof. Dr. Tipu Sultan Member
Prof of Paediatrics Neurology
6 Prof Dr Aiza Zaffar Member
Prof. of Paeds. Microbiology
7 Prof. Dr. Junaid Rasheed Member
Prof of Paeds Medicine
8 Prof. Dr. Nabeela Tallat Member
Prof. of Paeds Surgery
9 Prof. Abid Ali Qureshi Member
Prof. of Paeds. Radiology
10 Prof. Dr. Syed Muhammad Javed Member
Prof of Paeds. Medicine
11 Prof. Dr Saeedah Asif Member
Prof. of Paeds Anesthesia
12 Prof. Dr Muhammad Asim Khan Member
Prof. Paeds Cardiac Surgery
13 Dr. Farah Naz Member
Associate Prof. Paeds Medicine
14 Dr. Naureen Akhter Member
Associate Prof. Paeds Nephrology
15 Dr Farah Haroon Member
Associate Prof. Neonatology
16 Dr Anjum Saeed Member
Associate Prof. Paeds Gastroentrology
17 Dr Mehwish Faizan Member
Associate Prof Paeds Haematology & Oncology
18 Dr Nasir Rama Member
Associate Prof Paeds Medicine
19 Dr Mumtaz Hussain Member
Assistant Prof. Paeds Orthopedic Surgery
20 Usama Sardar Gorsi Member
Deputy Drugs Controller
21 Mst Bushra Shaheen Member
Nursing Superintendent
CH & UCHS, LAHORE 3

GUIDELINES FOR PRESCRIBERS
The following are guidelines for prescription writing in an attempt to help

reduce medication/prescribing errors.
1. Sign and date all prescriptions, this is a legal requirement.
2. Approved or generic names, should be used whenever possible and in order to

avoid medication errors due to poor handwriting it is recommended that the prescribers
use capital letters on all occasions, especially on In-Patient Medication Charts.
3. Write out names in full; avoid use of chemical symbols and abbreviations. e.g.
FeSO4 should be written as ferrous sulphate, PZA as Pyrazinamide, INH as Isoniazid
etc.
4. State the dose in terms of active ingredient, not for example the number of tablets,
puffs of inhaler, or volume of liquid, except in the case of compound preparations e.g.
multivitamins tablets once a day is allowed.
5. When writing units e.g. for heparin or insulin, write units in full and NOT as u.
6. When writing dose in terms of micrograms this must also be written in full, NOT
as mcg or g (milligrams can be written as mg).
7. For any dose changes, always cut off original drug and dose (sign and date when
stopped), then rewrite the drug again with the new dose.
8. Always specify the route and time of administration, standard drug

administration times for drugs advised 4 hourly should be as 02:00, 06:00, 10:00, 14:00,
18:00 and 22:00 hours.
9. When writing antibiotics prescriptions, frequency of dose should be mentioned in

hours e.g. four, six, eight, twelve and twenty four hourly
10. When re-writing prescription charts, take care not to miss off any drugs, or
rewrite drugs that have been discontinued.
ALWAYS WRITE THE DATE ON WHICH THE DRUG WAS STARTED,

NOT THE DATE THE CHART WAS RE-WRITTEN.
ADDITIONAL POINTS
Always document in patient notes, reason for starting or stopping a drug.
Make sure the nurse looking after a patient is aware of new prescriptions or once
only medicines to enable ordering and administration at correct time
CH & UCHS, LAHORE 4

SECTION 1: DRUGS ACTING ON GASTRO INTESTINAL
SYSTEM
1.1 AMINOSALICYLATES
1.1.1 Mesalazine
Indication & Doses
*Treatment of mild to moderate ulcerative colitis, acute attack
BY MOUTH
Child 12–17 years: 800 mg 3 times a day
*Maintenance of remission of ulcerative colitis and Crohn’s ileo-colitis
BY MOUTH
Child 12–17 years: 400–800 mg 2–3 times a day
Preparation
Tab 400mg
Masacol
1.1.2 Sulfasalazine
Indication & Doses
*Treatment of acute attack of mild to moderate and severe ulcerative colitis, Active
Crohn’s disease
BY MOUTH
Child 2–11 years: 10–15 mg/kg 4–6 times a day (max. per dose 1g) until remission
occurs; increased if necessary up to 60 mg/kg daily in divided doses
Child 12–17 years: 1–2g 4 times a day until remission occurs
BY RECTUM
Child 5–7 years: 500 mg twice daily
Child 8–11 years: 500 mg, dose to be administered in the morning and 1 g, dose to be
administered at night
Child 12–17 years: 0.5–1g twice daily
*Maintenance of remission of mild to moderate and severe ulcerative colitis
BY MOUTH
Child 2–11 years: 5–7.5 mg/kg4 times a day (max. per dose 500 mg)
BY RECTUM
Child 8–11 years: 500 mg, dose to be administered in the morning and 1g, dose to be
administered at night
Child 12–17 years: 0.5–1g twice daily
*Juvenile idiopathic arthritis
BY MOUTH
Child 2–11 years: Initially 5 mg/kg twice daily for 1 week, then 10 mg/kg twice daily for
1 week, then 20 mg/kg twice daily for 1week; maintenance 20–25 mg/kg twice daily;
maximum 2g per day Child 12–17 years: Initially 5 mg/kg twice daily for 1 week, then
10 mg/kg twice daily for 1 week, then 20 mg/kg twice daily for 1 week; maintenance 20–
25 mg/kg twice daily; maximum 3g per day
Preparation
Tab 500mg
CH & UCHS, LAHORE 5

Salazodine
1.2 ANTACIDS AND OTHER DRUGS FOR DYSPEPSIA

Oxethazine + Al(OH)3 + Mg(OH)2
Doses
5ml 4 times daily 15 min before meal and at bed time
Preparation
Syp
Mucaine
1.3 ANTISPASMODICS
Hyoscine Butyl Bromide
Indication & Doses
*Symptomatic relief of gastro-intestinal or genito-urinary disorders characterised by
smooth muscle spasm
BY MOUTH
*Acute spasm|Spasm in diagnostic procedures
INITIALLY BY INTRAMUSCULAR INJECTION, OR BY SLOW INTRAVENOUS
INJECTION
Child 2–5 years: 5 mg, then (by intramuscular injection or by slow intravenous
injection) 5mg after 30 minutes if required, dose may be repeated more frequently in
endoscopy; maximum 15 mg per day
Child 6–11 years: 5–10 mg, then (by intramuscular injection or by intravenous
injection) 5–10 mg after 30 minutes if required, dose may be repeated more frequently
in endoscopy; maximum 30mg per day
Child 12–17 years: 20 mg, then (by intramuscular injection or by slow intravenous
injection) 20mg after 30 minutes if required, dose may be repeated more frequently in
endoscopy; maximum 80mg per day
*Excessive respiratory secretions in palliative care
BY MOUTH
Child 1 month–1 year: 300–500 micrograms/kg 3–4 times a day (max. per dose 5mg)
Child 2–4 years: 5mg 3–4 times a day
Child 5–11 years: 10 mg 3–4 times a day
BY INTRAMUSCULAR INJECTION, OR BY INTRAVENOUS INJECTION
Child 1 month–4 years: 300–500 micrograms/kg 3–4 times a day (max. per dose 5mg)
Child 5–11 years: 5–10 mg 3–4times a day
*Bowel colic in palliative care
BY MOUTH
Child 1 month–1 year: 300–500 micrograms/kg 3–4 times a day (max. per dose 5mg)
CH & UCHS, LAHORE 6

Child 1 month–4 years: 300–500 micrograms/kg 3–4 times a day (max. per dose 5mg)
Preparation
Syp 5mg/5ml
Spasler P
1.4 PROTON PUMP INHIBITORS

Omeprazole
Indication and Doses
*Helicobacter pylori eradication in combination with amoxicillin and clarithromycin;
or in combination with amoxicillin and metronidazole; or in combination with
clarithromycin and metronidazole
BY MOUTH
Child 1–5 years: 1–2mg/kg once daily (max. per dose 40mg)
Child 6–11 years: 1–2mg/kg once daily (max. per dose 40mg)
Child 12–17 years: 40 mg once daily
*Treatment of duodenal ulcers including those complicating NSAID therapy
Treatment of benign gastric ulcers including those complicating NSAID therapy
BY MOUTH
Neonate: 700 micrograms/kg once daily for 7–14 days, then increased if necessary to
1.4–2.8mg/kg once daily.
Child 1 month–1 year: 700 micrograms/kg once daily, increased if necessary to 3
mg/kg once daily (max. per dose 20 mg)
Child 2–17 years (body-weight 10–19 kg): 10 mg once daily, increased if necessary to
20 mg once daily
Child 2–17 years (body-weight 20 kg and above): 20 mg once daily, increased if
necessary to 40 mg once daily
BY INTRAVENOUS INJECTION, OR BY INTRAVENOUS INFUSION
Child 1 month–11 years: Initially 500 micrograms/kg once daily (max. per dose 20
mg), increased if necessary to 2mg/kg once daily (max. per dose 40 mg), injection to be
given over 5 minutes
Child 12–17 years: 40 mg once daily, injection to be given over 5 minutes
*Zollinger–Ellison syndrome
BY MOUTH
Child 1 month–1 year: 700 micrograms/kg once daily, increased if necessary to3
mg/kg once daily (max. per dose20 mg)
20 mg once daily
mg), increased if necessary to 2mg/kg once daily (max. per dose 40 mg), injection to be
CH & UCHS, LAHORE 7

*Gastro-oesophageal reflux disease
BY MOUTH
20 mg once daily, in severe ulcerating reflux oesophagitis, maximum 12 weeks at higher
dose
necessary to 40 mg once daily, in severe ulcerating reflux oesophagitis, maximum 12
weeks at higher dose
mg), increased if necessary to 2mg/kg once daily (max. per dose40 mg), injection to be
*Acid-related dyspepsia
BY MOUTH
Neonate: 700 micrograms/kg once daily for 7–14 days, then increased if necessary
to1.4–2.8 mg/kg once daily.
20mg once daily
Child 2–17 years (body-weight 20 kg and above): 20mg once daily, increased if
Child 1 month–11 years: Initially 500 micrograms/kg once daily (max. per dose 20 mg),
increased if necessary to 2mg/kg once daily (max. per dose 40 mg), injection to be given
over 5 minutes
*Fat malabsorption despite pancreatic enzyme replacement therapy in cystic fibrosis
BY MOUTH
Neonate: 700 micrograms/kg once daily for 7–14 days, then increased if necessary
to1.4–2.8 mg/kg once daily.
20 mg once daily
Child 1 month–11 years: Initially 500 micrograms/kg once daily (max. per dose20
mg), increased if necessary to 2mg/kg once daily (max. per dose40 mg), injection to be
CH & UCHS, LAHORE 8

Side Effects
Gastro-intestinal disturbances (including nausea, vomiting, abdominal pain, flatulence,
diarrhoea, constipation), and headache. Less frequent side-effects include dry mouth,
peripheral oedema, dizziness, sleep disturbances, fatigue, paraesthesia, arthralgia,
myalgia, rash, and pruritus. Other side-effects reported rarely or very rarely include taste
disturbance, stomatitis, hepatitis, jaundice, hypersensitivity reactions (including
anaphylaxis, bronchospasm), fever, depression, hallucinations, confusion,
gynaecomastia, interstitial nephritis, hyponatraemia, blood disorders (including
leucopenia, leucocytosis, pancytopenia, thrombocytopenia), visual disturbances,
sweating, photosensitivity, alopecia, Stevens-Johnson syndrome, and toxic epidermal
necrolysis. By decreasing gastric acidity, proton pump inhibitors may increase the risk
of gastro-intestinal infections (including Clostridium difficile infection), agitation &
impotence
Preparation
Inj & Sachet 40mg
Losec
1.5 LAXATIVES
1.5.1 STIMULANT LAXATIVES
Glycerin suppositories
700mg/1gm
1.5.2 OSMOTIC LAXATIVES

Lactulose
Cautions
Lactose intolerance
Indication & Doses
*Constipation (may take up to 48 hours to act)
BY MOUTH
Child 1 month–1 year 2.5 mL twice daily, adjusted according to response
Child 1–5 years 2.5–10mL twice daily, adjusted according to response
Child 5–18 years 5–20mL twice daily, adjusted according to response
*Hepatic encephalopathy
BY MOUTH
Child 12–18 years 30–50mL 3 times daily; adjust dose to produce 2–3 soft stools per
day
Contraindication
Galactosaemia, intestinal obstruction
Side Effects
Nausea (can be reduced by administration with water, fruit juice or with meals),
vomiting, flatulence, cramps, and abdominal discomfort
Preparation
Syrup. 3.35gm/5ml
Duphalac
1.5.3 FAECAL SOFTNER

Sodium biphosphate (19.7gm) & Sodium phostpahe (7.2gm)
CH & UCHS, LAHORE 9

Indication & Doses
*Relief of constipation. Bowl cleaning before rectal examination, abdominal X rays,
pelvic & abdominal surgery
Child 5 to 11 Years: 60 ml or as directed by physician
Preparation
Enema 120 ml
Kleen Enema
1.6 DRUGS ACTING ON HEPATOBILIARY SYSTEM

Ursodeoxycholic acid
Indication & Doses
*Cholestasis
BY MOUTH
Neonate 5 mg/kg 3 times daily, adjust dose and frequency according to response, max.
10 mg/kg 3 times daily
Child 1 month–2 years 5 mg/kg 3 times daily, adjust dose and frequency according to
response, max. 10 mg/kg 3 times daily
*Improvement of hepatic metabolism of essential fatty acids and bile flow, in children
with cystic fibrosis
BY MOUTH
Child 10–15 mg/kg twice daily; total daily dose may alternatively be given in 3 divided
doses
*Cholestasis associated with total parenteral nutrition
BY MOUTH
Neonate 10 mg/kg 3 times daily
Child 10 mg/kg 3 times daily
*Sclerosing cholangitis
BY MOUTH
Child 5–10 mg/kg 2–3 times daily, adjusted according to response, max. 15 mg/ kg 3
times daily
Contraindication
Radio-opaque stones; non-functioning gall bladder (patients with radiolucent gallstones)
Side Effects
Rarely, diarrhea
Preparation
syp 250mg/5ml
Ursofolik
1.7 PRO BIOTICS

1.7.1 Bacillus Clausii
Preparation
Ampule 2 billion spores
Enterogermina
1.7.2 Saccharomyces Baulardii

Preparation
Sachet 250mg
Biflor
CH & UCHS, LAHORE 10

SECTION 2: DRUGS ACTING ON CARDIOVASCULAR SYSTEM
2.1 POSITIVE INOTROPIC DRUGS

2.1.1 CARDIAC GLYCOSIDES
Digoxin
Cautions
Sick sinus syndrome; thyroid disease; hypoxia; severe respiratory disease; avoid
hypokalaemia, hypomagnesaemia, hypercalcaemia, and hypoxia (risk of digitalis
toxicity); monitor serum electrolytes and renal function; avoid rapid intravenous
administration (risk of hypertension and reduced coronary flow)
Indication & doses
*Supraventricular arrhythmias and chronic heart Failure
BY MOUTH
Neonate under 1.5 kg: initially 25 micrograms/kg in 3 divided doses for 24 hours then
4–6 micrograms/ kg daily in 1–2 divided doses
Neonate 1.5–2.5 kg: initially 30 micrograms/kg in 3 divided doses for 24 hours then 4–6
micrograms/ kg daily in 1–2 divided doses
Neonate over 2.6 kg: initially 45 micrograms/kg in 3 divided doses for 24 hours then 10
micrograms/ kg daily in 1–2 divided doses
Child 1 month–1 year: initially 45 micrograms/kg in 3 divided doses for 24 hours then
10 micrograms/ kg daily in 1–2 divided doses
Child 2–4 years: initially 35 micrograms/kg in 3 divided doses for 24 hours then 10
micrograms/kg daily in 1–2 divided doses
Child 5–9 years: initially 25 micrograms/kg (max. 750 micrograms) in 3 divided doses
for 24 hours then 6 micrograms/kg daily (max.250 micrograms daily) in 1–2 divided
doses
Child 10–17 years: initially 0.75–1.5 mg in 3divided doses for 24 hours then 62.5–250
micrograms daily in 1–2 divided doses (higher doses may be necessary)
BY INTRAVENOUS INFUSION (but rarely necessary)
Neonate under 1.5 kg: initially 20 micrograms/kg in 3 divided doses for 24 hours then
4–6 micrograms/kg daily in 1–2 divided doses
Neonate 1.5–2.5 kg: initially 30 micrograms/kg in 3 divided doses for 24 hours then 4–6
micrograms/kg daiy in 1–2 divided doses
Neonate over 2.6 kg: initially 35 micrograms/kg in 3 divided doses for 24 hours then 10
Child 1 month–1 year: initially 35 micrograms/kg in 3 divided doses for 24 hours then
10 micrograms/kg daily in 1–2 divided doses
Child 2–4 years: initially 35 micrograms/kg in 3 divided doses for 24 hours then 10
Child 5–9 years: initially 25 micrograms/kg (max. 500 micrograms) in 3 divided doses
for 24 hours then 6 micrograms/kg daily (max.250 micrograms daily) in 1–2 divided
doses
Child 10–17 years: initially 0.5–1 mg in 3 divided doses for 24 hours then 62.5–250
micrograms daily in 1–2 divided doses (higher doses may be necessary)
Contraindications
Intermittent complete heart block, second degree AV block; supraventricular arrhythmias
associated with accessory conducting pathways e.g. Wolff-Parkinson-White syndrome

(although can be used in infancy); ventricular tachycardia or fibrillation; hypertrophic
cardiomyopathy (unless concomitant atrial fibrillation and heart failure—but use with
caution); myocarditis; constrictive pericarditis (unless to control atrial fibrillation or
improve systolic dysfunction—but use with caution)
Side Effects
nausea, vomiting, diarrhoea; arrhythmias, conduction disturbances; dizziness; blurred or
yellow vision; rash, eosinophilia; less commonly depression; very rarely anorexia,
intestinal ischaemia and necrosis, psychosis, apathy, confusion, headache, fatigue,
weakness, gynaecomastia on long-term use, and thrombocytopenia
Preparations
Injection & tab 500mcg & 250mcg
Lanoxin
2.1.2 PHOSPHODIESTRASES INHIBITORS

Milrinone
Cautions
Heart failure associated with hypertrophic cardiomyopathy, stenotic or obstructive
valvular disease or other outlet obstruction; monitor blood pressure, heart rate, ECG,
central venous pressure, fluid and electrolyte status, renal function, platelet count, hepatic
enzymes; avoid extravasation; correct hypokalaemia; monitor renal function;
Indication & Doses
*Congestive heart failure, low cardiac output following cardiac surgery, shock
BY INTRAVENOUS INFUSION
Neonate: Initially 50–75 micrograms/kg over 30–60 minutes (reduce or omit initial dose
if at risk of hypotension) then (by continuous IV Infusion) 30–45 micrograms/kg/hour by
continuous intravenous infusion for 2–3 days (usually for 12 hours after cardiac surgery)
Child: Initially 50–75 micrograms/kg over 30–60 minutes (reduce or omit initial dose if
at risk of hypotension) then (by continuous IV Infusion) 30–45 micrograms/kg/hour by
continuous intravenous infusion for 2–3 days (usually for 12 hours after cardiac surgery)
Side effects
Ectopic beats, ventricular tachycardia, supraventricular arrhythmias (more likely in
children with pre-existing arrhythmias), hypotension; headache; less commonly
ventricular fibrillation, chest pain, tremor, hypokalaemia, thrombocytopenia; very rarely
bronchospasm, anaphylaxis, and rash
Preparation
inj 10mg
Milron
2.2 DIURETICS
2.2.1 LOOP DIURETICS
Frusemide
Cautions
Hypovolaemia and hypotension should be corrected before initiation of treatment with
loop diuretics; electrolytes should be monitored during treatment. Loop diuretics should
be used with caution in comatose and precomatose states associated with liver cirrhosis.
Loop diuretics can exacerbate diabetes (but hyperglycaemia less likely than with
thiazides) and gout; they can also cause acute urinary retention in children with

obstruction of urinary outflow, therefore adequate urinary output should be established
before initiating treatment, hypoproteinaemia may reduce effect and increase risk of side-
effects; hepatorenal syndrome; risk of ototoxicity may be reduced by giving high oral
doses in 2 or more divided doses; effect may be prolonged in neonates; some liquid
preparations contain alcohol, caution especially in neonates.
Indication & Doses
*Oedema in heart failure, renal disease, and hepatic disease pulmonary oedema
BY MOUTH
Neonate: 0.5–2 mg/kg every 12–24 hours, alternatively 0.5–2 mg/kg every 24 hours if
corrected gestational age under 31 weeks
Child 1 month–11 years: 0.5–2 mg/kg 2–3 times daily alternatively 0.5–2 mg/kg every
24 hours if corrected gestational age under 31 weeks; higher doses may be required in
resistant oedema; max. 12 mg/kg/day, not to exceed 80 mg daily
Child 12–17 years: 20–40 mg daily, increased to 80-120mg daily in resistant oedema
BY SLOW IV INJECTION
Neonate: 0.5–1 mg/kg every 12–24 hours, alternatively 0.5–1 mg/kg every 24 hours if
corrected gestational age under 31 weeks
Child 1 month–11 years: 0.5–1 mg/kg every 8 hours (maximum per dose 40 mg every 8
hours) as required, max. 6 mg/kg/day
Child 12–17 years: 20–40 mg repeated every 8 hours as necessary; higher doses may be
required in resistant cases
BY CONTINOUS INTRAVENOUS INFUSION
Child: 0.1-2 mg/kg/hour
*Oedema in heart failure, renal disease, and hepatic disease following cardiac surgery,
Pulmonary oedema following cardiac surgery
BY CONTINUOUS INTRAVENOUS INFUSION
Child: Initially100 micrograms/kg/hour, dose to be doubled every2 hours until urine
output exceeds 1mL/kg/hour
*Oliguria
BY MOUTH
Child 12–17 years: Initially250 mg daily, then increased in steps of 250 mg every 4–6
hours (max. per dose 2g) if required
Child 1 month–11 years: 2–5 mg/kg up to4 times a day; max 1g per day
Child 12–17 years: Initially 250 mg, dose to be administered over 1 hour, increased to
500 mg, increased dose is given if satisfactory urine output not obtained; dose
administered over2hours, then increased to1 g, increased dose given if satisfactory
response not obtained within subsequent hour; dose to be administered over4 hours. If no
response obtained dialysis probably required; effective dose of up to 1g given at a
maximum rate of 4mg/minute can be repeated every 24 hours
Contraindications
Loop diuretics should be avoided in severe hypokalaemia, severe hyponatraemia, anuria,
and in renal failure due to nephrotoxic or hepatotoxic drugs.
Side Effects
Side-effects of loop diuretics include mild gastro-intestinal disturbances, pancreatitis,
hepatic encephalopathy, postural hypotension, temporary increase in serum-cholesterol
and triglyceride concentration, hyperglycaemia (less common), acute urinary retention,
electrolyte disturbances (including hyponatraemia, hypokalaemia, increased calcium

excretion (nephrocalcinosis and nephrolithiasis reported with long-term use of
furosemide in preterm infants), hypochloraemia, and hypomagnesaemia), metabolic
alkalosis, blood disorders (including bone marrow depression, thrombocytopenia, and
leucopenia), hyperuricaemia, visual disturbances, tinnitus and deafness (usually with high
doses and rapid intravenous administration, and in renal impairment), rash, and
photosensitivity.
Preparations
Injection & tab 10mg/ml (2ml) & 20,40mg
Lasix
2.2.2 POTASSIUM SPARING DIURETICS

Spiranolactone
Cautions
Monitor electrolytes (discontinue if hyperkalaemia); acute porphyria
Indication & Doses
*Oedema in heart failure and in ascites, nephrotic syndrome, reduction of
hypokalaemia induced by diuretics or amphotericin
BY MOUTH
Neonate: 1–2 mg/kg daily in 1–2 divided doses increased if necessary up to 7 mg/kg
daily in resistant ascites
Child 1 month–11 years: 1–3 mg/kg daily in 1–2 divided doses increased if necessary
up to 9 mg/kg daily in resistant ascites
Child 12–17 years: 50–100 mg daily in 1–2 divided doses increased if necessary up to 9
mg/kg daily (max. 400 mg daily) in resistant ascites
Contraindications
Hyperkalaemia, hyponatraemia; anuria; Addison’s disease
Side Effects
Gastro-intestinal disturbances, hepatotoxicity; malaise, headache, confusion, drowsiness,
dizziness; gynaecomastia, benign breast tumour, breast pain, menstrual disturbances,
changes in libido; hyperkalaemia (discontinue), hyponatraemia, acute renal failure,
hyperuricaemia, leucopenia, agranulocytosis, thrombocytopenia; leg cramps; alopecia,
hirsutism, rash, and Stevens-Johnson syndrome
Preparation
Tablets 25mg
Aldactone
2.2.3 OSMOTIC DIURETICS

Mannitol
Cautions
Extravasation causes inflammation and thrombophlebitis; monitor fluid and electrolyte
balance, serum osmolality, and pulmonary and renal function; assess cardiac function
before and during treatment
Indication & Doses
*Cerebral oedema
Child 1 month - 11 years 0.25–1.5 g/kg, repeated if necessary to be administered over
30 to 60 mins. Dose main may repeated 1-2 times after 4-8 hours

Child 12–17 years 0.25–2 g/kg repeated if necessary to be administered over 30 to 60
mins. Dose may be repeated 1–2 times after 4–8 hours
*Peripheral oedema and ascites
Child 1 month–17 years 1–2 g/kg to be given over 2-6 hours
Contraindications
Severe heart failure; severe pulmonary oedema; intracranial bleeding (except during
craniotomy); anuria; severe dehydration
Side Effects
Less commonly hypotension, thrombophlebitis, fluid and electrolyte imbalance; rarely
dry mouth, thirst, nausea, vomiting, oedema, raised intracranial pressure, arrhythmia,
hypertension, pulmonary oedema, chest pain, headache, convulsions, dizziness, chills,
fever, urinary retention, focal osmotic nephrosis, dehydration, cramp, blurred vision,
rhinitis, skin necrosis, and hypersensitivity reactions (including urticaria and
anaphylaxis); very rarely congestive heart failure and acute renal failure
Preparation
Infusion 20%
Mannitol
2.2.4 THIAZIDE DIURETIC

Hydrochlorthiazide
Cautions
Thiazides and related diuretics can exacerbate diabetes, gout, and systemic lupus
erythematosus. Electrolytes should be monitored particularly with high doses, long-term
use, or in renal impairment. Thiazides and related diuretics should also be used with
caution in nephrotic syndrome, hyperaldosteronism, and malnourishment
Indication & Doses
*Oedema in heart failure, renal disease, and hepatic disease; pulmonary oedema;
hypertension
BY MOUTH
Child 1 month–2 years: 50–100 micrograms/kg daily adjusted according to response
Child 2–12 years: initially 50–400 micrograms/kg (max. 10 mg) daily then 50–100
micrograms/kg daily adjusted according to response (max. 10 mg daily)
Child 12–18 years: initially 5–10 mg daily or on alternate days (2.5 mg daily in
hypertension) as a single morning dose, adjusted according to response (max. 10 mg
daily)
Contraindications
Thiazides and related diuretics should be avoided in refractory hypokalaemia,
hyponatraemia, and hypercalcaemia, symptomatic hyperuricaemia, and Addison’s
disease.
Side effects
Mild gastro-intestinal disturbances, postural hypotension, altered plasma-lipid
concentrations, metabolic and electrolyte disturbances including hypokalaemia,
hyponatraemia, hypomagnesaemia, hypercalcaemia, hyperglycaemia, hypochloraemic
alkalosis, and hyperuricaemia, and gout. Less common side-effects include blood
disorders including agranulocytosis, leucopenia and thrombocytopenia, and impotence.
Pancreatitis, intrahepatic cholestasis, cardiac arrhythmias, headache, dizziness,

paraesthesia, visual disturbances, and hypersensitivity reactions (including pneumonitis,
pulmonary oedema, photosensitivity, and severe skin reactions) have also been reported.
Preparation
Tab 25mg
Diuza
2.2.5 COMBINATION DIURETICS

Spiranolactone + Frusimide
Tablets 50:20mg
Spiromide
2.3 ANTI-ARRHYTHMIC DRUGS

2.3.1 Amiodarone
Cautions
liver-function and thyroid-function tests required before treatment and then every 6
months, hypokalaemia; pulmonary function tests and chest -ray required before
treatment; heart failure; severe bradycardia and conduction disturbances in excessive
dosage; intravenous use may cause moderate and Transient fall in blood pressure
(circulatory collapse precipitated by rapid administration or overdosage) or severe
hepato-cellular toxicity (monitor transaminases closely); ECG monitoring and
resuscitation facilities must be available during intravenous use; acute porphyria; avoid
benzyl alcohol containing injections in neonates
Indication & Doses
*Supraventricular and ventricular arrhythmias
BY MOUTH
Neonate initially 5–10 mg/kg twice daily for 7–10 days, then reduced to maintenance
dose of 5–10 mg/kg once daily
Child 1 month–11 years initially 5–10 mg/kg twice daily (max. 200 mg) for 7–10 days,
then reduced to maintenance dose of 5–10 mg/kg once daily (max. 200 mg daily)
Child 12–17 years 200 mg 3 times daily for 1 week then 200 mg twice daily for 1 week
then usually 200 mg daily adjusted according to response
Neonate: initially 5 mg/kg then 5 mg/kg (by IV Infusion) every 12–24 hours, dose to be
Child: initially 5–10 mg/kg dose to be given over 20 minutes–2 hours then by continuous
infusion 300 micrograms/kg/hour, increased if necessary up to 1.5 mg/kg/hour; maximum
1.2 g in 24 hours
*Ventricular fibrillation or pulseless ventricular tachycardia refractory to defibrillation
(for cardiopulmonary resuscitation)
Neonate: 5–10 mg/kg dose to be given over 3 minutes
Child 5 mg/kg max 300mg dose to be given over 3 minutes
Contraindications
except in cardiac arrest: sinus bradycardia, sino-atrial heart block; unless pacemaker
fitted avoid in severe conduction disturbances or sinus node disease; thyroid dysfunction;
iodine sensitivity; avoid intravenous use in severe respiratory failure, circulatory collapse,
or severe arterial hypotension; avoid bolus injection in congestive heart failure or
cardiomyopathy; avoid rapid loading after cardiac surgery

Side Effects
nausea, vomiting, taste disturbances, raised serum transaminases (may require dose
reduction or withdrawal if accompanied by acute liver disorders), jaundice; bradycardia;
pulmonary toxicity (including pneumonitis and fibrosis); tremor, sleep disorders;
hypothyroidism, hyperthyroidism; reversible corneal microdeposits (sometimes with
night glare); phototoxicity, persistent slategrey skin discoloration; less commonly onset
or worsening of arrhythmia, conduction disturbances (see Cautions), peripheral
neuropathy and myopathy (usually reversible on withdrawal); very rarely chronic liver
disease including cirrhosis, sinus arrest, bronchospasm (in patients with severe
respiratory failure), ataxia, benign intracranial hypertension, headache, vertigo,
epididymoorchitis, impotence, haemolytic or aplastic anaemia, thrombocytopenia, rash
(including exfoliative dermatitis), hypersensitivity including vasculitis, alopecia,
impaired vision due to optic neuritis or optic neuropathy (including blindness),
anaphylaxis on rapid injection, also hypotension, respiratory distress syndrome, sweating,
and hot flushes
Preparation
Inj & tab 150mg/3ml & 200mg
Cordarone
2.3.2 Lignocaine
Cautions
Lower doses in congestive heart failure and following cardiac surgery; monitor ECG;
resuscitation facilities should be available
Indication & Doses
*Ventricular arrhythmias|Pulseless ventricular tachycardia|Ventricular fibrillation
INITIALLY BY INTRAVENOUS INJECTION, OR BY INTRAOSSEOUS INJECTION
Neonate: Initially 0.5–1 mg/kg, followed immediately by (by intravenous infusion) 0.6–3
mg/kg/hour, alternatively (by intravenous injection or by intraosseous injection) 0.5–
1mg/kg repeated at intervals of not less than 5minutes if infusion is not immediately
available following initial injection, until infusion can be initiated; maximum3mg/kg per
course.
Child 1 month–11 years: Initially 0.5–1 mg/kg, followed immediately by (by
intravenous infusion) 0.6–3 mg/kg/hour, alternatively (by intravenous injection or by
intraosseous injection)0.5–1 mg/kg repeated at intervals of not less than5minutes if
infusion is not immediately available following initial injection, until infusion can be
initiated; maximum 3mg/kg per course
Child 12–17 years: Initially 50–100 mg, followed by (by intravenous infusion)120 mg,
dose to be given over 30minutes, then (by intravenous infusion) 240 mg, dose to be given
over 2 hours, then (by intravenous infusion) 60mg/hour, reduce dose further if infusion is
continued beyond 24 hours, if infusion not immediately available following initial
injection, the initial injection dose may be repeated at intervals of not less than 5 minutes
(to a maximum300mg dose in 1hour) until infusion can be initiated
*Neonatal seizures
Neonate: Initially 2mg/kg, dose to be given over 10minutes, followed by 6mg/kg/hour
for 6 hours; reduced to 4 mg/kg/hour for 12 hours, then reduced to 2mg/kg/hour for a
further12 hours, preterm neonates may require lower doses.
Contraindications

Sino-atrial disorders, all grades of atrioventricular block, severe myocardial depression;
acute porphyria
Side effects
Dizziness, paraesthesia, or drowsiness (particularly if injection too rapid); other CNS
effects include confusion, respiratory depression and convulsions; hypotension and
bradycardia (may lead to cardiac arrest); rarely hypersensitivity reactions including
anaphylaxis
Preparation
Inj. 2%
Lidocain
2.4 BETA-ADRENORECEPTOR BLOCKING DRUGS

Cautions
avoid abrupt withdrawal; first-degree AV block; portal hypertension (risk of deterioration
in liver function); diabetes; history of obstructive airways disease (introduce cautiously
and monitor lung function); myasthenia gravis; symptoms of thyrotoxicosis may be
masked; psoriasis; history of hypersensitivity— may increase sensitivity to allergens and
result in more serious hypersensitivity response, also may reduce response to adrenaline
(epinephrine)
Contraindications
asthma, uncontrolled heart failure, marked bradycardia, hypotension, sick sinus
syndrome, second- or thirddegree AV block, cardiogenic shock, metabolic acidosis,
severe peripheral arterial disease; phaeochromocytoma
2.4.1 Atenolol
Indication & Doses
*Hypertension
BY MOUTH
Neonate 0.5–2 mg/kg once daily; may be given in 2 divided doses
Child 1 month–11 years 0.5–2 mg/kg once daily; may be given in 2 divided doses
higher than 50 mg daily are rarely necessary
Child 12–17 years 25–50 mg once daily; may be given in 2 divided doses higher doses
are rarely necessary
*Arrhythmias
BY MOUTH
Neonate 0.5–2 mg/kg once daily; may be given in 2 divided doses
Child 1 month–11 years 0.5–2 mg/kg once daily dose may be given in 2 divided doses
(max. 100 mg per day)
Child 12–17 years 50–100 mg once daily dose may be given in 2 divided doses
Side effects
gastro-intestinal disturbances; bradycardia, heart failure, hypotension, conduction
disorders, peripheral vasoconstriction (including exacerbation of intermittent claudication
and Raynaud’s phenomenon); bronchospasm, dyspnoea; headache, fatigue, sleep
disturbances, paraesthesia, dizziness, psychoses; sexual dysfunction; purpura,
thrombocytopenia; visual disturbances; exacerbation of psoriasis, alopecia; rarely rashes
and dry eyes (reversible on withdrawal)
Preparation
Tablet 25mg

Tenormin
2.4.2 Carvedilol
Indication and dose
*Adjunct in heart failure
BY MOUTH
Child 2–17 years: Initially 50micrograms/kg twice daily (max. per dose 3.125 mg) for at
least 2 weeks, then increased to 100 micrograms/kg twice daily for at least 2 weeks, then
increased to 200 micrograms/kg twice daily, then increased if necessary up to 350
micrograms/kg twice daily (max. per dose 25mg)
Side effects
Postural hypotension, dizziness, headache, fatigue, gastro-intestinal disturbances,
bradycardia; occasionally diminished peripheral circulation, peripheral oedema and
painful extremities, dry mouth, dry eyes, eye irritation or disturbed vision, impotence,
disturbances of micturition, influenza-like symptoms; rarely angina, AV block,
exacerbation of intermittent claudication or Raynaud’s phenomenon; allergic skin
reactions exacerbation of psoriasis, nasal stuffiness, wheezing, depressed mood, sleep
disturbances, paraesthesia, heart failure, changes in liver enzymes, thrombocytopenia,
leucopenia also reported
Preparation
Tablet 6.25mg
Vedicar
2.4.3 Propranolol
Indication and doses
*Hyperthyroidism with autonomic symptoms
BY MOUTH
Neonate: Initially 250–500 micrograms/kg every 6–8 hours, adjusted according to
response.
Child: Initially 250–500 micrograms/kg every8 hours, adjusted according to response;
increased if necessary up to 1mg/kg every8hours (max. per dose 40 mg every 8 hours)
*Thyrotoxicosis (adjunct)
BY MOUTH
Neonate: Initially250–500 micrograms/kg every 6–8 hours, adjusted according to
response.
*Thyrotoxic crisis
BY MOUTH
Neonate: Initially 250–500 micrograms/kg every 6–8 hours, adjusted according to
response.
*Hypertension
BY MOUTH
Neonate: Initially 250 micrograms/kg 3 times a day, then increased if necessary up to
2mg/kg 3 times a day.

Child 1 month–11 years: Initially 0.25–1mg/kg 3times a day, then increased to 5mg/kg
daily in divided doses, dose should be increased at weekly intervals
Child 12–17 years: Initially 80 mg twice daily, then increased if necessary up to 160–
320 mg daily, dose should be increased at weekly intervals, slow-release preparations
may be used for once daily administration
*Migraine prophylaxis
BY MOUTH
Child 2–11 years: Initially 200–500 micrograms/kg twice daily; usual dose 10–20 mg
twice daily (max. per dose 2mg/kg twice daily)
Child 12–17 years: Initially 20–40 mg twice daily; usual dose40–80 mg twice daily
(max. per dose 120 mg); maximum4mg/kg per day
*Arrhythmias
BY MOUTH
Neonate: 250–500 micrograms/kg3times a day, adjusted according to response.
Child: 250–500 micrograms/kg3–4times a day (max. per dose1 mg/kg 4 times a day),
adjusted according to response; maximum160 mg per day
*Tetralogy of Fallot
BY MOUTH
Neonate: 0.25–1 mg/kg2–3times a day (max. per dose 2mg/kg 3 times a day).
Child 1 month–11 years: 0.25–1 mg/kg 3–4 times a day, maximum dose to be given in
divided doses; maximum 5mg/kg per day
Side effects
gastro-intestinal disturbances; bradycardia, heart failure, hypotension, conduction
disorders, peripheral vasoconstriction (including exacerbation of intermittent claudication
and Raynaud’s phenomenon); bronchospasm, dyspnoea; headache, fatigue, sleep
disturbances, paraesthesia, dizziness, psychoses; sexual dysfunction; purpura,
thrombocytopenia; visual disturbances; exacerbation of psoriasis, alopecia; rarely rashes
and dry eyes (reversible on withdrawal)
Preparation
Tablet 10mg
Inderal
2.4.4 Labetolol
Indication & Doses
*Hypertensive emergencies
Neonate: Initially 0.5 mg/kg/hour (max. per dose 4 mg/kg/hour), dose to be adjusted
according to response at intervals of at least 15 minutes.
Child 1 month–11 years: Initially 0.5–1mg/kg/hour (max. per dose 3mg/kg/hour), dose
to be adjusted according to response at intervals of at least 15 minutes
Child 12–17 years: Initially30–120 mg/hour, dose to be adjusted according to response
at intervals of at least 15 minutes
*Hypertension
BY MOUTH
Child 1 month–11 years: 1–2 mg/kg 3–4times a day
Child 12–17 years: Initially 50–100 mg twice daily, dose to be increased if required at
intervals of 3–14 days; usual dose 200–400 mg twice daily, higher doses to be given in 3
– 4 divided doses; maximum 2.4 g per day

BY INTRAVENOUS INJECTION
Child 1 month–11 years: 250–500 micrograms/kg (max. per dose 20mg) for 1 dose
Child 12–17 years: 50 mg, dose to be given over at least 1 minute, then 50mg after 5
minutes if required; maximum 200 mg per course
Side effects
Postural hypotension (avoid upright position during and for 3 hours after intravenous
administration), tiredness, weakness, headache, rashes, scalp tingling, difficulty in
micturition, epigastric pain, nausea, vomiting; liver damage; rarely lichenoid rash
Preparation
Inj 50mg
Labetalol
2.5 ANTI HYPERTENSIVE DRUGS

2.5.1 ALPHA-ADRENOCEPTOR BLOCKING DRUGS
Prazosin
Caution
First dose may cause collapse due to hypotension (therefore should be taken on retiring to
bed); cataract surgery (risk of intra-operative floppy iris syndrome); May affect
performance of skilled tasks e.g. driving
Indication and dose
*Hypertension
BY MOUTH
Child 1 month–11 years: initially 10–15 micrograms/kg 2–4 times daily (initial dose to
be taken at bed time) increased gradually to max. 500 micrograms/kg daily in divided
doses (maximum 20 mg daily)
Child 12–17 years: 500 micrograms 2–3 times daily (initial dose at bedtime), increased
after 3–7 days to 1 mg 2–3 times daily for a further 3–7 days; further increased gradually
if necessary to max. 20 mg daily in divided doses. Dose should be increased gradually
*Congestive heart failure
BY MOUTH
Child 1 month–11 years 5 micrograms/kg twice daily (initial dose at bedtime), increased
gradually to max. 100 micrograms/kg daily in divided doses. Dose should be increased
gradually
Child 12–17 years 500 micrograms 2–4 times daily (initial dose at bedtime), increasing
to 4 mg daily in divided doses; maintenance 4–20 mg daily in divided doses. Dose should
be increased gradually
Contraindication
Not recommended for congestive heart failure due to mechanical obstruction (e.g. aortic
stenosis)
Side effects
gastro-intestinal disturbances; postural hypotension, oedema, palpitation; dyspnoea, nasal
congestion; drowsiness, headache, depression, nervousness, vertigo; urinary frequency;
weakness; blurred vision; less commonly tachycardia, insomnia, paraesthesia, sweating,
impotence, arthralgia, eye disorders, tinnitus, epistaxis, allergic reactions including rash,
pruritus, and urticaria; rarely pancreatitis, flushing, vasculitis, bradycardia, hallucinations,
worsening of narcolepsy, gynaecomastia, priapism, urinary incontinence, and alopecia
Preparation

Tablet 1mg, 2mg
Minipress
2.5.2 DRUGS AFFECTING THE RENIN-ANGIOTENSIN SYSTEM

2.5.2.1 Angiotensin Converting Enzyme Inhibitors
Cautions
Need to be initiated with care in children receiving diuretics; first doses can cause
hypotension especially in children taking high doses of diuretics, on a low-sodium diet,
on dialysis, dehydrated, or with heart failure. Discontinue if marked elevation of hepatic
enzymes or jaundice (risk of hepatic necrosis). Renal function should be monitored
before and during treatment. For use in pre-existing renovascular disease. The risk of
agranulocytosis is possibly increased in collagen vascular disease (blood counts
recommended). Should be used with care in children with severe or symptomatic aortic
stenosis (risk of hypotension) and in hypertrophic cardiomyopathy. They should be used
with care (or avoided) in those with a history of idiopathic or hereditary angioedema.
Children with primary aldosteronism and Afro-Caribbean children may respond less
Contraindications
Contra-indicated in children with hypersensitivity to ACE inhibitors (including
angioedema) and in bilateral renovascular disease
2.5.2.1.1 Captopril
Indication and dose
*Hypertension
BY MOUTH
Preterm neonate (initiated under specialist supervision): Test dose10 micrograms/kg,
monitor blood pressure carefully for 1–2hours; usual dose 10–50 micrograms/kg2–3times
a day, then increased if necessary up to 300 micrograms/kg daily in divided doses,
ongoing doses should only be given if test dose tolerated.
Neonate (initiated under specialist supervision): Test dose 10–50 micrograms/kg,
monitor blood pressure carefully for 1–2hours; usual dose 10–50 micrograms/kg 2–
3times a day, then increased if necessary up to 2 mg/kg daily in divided doses, ongoing
doses should only be given if test dose tolerated.
Child 1–11 months (initiated under specialist supervision): Test dose100 micrograms/kg
(max. per dose 6.25 mg), monitor blood pressure carefully for 1–2 hours; usual dose 100–
300 micrograms/kg2–3 times a day, then increased if necessary up to 4mg/kg daily in
divided doses, ongoing doses should only be given if test dose tolerated
Child 1–11 years (initiated under specialist supervision): Test dose100 micrograms/kg
(max. per dose 6.25 mg), monitor blood pressure carefully for 1–2 hours; usual dose 100–
300 micrograms/kg2–3 times a day, then increased if necessary up to 6mg/kg daily in
Child 12–17 years (initiated under specialist supervision): Test dose100 micrograms/kg,
alternatively test dose 6.25 mg, monitor blood pressure carefully for 1–2 hours; usual
dose 12.5–25 mg 2–3 times a day, then increased if necessary up to 150 mg daily in
*Heart failure
BY MOUTH
Preterm neonate (initiated under specialist supervision): Test dose 10 micrograms/kg,
monitor blood pressure carefully for 1–2hours; usual dose 10–50 micrograms/kg 2–3

times a day, then increased if necessary up to 300 micrograms/kg daily in divided doses,
ongoing doses should only be given if test dose tolerated.
Neonate (initiated under specialist supervision): Test dose 10–50 micrograms/kg,
monitor blood pressure carefully for1–2hours; usual dose 10–50 micrograms/kg 2–3
times a day, then increased if necessary up to 2mg/kg daily in divided doses, ongoing
doses should only be given if test dose tolerated.
Child 1–11 months (initiated under specialist supervision): Test dose 100 micrograms/kg
(max. per dose6.25mg), monitor blood pressure carefully for 1–2hours; usual dose100–
300 micrograms/kg2–3times a day, then increased if necessary up to 4mg/kg daily in
Child 1–11 years (initiated under specialist supervision): Test dose 100 micrograms/kg
(max. per dose6.25mg), monitor blood pressure carefully for 1–2 hours; usual dose100–
300 micrograms/kg 2–3times a day, then increased if necessary up to 6mg/kg daily in
Child 12–17 years (initiated under specialist supervision): Test dose 100 micrograms/kg,
alternatively test dose 6.25mg, monitor blood pressure carefully for 1–2 hours; usual dose
12.5–25 mg 2–3 times a day, then increased if necessary up to 150 mg daily in divided
doses, ongoing doses should only be given if test dose tolerated
*Proteinuria in nephritis (under expert supervision)
BY MOUTH
Preterm neonate: Test dose10 micrograms/kg, monitor blood pressure carefully for 1–2
hours; usual dose 10–50 micrograms/kg 2–3 times a day, then increased if necessary up
to 300 micrograms/kg daily in divided doses, ongoing doses should only be given if test
dose tolerated.
Neonate: Test dose 10–50 micrograms/kg, monitor blood pressure carefully for 1–2
hours; usual dose 10–50 micrograms/kg 2–3 times a day, then increased if necessary up
to 2mg/kg daily in divided doses, ongoing doses should only be given if test dose
tolerated.
Child 1–11 months: Test dose100 micrograms/kg (max. per dose 6.25 mg), monitor
blood pressure carefully for 1–2 hours; usual dose 100–300 micrograms/kg 2–3 times a
day, then increased if necessary up to 4mg/kg daily in divided doses, ongoing doses
should only be given if test dose tolerated
Child 1–11 years: Test dose 100 micrograms/kg (max. per dose6.25 mg), monitor blood
pressure carefully for 1–2 hours; usual dose 100–300 micrograms/kg 2–3 times a day,
then increased if necessary up to 6mg/kg daily in divided doses, ongoing doses should
only be given if test dose tolerated
Child 12–17 years: Test dose100 micrograms/kg, alternatively test dose6.25mg, monitor
blood pressure
Side effects
Can cause profound hypotension, renal impairment, and a persistent dry cough. They can
also cause angioedema (onset may be delayed; higher incidence reported in Afro-
Caribbean patients), rash (which may be associated with pruritus and urticaria),
pancreatitis, and upper respiratory-tract symptoms such as sinusitis, rhinitis, and sore
throat. Gastro-intestinal effects reported with ACE inhibitors include nausea, vomiting,
dyspepsia, diarrhoea, constipation, and abdominal pain. Altered liver function tests,
cholestatic jaundice, hepatitis, fulminant he8patic necrosis, and hepatic failure have been
reported—discontinue if marked elevation of hepatic enzymes or jaundice.
Hyperkalaemia, hypoglycaemia and blood disorders including thrombocytopenia,

leucopenia, neutropenia, and haemolytic anaemia have also been reported. Other reported
side-effects include headache, dizziness, fatigue, malaise, taste disturbance, paraesthesia,
bronchospasm, fever, serositis, vasculitis, myalgia, arthralgia, positive antinuclear
antibody, raised erythrocyte sedimentation rate, eosinophilia, leucocytosis, and
photosensitivity.
Preparation
Tablet 12.5mg
Capoten
2.5.2.1.2 Enalapril Maleate

Indication and Doses
*Hypertension
BY MOUTH
Neonate (under expert supervision): Initially 10 micrograms/kg once daily, monitor
blood pressure carefully for 1–2 hours, increased if necessary up to 500 micrograms/kg
daily in 1–3divided doses, limited information.
Child 1 month–11 years (under expert supervision): Initially 100 micrograms/kg once
daily, monitor blood pressure carefully for 1–2 hours, then increased if necessary up to
1mg/kg daily in 1–2 divided doses
Child 12–17 years (under expert supervision) (body-weight up to 50 kg): Initially 2.5 mg
once daily, monitor blood pressure carefully for 1–2 hours, maintenance 10–20 mg daily
in 1–2 divided doses
Child 12–17 years (under expert supervision) (body-weight 50 kg and above):
Initially2.5mg once daily, monitor blood pressure carefully for 1–2 hours, maintenance
10–20 mg daily in 1–2 divided doses; maximum 40mg per day
*Heart failure
BY MOUTH
Neonate (under expert supervision): Initially 10 micrograms/kg once daily, monitor
blood pressure carefully for 1–2 hours, increased if necessary up to 500 micrograms/kg
daily in 1–3 divided doses, limited information.
Child 1 month–11 years (under expert supervision): Initially 100 micrograms/kg once
daily, monitor blood pressure carefully for 1–2 hours, then increased if necessary up to
1mg/kg daily in 1–2 divided doses
Child 12–17 years (under expert supervision) (body-weight up to 50 kg): Initially 2.5 mg
once daily, monitor blood pressure carefully for 1–2 hours, maintenance 10–20 mg daily
in 1–2divided doses
Child 12–17 years (under expert supervision) (body-weight 50 kg and above):
Initially2.5mg once daily, monitor blood pressure carefully for 1–2 hours, maintenance
10–20 mg daily in 1–2 divided doses; maximum 40mg per day
BY MOUTH
Neonate: Initially 10 micrograms/kg once daily, monitor blood pressure carefully for 1–2
hours, increased if necessary up to 500 micrograms/kg daily in 1–3 divided doses.
Child 1 month–11 years: Initially 100 micrograms/kg once daily, monitor blood
pressure carefully for 1–2hours, then increased if necessary up to1 mg/kg daily in 1–2
divided doses
Child 12–17 years (body-weight up to 50 kg): Initially 2.5 mg once daily, monitor blood
pressure carefully for 1–2 hours, maintenance 10–20 mg daily in 1–2divided doses

Child 12–17 years (body-weight 50 kg and above): Initially 2.5 mg once daily, monitor
blood pressure carefully for 1–2hours, maintenance10–20 mg daily in 1–2divided doses;
maximum40 mg per day
*Diabetic nephropathy (under expert supervision)
BY MOUTH
Child 12–17 years (body-weight up to 50 kg): Initially 2.5 mg once daily, monitor blood
pressure carefully for 1–2hours; maintenance10–20mg daily in 1–2 divided dose
Child 12–17 years (body-weight 50 kg and above): Initially 2.5 mg once daily, monitor
blood pressure carefully for 1–2hours; maintenance10–20 mg daily in 1–2divided doses;
maximum 40 mg per day
Side effects
cholestatic jaundice, hepatitis, fulminant hepatic necrosis, and hepatic failure have been
antibody, raised erythrocyte sedimentation rate, eosinophilia, leucocytosis,
photosensitivity. dyspnoea; depression, asthenia; blurred vision; less commonly dry
mouth, peptic ulcer, anorexia, ileus; arrhythmias, palpitation, flushing; confusion,
nervousness, drowsiness, insomnia, vertigo; impotence; muscle cramps; tinnitus;
alopecia, sweating; hyponatraemia; rarely stomatitis, glossitis, Raynaud’s syndrome,
pulmonary infiltrates, allergic alveolitis, abnormal dreams, gynaecomastia, Stevens-
Johnson syndrome, toxic epidermal necrolysis, exfoliative dermatitis, pemphigus; very
rarely gastro-intestinal angioedema
Preparation
tablet 5,10mg
Enlap
2.5.2.1.3 Ramipril
Side effects

antibody, raised ESR , eosinophilia, leucocytosis, photosensitivity
Preparation
Tab 1.25/2.5/5mg
Lipra
2.5.2.1.4 Lisinopril
Indication & Does
*Hypertension
BY MOUTH
Child 6–11 years (under expert supervision): Initially 70 micrograms/kg once daily
(max. per dose5 mg), increased to up to 600 micrograms/kg once daily, alternatively
increased to up to 40 mg once daily, dose to be increased in intervals of 1–2 weeks
Child 12–17 years (under expert supervision): Initially5 mg once daily; usual
maintenance10–20mg once daily; maximum 80 mg per day
BY MOUTH
Child 6–11 years: Initially 70 micrograms/kg once daily (max. per dose 5mg), increased
to up to 600 micrograms/kg once daily, alternatively increased to up to 40 mg once daily,
dose to be increased in intervals of 1–2 weeks
Child 12–17 years: Initially 5mg once daily; usual maintenance10–20 mg once daily;
*Diabetic nephropathy (under expert supervision)
BY MOUTH
Child 12–17 years: Initially 5mg once daily; usual maintenance 10–20 mg once daily;
*Heart failure (adjunct) (under close medical supervision)
BY MOUTH
Child 12–17 years: Initially 2.5mg once daily; increased in steps of up to 10 mg at least
every 2 weeks; maximum 35 mg per day
Side effects
antibody, raised erythrocyte sedimentation rate, eosinophilia, leucocytosis,
photosensitivity, less commonly tachycardia, palpitation, cerebrovascular
accident,Raynaud’s syndrome, confusion, mood changes, vertigo, sleep disturbances,
asthenia, impotence; rarely dry mouth, gynaecomastia, alopecia, psoriasis; very rarely

allergic alveolitis, pulmonary infiltrates, profuse sweating, pemphigus, Stevens-Johnson
syndrome, and toxic epidermal necrolysis
Preparation
Tab 5/10mg
Zestril
2.5.2.2 Angiotensin II Receptor Antagonist

Cautions
Should be used with caution in renal artery stenosis. Monitoring of plasma-potassium
concentration is advised, particularly in children with renal impairment. Should be used
with caution in aortic or mitral valve stenosis and in hypertrophic cardiomyopathy. They
should be used with caution in those with a history of angioedema. Children with primary
aldosteronism, and Afro-Caribbean children (particularly those with left ventricular
hypertrophy), may not be benefited
2.5.2.2.1 Losartan Potassium

Indication & Doses
*Hypertension
BY MOUTH
Child 6–17 years (under expert supervision) (body-weight 20–49 kg): Initially 700
micrograms/kg once daily (max. per dose 25mg), adjusted according to response to 50
mg daily, lower initial dose may be used in intravascular volume depletion; maximum 50
mg per day
Child 6–17 years (under expert supervision) (body-weight 50 kg and above): Initially 50
mg once daily, adjusted according to response to 1.4mg/kg once daily; maximum100 mg
per day
*Hypertension with intravascular volume depletion
BY MOUTH
Child 6–17 years (under expert supervision) (body-weight 50 kg and above): Initially25
mg once daily; adjusted according to response to 1.4mg/kg once daily; maximum100 mg
per day
Side effects
Symptomatic hypotension (including dizziness), particularly in children with
hyponatraemia or intravascular volume depletion (e.g. those taking high-dose diuretics).
Hyperkalaemia occurs occasionally; angioedema has also been reported (sometimes with
delayed onset). malaise, anaemia; less commonly abdominal pain, constipation, diarr-
hoea, nausea, vomiting, angina, palpitation, oedema, dyspnoea, cough, headache, sleep
disorders, drowsiness, urticaria, pruritus, rash; rarely hepatitis, atrial fibrillation,
cerebrovascular accident, and paraesthesia; also reported pancreatitis, depression, erectile
dysfunction, thrombocytopenia, hyponatraemia, arthralgia, myalgia, rhabdomyolysis,
tinnitus, photosensitivity, and vasculitis (including Henoch-Scho¨nlein purpura)
Preparation
tab 50mg
Cozaar
2.5.2.2.2 Valsartan
Indication & Doses

*Hypertension
BY MOUTH
Child 6–17 years (under expert supervision) (body-weight 18–34 kg): Initially 40 mg
once daily, adjusted according to response; maximum 80 mg per day
Child 6–17 years (under expert supervision) (body-weight 35–79 kg): Initially 80 mg
once daily, adjusted according to response; maximum160 mg per day
Child 6–17 years (under expert supervision) (body-weight 80 kg and above): Initially 80
mg once daily, adjusted according to response; maximum 320 mg per day
Contraindication
Biliary cirrhosis, cholestasis
Side effects
Side-effects of angiotensin-II receptor antagonists include symptomatic hypotension
(including dizziness), particularly in children with hyponatraemia or intravascular volume
depletion (e.g. those taking high-dose diuretics). Hyperkalaemia occurs occasionally;
angioedema has also been reported (sometimes with delayed onset). also less commonly
abdominal pain, nausea, diarrhoea, cough, malaise, headache; also reported anaemia,
renal failure, neutropenia, thrombocytopenia, myalgia, vasculitis, serum sickness, rash,
pruritus
Preparation
Tab 80/160mg
Diovan
2.5.3 ENDOTHELIN RECEPTOR ANTAGONIST

Bosentan Monohydrate
Cautions
not to be initiated if systemic systolic blood pressure is below 85 mmHg; monitor liver
function before and at monthly intervals during treatment, and 2 weeks after dose
increase (reduce dose or suspend treatment if liver enzymes raised significantly),
discontinue if symptoms of liver impairment; monitor haemoglobin before and during
treatment (monthly for first 4 months, then 3 monthly thereafter), withdraw gradually
Indication & Doses
*Pulmonary arterial hypertension (initiated under specialist supervision)
BY MOUTH
Child 2–17 years (body-weight 10–20 kg): Initially 31.25 mg once daily for 4weeks,
then increased to 31.25 mg twice daily
Child 2–17 years (body-weight 20–40 kg): Initially 31.25 mg twice daily for 4weeks,
then increased to 62.5mg twice daily
Child 12–17 years (body-weight 40 kg and above): Initially 62.5mg twice daily for
4weeks, then increased to 125 mg twice daily (max. per dose 250 mg)
Contraindications
Acute porphyria
Side effects
Gastro-intestinal disturbances, dry mouth, rectal haemorrhage, hepatic impairment (see
Cautions, above); flushing, hypotension, pa lpitation, oedema, chest pain; dyspnoea;
headache, dizziness, fatigue; back pain and pain in extremities; anaemia; hypersensitivity
reactions (including rash, pruritus, and anaphylaxis)
Preparation

Tablet 62.5mg
Bosmon
2.5.4 VASODILATOR ANTI HYPERTENSIVE

2.5.4.1 Hydralazine
Cautions
cerebrovascular disease; occasionally blood pressure reduction too rapid even with low
parenteral doses; manufacturer advises test for antinuclear factor and for proteinuria
every 6 months and check acetylator status before increasing dose, but evidence of
clinical value unsatisfactory;
Indication & Doses
*Resistant hypertension (adjunct)
BY MOUTH
Neonate: 250–500 micrograms/kg every8–12 hours, increased if necessary to 2–3mg/kg
every 8 hours.
Child 1 month–11 years: 250–500 micrograms/kg every 8–12 hours, increased if
necessary to 7.5 mg/kg daily; maximum 200 mg per day
Child 12–17 years: 25 mg twice daily, increased to 50–100 mg twice daily
BY SLOW INTRAVENOUS INJECTION
Neonate: 100–500 micrograms/kg, dose may be repeated if necessary every 4–6 hours;
maximum 3mg/kg per day.
Child 1 month–11 years: 100–500 micrograms/kg, dose may be repeated if necessary
every 4–6 hours; maximum 3 mg/kg per day; maximum 60 mg per day
Child 12–17 years: 5–10mg, dose may be repeated if necessary every 4–6 hours
Neonate: 12.5–50 micrograms/kg/hour, continuous intravenous infusion is the preferred
route in cardiac patients; maximum2 mg/kg per day.
Child 1 month–11 years: 12.5–50 micrograms/kg/hour, continuous intravenous infusion
is the preferred route in cardiac patients; maximum3mg/kg per day
Child 12–17 years: 3–9mg/hour, continuous intravenous infusion is the preferred route
in cardiac patients; maximum 3 mg/kg per day
Contraindications
idiopathic systemic lupus erythematosus, severe tachycardia, high output heart failure,
myocardial insufficiency due to mechanical obstruction, cor pulmonale; acute porphyria
Side effects
tachycardia, palpitation, flushing, hypotension, fluid retention, gastro-intestinal
disturbances; headache, dizziness; systemic lupus erythematosuslike syndrome after
long-term therapy (especially in slow acetylator individuals); rarely rashes, fever,
peripheral neuritis, polyneuritis, paraesthesia, arthralgia, myalgia, increased lacrimation,
nasal congestion, dyspnoea, agitation, anxiety, anorexia; blood disorders (including
leucopenia, thrombocytopenia, haemolytic anaemia), abnormal liver function, jaundice,
raised plasma creatinine, proteinuria and haematuria reported
Preparation
inj 20mg
Hydralazine
2.5.4.2 Sodium Nitropruside

Cautions
Hypothyroidism, hyponatraemia, impaired cerebral circulation, hypothermia; monitor
blood pressure and blood-cyanide concentration, and if treatment exceeds 3 days also
blood-thiocyanate concentration; avoid sudden withdrawal—terminate infusion over 15–
30 minutes;
Indication & Doses
*Hypertensive emergencies
Neonate: Initially 500 nanograms/kg/minute, then increased in steps of 200
nanograms/kg/minute (max. per dose 8 micrograms/kg/minute) as required, max.
4micrograms/kg/minute if used for longer than 24 hours.
Child: Initially 500 nanograms/kg/minute, then increased in steps of 200
nanograms/kg/minute (max. per dose 8 micrograms/kg/minute) as required, max. 4
micrograms/kg/minute if used for longer than 24 hours
Contraindications
Severe vitamin B12 deficiency; Leber’s optic atrophy; compensatory hypertension
Side Effects
Rrapid reduction in blood pressure (reduce infusion rate): headache, dizziness, nausea,
retching, abdominal pain, perspiration, palpitation, anxiety, retrosternal discomfort;
occasionally reduced platelet count, acute transient phlebitis
Preparation
Inj 50mg
Nitrop
2.5.5 NITRATES & CALCIUM-CHANNEL BLOCKERS

2.5.5.1 NITRATES
Glyceryl Trinitrate (GTN)
Cautions
hypothyroidism; malnutrition; hypothermia; recent history of myocardial infarction; heart
failure due to obstruction; hypoxaemia or other ventilation and perfusion abnormalities;
susceptibility to angleclosure glaucoma; metal-containing transdermal systems should be
removed before magnetic resonance imaging procedures, cardioversion, or diathermy;
avoid abrupt withdrawal; monitor blood pressure and heart rate during infusion; tolerance
Indication & Doses
*Hypertension during and after cardiac surgery, Heart failure after cardiac
surgery/Coronary vasoconstriction in myocardial ischaemia Vasoconstriction in shock
Neonate: 0.2–0.5microgram/kg/minute, adjusted according to response, maintenance 1–
3micrograms/kg/minute (max. per dose 10 micrograms/kg/minute).
Child: Initially 0.2–0.5microgram/kg/minute, adjusted according to response,
maintenance 1–3micrograms/kg/minute (max. per dose 10 micrograms/kg/minute);
maximum 200 micrograms/minute
Contraindications
Hypersensitivity to nitrates; hypotensive conditions and hypovolaemia; hypertrophic
cardiomyopathy; aortic stenosis; cardiac tamponade;
constrictive pericarditis; mitral stenosis; toxic pulmonary oedema; head trauma; cerebral
haemorrhage; cerebrovascular disease; marked anaemia

Side effects
postural hypotension, tachycardia (but paradoxical bradycardia also reported); throbbing
headache, dizziness; less commonly nausea, vomiting, heartburn, flushing, syncope,
temporary hypoxaemia, rash, application-site reactions with transdermal patches; very
rarely angle-closure glaucoma. Injection Specific side-effects following injection
(particularly if given too rapidly) include severe hypotension, diaphoresis, apprehension,
restlessness, muscle twitching, retrosternal discomfort, palpitation, abdominal pain;
prolonged administration has been associated with methaemoglobinaemia
Preparations
Inj & patch 10mg/10ml & 5mg
Nitronal
2.5.5.2 CALCIUM CHANNEL BLOCKERS

2.5.5.2.1 Nifedipine
Cautions
Poor cardiac grapefruit juice (may affect metabolism); acute porphyria reserve; heart
failure or significantly impaired left ventricular function (heart failure deterioration
observed); severe hypotension; diabetes mellitus; avoid grape fruit juice (may effect
metabolism), acute porphyria
Indication & Doses
*Hypertensive crisis / Acute angina in Kawasaki disease or progeria
BY MOUTH USING IMMEDIATE-RELEASE MEDICINES
Child: Initially 250–500 micrograms/kg (max. per dose 10mg), then repeat once if
necessary, may cause unpredictable and severe reduction of blood pressure— monitor
closely following administration; if ineffective consider alternative treatment and seek
specialist advice
*Hypertension|Angina in Kawasaki disease or progeria
Child 1 month–11 years: 200–300 micrograms/kg 3 times a day, dose frequency
depends on preparation used; maximum3mg/kg per day; maximum 90 mg per day
Child 12–17 years: 5–20 mg 3times a day, dose frequency depends on preparation used;
maximum 90mg per day
*Raynaud’s syndrome
Child 2–17 years: 2.5–10 mg 2–4 times a day, start with low doses at night and increase
gradually to avoid postural hypotension, dose frequency depends on preparation used
*Persistent hyperinsulinaemic hypoglycaemia
Neonate: 100–200 micrograms/kg 4 times a day (max. per dose 600 micrograms/kg).
Contraindications
Cardiogenic shock; significant aortic stenosis
Side effects
Gastro-intestinal disturbance; hypotension, oedema, vasodilatation, palpitation; headache,
dizziness, lethargy, asthenia; less commonly
tachycardia, hypotension, syncope, chills, nasal congestion, dyspnoea, anxiety, sleep
disturbance, vertigo, migraine, paraesthesia, tremor, polyuria, dysuria, nocturia, erectile
dysfunction, epistaxis, myalgia, joint swelling, visual disturbance, sweating, and

hypersensitivity reactions (including angioedema, jaundice, pruritus, urticaria, and rash);
rarely anorexia, gum hyperplasia, mood disturbances, hyperglycaemia, male
infertility,purpura, photosensitivity reactions; also reported dysphagia, intestinal
obstruction, intestinal ulcer, bezoar formation, gynaecomastia, agranulocytosis, and
anaphylaxis.
Preparation
Tablet 10mg
Adalat
2.5.5.2.2 Amlodipine Besylate

Cautions
Acute porphyria
Indication & Doses
*Hypertension
BY MOUTH
Child 1 month–11 years: Initially100–200 micrograms/kg once daily; increased if
necessary up to 400 micrograms/kg once daily, adjusted at intervals of 1–2 weeks;
Child 12–17 years: Initially 5 mg once daily, then increased if necessary up to 10mg
once daily, adjusted at intervals of 1–2weeks
Contraindications
Cardiogenic shock, significant aortic stenosis
Side effects
abdominal pain, nausea; palpitation, flushing, oedema; headache, dizziness, sleep
disturbances, fatigue; less commonly gastro-intestinal disturbances, dry mouth, taste
disturbances, hypotension, syncope, chest pain, dyspnoea, rhinitis, mood changes,
asthenia, tremor, paraesthesia, urinary disturbances, impotence, gynaecomastia, weight
changes, myalgia, muscle cramps, back pain, arthralgia, visual disturbances, tinnitus,
pruritus, rashes (including isolated reports of erythema multiforme), sweating, alopecia,
purpura, and skin discolouration; very rarely gastritis, pancreatitis, hepatitis, jaundice,
cholestasis, gingival hyperplasia, myocardial infarction, arrhythmias, tachycardia,
vasculitis, coughing, peripheral neuropathy, hyperglycaemia, thrombocytopenia,
angioedema, and urticarial
Preparation
Tablet 5mg
Norvasc
2.6 SYMPATHOMIMETICS
2.6.1 INOTROPIC SYMPATHOMIMETICS
2.6.1.1 Dobutamine
Cautions
Arrhythmias, acute myocardial infarction, acute heart failure, severe hypotension, marked
obstruction of cardiac ejection (such as idiopathic hypertrophic subaortic stenosis);
correct hypovolaemia before starting treatment; tolerance may develop with continuous
infusions longer than 72 hours; hyperthyroidism;
Indication & Doses

*Inotropic support in low cardiac output states, after cardiac surgery,
cardiomyopathies, shock
Neonate: initially 5 micrograms/kg/minute, adjusted according to response to 2–20
micrograms/ kg/minute; dose as low as 0.5-1micrograms/gk/min have been used
Child: initially 5 micrograms/ kg/minute adjusted according to response to 2– 20
micrograms/kg/min, dose as low as 0.5-1micrograms/gk/min have been used
Contraindications
Phaeochromocytoma
Side effects
Nausea; hypotension, hypertension (marked increase in systolic blood pressure indicates
overdose), arrhythmias, palpitation, chest pain; dyspnoea, bronchospasm; headache;
fever; increased urinary urgency; eosinophilia; rash, phlebitis; very rarely myocardial
infarction, hypokalaemia; also reported coronary artery spasm and thrombocytopenia
Preparation
Inj 250mg/20ml
Dobutrex
2.6.1.2 Dopamine
Cautions
Correct hypovolaemia; hyperthyroidism;
Indication & Doses
*To correct the haemodynamic imbalance due to acute hypotension, shock, cardiac
failure, adjunct following cardiac surgery
Neonate: initially 3 micrograms/kg/minute, max 20 micrograms/kg/minute adjusted
according to response
Child: initially 5 micrograms/kg/minute, max. 20 micrograms/kg/minute adjusted
Contraindications
Tachyarrhythmia, phaeochromocytoma
Side effects
Nausea, vomiting, chest pain, palpitation, tachycardia, vasoconstriction, hypotension,
dyspnoea, headache; less commonly bradycardia, hypertension, gangrene, mydriasis;
rarely fatal ventricular arrhythmias
Preparation
Inj 40mg/ml
Dopamine
2.6.2 VASOCONSTRICTOR SYMPATHOMYMETICS

2.6.2.1 Adrenaline
Cautions
ischaemic heart disease, severe angina, obstructive cardiomyopathy, hypertension,
arrhythmias, cerebrovascular disease; occlusive vascular disease, monitor blood pressure
and ECG; cor pulmonale; organic brain damage, psychoneurosis; phaeochromocytoma;
diabetes mellitus, hyperthyroidism; hypokalaemia, hypercalcaemia; susceptibility to
angle-closure glaucoma

Indication & Doses
*Acute hypotension
Neonate: Initially 100 nanograms/kg/minute, adjusted according to response, higher
doses up to 1.5micrograms/kg/minute have been used in acute hypotension.
Child: Initially 100 nanograms/kg/minute, adjusted according to response, higher doses
up to 1.5micrograms/kg/minute have been used in acute hypotension
Croup (when not effectively controlled with corticosteroid treatment)
BY INHALATION OF NEBULISED SOLUTION
Child 1 month–11 years: 400 micrograms/kg (max. per dose5 mg), dose to be repeated
after 30 minutes if necessary
*Emergency treatment of acute anaphylaxis (under expert supervision) / Angioedema
(if laryngeal oedema is present) (under expert supervision)
BY INTRAMUSCULAR INJECTION
Child 1 month–5 years: 150 micrograms, doses may be repeated several times if
necessary at 5 minute intervals according to blood pressure, pulse, and respiratory
function, suitable syringe to be used for measuring small volume; injected preferably into
the anterolateral aspect of the middle third of the thigh
Child 6–11 years: 300 micrograms, doses may be repeated several times if necessary at 5
minute intervals according to blood pressure, pulse, and respiratory function, to be
injected preferably into the anterolateral aspect of the middle third of the thigh
Child 12–17 years: 500 micrograms, to be injected preferably into the anterolateral
aspect of the middle third of the thigh, doses may be repeated several times if necessary
at 5 minute intervals according to blood pressure, pulse, and respiratory function,
300micrograms (0.3mL) to be administered if child small or prepubertal
*Acute anaphylaxis when there is doubt as to the adequacy of the circulation
(specialist use only), Angioedema (if laryngeal oedema is present) (specialist use only)
Child: 1 microgram/kg (max. per dose 50 micrograms), using dilute 1in 10000
adrenaline injection, dose to be repeated according to response, if multiple doses
required, adrenaline should be given as a slow intravenous infusion stopping when a
response has been obtained
Side effects
nausea, vomiting, dry mouth, anorexia, hypersalivation; arrhythmias, palpitation,
tachycardia, syncope, angina, hypertension (risk of cerebral haemorrhage), cold
extremities, pallor; dyspnoea, pulmonary oedema (on excessive dosage or extreme
sensitivity); anxiety, tremor, restlessness, headache, insomnia, confusion, weakness,
dizziness, hallucinations, psychosis; hyperglycaemia; difficulty in micturition, urinary
retention; metabolic acidosis; hypokalaemia; mydriasis, angle-closure glaucoma; tissue
necrosis at injection site and of extremities, liver and kidneys, sweating
Preparation
Inj 0.1mg/ml
Adrenaline
2.6.2.2 Nor Adrenaline

Cautions
coronary, mesenteric, or peripheral vascular thrombosis; following myocardial infarction;
Prinzmetal’s variant angina, hyperthyroidism, diabetes mellitus; hypoxia or hypercapnia;

uncorrected hypovolaemia; extravasation at injection site may cause necrosis;
susceptibility to angle-closure glaucoma
Indication & Doses
*Acute hypotension (septic shock) | Shock secondary to excessive vasodilation
Neonate: 20–100 nanograms/kg/minute (max. per dose 1 microgram/kg/minute),
adjusted according to response, dilute the 1 mg/mL concentrate for infusion for this dose.
Child: 20–100 nanograms /kg /minute (max. per dose 1 microgram /kg/ minute), adjusted
according to response, dilute the 1mg/mL concentrate for infusion for this dose
Contraindications
Hypertension
Side effects
Anorexia, nausea, vomiting, hypoxia, arrhythmias, peripheral ischaemia, palpitation,
hypertension, bradycardia, tachycardia, dyspnoea, headache, insomnia, confusion,
anxiety, psychosis, weakness, tremor, urinary retention, angle-closure glaucoma
Preparation
Inj 4mg
Noradrin
2.6.2.3 Phenylephrine
Cautions
coronary, mesenteric, or peripheral vascular thrombosis; following myocardial infarction;
Prinzmetal’s variant angina, hyperthyroidism, diabetes mellitus; hypoxia or hypercapnia;
uncorrected hypovolaemia; extravasation at injection site may cause necrosis;
susceptibility to angle-closure glaucoma, longer duration of action than noradrenaline
(norepinephrine),coronary disease
Indication & Doses
*Acute hypotension
BY SUBCUTANEOUS INJECTION, OR BY INTRAMUSCULAR INJECTION
Child 1–11 years: 100 micrograms/kg every1–2hours (max. per dose5 mg) as required
Child 12–17 years: Initially 2–5mg (max. per dose5 mg), followed by 1–10 mg, after at
least 15 minutes if required
Child 1–11 years: Initially 5–20micrograms/kg (max. per dose 500 micrograms),
repeated as necessary after at least 15 minutes
Child 12–17 years: 100–500 micrograms, repeated as necessary after at least 15 minutes
Child 1–15 years: Initially 100–500 nanograms/kg/minute, adjusted according to
response
Child 16–17 years: Initially up to 180 micrograms/minute, reduced to 30–60
micrograms/minute, adjusted according to response
Contraindications
Hypertension
Side effects
Anorexia, nausea, vomiting, hypoxia, arrhythmias, peripheral ischaemia, palpitation,
hypertension, bradycardia, tachycardia, dyspnoea, headache, insomnia, confusion,
anxiety, psychosis, weakness, tremor, urinary retention, angle-closure glaucoma,
tachycardia or reflex bradycardia

Preparation
Inj 10mg
Synephrine
2.7 ANTI COAGULANTS & PROTAMINE

2.7.1 ANTICOAGULANTS
2.7.1.1 Heparin
Cautions
Thrombocytopenia, Hyperkalaemia, Haemorrhage, Concomitant use of drugs that
increase risk of bleeding
Indication & Doses
*Prevention of clotting in extracorporeal circuits
TO THE DEVICE AS A FLUSH
Child: (consult product literature) Maintenance of neonatal umbilical arterial catheter
Neonate: 0.5 unit/hour.
*Treatment of thombotic episodes
INITIALLY BY INTRAVENOUS INJECTION
Neonate up to 35 weeks corrected gestational age: Initially 50units/kg, then (by
continuous intravenous infusion) 25units/kg/hour, adjusted according to APTT.
Neonate: Initially 75units/kg, then (by continuous intravenous infusion) 25units/kg/hour,
adjusted according to APTT.
Child 1–11 months: Initially75 units/kg, then (by continuous intravenous infusion) 25
units/kg/hour, adjusted according to APTT
Child 1–17 years: Initially 75units/kg, then (by continuous intravenous infusion) 20
units/kg/hour, adjusted according to APTT
BY SUBCUTANEOUS INJECTION
Child: 250 units/kg twice daily, adjusted according to APTT Prophylaxis of thrombotic
episodes
Child: 100 units/kg twice daily (max. per dose 5000 units), adjusted according to APTT
Maintenance of cardiac shunts and critical stents
TO THE DEVICE AS A FLUSH
Child: (consult local protocol)
Contraindications
Hemophilia and other haemorrhagic disorders, thrombocytopenia (including history of
heparin-induced thrombocytopenia), recent cerebral haemorrhage, severe hypertension;
peptic ulcer; after major trauma or recent surgery to eye or nervous system; acute
bacterial endocarditis; spina or epidural anaesthesia with treatment doses of
unfractionated heparin; hypersensitivity to unfractionated heparin
Side effects
Hemorrhage, thrombocytopenia; rarely rebound hyperlipidaemia following
unfractionated heparin withdrawal, priapism, hyperkalaemia, osteoporosis, alopecia on
prolonged use, injection-site reactions, skin necrosis, and hypersensitivity reactions
(including urticaria, angioedema, and anaphylaxis)
Preparation
Injection 5000 Units/ml

Heparinol
2.7.1.2 Warfarin Sodium

Cautions
Recent surgery; recent ischaemic stroke; history of gastro-intestinal bleeding; peptic
ulcer; concomitant use of drugs that increase risk of bleeding; bacterial endocarditis
(increased risk of bleeding; use only if warfarin otherwise indicated); avoid cranberry
juice;
Indication & Doses
*Treatment and prophylaxis of thrombotic episodes (induction)
BY MOUTH
Neonate (initiated under specialist supervision): Initially 200 micrograms/kg for 1
dose on day1, then reduced to 100 micrograms/kg once daily for the following 3 days,
subsequent doses dependent on INR levels, induction dose may need to be altered
according to condition (e.g. abnormal liver function tests, cardiac failure), concomitant
interacting drugs, and if baseline INR above 1.3.
Child: Initially 200 micrograms/kg (max. per dose 10mg) for 1 dose on day1, then
reduced to 100 micrograms/kg once daily (max. per dose 5mg) for the following 3days,
subsequent doses adjusted according to INR levels, induction dose may need to be altered
according to condition (e.g. abnormal liver function tests, cardiac failure), concomitant
interacting drugs, and if baseline INR above 1.3
*Treatment and prophylaxis of thrombotic episodes following induction dose (if INR
still below 1.4)
BY MOUTH
Neonate (under expert supervision): 200 micrograms/kg once daily.
Child: 200 micrograms/kg once daily (max. per dose 10 mg)
above 3.0)
BY MOUTH
Neonate (under expert supervision): 50 micrograms/kg once daily.
Child: 50 micrograms/kg once daily (max. per dose 2.5 mg)
above 3.5)
BY MOUTH
Neonate (under expert supervision): Dose to be omitted.
Child: Dose to be omitted
*Treatment and prophylaxis of thrombotic episodes (usual maintenance)
BY MOUTH
Neonate (under expert supervision): Maintenance 100–300 micrograms/kg once daily,
doses up to 400micrograms/kg once daily may be required especially if bottle fed, to be
adjusted according to INR.
Child: Maintenance100–300 micrograms/kg once daily, doses up to400micrograms/kg
once daily may be required especially if bottle fed, to be adjusted according to INR
Contraindication
Hemorrhagic stroke; significant bleeding; avoid use within 48 hours postpartum
Side effects
hemorrhage;nausea, vomiting, diarrhoea, jaundice, hepatic dysfunction, pancreatitis,
pyrexia, alopecia, purpura, rash, ‘purple toes’, skin necrosis (increased risk in patients

with protein C or protein S deficiency)
Preparation
Tablet 1mg
Marevan
2.7.1.3 Enoxaparin
Cautions
Thrombocytopenia, Hyperkalaemia, Haemorrhage, Concomitant use of drugs that
increase risk of bleeding
Indication & Doses
*Treatment of thrombotic episodes
Neonate: 1.5–2mg/kg twice daily.
Child 1 month: 1.5mg/kg twice daily
Child 2 months–17 years: 1 mg/kg twice daily
*Treatment of venous thromboembolism in pregnancy
Child 12–17 years (body-weight up to 50 kg): 40mg twice daily, dose based on early
pregnancy body-weight
Child 12–17 years (body-weight 50–69 kg): 60mg twice daily, dose based on early
Child 12–17 years (body-weight 70–89 kg): 80 mg twice daily, dose based on early
Child 12–17 years (body-weight 90 kg and above): 100 mg twice daily, dose based on
early pregnancy body- weight
*Prophylaxis of thrombotic episodes
Neonate: 750 micrograms/kg twice daily.
Child 1 month: 750 micrograms/kg twice daily
Child 2 months–17 years: 500 micrograms/kg twice daily; maximum 40 mg per day
Contraindications
Hemophilia and other haemorrhagic disorders, thrombocytopenia (including history of
heparin-induced thrombocytopenia), recent cerebral
haemorrhage, severe hypertension; peptic ulcer; after major trauma or recent surgery to
eye or nervous system; acute bacterial endocarditis; spina or epidural anaesthesia with
treatment doses of low molecular weight heparin; hypersensitivity to unfractionated
heparin
Side effects
Hemorrhage, thrombocytopenia; rarely rebound hyperlipidaemia following
unfractionated heparin withdrawal, priapism, hyperkalaemia, osteoporosis, alopecia on
prolonged use, injection-site reactions, skin necrosis, and hypersensitivity reactions
(including urticaria, angioedema, and anaphylaxis)
Preparation
Inj 4000units
Clexane
2.7.2 Protamine Sulphate

Caution
Monitor activated partial thromboplastin time or other appropriate blood clotting
parameters; if increased risk of allergic reaction to protamine (includes previous
treatment with protamine or protamine insulin, allergy to fish, and adolescent males who
are infertile)
Indication & Doses
*Over dosage with intravenous injection or intravenous infusion of unfractionated
heparin
BY INTRAVENOUS INJECTION (rate not exceeding 5 mg/minute)
Child 1 month–17 years to neutralise each 100 units of unfractionated heparin, 1 mg if
less than 30 minutes lapsed since overdose, 500–
750 micrograms if 30–60 minutes lapsed, 375– 500 micrograms if 60–120 minutes
lapsed, 250– 375 micrograms if over 120 minutes lapsed; max. 50 mg
*Over dosage with subcutaneous injection of unfractionated heparin
BY INTRAVENOUS INJECTION OR INTRAVENOUS INFUSION
Child 1 month–17 years 1 mg neutralises approx. 100 units of unfractionated heparin;
give 50–100% of the total dose by intravenous injection (rate not exceeding 5
mg/minute), then give any remainder of dose by intravenous infusion over 8–16 hours;
max. total dose 50 mg
*Over dosage with subcutaneous injection of low molecular weight heparin
BY INTRAVENOUS INJECTION (rate not exceeding 5 mg/minute) or BY
INTRAVENOU SINFUSION
Child 1 month–17 years 1 mg neutralises approx. 100 units low molecular weight
heparin (consult product literature of low molecular weight heparin for details); max. 50
mg
Side effects
Nausea, vomiting, lassitude, flushing, hypotension, hypertension, bradycardia, dyspnoea,
rebound bleeding, back pain; hypersensitivity reactions (including angioedema,
anaphylaxis) and pulmonary oedema reported
Preparation
Inj 10mg/ml
Protamine
2.8 ANTIPLATELET DRUGS

2.8.1 Aspirin
Cautions
Asthma; uncontrolled hypertension; previous peptic ulceration (but manufacturers may
advise avoidance of low-dose aspirin in history of pepticulceration); concomitant use of
drugs that increase risk of bleeding; G6PD deficiency
Indication & Doses
*Antiplatelet / Prevention of thrombus formation after cardiac surgery
BY MOUTH
Neonate: 1–5mg/kg once daily.
Child 1 month–11 years: 1–5 mg/kg once daily (max. per dose 75 mg)
Child 12–17 years: 75mg once daily
*Kawasaki disease
BY MOUTH

Neonate: Initially 8mg/kg 4times a day for2 weeks or until a febrile, followed by 5mg/kg
once daily for 6–8weeks, if no evidence of coronary lesions after 8 weeks, discontinue
treatment or seek expert advice.
Child 1 month–11 years: Initially7.5–12.5 mg/kg4 times a day for 2 weeks or until
afebrile, then2–5mg/kg once daily for6–8weeks, if no evidence of coronary lesions after
8 weeks, discontinue treatment or seek expert advice
*Mild to moderate pain (dose approved for use by community practitioner nurse
prescribers) Pyrexia (dose approved for use by community practitioner nurse
prescribers)
BY MOUTH
Child 16–17 years: 300–600 mg every 4–6 hours as required, maximum 2.4g per day
without doctor’s advice
Contraindications
Children under 16 years (risk of Reye’s syndrome) unless for indications below; active
peptic ulceration; haemophilia and other bleeding disorders
Side effects
Bronchospasm; gastro-intestinal haemorrhage (occasionally major), also other
haemorrhage (e.g. subconjunctival)
Preparation
Tablet 75mg & 300mg (soluble)
Dispirin
2.8.2 Beraprost
Prepration
Tab 20ug
Benprost
2.9 ANTI FIBRINOLYTIC DRUGS AND HAEMOSTATICS

2.9.1 Tranexamic Acid
Cautions
massive haematuria (avoid if risk of ureteric obstruction); not for use in disseminated
intravascular coagulation; before initiating treatment for menorrhagia, exclude structural
or histological causes or fibroids causing distortion of uterine cavity; irregular menstrual
bleeding (establish cause before initiating therapy); regular liver function tests in long-
term treatment of hereditary angioedema
Indication & Doses
*Inhibition of fibrinolysis
BY MOUTH
Child: 15–25 mg/kg 2–3 times a day (max. per dose 1.5g)
Child: 10 mg/kg 2–3 times a day (max. per dose 1 g), dose to be given over at least 10
minutes
Child: 45 mg/kg, dose to be given over 24 hours
*Menorrhagia
BY MOUTH

Child 12–17 years: 1g 3 times a day for up to4 days, to be initiated when menstruation
has started; maximum 4 g per day
*Hereditary angioedema
BY MOUTH
Child: 15–25mg/kg 2–3times a day (max. per dose 1.5 g), for short-term prophylaxis of
hereditary angioedema, tranexamic acid is started several days before planned procedures
which may trigger an acute attack of hereditary angioedema (e.g. dental work) and
continued for 2–5 days afterwards
Child: 10 mg/kg 2–3 times a day (max. per dose 1 g), dose to be given over at least 10
minutes
Child: 45 mg/kg, dose to be given over 24 hours
*Prevention of excessive bleeding after dental procedures (e.g. in haemophilia)
Child 6–17 years: 10 mg/kg (max. per dose 1.5 g), dose to be given pre-operatively
BY MOUTH
Child 6–17 years: 15–25 mg/kg (max. per dose 1.5g), dose to be given pre-operatively,
then 15–25mg/kg 2–3 times a day (max. per dose1.5g) for up to 8 days, dose to be given
postoperatively
*Prevention of excessive bleeding after dental procedures (e.g. in haemophilia) with
mouthwash 5% solution (specialist use only)
BY MOUTH
Child 6–17 years: 5–10 mL 4 times a day for 2 days, rinse mouth with solution; the
solution should not be swallowed
Contraindications
Thromboembolic disease; history of convulsions
Side effects
Nausea, vomiting, diarrhoea (reduce dose); rarely disturbances in colour vision
(discontinue), thromboembolic events, convulsions, allergic skin reactions; dizziness and
hypotension on rapid intravenous injection
Preparations
Injection & cap 250mg/5ml & 250mg
Transamin
2.9.2 Factor VIIa (Recombinant)
Preparations
Vial 1mg
NovoSeven
2.9.3 Factor VIII (Recombinant)
Preparations
Vial 250 mg
2.10 DRUGS EFFECTING DUCT ARTERIOSIS

Alprostadil PGE 1
Cautions
History of haemorrhage; avoid in hyaline membrane disease; monitor arterial pressure,
respiratory rate, heart rate, temperature, and venous blood pressure in arm and leg;

facilities for intubation and ventilation must be immediately available
Indication & Doses
*Maintaining patency of the ductus arteriosus
BY CONTINOUS IV INFUSION
Neonate initially 5 nanograms/kg/minute, adjusted according to response in steps of 5
nanograms/ kg/minute; max. 100 nanograms/kg/minute (but associated with increased
side-effects)
Side effects
apnoea (particularly in neonates under 2 kg), flushing, bradycardia, hypotension,
tachycardia, cardiac arrest, oedema, diarrhoea, fever, convulsions, disseminated
intravascular coagulation, hypokalaemia; cortical proliferation of long bones; weakening
of the wall of the ductus arteriosus and pulmonary artery may follow prolonged use;
gastric-outlet obstruction reported
Preparation
Inj 20mcg
Prostavasin

SECTION 3: DRUGS ACTING ON RESPITRATORY SYSTEM
3.1 ADRENORECEPTOR AGONIST (SLECTIVE BETA 2 AGONIST

Cautions
Should be used with caution in diabetes—monitor blood glucose (risk of ketoacidosis,
especially when a beta 2 agonist is given intravenously).should also be used with caution
in hyperthyroidism, cardiovascular disease, arrhythmias, susceptibility to QT-interval
prolongation, and hypertension
3.1.1 Salbutamol
Indication & Doses
*Acute asthma
Child 1–23 months: 5 micrograms/kg for 1dose, dose to be administered over 5 minutes,
reserve intravenous beta 2 agonists for those in whom inhaled therapy cannot be used
reliably or there is no current effect
Child 2–17 years: 15 micrograms/kg (max. per dose 250 micrograms) for 1 dose, dose to
be administered over 5 minutes, reserve intravenous beta 2 agonists for those in whom
inhaled therapy cannot be used reliably or there is no current effect
Child: 1–2 micrograms/kg/minute, adjusted according to response and heart rate,
increased if necessary up to 5 micrograms/kg/minute, doses above 2
micrograms/kg/minute should be given in an intensive care setting, reserve intravenous
beta 2 agonists for those in whom inhaled therapy cannot be used reliably or there is no
current effect
*Moderate, severe, or life-threatening acute asthma
Child 1 month–4 years: 2.5mg, repeat every 20–30 minutes or when required, give via
oxygen- driven nebuliser if available
Child 5–11 years: 2.5–5mg, repeat every20–30 minutes or when required, give via
oxygen-driven nebuliser if available
Child 12–17 years: 5 mg, repeat every 20–30 minutes or when required, give via
*Moderate and severe acute asthma
BY INHALATION OF AEROSOL
Child: 2–10 puffs, each puff is to be inhaled separately, repeat every 10–20 minutes or
when required, give via large volume spacer (and a close- fitting face mask in children
under 3 years), each puff is equivalent to 100 micrograms
*Exacerbation of reversible airways obstruction (including nocturnal asthma)
Prophylaxis of allergen- or exercise- induced bronchospasm
Child: 100–200 micrograms, up to 4 times a day for persistent symptoms
Child 1 month–1 year: 100 micrograms/kg 3–4 times a day (max. per dose 2mg),
inhalation route preferred over oral route
Child 2–5 years: 1–2 mg 3–4 times a day, inhalation route preferred over oral route
Child 6–11 years: 2 mg 3–4 times a day, inhalation route preferred over oral route

Child 12–17 years: 2–4mg 3–4 times a day, inhalation route preferred over oral route
*Severe hyperkalaemia
Neonate: 4 micrograms/kg, repeated if necessary, to be administered over 5 minutes.
Child: 4 micrograms/kg, repeated if necessary, to be administered over 5 minutes
Neonate: 2.5–5 mg, repeated if necessary, intravenous injection route preferred over
inhalation of nebulised solution.
Child: 2.5–5 mg, repeated if necessary, intravenous injection route preferred over
inhalation of nebulised solution
EASYHALER ® SALBUTAMOL
*Acute bronchospasm
BY INHALATION OF POWDER
Child 5–11 years: 100–200 micrograms; maximum 800 micrograms per day
Child 12–17 years: Initially 100–200 micrograms, increased if necessary to 400
micrograms; maximum 800 micrograms per day
*Prophylaxis of allergen- or exercise-induced bronchospasm
Child 5–11 years: 100–200 micrograms
Child 12–17 years: 200 micrograms
SALBULIN NOVOLIZER ®
*Acute bronchospasm
Child 6–11 years: 100–200 micrograms, up to 400 micrograms daily for persistent
symptoms
Child 12–17 years: Initially 100–200 micrograms, up to 800 micrograms daily for
persistent symptoms
Child 6–11 years: 100–200 micrograms
VENTOLIN ACCUHALER ®
*Acute bronchospasm
Child 5–17 years: Initially 200 micrograms, up to4 times daily for persistent symptoms
Side effects
Fine tremor (particularly in the hands), nervous tension, headache, peripheral dilatation
and palpitation. Tachycardia, arrhythmias, peripheral vasodilation, myocardial ischaemia,
and disturbances of sleep and behaviour. Muscle cramps and hypersensitivity reactions
including paradoxical bronchospasm (occasionally severe), urticaria, angioedema,
hypotension, and collapse have also been reported. High doses are associated with
hypokalaemia
Preparations
Syrup, sol & inhalor 2mg/5ml, 5mg/ml & 100mcg
Ventolin

3.1.2 Terbutaline
Indication & Doses
*Acute asthma
BY SUBCUTANEOUS INJECTION, OR BY SLOW INTRAVENOUS INJECTION
Child 2–14 years: 10 micrograms/kg up to 4 times a day (max. per dose300
micrograms), reserve intravenous beta2 agonists for those in whom inhaled therapy
cannot be used reliably or there is no current effect
Child 15–17 years: 250–500 micrograms up to 4 times a day, reserve intravenous beta 2
agonists for those in whom inhaled therapy cannot be used reliably or there is no current
effect
Child: Loading dose 2–4 micrograms/kg, then 1–10 micrograms/kg/hour, dose to be
adjusted according to response and heart rate, close monitoring is required for doses
above10micrograms/kg/hour, reserve intravenous beta2 agonists for those in whom
inhaled therapy cannot be used reliably or there is no current effect
*Moderate, severe, or life-threatening acute asthma
Child 1 month–4 years: 5 mg, repeat every 20–30 minutes or when required, give via
oxygen- driven nebuliser if available
Child 5–11 years: 5–10 mg, repeat every 20–30 minutes or when required, give via
Child 12–17 years: 10mg, repeat every 20–30 minutes or when required, give via
*Exacerbation of reversible airways obstruction (including nocturnal asthma)
Prevention of exercise-induced bronchospasm
Child 5–17 years: 500 micrograms up to 4 times a day, for occasional use only
BY MOUTH
Child 1 month–6 years: 75 micrograms/kg 3 times a day (max. per dose 2.5 mg),
administration by mouth is not recommended
Child 7–14 years: 2.5mg 2–3times a day, administration by mouth is not recommended
Child 15–17 years: Initially 2.5mg 3 times a day, then increased if necessary to 5mg 3
times a day, administration by mouth is not recommended
Side effects
Fine tremor (particularly in the hands), nervous tension, headache, peripheral dilatation
and palpitation. Tachycardia, arrhythmias, peripheral vasodilation, myocardial ischaemia,
and disturbances of sleep and behaviour. Muscle cramps and hypersensitivity reactions
including paradoxical bronchospasm (occasionally severe), urticaria, angioedema,
hypotension, and collapse have also been reported. High doses are associated with
hypokalaemia
Preparation
Injection & Syp 0.5mg/ml & 0.3mg/ml
Britanil
3.2 ANTIMUSCRANICS
Ipratropium Bromide
Cautions

Risk of glaucoma, bladder outflow obstruction
Indication & Doses
*Reversible airways obstruction
Child 1 month–5 years: 20 micrograms3times a day
Child 6–11 years: 20–40 micrograms3times a day
Child 12–17 years: 20–40 micrograms3–4 times a day
*Acute bronchospasm
Child 1 month–5 years: 125–250 micrograms as required; maximum1 mg per day
Child 6–11 years: 250 micrograms as required; maximum 1mg per day
Child 12–17 years: 500 micrograms as required, doses higher than max. can be given
under medical supervision; maximum 2 mg per day
*Severe or life-threatening acute asthma
Child 1 month–11 years: 250 micrograms every 20–30 minutes for the first 2 hours,
then 250 micrograms every 4–6 hours as required
Child 12–17 years: 500 micrograms every 4–6 hours as required
Side effects
dry mouth, nausea, throat irritation, cough, headache, dizziness; less commonly
diarrhoea, constipation, vomiting, palpitation, tachycardia, bronchospasm (including
paradoxical bronchospasm), laryngospasm, pharyngeal oedema, urinary retention, blurred
vision, mydriasis, raised intra-ocular pressure, angle-closure glaucoma, eye pain, con-
junctival hyperaemia, corneal oedema, stomatitis, rash, pruritus; rarely atrial fibrillation
Preparation
Neb sol 0.5mg
Atrovent
3.3 XANTHINES
Aminophylline
Cautions
cardiac arrhythmias or other cardiac disease, hypertension, hyperthyroidism; peptic ulcer;
epilepsy; fever; hypokalaemia risk, avoid in acute porphyria; monitor plasma-
theophylline concentration; dose adjustment may be necessary if smoking started or
stopped during treatment
Indication & Doses
*Severe acute asthma in patients not previously treated with theophylline
Child: 5 mg/kg (max. per dose500 mg), to be followed by intravenous infusion
*Severe acute asthma
Child 1 month–11 years: 1mg/kg/hour, adjusted according to plasma-theophylline
concentration
Child 12–17 years: 500–700 micrograms/kg/hour, adjusted according to plasma-
theophylline concentration
*Chronic asthma
BY MOUTH USING MODIFIED-RELEASE MEDICINES

Child (body-weight 40 kg and above): Initially 225 mg twice daily for 1 week, then
increased if necessary to 450 mg twice daily, adjusted according to plasma- theophylline
concentration
Side effects
Nausea, vomiting, gastric irritation, diarrhoea, palpitation, tachycardia, arrhythmias,
headache, CNS stimulation, insomnia, convulsions
Preparation
Inj 250mg/10ml
Aminophylline
3.4 Leukotropin Antagonists

Monteleukast
Indication & Doses
*Prophylaxis of asthma
BY MOUTH
Child 6 months–5 years: 4 mg once daily, dose to be taken in the evening
Child 6–14 years: 5mg once daily, dose to be taken in the evening
Child 15–17 years: 10 mg once daily, dose to be taken in the evening
*Symptomatic relief of seasonal allergic rhinitis in patients with asthma
BY MOUTH
Child 15–17 years: 10mg once daily, dose to be taken in the evening
Preparation
Tab & Sachet 5mg/10mg & 4mg
Singulair
3.5 CORTICOSTEROIDS
Cautions
Systemic therapy may be required during periods of stress, such as during severe
infections, or when airways obstruction or mucus prevent drug access to smaller airways;
Side effects
Inhaled corticosteroids have considerably fewer systemic effects than oral corticosteroids,
but adverse effects have been reported. High doses of inhaled corticosteroids used for
prolonged periods can induce adrenal suppression. Inhaled corticosteroids have
occasionally been associated with adrenal crisis and coma in children; excessive doses
should be avoided. Children using high doses of inhaled corticosteroids should be under
the supervision of a pediatrician for the duration of the treatment; Growth restriction
associated with systemic corticosteroid therapy does not seem to occur with
recommended doses of inhaled corticosteroids; although initial growth velocity may be
reduced, there appears to be no effect on achieving normal adult height. However, the
height of children receiving prolonged treatment with inhaled corticosteroid should be
monitored; if growth is slowed, referral to a pediatrician should be considered.
Hoarseness and candidiasis of the mouth or throat have been reported, usually only with
high doses. Hypersensitivity reactions (including rash and angioedema) have been
reported rarely. Other side effects that have very rarely been reported include paradoxical
bronchospasm, anxiety, depression, sleep disturbances, and behavioral changes including
hyperactivity, irritability, and aggression (particularly in children); skin thinning and
bruising have also been reported.

3.5.1 Beclomethasone Dipropionate
Indication & Doses
Child 5–11 years: 100–200 micrograms twice daily, dose to be adjusted as necessary
Child 12–17 years: 200–400 micrograms twice daily; increased if necessary up to 800
micrograms twice daily, dose to be adjusted as necessary
Preparations
Inhalor 250 microgram/actuation
Solution 0.8mg/2ml
Clenil A
3.5.2 Fluticasone Propionate

Indication & Doses
Child 5–15 years: Initially 50–100 micrograms twice daily (max. per dose 200
micrograms twice daily), dose to be adjusted as necessary
Child 16–17 years: Initially100–500 micrograms twice daily (max. per dose 1mg twice
daily), dose may be increased according to severity of asthma. Doses above 500
micrograms twice daily initiated by a specialist
Child 4–15 years: Initially50–100 micrograms twice daily (max. per dose 200
micrograms twice daily), dose to be adjusted as necessary
Child 16–17 years: Initially100–500 micrograms twice daily (max. per dose 1mg twice
daily), dose may be increased according to severity of asthma. Doses above
500micrograms twice daily initiated by a specialist
BY INHALATION OF NEBULISED SUSPENSION
Child 4–15 years: 1mg twice daily
Child 16–17 years: 0.5–2 mg twice daily
Preparation
Inhaler 125 & 250 mcg
Flixotide
3.5.3 Salmeterol + Fluticasone Propionate

Doses
Two inhalations twice daily
Preparation
Inhaler 25/125 & 25/50 mcg
Seritide
3.6 ANTIHISTAMINE
Cautions & Contraindications
Antihistamines should be used with caution in children with epilepsy. Most
antihistamines should be avoided in acute porphyria, but some are thought to be safe.
Sedating antihistamines have significant antimuscarinic activity—they should not be used

in neonates and should be used with caution in children with urinary retention, glaucoma,
or pyloroduodenal obstruction. Phenothiazine sedating antihistamines, such as
alimemazine and promethazine, should not be given to children under 2 years, except on
specialist advice, because the safety of such use has not been established.
Side effects
Drowsiness is a significant side-effect with most of the older antihistamines although
paradoxical stimulation may occur rarely in children, especially with high doses.
Drowsiness may diminish after a few days of treatment and is considerably less of a
problem with the newer antihistamines. Side-effects that are more common with the older
antihistamines include headache, psychomotor impairment, and antimuscarinic effects
such as urinary retention, dry mouth, blurred vision, and gastro-intestinal disturbances.
Other rare side-effects of antihistamines include hypotension, palpitation, arrhythmias,
extrapyramidal effects, dizziness, confusion, depression, sleep disturbances, tremor,
convulsions, hypersensitivity reactions (including bronchospasm, angioedema,
anaphylaxis, rashes, and photosensitivity reactions), blood disorders, and liver
dysfunction.
3.6.1 Pheniramine Maleate

Indication & Doses
6 month to 3 years: 0.4 to 1 ml IM once or twice a day
Over 4 years: 0.8 to 2 ml IM once or twice daily
Preparation
Injection 25mg/2ml
Avil
3.6.2 Promethazine HCl

Indication & Doses
*Symptomatic relief of allergy such as hay fever and urticaria|Insomnia associated
with urticaria and pruritus
BY MOUTH
Child 2–4 years: 5 mg twice daily, alternatively 5–15 mg once daily, dose to be taken at
night
Child 5–9 years: 5–10mg twice daily, alternatively 10–25 mg once daily, dose to be
taken at night
Child 10–17 years: 10–20 mg 2–3 times a day, alternatively25 mg once daily, dose to be
taken at night, increased if necessary to 25 mg twice daily
*Sedation (short-term use)
BY MOUTH
Child 2–4 years: 15–20 mg
*Sedation in intensive care
BY MOUTH, OR BY SLOW INTRAVENOUS INJECTION, OR BY DEEP
INTRAMUSCULAR INJECTION
Child 1 month–11 years: 0.5–1mg/kg 4times a day (max. per dose 25 mg), adjusted
Child 12–17 years: 25–50 mg 4times a day, adjusted according to response

*Nausea, Vomiting, Vertigo, Labyrinthine disorders, Motion sickness
BY MOUTH
Child 2–4 years: 5 mg, to be taken at bedtime on night before travel, repeat following
morning if necessary
Child 5–9 years: 10 mg, to be taken at bedtime on night before travel, repeat following
morning if necessary
Child 10–17 years: 20–25 mg, to be taken at bedtime on night before travel, repeat
following morning if necessary
Preparation
Elixir 5mg/5ml
Phenergan
3.6.3 Loratadine
Indication & Doses
*Symptomatic relief of allergy such as hay fever, chronic idiopathic urticaria
BY MOUTH
Child 2–11 years
Body-weight under 30 kg 5 mg once daily
Body-weight over 30 kg 10 mg once daily
Child 12–17 years 10 mg once daily
Preparation
Tab & Syp 10mg & 1mg/ml
Exigentin
3.6.4 Levocetirizine
Indication & Doses
*Symptomatic relief of allergy such as hay fever, urticaria
BY MOUTH
Child 2–5 years: 1.25 mg twice daily
Child 6–17 years: 5mg once daily
Preparation
Tab & Syp 5mg & 2.5mg/5ml
T-Day
3.7 ALLERGIC EMERGENCIES

Adrenaline
Cautions
ischaemic heart disease, severe angina, obstructive cardiomyopathy, hypertension,
arrhythmias, cerebrovascular disease; occlusive vascular disease, monitor blood pressure
and ECG; cor pulmonale; organic brain damage, psychoneurosis; phaeochromocytoma;
diabetes mellitus, hyperthyroidism; hypokalaemia, hypercalcaemia; susceptibility to
angle-closure glaucoma
Indication & Doses
*Emergency treatment of acute anaphylaxis, angioedema
BY INTRA MUSCULAR INJECTION (preferably midpoint in anterolateral thigh) of 1
in 1000 (1 mg/mL) solution
*Acute anaphylaxis when there is doubt as to the adequacy of the circulation

.BY SLOW IV INFUSION of 1 in 10 000 (100 micrograms/mL) solution (extreme
caution—specialist use only)
*Acute anaphylaxis
Child body-weight under 15 kg 150 micrograms repeated after 10–15 minutes as
necessary
Child body–weight 15–30 kg 150 micrograms (but on the basis of a dose of 10
micrograms/kg, 300 micrograms may be more appropriate for some children) repeated
after 10–15 minutes as necessary
Child body-weight over 30 kg 300 micrograms repeated after 10–15 minutes as
necessary
Child 12–18 years body-weight over 60 kg 500 micrograms repeated after 10–15
minutes if necessary
Side effects
nausea, vomiting, dry mouth, anorexia, hypersalivation; arrhythmias, palpitation,
tachycardia, syncope, angina, hypertension (risk of cerebral haemorrhage), cold
extremities, pallor; dyspnoea, pulmonary oedema (on excessive dosage or extreme
sensitivity); anxiety, tremor, restlessness, headache, insomnia, confusion, weakness,
dizziness, hallucinations, psychosis; hyperglycaemia; difficulty in micturition, urinary
retention; metabolic acidosis; hypokalaemia; mydriasis, angle-closure glaucoma; tissue
necrosis at injection site and of extremities, liver and kidneys, sweating
Preparation
Injection 1mg/ml
Adrenaline
3.8 RESPIRATORY DEPRESSION, RESPIRATORY DISTRESS

SYNDROME AND APNOEA
3.8.1 PULMONARY SURFACTANTS
Cautions
Continuous monitoring is required to avoid hyperoxaemia caused by rapid improvement
in arterial oxygen concentration.
Side effects
Pulmonary haemorrhage and bradycardia have been rarely associated with pulmonary
surfactants. Obstruction of the endotracheal tube by mucous secretions, and intracranial
haemorrhage have also been reported.
3.8.1.1 Beractant
Indication & Doses
*Treatment of respiratory distress syndrome in preterm neonates, birth-weight over
700g (specialist use only)
BY ENDOTRACHEAL TUBE
Preterm neonate: 100 mg/kg, preferably administer within 8hours of birth; dose may be
repeated within 48 hours at intervals of at least 6 hours for up to 4 doses
*Prophylaxis of respiratory distress syndrome in preterm neonates (specialist use only)

Neonate up to 32 weeks corrected gestational age: 100 mg/kg, preferably administer
within 15 minutes of birth; dose may be repeated within 48 hours at intervals of at least
6hours for up to 4 doses
Preparation
susp 27mg/ml
Bliss
3.8.1.2 Proactant Alpha

Side effect
Rarely hypotension
Indication & Doses
*Treatment of respiratory distress syndrome in neonates, birth weight over 700g
(specialist use only)
Neonate: 100–200 mg/kg, then 100 mg/kg every 12 hours if required, maximum 300–
400mg/kg per course.
*Prophylaxis of respiratory distress syndrome (specialist use only)
Neonate 24 weeks to 31 weeks corrected gestational age: 100–200 mg/kg, administer
soon after birth, preferably within 15 minutes, then100 mg/kg after 6–12 hours if
required, then 100 mg/kg after 12 hours if required, and if neonate still intubated. Max
300–400 mg/kg per course.
Preparation
Susp 80mg/ml
Curosurf
3.8.2 NEONATAL APNOEA

Caffeine
Indication & Doses
*Neonatal apnoea (specialist supervision in hospital)
BY MOUTH, OR BY INTRAVENOUS INFUSION
Neonate: Loading dose 20mg/kg, then maintenance 5mg/kg once daily, started24 hours
after the loading dose; increased if necessary up to20 mg/kg daily, a maintenance dose
above20mg/kg daily can be considered if therapeutic efficacy is not achieved—the
plasma-caffeine concentration should be monitored to ensure that a safe level is
maintained.
Preparation
Susp 20mg/ml
Peyona

SECTION 4: DRUGS ACTING ON CENTRAL NERVOUS SYSTEM
4.1 HYPNOTICS
Chloral Hydrate
Cautions
Reduce dose in debilitated; avoid prolonged use (and abrupt withdrawal thereafter); avoid
contact with skin and mucous membranes
Indication & Doses
*Sedation for painless procedures
BY MOUTH, OR BY RECTUM
Neonate: 30–50 mg/kg, to be given 45–60 minutes before procedure, doses up to
100mg/kg may be used with respiratory monitoring, administration by rectum only if oral
route not available.
Child 1 month–11 years: 30–50 mg/kg (max. per dose 1g), to be given 45–60 minutes
before procedure, administration by rectum only if oral route not available, increased if
necessary up to 100 mg/kg (max. per dose2 g)
Child 12–17 years: 1–2g, to be given 45–60 minutes before procedure, administration by
rectum only if oral route not available
*Insomnia (short-term use)
BY MOUTH USING ORAL SOLUTION
Child 2–11 years: 30–50 mg/kg once daily (max. per dose 1g), dose to be taken with
water or milk at bedtime
Child 12–17 years: 430–860 mg once daily (max. per dose 2g), dose to be taken with
water or milk at bedtime
Contraindications
Severe cardiac disease; gastritis; acute porphyria
Side effects
Gastric irritation (nausea and vomitingreported), abdominal distention, flatulence,
headache, tolerance, dependence, excitement, delirium (especially on abrupt withdrawal),
ketonuria, and rash
Preparation
Syrup 500mg/5ml
Apnotek
4.2 DRUGS USED IN PSYCHOSIS AND RELATED DISORDERS

4.2.1 ANTIPSYCHOTIC DRUGS
Risperidone
Cautions
Hyperprolactinaemia, prolactin- dependent tumors; dehydration; family history of sudden
cardiac death (perform ECG); avoid in acute porphyria , used with care if prescribed with
other drugs that increase the QT interval, used with caution in children with
cardiovascular disease, or a history of epilepsy
Indication & Doses
*Acute and chronic psychosis
BY MOUTH
Child 12–17 years (under expert supervision): 2 mg daily in 1–2divided doses for
day1, then 4mg daily in 1–2 divided doses for day 2, slower titration is appropriate in

some patients; usual dose 4–6 mg daily, doses above10mg daily only if benefit
considered to outweigh risk; maximum16 mg per day
*Short-term monotherapy of mania in bipolar disorder (under expert supervision)
BY MOUTH
Child 12–17 years: Initially 500 micrograms once daily, then adjusted in steps of 0.5–
1mg daily, adjusted according to response; usual dose 2.5 mg daily in 1–2 divided doses;
maximum 6mg per day
*Short-term treatment (up to 6 weeks) of persistent aggression in conduct disorder
(under expert supervision)
BY MOUTH
Child 5–17 years (body-weight up to 50 kg): Initially 250 micrograms once daily, then
increased in steps of 250 micrograms once daily on alternate days, adjusted according to
response; usual dose 500 micrograms once daily; maximum750 micrograms per day
Child 5–17 years (body-weight 50 kg and above): Initially 500 micrograms once daily,
then increased in steps of 500 micrograms once daily on alternate days, adjusted
according to response; usual dose1 mg once daily; maximum1.5 mg per day
*Short-term treatment of severe aggression in autism (under expert supervision)
BY MOUTH
Child 5–17 years (body-weight 15–20 kg): Initially 250 micrograms daily for at least
4days, then increased if necessary to500 micrograms daily, then increased in steps of 250
micrograms daily, dose to be increased at intervals of 2 weeks, review effectiveness and
any side- effects after 3–4 weeks; stop if no response at 6weeks; maximum 1mg per day
Child 5–17 years (body-weight 20–45 kg): Initially 500 micrograms daily for at least 4
days, then increased if necessary to 1 mg daily, then increased in steps of 500
any side-effects after 3–4 weeks; stop if no response at 6 weeks; maximum 2.5 mg per
day
Child 5–17 years (body-weight 45 kg and above): Initially 500 micrograms daily for at
least 4days, then increased if necessary to1 mg daily, then increased in steps of 500
any side-effects after 3–4 weeks; stop if no response at6 weeks; maximum3mg per day
Side effects
Weight gain, dizziness, postural hypotension (especially during initial dose titration)
which may be associated with syncope or reflex tachycardia in some children,
extrapyramidal symptoms (usually mild and transient and which respond to dose
reduction or to an antimuscarinic drug), and occasionally tardive dyskinesia on long-term
administration (discontinue drug on appearance of early signs); venous thromboembolism
has been reported. Hyperglycaemia and sometimes diabetes can occur; monitoring weight
and plasma-glucose concentration may identify the development of hyperglycaemia.
Neuroleptic malignant syndrome has been reported rarely. Gastro-intestinal disturbances
(including diarrhoea, constipation, nausea and vomiting, dyspepsia, abdominal pain), dry
mouth; dyspnoea; drowsiness, asthenia, tremor, sleep disturbances, agitation, anxiety,
headache; urinary incontinence; hyperprolactinaemia (less commonly galactorrhoea,
menstrual disturbances, gynaecomastia); arthralgia, myalgia; abnormal vision; epistaxis;
rash; less commonly anorexia, ECG changes, hypoaesthesia, impaired concentration,
sexual dysfunction, blood disorders, tinnitus, angioedema; rarely intestinal obstruction,
pancreatitis, jaundice, seizures, hyponatraemia, abnormal temperature regulation; oedema
and priapism also reported

Preparation
Tab 1mg
Persch
4.3 DRUGS USED IN NAUSEA AND VERTIGO

4.3.1 ANTIHISTAMINES
Cautions & Contraindications
Antihistamines should be used with caution in children with epilepsy. Most
antihistamines should be avoided in acute porphyria, but some are thought to be safe.
Sedating antihistamines have significant antimuscarinic activity—they should not be used
in neonates and should be used with caution in children with urinary retention, glaucoma,
or pyloroduodenal obstruction. Phenothiazine sedating antihistamines, such as
alimemazine and promethazine, should not be given to children under 2 years, except on
specialist advice, because the safety of such use has not been established.
Side effects
Drowsiness is a significant side-effect with most of the older antihistamines although
paradoxical stimulation may occur rarely in children, especially with high doses.
Drowsiness may diminish after a few days of treatment and is considerably less of a
problem with the newer antihistamines. Side-effects that are more common with the older
antihistamines include headache, psychomotor impairment, and antimuscarinic effects
such as urinary retention, dry mouth, blurred vision, and gastro-intestinal disturbances.
Other rare side-effects of antihistamines include hypotension, palpitation, arrhythmias,
extrapyramidal effects, dizziness, confusion, depression, sleep disturbances, tremor,
convulsions, hypersensitivity reactions (including bronchospasm, angioedema,
anaphylaxis, rashes, and photosensitivity reactions), blood disorders, and liver
dysfunction.
4.3.1.1 Promethazine HCL

Indication & Doses
*Sedation (short-term use)
BY MOUTH
*Sedation in intensive care
BY MOUTH, OR BY SLOW INTRAVENOUS INJECTION, OR BY DEEP
Child 1 month–11 years: 0.5–1mg/kg 4 times a day (max. per dose 25 mg), adjusted
Child 12–17 years: 25–50 mg 4 times a day, adjusted according to response
Preparation
Syrup 5mg/5ml
Phenergan
4.3.1.2 Dimenhydrinate
Indication & Doses
*Treatment of nausea, vomiting and vertigo associated with motion sickness

1.25 mg/kg or 37.5mg/ meter sq IV/IM q 6hrly do not exceed 300mg/day
Preparation
inj 50mg/ml
Gravinate
4.3.2 DOPAMINE RECEPTOR ANTAGONIST

Domperidone
Cautions
Children
Indication & Doses
*Relief of nausea and vomiting
BY MOUTH
Child 12–17 years (body-weight 35 kg and above): 10 mg up to 3times a day for a
usual maximum of 1 week; maximum 30 mg per day
*Gastro-oesophageal reflux disease (but efficacy not proven) (specialist use only)
BY MOUTH
Neonate: 250 micrograms/kg 3 times a day, dose can be increased if response
inadequate, increased if necessary up to400 micrograms/kg 3 times a day, interrupt
treatment occasionally to assess recurrence—consider restarting if symptoms recur,
discontinue if response inadequate at higher dose.
Child: 250 micrograms/kg 3 times a day (max. per dose 10 mg), dose can be increased if
response inadequate, increased if necessary up to400 micrograms/kg3times a day (max.
per dose 20 mg), interrupt treatment occasionally to assess recurrence—consider
restarting if symptoms recur, discontinue if response inadequate at higher dose
Contra indication
Prolactinaemia; if increased gastro-intestinal motility harmful
Side Effects
Rarely gastro-intestinal disturbances (including cramps), and hyper prolactinaemia; very
rarely ventricular arrhythmias, agitation, drowsiness, nervousness, seizures,
extrapyramidal effects, headache, and rashes; also reported QT-interval prolongation
Prepration
Syrup 1mg/ml
Motilium
4.3.3 5 H T3 ANTAGONIST
Ondansterone
Cautions
QT-interval prolongation (avoid concomitant use of drugs that prolong QT interval);
subacute intestinal obstruction; adenotonsillar surgery
Indication & Doses
*Prevention of postoperative nausea and vomiting
Child: 100 micrograms/kg (max. per dose 4 mg) for 1dose, dose to be given over at
least30 seconds before, during, or after induction of anaesthesia
*Treatment of postoperative nausea and vomiting

Child: 100 micrograms/kg (max. per dose 4 mg) for 1 dose, dose to be given over at least
30 seconds
*Prevention and treatment of chemotherapy- and radiotherapy-induced nausea and
vomiting
Child 6 months–17 years (body surface area up to 1.3 m2): 5mg/m2 for 1 dose then
give orally, alternatively 150 micrograms/kg (max. per dose 8 mg), dose to be
administered immediately before chemotherapy, then 150 micrograms/kg every 4 hours
(max. per dose 8mg) for 2 further doses then give orally; maximum 32 mg per day
Child 6 months–17 years (body surface area 1.3 m2 and above): 8 mg for 1dose then
give orally, alternatively 150 micrograms/kg (max. per dose 8 mg), dose to be
administered immediately before chemotherapy, then 150 micrograms/kg every 4 hours
(max. per dose 8mg) for 2 further doses then give orally, intravenous infusion to be
administered over at least 15 minutes; maximum 32 mg per day
vomiting—(follow-on dose based on body surface area)
BY MOUTH
Child 6 months–17 years (body surface area up to 0.6 m2): 2mg every 12 hours for up
to 5 days (dose can be started12 hours after intravenous administration); maximum 32 mg
per day
Child 6 months–17 years (body surface area 0.6–1.2 m2): 4mg every 12 hours for up
to 5 days (dose can be started 12 hours after intravenous administration); maximum 32mg
per day
Child 6 months–17 years (body surface area 1.3 m2 and above): 8 mg every12 hours
for up to 5 days (dose can be started 12 hours after intravenous administration);
vomiting—(follow-on dose based on body-weight)
BY MOUTH
Child 6 months–17 years (body-weight up to 10.1 kg): 2mg every 12 hours for up to
5days (dose can be started 12 hours after intravenous administration); maximum 32 mg
per day
Child 6 months–17 years (body-weight 10.1–40 kg): 4 mg every 12 hours for up to
5days (dose can be started 12hours after intravenous administration); maximum 32 mg
per day
Child 6 months–17 years (body-weight 41 kg and above): 8mg every 12 hours for up
to 5 days (dose can be started12 hours after intravenous administration); maximum 32 mg
per day
Side effects
Constipation; headache; flushing; injection- site reactions; less commonly hiccups,
hypotension, bradycardia, chest pain, arrhythmias, movement disorders, seizures; on
intravenous administration, rarely dizziness, transient visual disturbances (very rarely
transient blindness)
Preparation
Inj. 8mg/4ml
Zofran

4.3.4 NEUROKININ RECEPTOR ANTAGONIST
Aprepitent
Indication & Doses
*Adjunct treatment to prevent nausea and vomiting associated with moderately and
highly emetogenic chemotherapy
BY MOUTH
Child 6 months–11 years (body-weight 6 kg and above):
(Consult product literature)
Child 12–17 years: Initially 125 mg, dose to be taken 1hour before chemotherapy, then
80 mg once daily for 2days, dose to be taken 1 hour before chemotherapyor in the
morning if no chemotherapy is given, consult product literature for dose of concomitant
5HT3- antagonist (and corticosteroid if required)
Preparation
Cap 40mg
Apreon
4.4 ANALGESICS
4.4.1 OPIOID ANALGESICS
Cautions
Opioids should be used with caution in children with impaired respiratory function and
asthma (avoid during an acute attack), hypotension, shock, Obstructive or inflammatory
bowel disorders, diseases of the biliary tract, and convulsive disorders. A reduced dose is
recommended in hypothyroidism or adrenocortical insufficiency. Repeated use of opioid
analgesics is associated with the development of psychological and physical dependence;
although this is rarely a problem with therapeutic use, caution is advised if prescribing for
patients with a history of drug dependence. Avoid abrupt withdrawal after long-term
treatment. Transdermal preparations (fentanyl or buprenorphine patches) are not suitable
for acute pain or in those children whose analgesic requirements are changing rapidly,
because the long time to steady state prevents rapid titration of the dose.
Contraindications
Opioid analgesics should be avoided in children with acute respiratory depression, and
when there is a risk of paralytic ileus. They are also Contra-indicated in conditions
associated with raised intracranial pressure, and in heainjury (opioid analgesics interfere
with pupillary responses vital for neurological assessment). Comatose children should not
be treated with opioid analgesics.
4.4.1.1 Morphine Sulphate
Cautions
Pancreatitis, myasthenia gravis, cardiac arrhythmias, severe cor pulmonal
Indication & Doses
*Pain
Neonate: Initially 100 micrograms/kg every6hours, adjusted according to response.
Child 1–5 months: Initially 100–200 micrograms/kg every6hours, adjusted according to
response
Child 6 months–1 year: Initially 100–200 micrograms/kg every4hours, adjusted

Child 2–11 years: Initially 200 micrograms/kg every 4 hours, adjusted according to
response
Child 12–17 years: Initially 2.5–10 mg every4 hours, adjusted according to response
Neonate: 50 micrograms/kg every 6 hours, adjusted according to response, dose to be
administered over at least 5 minutes, alternatively (by intravenous injection) initially 50
micrograms/kg, dose to be administered over at least 5 minutes, followed by (by
continuous intravenous infusion) 5–20 micrograms/kg/hour, adjusted according to
response.
Child 1–5 months: 100 micrograms/kg every 6 hours, adjusted according to response,
dose to be administered over at least 5 minutes, alternatively (by intravenous injection)
initially 100 micrograms/kg, dose to be administered over at least 5 minutes, followed by
(by continuous intravenous infusion) 10–30 micrograms/kg/hour, adjusted according to
response
Child 6 months–11 years: 100 micrograms/kg every 4 hours, adjusted according to
response, dose to be administered over at least 5minutes, alternatively (by intravenous
injection) initially 100 micrograms/kg, dose to be administered over at least 5 minutes,
followed by (by continuous intravenous infusion) 20–30 micrograms/kg/hour, adjusted
Child 12–17 years: 5mg every 4 hours, adjusted according to response, dose to be
administered over at least 5 minutes, alternatively (by intravenous injection) initially 5
mg, dose to be administered over at least 5 minutes, followed by (by continuous
intravenous infusion) 20–30 micrograms/kg/hour, adjusted according to response
BY MOUTH, OR BY RECTUM
Child 1–2 months: Initially 50–100 micrograms/kg every 4 hours, adjusted according to
response
Child 3–5 months: 100–150 micrograms/kg every 4 hours, adjusted according to
response
Child 6–11 months: 200 micrograms/kg every4hours, adjusted according to response
Child 1 year: Initially200–300 micrograms/kg every 4 hours, adjusted according to
response
Child 2–11 years: Initially 200–300 micrograms/kg every 4 hours (max. per dose 10
mg), adjusted according to response
Child 12–17 years: Initially5–10 mg every4 hours, adjusted according to response
BY CONTINUOUS SUBCUTANEOUS INFUSION
Child 1–2 months: 10 micrograms/kg/hour, adjusted according to response
Child 3 months–17 years: 20 micrograms/kg/hour, adjusted according to response
*Neonatal opioid withdrawal (under expert supervision)
BY MOUTH
Neonate: Initially 40 micrograms/kg every4 hours until symptoms controlled, dose to be
increased if necessary; reduce frequency gradually over 6–10 days, stop when 40
micrograms/kg once daily achieved, dose may vary
*Persistent cyanosis in congenital heart disease when blood glucose less than
3mmol/litre (following glucose)
BY INTRAVENOUS INJECTION, OR BY INTRAMUSCULAR INJECTION
Child: 100 micrograms/kg
Contraindications

Delayed gastric emptying, acute abdomen; heart failure secondary to chronic lung
disease; phaeochromocytoma
Side effects
paralytic ileus, abdominal pain, anorexia, dyspepsia, exacerbation of pancreatitis, taste
disturbance, hypertension, hypothermia, syncope, bronchospasm, inhibition of cough
reflex, restlessness, seizures, paraesthesia, asthenia, malaise, disorientation, excitation,
agitation, delirium,raised intracranial pressure, amenorrhoea, myoclonus, muscle
fasciculation, rhabdomyolysis, nystagmus
Preparation
Injection 15mg/ml
Morphine
4.4.1.2 Fentanyl
Cautions
Diabetes mellitus, impaired consciousness, cerebral tumour, myasthenia gravis
Indications & Doses
*Chronic intractable pain not currently treated with a strong opioid analgesic
BY TRANSDERMAL APPLICATION
Child 16–17 years: Initially 12 micrograms/hour every 72 hours, alternatively initially
25 micrograms/hour every 72 hours, when starting, evaluation of the analgesic effect
should not be made before the system has been worn for 24hours (to allow for the gradual
increase in plasma-fentanyl concentration)—previous analgesic therapy should be phased
out gradually from time of first patch application, dose should be adjusted at48–72 hour
intervals in steps of 12–25 micrograms/hour if necessary, more than one patch may be
used at a time (but applied at the same time to avoid confusion)—consider additional or
alternative analgesic therapy if dose required exceeds 300micrograms/hour (important: it
takes17 hours or more for the plasma-fentanyl concentration to decrease by 50%—
replacement opioid therapy should be initiated at a low dose and increased gradually)
*Chronic intractable pain currently treated with a strong opioid analgesic
BY TRANSDERMAL APPLICATION
Child 2–17 years: Initial dose based on previous 24-hour opioid requirement (consult
product literature), for evaluating analgesic efficacy and dose increments, see under
Chronic intractable pain not currently treated with astrongopioidanalgesic, for conversion
from long term oral morphine to transdermal fentanyl,.
*Spontaneous respiration: analgesia and enhancement of anaesthesia, during
operation
Child 1 month–11 years: Initially1–3micrograms/kg, then1 microgram/kg as required,
dose to be administered over at least 30 seconds
Child 12–17 years: Initially 50–100 micrograms (max. per dose200 micrograms), dose
maximum on specialist advice, then 25–50 micrograms as required, dose to be
administered over at least 30 seconds
*Assisted ventilation: analgesia and enhancement of anaesthesia during operation
Neonate: Initially1–5micrograms/kg, then 1–3 micrograms/kg as required, dose to be
administered over at least 30seconds.
Child 1 month–11 years: Initially1–5micrograms/kg, then1–3micrograms/kg as
required, dose to be administered over at least 30 seconds

Child 12–17 years: Initially 1–5 micrograms/kg, then 50–200 micrograms as required,
dose to be administered over at least 30 seconds
*Assisted ventilation: analgesia and respiratory depression in intensive care
Neonate: Initially 1–5 micrograms/kg, then (by intravenous infusion) 1.5
micrograms/kg/hour, adjusted according to response.
Child: Initially 1–5 micrograms/kg, then (by intravenous infusion) 1–6
micrograms/kg/hour, adjusted according to response
*Break through pain in patients receiving opioid therapy for chronic cancer pain
BY BUCCAL ADMINISTRATION USING LOZENGES
Child 16–17 years: Initially 200 micrograms, dose to be given over 15 minutes, then 200
micrograms after 15 minutes if required, no more than 2 dose units for each pain episode;
if adequate pain relief not achieved with 1 dose unit for consecutive breakthrough pain
episodes, increase the strength of the dose unit until adequate pain relief achieved with 4
lozenges or less daily, if more than 4 episodes of breakthrough pain each day, adjust
background analgesia
Side effects
Abdominal pain, dyspepsia, diarrhoea, gastro-oesophageal reflux disease, stomatitis,
anorexia, hypertension, vasodilatation, dyspnoea, aesthenia, myoclonus, anxiety, tremor,
appetite changes, rhinitis, pharyngitis, paraesthesia, application-site reactions; less
commonly ileus, flatulence, hypoventilation, impaired concentration, impaired
coordination, amnesia, speech disorder, malaise, seizure, pyrexia, thirst, blood disorders
(including thrombocytopenia), chills; rarely hiccups, very rarely arrhythmia, apnoea,
haemoptysis, ataxia, delusions, bladder pain
Preparation
Inj 50mcg/ml 5ml inj
Fentra
4.4.1.3 Tramadol HCl

Cautions
Impaired consciousness; excessive bronchial secretions; not suitable as substitute in
opioid-dependent patients
Indication & Doses
*Moderate to severe pain
BY INTRAMUSCULAR INJECTION, OR BY INTRAVENOUS INJECTION, OR BY
INTRAVENOUS INFUSION, OR BY SUBCUTANEOUS INJECTION
Child 12–17 years: 50–100 mg every 4–6 hours, intravenous injection to be given over
2–3 minutes; usual maximum 400 mg/24 hours
*Moderate to severe acute pain
Child 12–17 years: Initially 100 mg, then50–100 mg every 4–6 hours; usual maximum
400 mg/24hours
*Moderate to severe chronic pain
Child 12–17 years: Initially 50mg, then, adjusted according to response; Usual
maximum 400 mg/24 hours
*Postoperative pain

BY INTRAVENOUS INJECTION, OR BY INTRAMUSCULAR INJECTION, OR BY
INTRAVENOUS INFUSION, OR BY SUBCUTANEOUS INJECTION
Child 12–17 years: Initially 100 mg, then 50 mg every 10–20 minutes if required up to
total maximum250mg (including initial dose) in first hour, then 50–100 mg every 4–6
hours, intravenous injection to be given over 2–3 minutes; Usual maximum 400 mg/24
hours
Contraindications
Uncontrolled epilepsy
Side effects
Diarrhoea, retching, fatigue, paraesthesia; less commonly gastritis, and flatulence; rarely
anorexia, syncope, hypertension, bronchospasm, dyspnoea, wheezing, seizures, and
muscle weakness; blood disorders also reported
Preparation
Inj 50mg
Lamadol
4.4.1.4 Nalbuphine
Indication & Doses
*Moderate to severe pain
One year & above: 0.1 to 0.2mg/kg IV,IM,SC 3 to 4 hrly max single dose is 20mg
Preparation
Injection 10mg/ml
Sonotic
4.4.1.5 Pentazocine
Indication & Doses
*Preoperative or preanasthetic or supplement to surgical anesthesia
Above 1 year: 0.5mg/kg IM as single dose
*Analgesia
5 to 8 years: 15mg IM
Above 8 years: 30mg IM
Preparation
Injection 30mg/ml
Sosegon
4.4.2 NON-OPOID ANALGESICS

Paracetomol
Cautions
Alcohol dependence; max. Daily infusion dose 3 g in patients with hepatocellular
insufficiency, chronic alcoholism, chronic malnutrition, or dehydration; high risk of liver
toxicity with high doses
Indication & Doses
*Pain Pyrexia with discomfort
BY MOUTH
Neonate 28 weeks to 32 weeks corrected gestational age: 20 mg/kg for 1 dose, then
10–15 mg/kg every 8–12 hours as required, maximum daily dose to be given in divided
doses; maximum 30mg/kg per day.

Neonate 32 weeks corrected gestational age and above: 20 mg/kg for 1 dose, then 10–
15 mg/kg every 6–8 hours as required, maximum daily dose to be given in divided doses;
maximum 60 mg/kg per day.
Child 1–2 months: 30–60 mg every 8 hours as required, maximum daily dose to be
given in divided doses; maximum 60 mg/kg per day
Child 3–5 months: 60 mg every 4–6 hours; maximum 4 doses per day
Child 6–23 months: 120 mg every 4–6 hours; maximum 4 doses per day
Child 2–3 years: 180 mg every4–6 hours; maximum 4 doses per day
Child 4–5 years: 240 mg every4–6 hours; maximum 4 doses per day
Child 6–7 years: 240–250 mg every4–6 hours; maximum 4 doses per day
Child 10–11 years: 480–500 mg every4–6hours; maximum 4 doses per day
Child 16–17 years: 0.5–1 g every4–6 hours; maximum 4 doses per day
BY RECTUM
Neonate 28 weeks to 32 weeks corrected gestational age: 20 mg/kg for 1 dose, then
10–15 mg/kg every12 hours as required, maximum daily dose to be given in divided
doses; maximum30 mg/kg per day.
Neonate 32 weeks corrected gestational age and above: 30 mg/kg for 1 dose, then 15–
20 mg/kg every 8 hours as required, maximum daily dose to be given in divided doses;
maximum 60 mg/kg per day.
Child 1–2 months: 30–60 mg every8hours as required, maximum daily dose to be given
in divided doses; maximum 60 mg/kg per day
Child 3–11 months: 60–125 mg every 4–6 hours as required; maximum 4 doses per day
Child 1–4 years: 125–250 mg every 4–6hours as required; maximum 4 doses per day
Child 5–11 years: 250–500 mg every 4–6 hours as required; maximum 4 doses per day
Child 12–17 years: 500 mg every 4–6 hours
Neonate 32 weeks corrected gestational age and above: 7.5 mg/kg every8 hours, dose
to be administered over 15 minutes.
Neonate: 10 mg/kg every4–6 hours, dose to be administered over15 minutes;
maximum30 mg/kg per day.
Child (body-weight up to 10 kg): 10 mg/kg every 4–6hours, dose to be administered
over15 minutes; maximum30 mg/kg per day
Child (body-weight 10–50 kg): 15mg/kg every4–6 hours, dose to be administered
over15minutes; maximum 60 mg/kg per day
Child (body-weight 50 kg and above): 1g every4–6 hours, dose to be administered over
15 minutes; maximum 4 g per day
*Pain in children with risk factors for hepatotoxicity Pyrexia with discomfort in
children with risk factors for hepatotoxicity
Neonate 32 weeks corrected gestational age and above: 7.5mg/kg every 8 hours, dose
to be administered over 15 minutes.
Neonate: 10mg/kg every 4–6 hours, dose to be administered over 15 minutes; maximum
30 mg/kg per day.
Child (body-weight up to 10 kg): 10 mg/kg every 4–6 hours, dose to be administered
over 15 minutes; maximum 30 mg/kg per day

Child (body-weight 10–50 kg): 15mg/kg every 4–6 hours, dose to be administered over
15 minutes; maximum 60 mg/kg per day
Child (body-weight 50 kg and above): 1g every 4–6 hours, dose to be administered
over 15 minutes; maximum 3 g per day
*Post-operative pain
BY MOUTH
Child 1 month–5 years: 20–30mg/kg for 1dose, then 15–20 mg/kg every 4–6 hours,
maximum daily dose to be given in divided doses; maximum 75 mg/kg per day
Child 6–11 years: 20–30 mg/kg (max. per dose 1g) for 1 dose, then 15–20 mg/kg
every4–6hours, maximum daily dose to be given in divided doses; maximum 75 mg/kg
per day; maximum4 g per day
Child 12–17 years: 1 g every 4–6 hours; maximum 4 doses per day
BY RECTUM
Child 1–2 months: 30mg/kg for 1dose, then 15–20 mg/kg every 4–6hours, maximum
daily dose to be given in divided doses; maximum 75 mg/kg per day
Child 3 months–5 years: 30–40mg/kg for 1dose, then 15–20 mg/kg every 4–6 hours,
maximum daily dose to be given in divided doses; maximum 75 mg/kg per day
Child 6–11 years: 30–40 mg/kg (max. per dose 1g) for 1 dose, then 15–20 mg/kg every
4–6 hours, maximum daily dose to be given in divided doses; maximum 75 mg/kg per
day; maximum 4 g per day
Child 12–17 years: 1 g every 4–6 hours; maximum 4 doses per day
*Prophylaxis of post-immunisation pyrexia following immunisation with
meningococcal group B vaccine (Bexsero ®) given as part of the routine immunisation
schedule
BY MOUTH
Child 2 months: 60 mg, first dose to be given at the time of vaccination, then 60 mg after
4–6 hours, then 60 mg after 4–6 hours, use weight-based doses for preterm infants born at
less than 32 weeks gestation and currently weighing less than 4kg—see oral doses for
pain and pyrexia with discomfort
Child 4 months: 60 mg,first dose to be given at the time of vaccination, then 60 mg
after4–6hours, then 60 mg after 4–6 hours, use weight-based doses for preterm infants
born at less than 32 weeks gestation and currently weighing less than 4 kg—see oral
doses for pain and pyrexia with discomfort
*Post-immunisation pyrexia in infants
BY MOUTH
Child 2–3 months: 60 mg for 1dose, then 60 mg after 4–6 hours if required
Child 4 months: 60 mg for 1 dose, then 60 mg after 4–6 hours; maximum 4 doses per
day
Side effects
Side-effects rare, but rashes, blood disorders (including thrombocytopenia, leucopenia,
neutropenia) reported; hypotension, flushing, and Tachycardia also reported on infusion;
important: liver damage (and less frequently renal damage)
Preparations
Syrup & Tablet 120mg and 250mg/5ml & 500mg
Inj 1gm/100ml
Calpol & Provas
4.5 ANTIEPILEPTICS

4.5.1 Carbamazepine
Cautions
cardiac disease; skin reactions; test for HLAB* 1502 allele in individuals of Han Chinese
or Thai origin (avoid unless no alternative—risk of Stevens- Johnson syndrome in the
presence of HLA-B*1502 allele); history of haematological reactions to other drugs;
manufacturer recommends blood counts and hepatic and renal function tests (but
evidence of practical value uncertain); may exacerbate absence and myoclonic seizures;
consider vitamin D supplementation in patients who are immobilised for long periods or
who have inadequate sun exposure or dietary intake of calcium; susceptibility to angle-
closure glaucoma; cross-sensitivity reported with oxcarbazepine, and with phenytoin;
avoid abrupt withdrawal
Indication & doses
*Trigeminal neuralgia
Child 1 month–11 years: Initially 5mg/kg once daily, dose to be taken at night,
alternatively initially 2.5mg/kg twice daily, then increased in steps of 2.5–5mg/kg
every3–7 days as required; maintenance 5 mg/kg 2–3 times a day, increased if necessary
up to 20 mg/kg daily
Child 12–17 years: Initially 100–200 mg 1–2 times a day, then increased to 200–400 mg
2–3 times a day, increased if necessary up to 1.8 g daily, dose should be increased slowly
*Prophylaxis of bipolar disorder
alternatively initially 2.5mg/kg twice daily, then increased in steps of2.5–5mg/kg every
3–7 days as required; maintenance5 mg/kg 2–3 times a day, increased if necessary up
to20 mg/kg daily
Child 12–17 years: Initially 100–200 mg 1–2 times a day, then increased to 200–400 mg
*Focal and generalised tonic-clonic seizures
alternatively initially 2.5mg/kg twice daily, then increased in steps of 2.5–5mg/kg every
3–7 days as required; maintenance5 mg/kg 2–3 times a day, increased if necessary up
to20 mg/kg daily
Child 12–17 years: Initially 100–200 mg 1–2times a day, then increased to 200–400 mg
BY RECTUM
Child: Up to 250 mg up to 4times a day, to be used for short-term use (max.7 days) when
oral therapy temporarily not possible, use approx.25% more than the oral dose
Contraindications
AV conduction abnormalities (unless paced); history of bone marrow depression, acute
porphyria
Side effects
Dry mouth, nausea, vomiting, oedema, ataxia, dizziness, drowsiness, fatigue, headache,
hyponatraemia (leading in rare cases to water intoxication), blood disorders (including
eosinophilia, leucopenia, thrombocytopenia, haemolytic anaemia, and aplastic anaemia),
dermatitis, urticaria; less commonly diarrhoea, constipation, involuntary movements
(including nystagmus), visual disturbances; rarely abdominal pain, anorexia, hepatitis,

jaundice, vanishing bile duct syndrome, cardiac conduction disorders, hypertension,
hypotension, peripheral neuropathy, dysarthria, aggression, agitation, confusion,
depression, hallucinations, restlessness, paraesthesia, lymph node enlargement, muscle
weakness, systemic lupus erythematosus, delayed multi-organ hypersensitivity disorder;
very rarely pancreatitis, stomatitis, hepatic failure, taste disturbance, exacerbation of
coronary artery disease, AV block with syncope, circulatory collapse, hyper
cholesterolaemia, thrombophlebitis, thromboembolism,pulmonary hypersensitivity,
psychosis, neuroleptic malignant syndrome, osteomalacia, osteoporosis, galactorrhoea,
gynaecomastia, impaired male fertility, interstitial nephritis, renal failure, sexual
dysfunction, urinary frequency, urinary retention, arthralgia, muscle pain, muscle spasm,
conjunctivitis, angle-closure glaucoma, hearing disorders, acne, alterations in skin
pigmentation, alopecia, hirsutism, sweating, photosensitivity, purpura Stevens-Johnson
syndrome, toxic epidermal necrolysis, aseptic meningitis; suicidal ideation,
Preparation
Tablet & syp 200mg & 100mg
Tegral
4.5.2 Lacosamide
Cautions
Risk of PR-interval prolongation (including conduction problems, severe cardiac disease,
and concomitant use of drugs that prolong PR interval), elderly;
Indication & Doses
*Monotherapy of focal seizures with or without secondary generalisation
Child (body-weight 50 kg and above): Initially 50mg twice daily, then increased to100
mg twice daily, after one week, alternatively initially 100 mg twice daily; increased in
steps of 50 mg twice daily (max. per dose 300 mg twice daily) if necessary and if
tolerated, dose to be increased at weekly intervals
Child 4–17 years (body-weight up to 50 kg): (consult product literature)
*Monotherapy of focal seizures with or without secondary generalisation (alternative
loading dose regimen when it is necessary to rapidly attain therapeutic plasma
concentrations) (under close medical supervision)
Child (body-weight 50 kg and above): Loading dose 200 mg, followed by 100 mg
twice daily, to be given 12 hours after initial dose; increased in steps of 50mg twice daily
(max. per dose 300 mg twice daily) if necessary and if tolerated, dose to be increased at
weekly intervals
*Adjunctive treatment of focal seizures with or without secondary generalisation
Child (body-weight 50 kg and above): Initially 50mg twice daily, then increased to100
mg twice daily, after one week; increased in steps of 50 mg twice daily (max. per
dose200 mg twice daily) if necessary and if tolerated, dose to be increased at weekly
intervals
Child 4–17 years (body-weight up to 50 kg): (consult product literature)
*Adjunctive treatment of focal seizures with or without secondary generalisation
(alternative loading dose regimen when it is necessary to rapidly attain therapeutic
plasma concentrations) (under close medical supervision)

Child (body-weight 50 kg and above): Loading dose 200 mg, followed by 100 mg
twice daily, to be given 12 hours after initial dose; increased in steps of 50mg twice daily
(max. per dose 200 mg twice daily) if necessary and if tolerated, dose to be increased at
weekly intervals
Contraindications
Second- or third-degree AV block
Side effects
Nausea, vomiting, constipation, flatulence, dizziness, headache, impaired coordination,
cognitive disorder, drowsiness, tremor, depression, Fatigue, abnormal gait, blurred vision,
nystagmus, pruritus; also reported dyspepsia, dry mouth, firstdegree AV block,
bradycardia, PR-interval prolongation, confusion, hypoesthesia, dysarthria, irritability,
muscle spasm, tinnitus, rash; suicidal ideation
Preparation
Tab 50mg
Epilap
4.5.3 Lamotrigin
Cautions
Closely monitor and consider withdrawal if rash, fever, or signs of hypersensitivity
syndrome develop; avoid abrupt withdrawal (taper off over 2 weeks or longer) unless
serious skin reaction occurs; myoclonic seizures (may be exacerbated)
Indication & Doses
*Monotherapy of focal seizures, Monotherapy of primary and secondary generalised
tonic-clonic seizures, Monotherapy of seizures associated with Lennox- Gastaut
syndrome
BY MOUTH
Child 12–17 years: Initially 25 mg once daily for 14 days, then increased to 50 mg once
daily for further14 days, then increased in steps of up to 100 mg every 7–14 days;
maintenance100–200 mg daily in 1–2 divided doses; increased if necessary up to 500 mg
daily, dose titration should be repeated if restarting after interval of more than 5 days
*Monotherapy of typical absence seizures
BY MOUTH
Child 2–11 years: Initially 300 micrograms/kg daily in 1–2divided doses, for 14 days,
then 600 micrograms/kg daily in 1–2 divided doses, for further 14 days, then increased in
steps of up to 600 micrograms/kg every 7–14 days; maintenance1–10 mg/kg daily in 1–2
divided doses, increased if necessary up to 15 mg/kg daily, dose titration should be
repeated if restarting after interval of more than 5days
*Adjunctive therapy of focal seizures with valproate, Adjunctive therapy of primary
and secondary generalised tonic-clonic seizures with valproate, Adjunctive therapy of
seizures associated with Lennox- Gastaut syndrome with valproate
BY MOUTH
Child 2–11 years (body-weight up to 13 kg): Initially2 mg once daily on alternate days
for first 14 days, then 300 micrograms/kg once daily for further 14 days, then increased in
steps of up to 300 micrograms/kg every 7–14 days; maintenance 1–5mg/kg daily in 1–2
divided doses, dose titration should be repeated if restarting after interval of more
than5days; maximum 200 mg per day
Child 2–11 years (body-weight 13 kg and above): Initially 150 micrograms/kg once
daily for 14 days, then 300 micrograms/kg once daily for further14 days, then increased

in steps of up to 300 micrograms/kg every 7–14 days; maintenance1–5mg/kg daily in 1–2
divided doses, dose titration should be repeated if restarting after interval of more than 5
days; maximum 200 mg per day
Child 12–17 years: Initially 25 mg once daily on alternate days for 14 days, then 25 mg
once daily for further 14 days, then increased in steps of up to 50mg every 7–14 days;
maintenance 100–200 mg daily in 1–2 divided doses, dose titration should be repeated if
restarting after interval of more than 5 days
*Adjunctive therapy of focal seizures (with enzyme inducing drugs) without
valproate,Adjunctive therapy of primary and secondary generalised tonic-clonic
seizures (with enzyme inducing drugs) without valproate, Adjunctive therapy of
seizures associated with Lennox- Gastaut syndromes (with enzyme inducing drugs)
without valproate
BY MOUTH
Child 2–11 years: Initially 300 micrograms/kg twice daily for 14 days, then 600
micrograms/kg twice daily for further 14 days, then increased in steps of up to 1.2 mg/kg
every7–14 days; maintenance 5–15 mg/kg daily in 1–2 divided doses, dose titration
should be repeated if restarting after interval of more than 5 days; maximum 400 mg per
day
Child 12–17 years: Initially50 mg once daily for14 days, then 50 mg twice daily for
further14 days, then increased in steps of up to100 mg every 7–14 days; maintenance
200–400 mg daily in 2divided doses, increased if necessary up to 700 mg daily, dose
titration should be repeated if restarting after interval of more than 5 days
*Adjunctive therapy of focal seizures (without enzyme inducing drugs) without
valproate|Adjunctive therapy of primary and secondary generalised tonic-clonic
seizures (without enzyme inducing drugs) without valproate| Adjunctive therapy of
seizures associated with Lennox- Gastaut syndromes (without enzyme inducing drugs)
without valproate
BY MOUTH
Child 2–11 years: Initially 300 micrograms/kg daily in 1–2 divided doses for 14 days,
then 600 micrograms/kg daily in 1–2 divided doses for further14 days, then increased in
steps of up to600 micrograms/kg every 7–14 days; maintenance1–10 mg/kg daily in 1–
2divided doses, dose titration should be repeated if restarting after interval of more
than5days; maximum 200 mg per day
Child 12–17 years: Initially 25 mg once daily for14 days, then increased to 50 mg once
daily for further14 days, then increased in steps of up to100 mg every 7–14 days;
maintenance100–200 mg daily in 1–2divided doses, dose titration should be repeated if
restarting after interval of more than 5 Days
Side effects
Nausea, vomiting, diarrhoea, dry mouth, aggression, agitation, headache, drowsiness,
dizziness, tremor, insomnia, ataxia, back pain, arthralgia, nystagmus, diplopia, blurred
vision, rash (see Skin Reactions, below); rarely conjunctivitis; very rarely hepatic failure,
movement disorders, unsteadiness, increase in seizure frequency, confusion,
hallucination, blood disorders (including anaemia, leucopenia, thrombocytopenia,
pancytopenia—see Blood Disorders, above), hypersensitivity syndrome (possibly
including rash, fever, facial oedema, lymphadenopathy, hepatic dysfunction, blood
disorders, disseminated intravascular coagulation, and multi-organ dysfunction), lupus
erythematosus-like reactions; also reported suicidal ideation, aseptic meningitis

Preparation
Tab 25/50mg
Lamictal
4.5.4 Levetiracetam
Cautions
Avoid abrupt withdrawal
Indication & doses
*Monotherapy of focal seizures with or without secondary generalisation
Child 16–17 years: Initially 250 mg once daily for 1week, then increased to 250 mg
twice daily, then increased in steps of 250 mg twice daily (max. per dose 1.5g twice
daily), adjusted according to response, dose to be increased every 2 weeks
*Adjunctive therapy of focal seizures with or without secondary generalisation
BY MOUTH
Child 1–5 months: Initially7 mg/kg once daily, then increased in steps of up to 7mg/kg
twice daily (max. per dose 21 mg/kg twice daily), dose to be increased every 2 weeks
Child 6 months–17 years (body-weight up to 50 kg): Initially 10 mg/kg once daily,
then increased in steps of up to 10 mg/kg twice daily (max. per dose 30 mg/kg twice
daily), dose to be increased every 2 weeks
Child 12–17 years (body-weight 50 kg and above): Initially 250 mg twice daily, then
increased in steps of 500 mg twice daily (max. per dose 1.5g twice daily), dose to be
increased every 2–4 weeks
Child 4–17 years (body-weight up to 50 kg): Initially 10 mg/kg once daily, then
increased in steps of up to 10mg/kg twice daily (max. per dose 30 mg/kg twice daily),
dose to be increased every 2 weeks
increased in steps of500 mg twice daily (max. per dose 1.5g twice daily), dose to be
increased every 2 weeks
*Adjunctive therapy of myoclonic seizures and tonic-clonic seizures
Child 12–17 years (body-weight up to 50 kg): Initially 10mg/kg once daily, then
increased in steps of up to 10mg/kg twice daily (max. per dose 30 mg/kg twice daily),
dose to be increased every 2 weeks
increased in steps of 500 mg twice daily (max. per dose 1.5g twice daily), dose to be
increased every 2 weeks
Side effects
Anorexia, weight changes, abdominal pain, nausea, vomiting, dyspepsia, diarrhoea,
cough, drowsiness, amnesia, ataxia, convulsion, dizziness, headache, tremor,
hyperkinesia, malaise, impaired attention, aggression, agitation, depression, insomnia,
anxiety, irritability, personality disorder, thrombocytopenia, myalgia, diplopia, blurred
vision, rash; also reported pancreatitis, hepatic failure, paraesthesia, confusion,
hallucinations, psychosis, suicidal ideation, leucopenia, neutropenia, pancytopenia,
alopecia, toxic epidermal necrolysis, Stevens-Johnson syndrome
Preparation
Inj, tab & syp 500mg/5ml, 250/500 mg &100mg/ml

Keppra
4.5.5 Phenytoin Sodium

Cautions
Cross-sensitivity reported with cabamazepine; avoid abrupt withdrawal; HLA-B* 1502
allele in individuals of Han Chinese or Thai origin – avoid unless essential (increased risk
of Stevens– Johnson syndrome); manufacturer recommends blood counts (but evidence
of practical value uncertain); Consider vitamin D supplementation in patients that are
immobilised for long periods or who have inadequate sun exposure or dietary intake of
calcium; enteral feeding (interrupt feeding for 2 hours before and after dose; more
frequent monitoring may be necessary); avoid in acute porphyria
Indication & Doses
*Tonic-clonic seizures, Focal seizures
BY MOUTH
Child 1 month–11 years: Initially 1.5–2.5 mg/kg twice daily, then adjusted according to
response to 2.5–5 mg/kg twice daily (max. per dose 7.5 mg/kg twice daily), dose also
adjusted according to plasma- phenytoin concentration; maximum 300 mg per day
Child 12–17 years: Initially 75–150 mg twice daily, then adjusted according to response
to 150–200 mg twice daily (max. per dose 300 mg twice daily), dose also adjusted
according to plasma-phenytoin concentration
INITIALLY BY SLOW INTRAVENOUS INJECTION
Neonate: Loading dose 18 mg/kg, dose to be administered over 20–30 minutes, then (by
mouth) 2.5–5 mg/kg twice daily (max. per dose 7.5mg/kg twice daily), adjusted
according to response, dose also adjusted according to plasma-phenytoin concentration.
*Prevention and treatment of seizures during or following neurosurgery or severe head
injury
BY MOUTH
Child: Initially 2.5 mg/kg twice daily, then adjusted according to response to 4–8 mg/kg
daily, dose also adjusted according to plasma-phenytoin concentration; maximum 300 mg
per day
*Status epilepticus, acute symptomatic seizures associated with head trauma or
neurosurgery
INITIALLY BY SLOW INTRAVENOUS INJECTION, OR BY INTRAVENOUS
INFUSION
Neonate: Loading dose 20 mg/kg, then (by slow intravenous injection or by intravenous
infusion) 2.5–5 mg/kg twice daily.
Child 1 month–11 years: Loading dose 20 mg/kg, then (by slow intravenous injection or
by intravenous infusion) 2.5–5 mg/kg twice daily
Child 12–17 years: Loading dose 20mg/kg, then (by intravenous infusion or by slow
intravenous injection) up to 100 mg 3–4times a day
Side effects
nausea, vomiting, constipation; drowsiness, insomnia, transient nervousness, tremor,
paraesthesia, dizziness, headache, anorexia; gingival hypertrophy and tenderness
(maintain good oral hygiene); rash (discontinue; if mild reintroduce cautiously but
discontinue immediately if recurrence), acne, hirsutism, coarsening of facial appearance;
rarely hepatoxicity (discontinue immediately and do not readminister), peripheral
neuropathy, dyskinesia, lymphadenopathy, osteomalacia, blood disorders (including
megaloblastic anaemia, leucopenia, thrombocytopenia, and aplastic anaemia),polyarteritis

nodosa, lupus erythematosus, Stevens- Johnson syndrome, and toxic epidermal
necrolysis; also reported polyarthropathy, pneumonitis, interstitial nephritis; suicidal
ideation
Preparation
Injection 250mg/5ml
Syp 125mg
Epigran
4.5.6 Sodium Valproate

Cautions
monitor liver function before therapy and during first 6 months especially in children
most at risk (see also below); measure full blood count and ensure no undue potential for
bleeding before starting and before surgery; systemic lupus erythematosus; false-positive
urine tests for ketones; avoid sudden withdrawal; consider vitamin D supplementation in
patients that are immobilised for long periods or who have inadequate sun exposure or
dietary intake of calcium;
Indication & Doses
*All forms of epilepsy
Neonate: Initially 20 mg/kg once daily; maintenance 10mg/kg twice daily.
Child 1 month–11 years: Initially10–15 mg/kg daily in 1–2 divided doses (max. per
dose 600 mg); maintenance 25–30 mg/kg daily in 2 divided doses, doses up to 60 mg/kg
daily in 2 divided doses may be used in infantile spasms; monitor clinical chemistry and
haematological parameters if dose exceeds 40 mg/kg daily
Child 12–17 years: Initially 600 mg daily in 1–2 divided doses, increased in steps of
150–300 mg every 3 days; maintenance 1–2g daily in 2 divided doses; maximum 2.5g
per day
BY RECTUM
Neonate: Initially 20 mg/kg once daily; maintenance 10 mg/kg twice daily.
Child 1 month–11 years: Initially 10–15 mg/kg daily in 1–2 divided doses (max. per
dose 600 mg); maintenance 25–30 mg/kg daily in 2 divided doses, doses up to 60 mg/kg
daily in 2 divided doses may be used in infantile spasms; monitor clinical chemistry and
haematological parameters if dose exceeds 40 mg/kg daily
Child 12–17 years: Initially 600 mg daily in 1–2 divided doses, increased in steps of
150–300 mg every 3 days; maintenance 1–2g daily in 2 divided doses; maximum 2.5g
per day Initiation of valproate treatment
Neonate: 10 mg/kg twice daily.
Child 1 month–11 years: Initially 10 mg/kg, then (by intravenous infusion or by
intravenous injection) increased to 20–40 mg/kg daily in 2–4 divided doses, alternatively
(by continuous intravenous infusion) increased to 20–40mg/kg daily, monitor clinical
chemistry and haematological parameters if dose exceeds 40mg/kg daily
Child 12–17 years: Initially 10mg/kg, followed by (by intravenous infusion or by
intravenous injection) up to 2.5g daily in 2–4 divided doses, alternatively (by continuous
intravenous infusion) up to2.5 g daily; (by intravenous injection or by intravenous
infusion or by continuous intravenous infusion) usual dose1–2 g daily, alternatively (by
intravenous injection or by intravenous infusion or by continuous intravenous infusion)
usual dose 20–30 mg/kg daily, intravenous injection to be administered over 3–5 minutes

*Continuation of valproate treatment
BY INTRAVENOUS INJECTION, OR BY INTRAVENOUS INFUSION, OR BY
CONTINUOUS INTRAVENOUS INFUSION
Child: If switching from oral therapy to intravenous therapy give the same dose as
current oral daily dose, give over 3–5 minutes by intravenous injection or in 2–4 divided
doses by intravenous infusion
Contraindication
Family history of severe hepatic dysfunction; acute porphyria
Side effects
Nausea, gastric irritation, diarrhoea; weight gain; hyperammonaemia, thrombocytopenia;
transient hair loss (regrowth may be curly); less frequently increased alertness,
aggression, hyperactivity, behavioural disturbances, ataxia, tremor, and vasculitis; rarely
hepatic dysfunction, lethargy, drowsiness, confusion, stupor, hallucinations, blood
disorders (including anaemia, leucopenia, and pancytopenia), hearing loss, and rash; very
rarely pancreatitis, peripheral oedema, increase in bleeding time, extrapyramidal
symptoms, encephalopathy, coma, gynaecomastia, Fanconi’s syndrome, hirsutism,
enuresis, hyponatraemia, acne, toxic epidermal necrolysis, and Stevens-Johnson
syndrome; suicidal ideation; reduced bone mineral density; also reported menstrual
disturbances
Preparation
Syrup & tab 250mg/5ml & 250mg
Epival
4.5.7 Topiramate
Caution
Avoid abrupt withdrawal; risk of metabolic acidosis; risk of nephrolithiasis—ensure
adequate hydration (especially in strenuous activity or warm environment); avoid in acute
porphyria
Indication & doses
*Monotherapy of generalised tonic-clonic seizures or focal seizures with or without
secondary generalisation
BY MOUTH
Child 6–17 years: Initially 0.5–1 mg/kg once daily (max. per dose25 mg) for 1 week,
dose to be taken at night, then increased in steps of 250–500 micrograms/kg twice daily,
dose to be increased by a maximum of 25 mg twice daily at intervals of 1–2 weeks; usual
dose 50 mg twice daily (max. per dose 7.5 mg/kg twice daily), if child cannot tolerate
titration regimens recommended above then smaller steps or longer interval between
steps may be used; maximum5 00 mg per day
*Adjunctive treatment of generalised tonic-clonic seizures or focal seizures with or
without secondary generalization, Adjunctive treatment for seizures associated with
Lennox-Gastaut syndrome
BY MOUTH
Child 2–17 years: Initially 1–3 mg/kg once daily (max. per dose 25 mg) for 1 week, dose
to be taken at night, then increased in steps of 0.5–1.5 mg/kg twice daily, dose to be
increased by a maximum of 25mg twice daily at intervals of 1–2 weeks; usual dose 2.5–
4.5 mg/kg twice daily (max. per dose 7.5mg/kg twice daily), if child cannot tolerate
recommended titration regimen then smaller steps or longer interval between steps may
be used; maximum 400 mg per day

*Migraine prophylaxis
BY MOUTH
Child 16–17 years: Initially 25mg once daily for 1 week, dose to be taken at night, then
increased in steps of 25mg every week; usual dose 50–100 mg daily in 2 divided doses, if
child cannot tolerate recommended titration regimen then smaller steps or longer interval
between steps may be used; maximum 200 mg per day
Side effects
nausea, diarrhoea, vomiting, constipation, dyspepsia, abdominal pain, dry mouth, taste
disturbance, gastritis, appetite changes, dyspnoea, impaired attention, cognitive
impairment, movement disorders, seizures, tremor, malaise, impaired coordination,
speech disorder, drowsiness, dizziness, sleep disturbance, anxiety, confusion,
paraesthesia, aggression, mood changes, depression, agitation, irritability, nephrolithiasis,
urinary disorders, anaemia, arthralgia, muscle spasm, myalgia, muscular weakness, visual
disturbances, nystagmus, tinnitus, epistaxis, alopecia, rash, pruritus; less commonly
pancreatitis, flatulence, abdominal distension, gingival bleeding, salivation, halitosis,
thirst, glossodynia, bradycardia, palpitation, hypotension, postural hypotension, flushing,
altered sense of smell, peripheral neuropathy, suicidal ideation, psychosis, panic attack,
influenza-like symptoms, sexual dysfunction, urinary calculus, haematuria, blood
disorders (including leucopenia, neutropenia, and thrombocytopenia), hypokalaemia,
metabolic acidosis, dry eye, photophobia, blepharospasm, increased lacrimation,
mydriasis, hearing loss, reduced sweating, skin discoloration; rarely Raynaud’s
syndrome, periorbital oedema, unilateral blindness, Stevens-Johnson syndrome, abnormal
skin odour, calcinosis; very rarely angle-closure glaucoma; also reported hepatitis,
hepatic failure, encephalopathy, hyperammonaemia, maculopathy, toxic epidermal
necrolysis
Preparation
Tab 25 & 50mg
Hitop
4.5.8 BARBITURATES
4.5.8.1 Phenobarbitone
Cautions
debilitated; respiratorydepression (avoid if severe); avoid abrupt withdrawal (dependence
with prolonged use); history of drug and alcohol abuse; consider vitamin D
supplementation in patients who are immobilised for long periods or who have
inadequate sun exposure or dietary intake of calcium; avoid in acute porphyria
Indication & Doses
*All forms of epilepsy except typical absence seizures
BY MOUTH
Child 1 month–11 years: Initially 1–1.5mg/kg twice daily, then increased in steps of
2mg/kg daily as required; maintenance 2.5–4 mg/kg 1–2 times a day
Child 12–17 years: 60–180 mg once daily
Neonate: Initially 20 mg/kg, then (by slow intravenous injection or by mouth) 2.5–
5mg/kg once daily, adjusted according to response.
*Status epilepticus

Neonate: Initially 20 mg/kg, dose to be administered at a rate no faster than
1mg/kg/minute, then 2.5–5 mg/kg 1–2 times a day.
Child 1 month–11 years: Initially 20 mg/kg, dose to be administered at a rate no faster
than 1mg/kg/minute, then 2.5–5mg/kg 1–2 times a day
Child 12–17 years: Initially 20 mg/kg (max. per dose 1g), dose to be administered at a
rate no faster than 1 mg/kg/minute, then 300 mg twice daily
Side effects
Hepatitis, cholestasis; hypotension; respiratory depression; drowsiness, lethargy,
depression, ataxia, behavioural disturbances, nystagmus, irritability, hallucinations,
impaired memory and cognition, hyperactivity; osteomalacia (see Cautions);
megaloblastic anaemia (may be treated with folic acid), agranulocytosis,
thrombocytopenia; allergicskin reactions; very rarely Stevens-Johnson syndrome and
toxic epidermal necrolysis; suicidal ideation;
Preparation
Injection 130mg/ml
Syp 20mg/5ml
Phenobarbitone
4.6 HYPNOTICS, SEDATIVES & ANXYOLITICS

4.6.1BENZODIAZEPINES
4.6.1.1 Clobazam
Cautions
respiratory disease, muscle weakness and myasthenia gravis, history of drug or alcohol
abuse, marked personality disorder; avoid prolonged use (and abrupt withdrawal
thereafter); when given parenterally, close observation required until full recovery from
sedation; when given intravenously, facilities for reversing respiratory depression with
mechanical ventilation must be at hand; porphyria
Indication & Doses
*Adjunct in epilepsy
BY MOUTH
Child 1 month-5 years: Initially 125 micrograms/kg twice daily, dose to be increased if
necessary every 5 days , maintenance 250 micrograms/kg twice daily, (max dose is 500
micrograms/kg twice daily); maximum 30 mg per day
Child 6–17 years: Initially 5 mg daily, dose to be increased if necessary at intervals of 5
days, maintenance 0.3–1mg/kg daily, daily doses of up to 30 mg may be given as a single
dose at bedtime, higher doses should be divided; maximum 60 mg per day
*Monotherapy for catamenial (menstruation) seizures (usually for 7–10 days each
month, just before and during menstruation) (under expert supervision), Cluster
seizures
BY MOUTH
Child 1 month–5 years: Initially 125 micrograms/kg twice daily, dose to be increased if
necessary every 5 days, maintenance 250 micrograms/kg twice daily (max. per dose 500
micrograms/kg twice daily); maximum 30 mg per day
Child 6–17 years: Initially 5 mg daily, dose to be increased if necessary at intervals of 5
days, maintenance 0.3–1mg/kg daily, daily doses of up to 30 mg may be given as a single
dose at bedtime, higher doses should be divided; maximum 60 mg per day
Contraindication

Respiratory depression; marked neuromuscular respiratory weakness including unstable
myasthenia gravis; acute pulmonary insufficiency; sleep apnoea syndrome; not for
chronic psychosis; should not be used alone in depression or in anxiety with depression;
avoid injections containing benzyl alcohol in neonates
Side effects
Drowsiness and lightheadedness the next day; confusion and ataxia; amnesia;
dependence; paradoxical increase in aggression; muscle weakness; occasionally:
headache, vertigo, hypotension, salivation changes, gastrointestinal disturbances, visual
disturbances, dysarthria, tremor, changes in libido, incontinence, urinary retention; blood
disorders and jaundice reported; skin reactions; on intravenous injection, pain,
thrombophlebitis, and rarely apnoea
Preparation
Tab 10mg
Frisium
4.6.1.2 Diazepam
Cautions
respiratory disease, muscle weakness and myasthenia gravis, history of drug or alcohol
abuse, marked personality disorder; avoid prolonged use (and abrupt withdrawal
thereafter); when given parenterally, close observation required until full recovery from
sedation; when given intravenously, facilities for reversing respiratory depression with
mechanical ventilation must be at hand; porphyria
Indication & Doses
*Tetanus
Child: 100–300 micrograms/kg every 1–4 hours
BY INTRAVENOUS INFUSION, OR BY NASODUODENAL TUBE
Child: 3–10 mg/kg, adjusted according to response, to be given over 24 hours
*Muscle spasm in cerebral spasticity or in postoperative skeletal muscle spasm
BY MOUTH
Child 1–11 months: Initially250 micrograms/kg twice daily
Child 1–4 years: Initially 2.5mg twice daily
Child 5–11 years: Initially 5 mg twice daily
Child 12–17 years: Initially 10 mg twice daily; maximum 40 mg per day
*Status epilepticus, febrile convulsions, Convulsions due to poisoning
Neonate: 300–400 micrograms/kg, then 300–400 micrograms/kg after 10 minutes if
required, to be given over 3–5minutes.
Child 1 month–11 years: 300–400 micrograms/kg (max. per dose 10mg), then 300–400
micrograms/kg after 10 minutes if required, to be given over 3–5 minutes
Child 12–17 years: 10mg, then 10 mg after 10 minutes if required, to be given over 3–5
minutes
BY RECTUM
Neonate: 1.25–2.5mg, then 1.25–2.5 mg after 10 minutes if required.
Child 1 month–1 year: 5 mg, then 5 mg after10 minutes if required
Child 2–11 years: 5–10 mg, then5–10 mg after 10 minutes if required
Child 12–17 years: 10–20mg, then 10–20 mg after 10 minutes if required
*Life-threatening acute drug-induced dystonic reactions

Child 1 month–11 years: 100 micrograms/kg, repeated if necessary, to be given over 3–
5 minutes
Child 12–17 years: 5–10 mg, repeated if necessary, to be given over 3–5 minutes
Contraindication
Respiratory depression; marked neuromuscular respiratory weakness including unstable
myasthenia gravis; acute pulmonary insufficiency; Sleep apnoea syndrome; not for
chronic psychosis; should not be used alone in depression or in anxiety with depression;
avoid injections containing Benzyl alcohol in neonates
Side effects
Drowsiness and lightheadedness the next day; confusion and ataxia; amnesia;
dependence; paradoxical increase in aggression, muscle weakness; occasionally:
headache, vertigo, hypotension, salivation changes, gastrointestinal disturbances, visual
disturbances, dysarthria, tremor, changes in libido, incontinence, urinary retention; blood
disorders and jaundice reported; skin reactions; on intravenous injection, pain,
thrombophlebitis, and rarely apnoea;
Preparation
Injection 10mg/2ml
Valium
4.5.9 Nitrazepam
Cautions
Avoid abrupt withdrawal; respiratory disease; acute porphyria; muscle weakness and
myasthenia gravis
Indication & Doses
*Infantile spasms
BY MOUTH
Child 1 month–2 years initially 125 micrograms/ kg twice daily, adjusted according to
response over 2–3 weeks to 250 micrograms/kg twice daily; max. 500 micrograms/kg
(not exceeding 5 mg) twice daily; total daily dose may alternatively be given in 3 divided
doses.
Contraindications
Respiratory depression, acute pulmonary insufficiency, sleep apnoea syndrome; marked
neuromuscular respiratory weakness including myasthenia gravis,
Side effects
confusion, ataxia; drowsiness and lightheadedness the next day; confusion and ataxia;
amnesia; dependence; paradoxical increase in aggression; muscle weakness;
occasionally: headache, vertigo, hypotension, salivation changes, gastrointestinal
disturbances, visual disturbances, dysarthria, tremor, changes in libido, incontinence,
urinary retention; blood disorders and jaundice reported; skin reactions; on intravenous
injection, pain, thrombophlebitis, and rarely apnoea;
Preparation
Tab 5mg
Mogadon
4.5.10 Midazolam
Cautions

Cardiac disease; respiratory disease; myasthenia gravis; neonates; history of drug or
alcohol abuse; reduce dose if debilitated; risk of severe hypotension in children with
hypovolaemia, vasoconstriction, hypothermia; avoid prolonged use (and abrupt
withdrawal thereafter)
Indication & Doses
*Status epilepticus, febrile convulsions
BY BUCCAL ADMINISTRATION
Neonate: 300 micrograms/kg, then 300 micrograms/kg after 10 minutes if required.
Child 1–2 months: 300 micrograms/kg (max. per dose 2.5mg), then 300 micrograms/kg
after 10 minutes (max. per dose 2.5mg) if required
Child 3–11 months: 2.5mg, then 2.5mg after 10 minutes if required
Child 1–4 years: 5mg, then 5mg after 10 minutes if required
Child 5–9 years: 7.5 mg, then 7.5mg after10 minutes if required
Child 10–17 years: 10 mg, then 10mg after 10 minutes if required
Neonate: Initially150–200 micrograms/kg, followed by (by continuous intravenous
infusion) 60micrograms/kg/hour, (by continuous intravenous infusion) increased in steps
of 60 micrograms/kg/hour every 15 minutes (max. per dose 300 micrograms/kg/hour)
until seizure controlled.
Child: Initially 150–200 micrograms/kg, followed by (by continuous intravenous
infusion) 60micrograms/kg/hour, (by continuous intravenous infusion) increased in steps
of 60 micrograms/kg/hour every15 minutes (max. per dose 300 micrograms/kg/hour)
until seizure controlled
*Conscious sedation for procedures
BY MOUTH
Child: 500 micrograms/kg (max. per dose 20 mg), to be administered 30–60 minutes
before procedure
BY BUCCAL ADMINISTRATION
Child 6 months–9 years: 200–300 micrograms/kg (max. per dose 5 mg)
Child 10–17 years (body-weight up to 70 kg): 6–7 mg
Child 10–17 years (body-weight 70 kg and above): 6–7mg (max. per dose 8mg)
BY RECTUM
Child 6 months–11 years: 300–500 micrograms/kg, to be administered15–30 minutes
before procedure
Child 1 month–5 years: Initially 25–50 micrograms/kg, to be administered over 2–3
minutes,5–10 minutes before procedure, dose can be increased if necessary in small steps
to maximum total dose per course; maximum 6 mg per course
Child 6–11 years: Initially25–50 micrograms/kg, to be administered over 2–3 minutes,
5–10minutes before procedure, dose can be increased if necessary in small steps to
maximum total dose per course; maximum 10 mg per course
Child 12–17 years: Initially 25–50 micrograms/kg, to be administered over 2–3 minutes,
5–10minutes before procedure, dose can be increased if necessary in small steps to
maximum total dose per course; maximum 7.5mg per course
*Premedication
BY MOUTH
Child: 500 micrograms/kg (max. per dose20 mg), to be taken 15–30 minutes before the
procedure

BY RECTUM
Child 6 months–11 years: 300–500 micrograms/kg, to be administered 15–30 minutes
before induction
*Induction of anaesthesia (but rarely used)
Child 7–17 years: Initially 150 micrograms/kg (max. per dose7.5mg), dose to be given
in steps of 50micrograms/kg (max.2.5mg) over2–5 minutes; wait for 2–5 minutes before
subsequent dosing, then 50micrograms/kg every2 minutes (max. per dose 2.5mg) if
required; maximum 500 micrograms/kg per course; maximum 25 mg per course
*Sedation of patient receiving intensive care
Child 6 months–11 years: Initially 50–200 micrograms/kg, to be administered over at
least 3 minutes, followed by (by continuous intravenous infusion) 30–120
micrograms/kg/hour, adjusted according to response, initial dose may not be required and
lower maintenance doses needed if opioid analgesics also used; reduce dose (or reduce or
omit initial dose) in hypovolaemia, vasoconstriction, or hypothermia
Child 12–17 years: Initially 30–300 micrograms/kg, dose to be given in steps of1–2.5mg
every2minutes, followed by (by continuous intravenous infusion) 30–200
micrograms/kg/hour, adjusted according to response, initial dose may not be required and
lower maintenance doses needed if opioid analgesics also used; reduce dose (or reduce or
omit initial dose) in hypovolaemia, vasoconstriction, or hypothermia
Neonate up to 32 weeks corrected gestational age: 60 micrograms /kg/hour for 24
hours, then reduced to 30micrograms/kg/hour, adjusted according to response for
maximum treatment duration of 4 days.
Neonate 32 weeks corrected gestational age and above: 60 micrograms /kg/hour,
adjusted according to response for maximum treatment duration of 4 days.
Child 1–5 months: 60 micrograms/kg/hour, adjusted according to response
Contraindication
Marked neuromuscular respiratory weakness including unstable myasthenia gravis;
severe respiratory depression; acute pulmonary insufficiency
Side effects
gastro-intestinal disturbances, increased appetite, jaundice; hypotension, cardiac arrest,
heart rate changes, anaphylaxis, thrombosis; laryngospasm, bronchospasm, respiratory
depression and respiratory arrest (particularly with high doses or on rapid injection);
drowsiness, confusion, ataxia, amnesia, headache, euphoria, hallucinations, convulsions
(more common in neonates), fatigue, dizziness, vertigo, involuntary movements,
paradoxical excitement and aggression, dysarthria; urinary retention, incontinence; blood
disorders; muscle weakness; visual disturbances; salivation changes; skin reactions;
injection-site reactions; with intranasal administration burning sensation, lacrimation, and
severe irritation of nasal mucosa
Preparation
Inj. 1mg/ml (5ml)
Dormicum.
4.7 CNS STIMULANTS AND OTHER DRUGS FOR ATTENTION

DEFECIT HYPERACTIVITY DISORDER

4.7.1 Atomoxetine
Cautions
Cardiovascular disease including hypertension and tachycardia; structural cardiac
abnormalities; QT-interval prolongation (avoid concomitant use of drugs that prolong QT
interval); psychosis or mania; history of seizures; aggressive behaviour, hostility, or
emotional lability; susceptibility to angle-closure glaucoma
Indication & Doses
*Attention deficit hyperactivity disorder (initiated by a specialist)
BY MOUTH
Child 6–17 years (body-weight up to 70 kg): Initially 500 micrograms/kg daily for 7
days, dose is increased according to response; maintenance 1.2mg/kg daily, total daily
dose may be given either as a single dose in the morning or in 2 divided doses with last
dose no later than early evening, high daily doses to be given under the direction of a
specialist; maximum 1.8 mg/kg per day; maximum 120 mg per day
Child 6–17 years (body-weight 70 kg and above): Initially 40 mg daily for 7 days, dose
is increased according to response; maintenance 80mg daily, total daily dose may be
given either as a single dose in the morning or in 2 divided doses with last dose no later
than early evening, high daily doses to be given under the direction of a specialist;
Side effects
Anorexia, dry mouth, nausea, vomiting, abdominal pain, constipation, dyspepsia,
flatulence; palpitation, tachycardia, increased blood pressure, postural hypotension, hot
flushes; sleep disturbance, dizziness, headache, fatigue, lethargy, depression, psychotic or
manic symptoms, aggression, hostility,emotional lability, drowsiness, anxiety, irritability,
tremor, rigors; urinary retention, prostatitis, sexual dysfunction, menstrual disturbances;
mydriasis, conjunctivitis; dermatitis, pruritus, rash, sweating; less commonly suicidal
ideation, cold extremities; very rarely hepatic disorders, seizures, Raynaud’s
phenomenon, and angle-closure glaucoma
Preparation
Tab 10/25mg
Strattera
4.7.2 Methylphenidate
Cautions
Monitor for psychiatric disorders; anxiety or agitation; tics or a family history of Tourette
syndrome; drug or alcohol dependence; epilepsy (discontinue if increased seizure
frequency); avoid abrupt withdrawal
Indication & Doses
*Attention deficit hyperactivity disorder (initiated under specialist supervision)
Child 4–5 years: Initially 2.5 mg twice daily, increased in steps of 2.5 mg daily if
required, at weekly intervals, increased if necessary up to 1.4 mg/kg daily in 2–3 divided
doses, discontinue if no response after 1month, if effect wears off in evening (with
rebound hyperactivity) a dose at bedtime may be appropriate (establish need with trial
bedtime dose). Treatment may be started using a modified-release preparation
Child 6–17 years: Initially 5mg 1–2 times a day, increased in steps of 5–10 mg daily if
required, at weekly intervals, increased if necessary up to 60 mg daily in 2–3 divided

doses, increased if necessary up to 2.1 mg/kg daily in 2–3 divided doses, the licensed
maximum dose is 60mg daily in 2–3doses, higher dose (up to a maximum of 90mg daily)
under the direction of a specialist, discontinue if no response after 1 month, if effect
wears off in evening (with rebound hyperactivity) a dose at bedtime may be appropriate
(establish need with trial bedtime dose). Treatment may be started using a modified-
release preparation
Contraindications
severe depression, suicidal ideation; anorexia nervosa; psychosis; uncontrolled bipolar
disorder; hyperthyroidism; cardiovascular disease (including heart failure,
cardiomyopathy, severe hypertension, and arrhythmias), structural cardiac abnormalities;
phaeochromocytoma; vasculitis; cerebrovascular disorders
Side effects
abdominal pain, nausea, vomiting, diarrhoea, dyspepsia, dry mouth, anorexia, reduced
weight gain; tachycardia, palpitation, arrhythmias, changes in blood pressure; tics (very
rarely Tourette syndrome), insomnia, nervousness, asthenia, depression, irritability,
aggression, headache, drowsiness, dizziness, movement disorders; fever, arthralgia; rash,
pruritus, alopecia; growth restriction; less commonly constipation, abnormal dreams,
confusion, suicidal ideation, urinary frequency, haematuria, muscle cramps, epistaxis;
rarely sweating and visual disturbances; very rarely hepatic dysfunction, cerebral arteritis,
psychosis, seizures, neuroleptic malignant syndrome, tolerance and dependence, blood
disorders including leucopenia and thrombocytopenia, exfoliative dermatitis, and
erythema multiforme; supraventricular tachycardia, bradycardia, and convulsions also
reported
Preparation
Tab 10mg
Ritalin

SECTION 5: DRUGS USED IN THE TREATMENT OF
INFECTIONS
5.1 ANTIBACTERIAL DRUGS

5.1.1 PENICILLINS
5.1.1.1 NATURAL PENICILLIN
Benzyl Penicillin
Cautions
History of allergy; false-positive urinary glucose (if tested for reducing substances)
Indication & Doses
*Mild to moderate susceptible infection, Throat infections |Otitis media, Pneumonia,
Cellulitis
BY INTRAMUSCULAR INJECTION, OR BY SLOW INTRAVENOUS INJECTION,
OR BY INTRAVENOUS INFUSION
Neonate up to 7 days: 25 mg/kg every 12 hours; increased if necessary to 25 mg/kg
every 8 hours, intravenous route recommended in neonates.
Neonate 7 days to 28 days: 25 mg/kg every 8 hours; increased if necessary to 50 mg/kg
every 8 hours in severe infection, intravenous route recommended in neonates.
Child: 25 mg/kg every 6 hours; increased if necessary to 50 mg/kg every 4–6 hours
(max. per dose 2.4 g every 4 hours) in severe infection, intravenous route recommended
in infants
*Endocarditis (in combination with other antibacterial if necessary)
BY SLOW INTRAVENOUS INJECTION, OR BY INTRAVENOUS INFUSION
Child: 25 mg/kg every 4 hours; increased if necessary to 50 mg/kg every 4 hours (max.
per dose 2.4g every 4 hours)
*Meningitis, Meningococcal disease
Neonate up to 7 days: 50 mg/kg every 12 hours.
Neonate 7 days to 28 days: 50 mg/kg every 8 hours.
Child: 50 mg/kg every 4–6 hours (max. per dose 2.4 g every 4 hours)
*Suspected meningococcal disease (meningitis with non- blanching rash or
meningococcal septicaemia) prior to urgent transfer to hospital
Child 1–11 months: 300 mg, administer as single dose prior to urgent transfer to hospital
so long as does not delay transfer
Child 1–9 years: 600 mg, administer as single dose prior to urgent transfer to hospital so
long as does not delay transfer
Child 10–17 years: 1.2 g, administer as single dose prior to urgent transfer to hospital so
long as does not delay transfer
*Suspected bacterial meningitis without non-blanching rash where patient cannot be
transferred to hospital urgently
Child 1–11 months: 300 mg, administer as single dose prior to transfer to hospital
Child 1–9 years: 600 mg, administer as single dose prior to transfer to hospital
Child 10–17 years: 1.2 g, administer as single dose prior to transfer to hospital
*Neonatal sepsis

Neonate up to 7 days: 25 mg/kg every 12 hours; increased if necessary to 25mg/kg
every 8 hours, intravenous route recommended in neonates.
Neonate 7 days to 28 days: 25 mg/kg every 8 hours; increased if necessary to 50 mg/kg
every 8 hours in severe infection, intravenous route recommended in neonates.
Contraindications
Penicillin hypersensitivity
Side effects
Hypersensitivity reactions including urticaria, fever, joint pains, rashes, angioedema,
anaphylaxis, serum sickness-like reactions; rarely CNS toxicity including convulsions
(especially with high doses or in severe renal impairment), interstitial nephritis,
haemolytic anaemia leucopenia, thrombocytopenia and coagulation disorders; also
reported diarrhea
Preparation
Injection 10 Lac units
Benzyl Penicillin
5.1.1.2 BROAD SPECTRUM PENICILLIN

Cautions
History of allergy; erythematous rashes common in glandular fever; increased risk of
erythematous rashes in cytomegalovirus infection, and acute or chronic lymphocytic
leukaemia, maintain adequate hydration with high doses
Contraindications
Penicillin hypersensitivity, history of co-amoxiclav associated or penicillin-associated
jaundice or hepatic dysfunction
Side effects
Nausea, vomiting, diarrhoea; rashes (discontinue treatment); rarely, antibiotic-associated
colitis; Hypersensitivity reactions including urticaria, fever, joint pains, rashes,
angioedema, anaphylaxis, serum sickness-like reactions; rarely CNS toxicity including
convulsions (especially with high doses or in severe renal impairment), interstitial
nephritis, haemolytic anaemia leucopenia, thrombocytopenia and coagulation disorders
5.1.1.2.1 Amoxycillin
Indication & Doses
*Susceptible infections (e.g. sinusitis, salmonellosis, oral infections)
BY MOUTH
Neonate 7 days to 28 days: 30 mg/kg 3 times a day (max. per dose 125 mg).
Child 1–11 months: 125 mg 3 times a day; increased if necessary up to 30mg/kg 3 times
a day
Child 1–4 years: 250 mg3 times a day; increased if necessary up to 30mg/kg 3 times a
day
Child 5–11 years: 500 mg 3times a day; increased if necessary up to 30mg/kg 3 times a
day (max. per dose 1 g)
Child 12–17 years: 500 mg 3 times a day; increased if necessary up to 1g 3 times a day,
use increased dose in severe infections

Neonate up to 7 days: 30 mg/kg every 12 hours, increased if necessary to 60 mg/kg
every 12 hours, increased dose used in severe infection.
Neonate 7 days to 28 days: 30 mg/kg every 8 hours, increased if necessary to 60 mg/kg
every8 hours, increased dose used in severe infection.
Child: 20–30 mg/kg every 8 hours (max. per dose 500 mg), increased if necessary to 40–
60 mg/kg every 8 hours (max. per dose 1 g every 8 hours), increased dose used in severe
infection
*Community-acquired pneumonia
BY MOUTH
Child 1–11 months: 125 mg 3 times a day for 5 days; increased if necessary up to
30mg/kg 3 times a day
Child 1–4 years: 250 mg3 times a day for 5 days; increased if necessary up to 30mg/kg
3times a day
Child 5–11 years: 500 mg 3 times a day for 5 days; increased if necessary up to 30mg/kg
3 times a day (max. per dose 1 g 3 times a day)
Child 12–17 years: 500 mg 3times a day for 5 days; increased if necessary up to 1g 3
times a day
*Acute exacerbation of bronchiectasis
BY MOUTH
Child 1–11 months: 125 mg 3 times a day for7–14 days
Child 1–4 years: 250 mg 3 times a day for 7–14 days
*Acute cough [if systemically very unwell or at higher risk of complications]
BY MOUTH
Child 1–11 months: 125 mg 3 times a day for 5 days
Child 1–4 years: 250 mg 3 times a day for 5days
Child 5–17 years: 500 mg 3 times a day for 5 days
*Acute otitis media
BY MOUTH
Child 1–11 months: 125 mg 3 times a day for 5–7days
*Cystic fibrosis (treatment of asymptomatic Haemophilus influenza carriage or mild
exacerbation)
BY MOUTH
Neonate 7 days to 28 days: 30 mg/kg 3 times a day (max. per dose 125 mg).
Child 1–11 months: 125 mg 3 times a day; increased if necessary up to 30 mg/kg 3
times a day
Child 1–4 years: 250 mg 3times a day; increased if necessary up to 30 mg/kg 3 times a
day
Child 5–11 years: 500 mg 3 times a day; increased if necessary up to 30 mg/kg 3 times a
day (max. per dose 1g)
Child 12–17 years: 500 mg 3 times a day; increased if necessary up to 1g 3 times a day,
use increased dose in severe infections
Neonate up to 7 days: 30 mg/kg every 12 hours, increased if necessary to 60mg/kg

Child: 20–30 mg/kg every 8 hours (max. per dose 500 mg), increased if necessary to 40–
60 mg/kg every 8 hours (max. per dose1 g every 8 hours), increased dose used in severe
infection
*Lyme disease (under expert supervision)
BY MOUTH
Neonate 7 days to 28 days: 30 mg/kg 3times a day (max. per dose 125 mg 3 times a day)
usual duration 2–4 weeks.
*Lyme disease [erythema migrans and/or non-focal symptoms], Lyme disease
[affecting cranial nerves or peripheral nervous system]
BY MOUTH
Child 1 month–11 years (administered on expert advice) (body-weight up to 34 kg):
30 mg/kg 3times a day for 21 days
Child 1 month–11 years (administered on expert advice) (body-weight 34 kg and
above): 1g 3 times a day for 21 days
Child 12–17 years (administered on expert advice): 1 g 3times a day for 21 days
*Lyme arthritis, Acrodermatitis chronica atrophicans
BY MOUTH
Child 1 month–11 years (administered on expert advice) (body-weight up to 34 kg):
30 mg/kg 3times a day for 28 days
Child 1 month–11 years (administered on expert advice) (body-weight 34 kg and
above): 1g 3times a day for 28 days
Child 12–17 years (administered on expert advice): 1 g 3 times a day for 28 days
*Anthrax (treatment and post-exposure prophylaxis)
BY MOUTH
Child (body-weight up to 20 kg): 80mg/kg daily in 3 divided doses
Child (body-weight 20 kg and above): 500 mg 3 times a day *
Neonate up to 7 days: 50–100 mg/kg every12 hours.
Neonate 7 days to 28 days: 50–100 mg/kg every 8 hours.
Child: 50 mg/kg every 4–6 hours (max. per dose 2 g every4hours)
*Group B streptococcal infection|Enterococcal endocarditis (in combination with
another antibiotic)
Neonate 7 days to 28 days: 50mg/kg every 8 hours.
Child: 50 mg/kg every 4–6 hours (max. per dose 2 g every4hours)
*Prevention of pneumococcal infection in asplenia or in patients with sickle-cell
disease—if cover also needed for Haemophilus influenza
BY MOUTH
Child 1 month–4 years: 125 mg twice daily
*Prophylaxis of recurrent urinary-tract infection
BY MOUTH
Child 16–17 years: 250 mg once daily, dose to be taken at night, alternatively 500 mg
for 1 dose, following exposure to a trigger

*Prophylaxis of recurrent urinary-tract infection (initiated under specialist
supervision)
BY MOUTH
Child 3–11 months: 62.5 mg once daily, dose to be taken at night
Child 1–4 years: 125 mg once daily, dose to be taken at night
Child 5–15 years: 250 mg once daily, dose to be taken at night
*Lower urinary-tract infection in pregnancy
BY MOUTH
*Lower urinary-tract infection
BY MOUTH
Child 3–11 months: 125 mg 3 times a day for 3 days
*Asymptomatic bacteriuria in pregnancy
BY MOUTH
Child (body-weight 40 kg and above): 250–500 mg 3times a day, alternatively 750–
1000 mg twice daily
*Urinary-tract infection (catheter-associated)
BY MOUTH
Child 3–11 months: 125 mg 3 times a day for 7 to 10 days
Child 1–4 years: 250 mg 3times a day for 7 to10 days
Child 5–15 years: 500 mg 3times a day for 7 to10 days
Child 16–17 years: 500 mg 3times a day for 7 days
Preparation
Susp 125mg/5ml
Amoxil
5.1.1.2.2 Ampicillin
Indication & Doses
*Susceptible infections (including bronchitis, urinary-tract infections, otitis media,
sinusitis, uncomplicated community-acquired pneumonia, salmonellosis)
BY MOUTH
Neonate 7 days to 20 days: 30mg/kg 3 times a day (max. per dose 125 mg).
Neonate 21 days to 28 days: 30 mg/kg4 times a day (max. per dose 125 mg).
Child 1–11 months: 125 mg 4times a day; increased if necessary up to 30mg/kg 4 times
a day
Child 1–4 years: 250 mg4 times a day; increased if necessary up to 30mg/kg 4 times a
day
Child 5–11 years: 500 mg 4times a day; increased if necessary up to 30mg/kg 4 times a
day
Child 12–17 years: 500 mg 4 times a day; increased if necessary to 1 g 4 times a day,
use increased dose in severe infection
every 12 hours, increased dose used in severe infection, community-acquired pneumonia
or salmonellosis.

every 8 hours, increased dose used in severe infection, community- acquired pneumonia
or salmonellosis.
every 6 hours, increased dose used in severe infection, community- acquired pneumonia
or salmonellosis.
Child: 25 mg/kg every 6 hours (max. per dose 500 mg every 6 hours), increased if
necessary to 50 mg/kg every 6hours (max. per dose 1 g every 6 hours), increased dose
used in severe infection
*Group B steptococcal infection, Enterococcal endocarditis (in combination with
another antibacterial)
Child: 50 mg/kg every 4–6 hours (max. per dose 2g every 4 hours)
*Listerial meningitis
Child: 50 mg/kg every 4–6 hours (max. per dose 2g every 4 hours)*
Preparation
Injection 500mg/vial
Penbiritin
5.1.1.2.3 Co-Amoxiclav
Indication & Doses
*Infections due to beta-lactamase-producing strains (where amoxicillin alone not
appropriate), including respiratory tract infections, bone and joint infections, genito-
urinary and abdominal infections, and animal bites
BY MOUTH USING TABLETS
Child 12–17 years: 250/125 mg every 8 hours; increased to 500/125 mg every 8 hours,
increased dose used for severe infection
Neonate: 30mg/kg every 12 hours, Intravenous infusion recommended in children less
than 3 months.
Child 1–2 months: 30 mg/kg every12hours, intravenous infusion recommended in
children less than 3 months
Child 3 months–17 years: 30 mg/kg every 8 hours (max. per dose 1.2g every 8 hours)
appropriate) including respiratory-tract infections, bone and joint infections, genito-
urinary and abdominal infections, and animal bites (doses for 125/31 suspension)
BY MOUTH USING ORAL SUSPENSION
Neonate: 0.25mL/kilogram 3 times a day.
Child 1–11 months: 0.25 mL/kilogram3 times a day, dose doubled in severe infection
Child 1–5 years: 0.25 mL/kilogram 3 times a day, alternatively 5 mL 3 times a day, dose
doubled in severe infection

Child 6–11 years: 0.15 mL/kilogram3 times a day, alternatively 5 mL 3 times a day,
dose doubled in severe infection
Child 2–23 months: 0.15 mL/kilogram twice daily, doubled in severe infection
Child 2–6 years (body-weight 13–21 kg): 2.5 mL twice daily, doubled in severe
infection
Child 7–12 years (body-weight 22–40 kg): 5 mL twice daily, doubled in severe
infection
Child 12–17 years (body-weight 41 kg and above): 10 mL twice daily; increased if
necessary to 10 mL 3 times a day, increased frequency to be used in severe infection
*Cellulitis, Erysipelas
Child 12–17 years: 250/125 mg every8hours, alternatively 500/125 mg every 8 hours for
5–7 days then review (review after 7 days in severe infection or if infection near the eyes
or nose)
Child 1–2 months: 30mg/kg every12 hours, intravenous infusion recommended in
Child 3 months–17 years: 30 mg/kg every 8 hours (max. per dose 1.2 g every 8 hours)
Cellulitis (doses for 125/31 suspension),
*Erysipelas (doses for 125/31 suspension)
Child 1–11 months: 0.25 mL/kilogram3 times a day for 5–7days then review (review
after 7 days in severe infection or if infection near the eyes or nose), dose doubled in
severe infection
Child 1–5 years: 0.25 mL/kilogram 3 times a day, alternatively 5mL 3 times a day for 5–
7 days then review (review after 7 days in severe infection or if infection near the eyes or
nose), dose doubled in severe infection
*Cellulitis (doses for 250/62 suspension), Erysipelas (doses for 250/62 suspension)
Child 6–11 years: 0.15 mL/kilogram 3 times a day, alternatively 5mL 3 times a day for
5–7 days then review (review after 7 days in severe infection or if infection near the eyes
or nose), dose doubled in severe infection
*Severe dental infection with spreading cellulitis, Dental infection not responding to
first-line antibacterial
Child 12–17 years: 250/125 mg every 8 hours for 5 days Community-acquired
pneumonia (doses for 125/31 suspension)
Child 1–11 months: 0.5 mL/kilogram 3 times a day for 5 days

Child 1–5 years: 0.5 mL/kilogram 3 times a day for 5 days, alternatively 10 mL 3 times
a day for 5 days
*Community-acquired pneumonia (doses for 250/62 suspension)
Child 6–11 years: 0.3 mL/kilogram 3 times a day for 5 days, alternatively 10 mL 3 times
a day for 5 days
Child 12–17 years: 500/125 mg 3 times a day for 5 days
Child 1–2 months: 30mg/kg every 12 hours, intravenous infusion recommended in
*Hospital-acquired pneumonia (doses for 125/31 suspension)
Child 1–11 months: 0.5 mL/kilogram 3 times a day for 5days then review
Child 1–5 years: 0.5 mL/kilogram 3 times a day for 5 days then review, alternatively 10
mL 3 times a day for 5 days then review
*Hospital-acquired pneumonia (doses for 250/62 suspension)
Child 6–11 years: 0.3mL/kilogram 3 times a day for 5 days then review, alternatively 10
mL 3 times a day for 5 days then review
*Hospital-acquired pneumonia
Child 12–17 years: 500/125 mg 3 times a day for 5 days then review
*Acute exacerbation of bronchiectasis (doses for 125/31 suspension)
Child 1–11 months: 0.25 mL/kilogram3times a day for 7–14 days
Child 1–5 years: 5 mL 3 times a day for 7–14 days, alternatively 0.25 mL/kilogram 3
times a day for 7–14 days
*Acute exacerbation of bronchiectasis (doses for 250/62 suspension)
Child 12–17 years: 250/125 mg 3 times a day for 7–14 days, alternatively 500/125 mg 3
BY INTRAVENOUS INFUSION, OR BY INTRAVENOUS INJECTION
Child 1–2 months: 30 mg/kg every 12 hours, intravenous infusion is recommended in
*Acute sinusitis (doses for 125/31 suspension)
Child 1–11 months: 0.25 mL/kilogram 3 times a day for 5 days
Child 1–5 years: 5 mL 3 times a day for 5 days, alternatively 0.25 mL/kilogram 3 times
a day for 5 days
*Acute sinusitis (doses for 250/62 suspension)

Child 6–11 years: 5 mL 3 times a day for 5 days, alternatively 0.15 mL/kilogram 3 times
a day for 5 days
*Acute sinusitis
Child 12–17 years: 250/125 mg 3 times a day for 5 days, alternatively 500/125 mg 3
times a day for 5 days
*Acute otitis media (doses for 125/31 suspension)
Child 1–11 months: 0.25 mL/kilogram 3 times a day for 5–7 days
*Acute otitis media (doses for 250/62 suspension)
*Acute otitis media
*Acute pyelonephritis (doses for 125/31 suspension), Urinary-tract infection (catheter-
associated) (doses for 125/31 suspension)
Child 3–11 months: 0.25 mL/kilogram 3 times a day for 7 to 10 days, dose doubled in
severe infection
Child 1–5 years: 0.25mL/kilogram 3 times a day, alternatively 5 mL 3 times a day for 7
to 10 days, dose doubled in severe infection
*Acute pyelonephritis (doses for 250/62 suspension), Urinary-tract infection (catheter-
associated) (doses for 250/62 suspension)
Child 6–11 years: 0.15 mL/kilogram 3 times a day, alternatively 5 mL 3 times a day for
7 to 10 days, dose doubled in severe infection
*Acute pyelonephritis, Urinary-tract infection (catheter- associated)
Child 16–17 years: 500/125 mg 3 times a day for 7–10 days
Child 3 months–15 years: 30mg/kg every 8 hours (max. per dose 1.2g)
Child 16–17 years: 1.2 g every 8 hours
Preparations
Inj, syp, drops 600mg, 312.5mg/5ml
Augmentin
5.1.1.3 ANTI-PSEUDOMONAL PENCILLINS

Piperacillin with Tazobactam
Cautions
History of allergy; false-positive urinary glucose (if tested for reducing substances)

Indication & Doses
*Hospital-acquired pneumonia, Septicaemi, Complicated infections involving the
urinary-tract, complicated infections involving the skin, Complicated infections
involving the soft-tissues
Neonate: 90mg/kg every 8 hours.
Child 1 month–11 years: 90mg/kg every 6–8 hours (max. per dose 4.5 g every 6 hours)
Child 12–17 years: 4.5 g every 8 hours; increased if necessary to 4.5 g every 6 hours,
increased frequency may be used for severe infections
*Complicated intra-abdominal infections
Child 2–11 years: 112.5 mg/kg every 8 hours (max. per dose 4.5 g)
Child 12–17 years: 4.5 g every 8 hours; increased if necessary to 4.5 g every 6 hours,
Child 1 month–11 years: 90mg/kg every 6–8 hours (max. per dose 4.5 g every 6 hours)
Child 12–17 years: 4.5 g every8hours; increased if necessary to 4.5 g every 6 hours,
*Infections in neutropenic patients
Child: 90 mg/kg every6 hours (max. per dose 4.5 g)
Contraindications
Penicillin hypersensitivity
Side effects
Hypersensitivity reactions including urticaria, fever, joint pains, rashes, angioedema,
anaphylaxis, serum sickness-like reactions; rarely CNS toxicity including convulsions
(especially with high doses or in severe renal impairment), interstitial nephritis,
haemolytic anaemia leucopenia, thrombocytopenia and coagulation disorders; nausea,
vomiting, diarrhoea; less commonly stomatitis, dyspepsia, constipation, jaundice,
hypotension, headache, insomnia, and injection-site reactions; rarely abdominal pain,
hepatitis, oedema, fatigue and eosinophilia; very rarely hypoglycaemia, hypokalaemia,
pancytopenia, Stevens-Johnson syndrome, and toxic epidermal necrolysis
Preparation
Injection 2.25 gms /4.5 gms
Tazocin.
5.1.2 CEPHALOSPORINS
Cautions
Sensitivity to beta-lactam antibacterials (avoid if history of immediate hypersensitivity
reaction; false positive urinary glucose (if tested for reducing substances) and false
positive Coombs’ test
Contraindications
Cephalosporin hypersensitivity
Side effects
diarrhoea (rarely antibiotic-associated colitis), nausea and vomiting, abdominal
discomfort, headache; allergic reactions including rashes, pruritus, urticaria, serum
sickness-like reactions with rashes, fever and arthralgia, and anaphylaxis; Stevens-

Johnson syndrome, toxic epidermal necrolysis reported; disturbances in liver enzymes,
transient hepatitis and cholestatic jaundice; other side-effects reported include
eosinophilia and blood disorders (including thrombocytopenia, leucopenia,
agranulocytosis, aplastic anaemia and haemolytic anaemia); reversible interstitial
nephritis, hyperactivity, nervousness, sleep disturbances, hallucinations, confusion,
hypertonia, and dizziness
5.1.2.1 Cephradine
Indication & Doses
*Susceptible infections due to sensitive Gram-positive and Gram-negative bacteria,
surgical prophylaxis
BY MOUTH
Child 7–11 years: 25–50 mg/kg daily in 2–4 divided doses
Child 12–17 years: 250–500 mg 4 times a day, alternatively 0.5–1g twice daily;
increased if necessary up to 1g 4times a day, increased dose may be used in severe
infections
*Prevention of Staphylococcus aureus lung infection in cystic fibrosis
BY MOUTH
Child 7–17 years: 2 g twice daily
Preparations
Injection, & syp 500mg & 250/500mg
Velocef
5.1.2.2 Cefuroxime
Indication & Doses
*Susceptible infections due to Gram-positive and Gram- negative bacteria
BY MOUTH
Child 3 months–1 year: 10mg/kg twice daily (max. per dose 125 mg)
Child 2–11 years: 15mg/kg twice daily (max. per dose 250 mg)
Child 12–17 years: 250 mg twice daily, dose may be doubled in severe lower
respiratory-tract infections or if pneumonia is suspected
BY INTRAVENOUS INFUSION, OR BY INTRAVENOUS INJECTION, OR BY
Child: 20 mg/kg every 8 hours (max. per dose750 mg); increased to 50–60mg/kg every
6–8 hours (max. per dose1.5 g), increased dose used for severe infection and cystic
fibrosis
Child: 20 mg/kg every 8 hours (max. per dose750 mg); increased if necessary up to 50–
60mg/kg every 6–8 hours (max. per dose 1.5 g)
*Lyme disease
BY MOUTH

Child 3 months–11 years: 15 mg/kg twice daily (max. per dose 500 mg) for 14–21 days
(for 28 days in Lyme arthritis)
Child 12–17 years: 500 mg twice daily for14–21 days (for 28 days in Lyme arthritis)
*Surgical prophylaxis
Child: 50 mg/kg (max. per dose 1.5g), to be administered up to 30 minutes before the
procedure, then (by intravenous injection or by intramuscular injection) 30 mg/kg every 8
hours (max. per dose 750 mg) if required for up to 3 doses (for high-risk procedures)
*Urinary-tract infection (lower)
BY MOUTH
Child (body-weight up to 40 kg): 15 mg/kg twice daily (max. per dose 250 mg)
Child (body-weight 40 kg and above): 250 mg twice daily
*Urinary tract infection (catheter-associated)
Child 3 months–15 years: 20mg/kg every 8 hours (max. per dose750 mg); increased to
50–60 mg/kg every 6–8 hours (max. per dose1.5 g), increased dose used for severe
infection
Child 16–17 years: 0.75–1.5 g every 6–8 hours
*Acute pyelonephritis
BY MOUTH
Child (body-weight up to 40 kg): 15 mg/kg twice daily (max. per dose 250 mg)
Child (body-weight 40 kg and above): 250 mg twice daily
Child 3 months–15 years: 20mg/kg every 8 hours (max. per dose750 mg); increased to
50–60 mg/kg every 6–8 hours (max. per dose 1.5 g), increased dose used for severe
infection
Child 16–17 years: 0.75–1.5 g every 6–8 hours
Preparation
Inj 750mg
Zinacef
5.1.2.3 Ceftriaxone
Cautions
neonates; may displace bilirubin from serum albumin, administer over 60 minutes in
neonates; treatment longer than 14 days, renal failure, dehydration — risk of ceftriaxone
precipitation in gall bladder
Indication & Doses
*Community-acquired pneumonia, Hospital-acquired pneumonia, Intra-abdominal
infections, complicated urinary-tract infections
Neonate up to 15 days: 20–50 mg/kg once daily, doses at the higher end of the
recommended range used in severe cases.
Neonate 15 days to 28 days: 50–80 mg/kg once daily, doses at the higher end of the
Child 1 month–11 years (body-weight up to 50 kg): 50–80 mg/kg once daily, doses at
the higher end of the recommended range used in severe cases; maximum 4 g per day
Child 9–11 years (body-weight 50 kg and above): 1–2 g once daily, 2g dose to be used
for hospital-acquired pneumonia and severe cases

Child 12–17 years: 1–2 g once daily, 2g dose to be used for hospital-acquired
pneumonia and severe cases
Child 9–11 years (body-weight 50 kg and above): 1–2 g once daily, 2 g dose to be used
BY DEEP INTRAMUSCULAR INJECTION
Child 1 month–11 years (body-weight up to 50 kg): 50–80 mg/kg daily, doses at the
higher end of the recommended range used in severe cases; maximum 4 g per day
Child 9–11 years (body-weight 50 kg and above): 1–2 g once daily, 2g dose to be used
*Complicated skin and soft tissue infections|Infections of bones and joints
Neonate up to 15 days: 20–50mg/kg once daily, doses at the higher end of the
the higher end of the recommended range used in severe cases; maximum 4g per day
Child 9–11 years (body-weight 50 kg and above): 2g once daily
Child 12–17 years: 2g once daily
*Suspected bacterial infection in neutropenic patients
Neonate up to 15 days: 20–50mg/kg once daily, doses at the higher end of the
the higher end of the recommended range used in severe cases; maximum 4g per day
Child 9–11 years (body-weight 50 kg and above): 2–4 g once daily, doses at the higher
end of the recommended range used in severe cases
Child 12–17 years: 2–4g once daily, doses at the higher end of the recommended range
used in severe cases
end of the recommended range used in severe cases; doses of 50mg/kg or more should be
given by infusion

Child 9–11 years (body-weight 50 kg and above): 2–4 g daily, doses at the higher end
of the recommended range used in severe cases
Child 12–17 years: 2–4g daily, doses at the higher end of the recommended range used
in severe cases
*Bacterial meningitis, Bacterial endocarditis
Neonate up to 15 days: 50 mg/kg once daily.
Neonate 15 days to 28 days: 80–100 mg/kg once daily, 100mg/kg once daily dose
should be used for bacterial endocarditis.
Child 1 month–11 years (body-weight up to 50 kg): 80–100 mg/kg once daily, 100
mg/kg once daily dose should be used for bacterial endocarditis; maximum 4g per day
end of the recommended range used in severe cases
end of the recommended range used in severe cases; doses of 50mg/kg or more should be
given by infusion
Child 1 month–11 years (body-weight up to 50 kg): 80–100 mg/kg daily, 100 mg/kg
daily dose should be used for bacterial endocarditis; maximum4 g per day
Child 9–11 years (body-weight 50 kg and above): 2–4 g daily, doses at the higher end
of the recommended range used in severe cases
Child 12–17 years: 2–4g daily, doses at the higher end of the recommended range used
in severe cases
Neonate up to 15 days: 20–50 mg/kg for 1dose, dose to be administered 30–90 minutes
before procedure.
Neonate 15 days to 28 days: 50–80 mg/kg for 1 dose, dose to be administered 30–90
minutes before procedure.
Child 1 month–11 years (body-weight up to 50 kg): 50–80 mg/kg (max. per dose 2g)
for1 dose, dose to be administered 30–90 minutes before procedure
Child 9–11 years (body-weight 50 kg and above): 2g for 1 dose, dose to be
administered 30–90 minutes before procedure
Child 12–17 years: 2 g for 1 dose, dose to be administered 30–90 minutes before
procedure
Child 9–11 years (body-weight 50 kg and above): 2 g for 1 dose, dose to be

Child 12–17 years: 2 g for 1 dose, dose to be administered 30–90 minutes before
procedure
Child 1 month–11 years (body-weight up to 50 kg): 50–80 mg/kg (max. per dose 2g)
for 1 dose, dose to be administered 30–90 minutes before procedure
Child 9–11 years (body-weight 50 kg and above): 2 g for 1 dose, dose to be
Child 12–17 years: 2 g for1dose, dose to be administered 30–90 minutes before
procedure
*Uncomplicated gonorrhoea|Pelvic inflammatory disease
Child 1 month–11 years (body-weight up to 45 kg): 125 mg for 1 dose
Child 9–11 years (body-weight 45 kg and above): 250 mg for1 dose
Child 12–17 years: 500 mg for 1dose
*Syphilis
Neonate up to 15 days: 50 mg/kg once daily for 10–14 days.
Neonate 15 days to 28 days: 75–100 mg/kg once daily for 10–14 days.
Child 1 month–11 years (body-weight up to 50 kg): 75–100 mg/kg once daily for 10–
14 days; maximum 4 g per day
Child 9–11 years (body-weight 50 kg and above): 0.5–1g once daily for 10–14 days,
dose increased to2g once daily for neurosyphilis
Child 12–17 years: 0.5–1g once daily for 10–14 days, dose increased to 2g once daily
for neurosyphilis
Child 9–11 years (body-weight 50 kg and above): 0.5–1g once daily for 10–14 days,
for neurosyphilis
Child 1 month–11 years (body-weight up to 50 kg): 75–100 mg/kg daily for10–14
days; maximum4 g per day
Child 9–11 years (body-weight 50 kg and above): 0.5–1g once daily for 10–14days,
for neurosyphilis
*Disseminated Lyme borreliosis (early [Stage II] and late [Stage III]) (administered on
expert advice)
Neonate 15 days to 28 days: 50–80 mg/kg once daily for 14–21 days, the recommended
treatment durations vary and national or local guidelines should be taken into
consideration.
*Lyme disease [affecting central nervous system]
Child 1 month–11 years (body-weight up to 50 kg): 80 mg/kg once daily (max. per
dose 4 g) for 21 days
Child 1 month–11 years (body-weight 50 kg and above): 2g twice daily for 21 days,
alternatively 4 g once daily for 21 days

Child 12–17 years): 2 g twice daily for 21 days, alternatively 4g once daily for 21 days
Child 1 month–11 years (body-weight 50 kg and above): 2 g twice daily for 21 days
Child 12–17 years (administered on expert advice): 2 g twice daily for 21 days,
alternatively 4g once daily for 21 days
*Lyme arthritis, Acrodermatitis chronica atrophicans
Child 1 month–11 years (body-weight up to 50 kg): 80mg/kg once daily (max. per
Child 1 month–11 years (body-weight 50 kg and above): 2 g once daily for 28 days
Child 12–17 years 2 g once daily for 28 days
*Lyme carditis
Child 1 month–11 years (body-weight up to 50 kg): 80mg/kg once daily (max. per
Child 1 month–11 years (body-weight 50 kg and above): 2 g once daily for 21 days
Child 12–17 years (administered on expert advice): 2 g once daily for 21 days
*Congenital gonococcal conjunctivitis
BY DEEP INTRAMUSCULAR INJECTION, OR BY INTRAVENOUS INFUSION
Neonate: 25–50 mg/kg (max. per dose125 mg) for 1 dose, intravenous infusion to be
administered over 60 minutes.
*Prevention of secondary case of meningococcal meningitis
Child 1 month–11 years: 125 mg for 1dose
Child 12–17 years: 250 mg for 1 dose
*Prevention of secondary case of Haemophilus influenzae type B disease
Child 1 month–11 years: 50 mg/kg daily (max. per dose 1g) for 2 days
INTRAVENOUS INFUSION
Child 12–17 years: 1 g daily for 2days
*Acute otitis media
Child 1 month–11 years (body-weight up to 50 kg): 50mg/kg (max. per dose2 g) for 1
dose, dose can be given for 3days if severely ill or previous therapy failed
Child 9–11 years (body-weight 50 kg and above): 1–2g for 1dose, dose can be given
for 3 days if severely ill or previous therapy failed
Child 12–17 years: 1–2g for1dose, dose can be given for 3days if severely ill or previous
therapy failed
Contraindications
Nneonates less than 41 weeks postmenstrual age; neonates over 41 weeks postmenstrual
age with jaundice, hypo albuminaemia, or acidosis; concomitant treatment with
intravenous calcium (including total parenteral nutrition containing calcium) in neonates
over 41 weeks postmenstrual age—risk of precipitation in urine and lungs
Side effects

Calcium ceftriaxone precipitates in urine (particularly in very young, dehydrated or those
who are immobilised) or in gall bladder—consider discontinuation if symptomatic; rarely
prolongation of prothrombin time, pancreatitis
Preparation
Inj. 1gm / 2gms
Rocephin
5.1.2.4 Cefotaxime
Indication & Doses
*Uncomplicated gonorrhoea
*Severe exacerbations of Haemophilus influenzae infection in cystic fibrosis
Child: 50 mg/kg every6–8hours; maximum 12 g per day
*Congenital gonococcal conjunctivitis
Neonate: 100 mg/kg (max. per dose1 g) for 1 dose.
*Infections due to sensitive Gram-positive and Gram- negative bacteria, surgical
prophylaxis, and Haemophilus epiglottitis
Neonate 21 days to 28 days: 25 mg/kg every 6–8 hours.
Child: 50 mg/kg every 8–12 hours
*Severe susceptible infections due to sensitive Gram- positive and Gram-negative
bacteria, Meningitis
Neonate 21 days to 28 days: 50 mg/kg every 6–8 hours.
Child: 50 mg/kg every 6 hours; maximum 12g per day
*Emergency treatment of suspected bacterial meningitis or meningococcal disease,
before urgent transfer to hospital, in patients who cannot be given benzylpenicillin (e.g.
because of an allergy)
Child 1 month–11 years: 50mg/kg for 1 dose
Child 12–17 years: 1 g for 1 dose
Side effects
Rarely arrhythmias following rapid injection reported
Preparation
Inj. 1gm
Claforan
5.1.2.5 Ceftazidime
Indication & Doses

*Pseudomonal lung infection in cystic fibrosis
BY INTRAVENOUS INFUSION, OR BY INTRAVENOUS INJECTION, OR BY
DEEP INTRAMUSCULAR INJECTION
*Febrile neutropenia
*Meningitis
Child: 50 mg/kg every 8 hours; maximum6g per day
*Susceptible infections due to sensitive Gram-positive and Gram-negative bacteria
*Severe susceptible infections due to sensitive Gram- positive and Gram-negative
bacteria
Child: 50 mg/kg every8 hours; maximum 6g per day
*Chronic Burkholderia cepacia infection in cystic fibrosis
Child: 1 g twice daily
Preparation
Inj. 1gm
Fortum
5.1.2.6 Cefixime
Indication & Doses
*Acute infections due to sensitive Gram-positive and Gram- negative bacteria
BY MOUTH
Child 6–11 months: 75 mg daily
Child 1–4 years: 100 mg daily
Child 5–9 years: 200 mg daily
Child 10–17 years: 200–400 mg daily, alternatively 100–200 mg twice daily
*Uncomplicated gonorrhoea
BY MOUTH
Child 12–17 years: 400 mg for1 dose
Preparation
Susp 100mg/5ml
Cefspan

5.1.2.7 Cefoparazone+Sulbactam
Cautions
Serious and occasionally fatal hypersensitivity (anaphylactic). These reactions are more
apt to occur in individuals with a history of hypersensitivity reactions to multiple
allergens
Indication & Doses
40-80mg/kg/day in 2 divided doses
Contraindications
Sulbactam/cefoperazone is contraindicated in patients with known allergy to penicillins,
sulbactam, cefoperazone, or any of the cephalosporins
Side effects
Sulbactam/cefoperazone is generally well tolerated. The majority of side effects are of
mild or moderate severity and are tolerated with continued treatment. They include
Diarrhea/loose stools,followed by nausea and vomiting, maculopapular rash, urticaria,
reversible neutropenia, positive direct Coombs test, Decreased hemoglobin, Transient
eosinophilia, thrombocytopenia, hypo-prothrombinemia, Headache, fever, injection pain,
chills, elevations of liver function tests.
Preparation
inj 500mg + 500mg
Sulzon
5.1.2.8 Cefepime
Cautions
Kidney problems, colitis
Indication & Doses
*Infections due to sensitive Gram-positive and Gram- negative bacteria
Child 1 month: 30 mg/kg every 8–12 hours, experience in children aged less than 2
months is limited intravenous route preferred in severe infections
Child 2 months–17 years (body-weight up to 41 kg): 50 mg/kg every 12 hours (max.
per dose 2g), increased if necessary to 50 mg/kg every 8 hours (max. per dose 2 g),
increased dose used for severe infections, experience of intramuscular use is limited;
intravenous route preferred in severe infections
*Mild to moderate urinary tract infections
Child (body-weight 41 kg and above): 0.5–1 g 12 hourly (limited use)
*Mild to moderate infections due to sensitive Gram- positive and Gram-negative
bacteria
Child (body-weight 41 kg and above): 1 g every 12 hours, experience of intramuscular
use is limited
*Severe infections due to sensitive Gram-positive and Gram-negative bacteria
Child (body-weight 41 kg and above): 2 g every12 hours, increased if necessary to 2 g
every 8 hours, increased dose used for very severe infections

Side effects
colitis, severe allergic reaction, convulsions, destruction and inability to form red blood
cells, lack of white blood cells, coma, reduced consciousness, paralysis of part or all of
the body, stiff neck, abnormal speech and eye movements, sudden muscle contraction,
peeling and blistering of the skin, mouth, eyes and genitals, kidney failure
Preparation
inj 500mg
Maxipime
5.1.3 CARBEPENAMS ANTIBIOTICS

5.1.3.1 Meropenem
Cautions
Hypersensitivity to beta-lactam antibacterials (avoid if history of immediate
hypersensitivity reaction)
Indication & Doses
*Aerobic and anaerobic Gram-positive and Gram-negative infection, Hospital-
acquired septicaemia
Child 1 month–11 years (body-weight up to 50 kg): 10–20 mg/kg every 8 hours
Child 1 month–11 years (body-weight 50 kg and above): 0.5–1 g every 8 hours
Child 12–17 years: 0.5–1g every 8 hours
*Severe aerobic and anaerobic Gram-positive and Gram- negative infections
*Exacerbations of chronic lower respiratory-tract infection in cystic fibrosis
Child 1 month–11 years (body-weight up to 50 kg): 40mg/kg every 8 hours
Child 1 month–11 years (body-weight 50 kg and above): 2g every 8 hours
Child 12–17 years: 2 g every 8 hours
*Meningitis
Child 1 month–11 years (body-weight up to 50 kg): 40mg/kg every 8 hours
Child 1 month–11 years (body-weight 50 kg and above): 2 g every 8 hours
Child 12–17 years: 2 g every8 hours
Side effects
Nausea, vomiting, diarrhoea (antibioticassociated colitis reported), abdominal pain,
disturbances in liver function tests, headache,Thrombocythaemia, rash, pruritus; less
commonly paraesthesia, eosinophilia, thrombocytopenia, leucopenia; rarely convulsions;
also reported haemolytic anaemia, positive Coombs’ test, Stevens-Johnson syndrome,
toxic epidermal necrolysis
Preparation
Inj. 500mg / 1gm

Meronem
5.1.3.2 Imipenam with Cilastin

Cautions
CNS disorders (e.g. epilepsy); hypersensitivity to beta-lactam antibacterials (avoid if
history of immediate hypersensitivity reaction)
Indication & Doses
*Aerobic and anaerobic Gram-positive and Gram-negative infections (not indicated for
CNS infections), Hospital- acquired septicaemia
Child 1–2 months: 20mg/kg every 6 hours
Child 3 months–17 years: 15 mg/kg every 6 hours (max. per dose 500 mg)
*Infection caused by Pseudomonas or other less sensitive organisms, Empirical
treatment of infection in febrile patients with neutropenia, Life-threatening infection
Child 3 months–17 years: 25 mg/kg every 6 hours (max. per dose 1 g)
*Cystic fibrosis
Child: 25 mg/kg every6 hours (max. per dose 1 g)
Side effects
nausea, vomiting, diarrhoea (antibioticassociated colitis reported), taste disturbances,
tooth or tongue discoloration, hearing loss; blood disorders, positive Coombs’ test;
allergic reactions (with rash, pruritus, urticaria, Stevens-Johnson syndrome, fever,
anaphylactic reactions, rarely toxic epidermal necrolysis, exfoliative dermatitis);
myoclonic activity, convulsions, confusion and mental disturbances reported; slight
increases in liver enzymes and bilirubin reported, rarely hepatitis; increases in serum
creatinine and blood urea; red coloration of urine in children reported; local reactions:
erythema, pain and induration, and thrombophlebitis
Preparation
Inj. 250mg / 500mg
Tienam
5.1.4 AMINOGLYCOSIDES
Cautions
Neonates, infants (adjust dose and monitor renal, auditory and vestibular function
together with serum gentamicin concentrations); avoid prolonged use; conditions
characterised by muscular weakness;
Contraindications
Myasthenia gravis
Side effects
Vestibular and auditory damage, nephrotoxicity; rarely, hypomagnesaemia on prolonged
therapy, antibiotic-associated colitis; also reported, nausea, vomiting, rash, blood
disorders, on inhalation, mouth ulcers, taste disturbances, voice alteration, cough,
bronchospasm

5.1.4.1 Gentamicin
Indication & doses
*Septicaemia/ Meningitis and other CNS infections, Biliary- tract infection,
Endocarditis, Pneumonia in hospital patients, Adjunct in listerial meningitis
Child: Initially 7 mg/kg, to be given in a once daily regimen (not suitable for endocarditis
or meningitis), subsequent doses adjusted according to serum- gentamicin concentration
BY INTRAMUSCULAR INJECTION, OR BY SLOW INTRAVENOUS INJECTION
Child 1 month–11 years: 2.5 mg/kg every 8 hours, to be given in a multiple daily dose
regimen, intravenous injection to be administered over at least 3 minutes
Child 12–17 years: 2 mg/kg every8hours, to be given in a multiple daily dose regimen,
intravenous injection to be administered over at least 3 minutes
*Neonatal sepsis
Neonate up to 7 days: 5 mg/kg every 36 hours, to be given in an extended interval dose
regimen.
Neonate 7 days to 28 days: 5 mg/kg every 24 hours, to be given in an extended interval
dose regimen.
Child: 3 mg/kg every 8 hours, to be given in a multiple daily dose regimen, intravenous
injection to be administered over at least 3 minutes
*Bacterial ventriculitis and CNS infection (supplement to systemic therapy)
(administered on expert advice)
BY INTRATHECAL INJECTION, OR BY INTRAVENTRICULAR INJECTION
Neonate: (consult local protocol).
Child: Initially 1mg daily, then increased if necessary to5 mg daily, seek specialist
advice
*Acute pyelonephritis (once daily dose regimen), Urinary tract infection (catheter-
associated, once daily dose regimen)
Child 3 months–15 years: Initially 7 mg/kg once daily, subsequent doses adjusted
according to serum- gentamicin concentration
Child 16–17 years: Initially 5–7 mg/kg once daily, subsequent doses adjusted according
to serum- gentamicin concentration
Prepration
Inj. 20mg
Refobacin
5.1.4.2 Amikacin
Indication & Doses
*Serious Gram-negative infections resistant to gentamicin (multiple daily dose
regimen)
Child 1 month–11 years: 7.5mg/kg every 12 hours, to be administered over 3–5 minutes

Child 12–17 years: 7.5 mg/kg every 12 hours; increased to 7.5 mg/kg every 8 hours
(max. per dose 500 mg every 8 hours) for up to 10 days, higher dose to be used in severe
infection, to be administered over 3–5 minutes; maximum 15 g per course.
*Serious Gram-negative infections resistant to gentamicin (once daily dose regimen)
Child: Initially 15mg/kg once daily adjusted according to plasma-concentration
monitoring, not to be used for endocarditis or meningitis, dose to be adjusted according to
serum-amikacin concentration, intravenous injection to be administered over 3–5minutes
*Neonatal sepsis (extended interval dose regimen)
Neonate: 15mg/kg every 24 hours, intravenous injection to be administered over 3–5
minutes.
*Neonatal sepsis (multiple daily dose regimen)
Neonate: Loading dose 10 mg/kg, then 7.5mg/kg every 12 hours, intravenous injection to
be administered over 3–5 minutes.
Child: 10 mg/kg every 8 hours (max. per dose 500 mg every 8 hours), intravenous
injection to be administered over 3–5 minutes
*Acute pyelonephritis (once daily dose regimen) / Urinary tract infection (catheter-
associated, once daily dose regimen)
BY INTRAVENOUS INFUSION, OR BY SLOW INTRAVENOUS INJECTION
Child 3 months–15 years: Initially 15 mg/kg once daily, dose to be adjusted according
to serum-amikacin concentration
Child 16–17 years: Initially15 mg/kg once daily (max. per dose 1.5 g once daily), dose
to be adjusted according to serum-amikacin concentration; maximum 15g per course
Preparation
Inj. 250mg
Amikin
5.1.4.3 Tobramycin
Indication & Doses
*Chronic Pseudomonas aeruginosa infection in patients with cystic fibrosis
Child 6–17 years: 300 mg every 12 hours for 28 days, subsequent courses repeated after
28-day interval without tobramycin nebuliser solution
Child 6–17 years: 112 mg every 12 hours for 28 days, subsequent courses repeated after
28-day interval without tobramycin inhalation powder
Child: 8–10 mg/kg daily in 3 divided doses, to be given as a multiple daily dose regimen
over 3–5 minutes
Child: Initially 10mg/kg once daily (max. per dose 660 mg), to be given over 30 minutes,
subsequent doses adjusted according to serum-tobramycin concentration

*Septicaemia, Meningitis and other CNS infections, Biliary-tract infection, acute
pyelonephritis, Pneumonia in hospital patients
Child 1 month–11 years: 2–2.5 mg/kg every 8 hours, to be given as a multiple daily
dose regimen over 3–5 minutes
Child 12–17 years: 1 mg/kg every 8 hours, to be given as a multiple daily dose regimen
over 3–5 minutes; increased if necessary up to 5mg/kg daily in 3–4 divided doses, to be
given in severe infections as a multiple daily dose regimen over 3–5 minutes, dose to be
reduced back to 3mg/kg as soon as clinically indicated
Child: Initially 7mg/kg, to be given as a once daily dose regimen, subsequent doses
adjusted according to serum-tobramycin concentration
*Neonatal sepsis
Neonate up to 32 weeks corrected gestational age: 4–5 mg/kg every 36 hours, to be
given as an extended interval dose regimen, intravenous injection to be given over 3–5
minutes.
Neonate 32 weeks corrected gestational age and above: 4–5 mg/kg every 24 hours, to
be given as an extended interval dose regimen, intravenous injection to be given over 3–5
minutes.
Neonate up to 7 days: 2 mg/kg every 12 hours, to be given as a multiple daily dose
regimen.
Neonate 7 days to 28 days: 2–2.5 mg/kg every8hours, to be given as a multiple daily
dose regimen
Preparation
Vial 80mg
Nebcin
5.1.4.4 Streptomycin
Indication & Doses
*Tuberculosis, resistant to other treatment, in combination with other drugs
Child: 15 mg/kg once daily (max. per dose 1g)
*Adjunct to doxycycline in brucellosis (administered on expert advice)
Child: 5–10 mg/kg every 6 hours, total daily dose may alternatively be given in 2–3
divided doses
Preparations
Vial 1gm
Streptomycin
5.1.5 MACROLIDES
Cautions
Macrolides should be used with caution in children with a predisposition to QT interval
prolongation (including electrolyte disturbances and concomitant use of drugs that
prolong the QT interval)

Side effects
Nausea, vomiting, abdominal discomfort, and diarrhoea are the most common side-
effects of the macrolides, but they are mild and less frequent with azithromycin and
clarithromycin than with erythromycin. Hepatotoxicity (including cholestatic jaundice)
and rash occur less frequently. Other side-effects reported rarely or very rarely include
pancreatitis, antibiotic- associated colitis, QT interval prolongation, arrhythmias,
generally reversible hearing loss (sometimes with tinnitus) after large doses, Stevens-
Johnson syndrome, and toxic epidermal necrolysis. Intravenous infusion may cause local
tenderness and phlebitis.
5.1.5.1 Clarithromycin
Indication & Doses
Child 1 month–11 years (body-weight up to 8 kg): 7.5mg/kg twice daily for 5–7 days
then review (review after 7 days if infection near the eyes or nose)
Child 1 month–11 years (body-weight 8–11 kg): 62.5 mg twice daily for 5–7 days then
review (review after 7 days if infection near the eyes or nose)
Child 1 month–11 years (body-weight 12–19 kg): 125 mg twice daily for 5–7 days then
Child 1 month–11 years (body-weight 20–29 kg): 187.5mg twice daily for 5–7 days
then review (review after 7 days if infection near the eyes or nose)
Child 1 month–11 years (body-weight 30–40 kg): 250 mg twice daily for 5–7 days then
Child 12–17 years: 250–500 mg twice daily for 5–7 days then review (review after 7
days if infection near the eyes or nose)
Child 1 month–11 years: 7.5 mg/kg every 12 hours (max. per dose 500 mg every 12
hours)
Child 12–17 years: 500 mg every 12 hours
*Impetigo
Child 1 month–11 years (body-weight up to 8 kg): 7.5mg/kg twice daily for 5–7 days
Child 1 month–11 years (body-weight 8–11 kg): 62.5 mg twice daily for 5–7 days
Child 1 month–11 years (body-weight 12–19 kg): 125 mg twice daily for 5–7days
Child 1 month–11 years (body-weight 30–40 kg): 250 mg twice daily for 5–7 days
Child 12–17 years: 250 mg twice daily for 5–7 days, increased if necessary to 500 mg
twice daily, increased dose used in severe infections
Child 1 month–11 years (body-weight up to 8 kg): 7.5mg/kg twice daily for 5 days
Child 1 month–11 years (body-weight 8–11 kg): 62.5 mg twice daily for 5 days
Child 1 month–11 years (body-weight 12–19 kg): 125 mg twice daily for 5 days
Child 12–17 years: 250–500 mg twice daily for 5 days

Child 1 month–11 years: 7.5mg/kg every 12 hours (max. per dose 500 mg every 12
hours)
*Hospital-acquired pneumonia
Child 1 month–11 years (body-weight up to 8 kg): 7.5 mg/kg twice daily for 5 days
then review
Child 1 month–11 years (body-weight 8–11 kg): 62.5mg twice daily for 5 days then
review
Child 1 month–11 years (body-weight 12–19 kg): 125 mg twice daily for 5 days then
review
Child 1 month–11 years (body-weight 20–29 kg): 187.5 mg twice daily for 5days then
review
Child 1 month–11 years (body-weight 30–40 kg): 250 mg twice daily for 5days then
review
Child 12–17 years: 500 mg twice daily for 5 days then review
*Respiratory-tract infections, Mild to moderate skin and soft-tissue infections
Neonate: 7.5mg/kg twice daily.
Child 1 month–11 years (body-weight up to 8 kg): 7.5 mg/kg twice daily
Child 1 month–11 years (body-weight 8–11 kg): 62.5mg twice daily
Child 1 month–11 years (body-weight 12–19 kg): 125 mg twice daily
Child 1 month–11 years (body-weight 20–29 kg): 187.5 mg twice daily
Child 1 month–11 years (body-weight 30–40 kg): 250 mg twice daily
Child 12–17 years: 250 mg twice daily usually for 7–14 days, increased to 500 mg twice
daily, if required in severe infections
Child 12–17 years: 500 mg once daily usually for 7–14days, increased to1 g once daily,
if required in severe infections
Child 1 month–11 years: 7.5mg/kg every12hours (max. per dose 500 mg every12hours)
maximum duration 5 days, switch to oral route when appropriate, to be administered into
a large proximal vein
Child 12–17 years: 500 mg every12hours maximum duration 5days, switch to oral route
when appropriate, to be administered into a large proximal vein
Child 1 month–11 years (body-weight up to 8 kg): 7.5 mg/kg twice daily for 7–14 days
Child 12–17 years: 250–500 mg twice daily for 7–14 days
*Acute cough [if systemically very unwell or at higher risk of complications], Acute
sore throat
Child 1 month–11 years (body-weight 8–11 kg): 62.5mg twice daily for 5 days

Child 1 month–11 years (body-weight 30–40 kg): 250 mg twice daily for 5days
Child 12–17 years: 250–500 mg twice daily for5 days
*Acute otitis media
Neonate: 7.5mg/kg twice daily.
Child 1 month–11 years (body-weight up to 8 kg): 7.5 mg/kg twice daily for 5–7 days
Child 12–17 years: 250–500 mg twice daily for 5–7days
Child 1 month–11 years: 7.5 mg/kg every 12 hours (max. per dose 500 mg every 12
hours) maximum duration 5 days, switch to oral route when appropriate, to be
administered into a large proximal vein
Child 12–17 years: 500 mg every 12 hours maximum duration 5 days, switch to oral
route when appropriate, to be administered into a large proximal vein
*Prevention of pertussis
Neonate: 7.5mg/kg twice daily for 7 days.
Child 12–17 years: 500 mg twice daily for 7 days
*Helicobacter pylori eradication in combination with omeprazole, and amoxicillin or
metronidazole
BY MOUTH
Child 1–5 years: 7.5 mg/kg twice daily (max. per dose 500 mg)
Child 6–11 years: 7.5 mg/kg twice daily (max. per dose 500 mg)
*Acute sinusitis
Child 1 month–11 years (body-weight 30–40 kg): 250 mg twice daily for 5days
Child 12–17 years: 250 mg twice daily for 5 days, alternatively 500 mg twice daily for 5
days
Side effects
Dyspepsia, tooth and tongue discoloration, smell and taste disturbances, stomatitis,
glossitis, and headache; less commonly arthralgia and myalgia; rarely tinnitus; very rarely
dizziness, insomnia, nightmares, anxiety, confusion, psychosis, paraesthesia, convulsions,
hypoglycaemia, renal failure, interstitial nephritis, leucopenia, and thrombocytopenia

Preparation
Inj. & Tab 500mg/vial & 250mg
Klaricid
5.1.5.2 Azithromycin
Indication & Doses
*Prevention of secondary case of invasive group A streptococcal infection in patients
who are allergic to penicillin
BY MOUTH
Child 6 months–11 years: 12 mg/kg once daily (max. per dose 500 mg) for 5days
Child 12–17 years: 500 mg once daily for 5 days
*Respiratory-tract infections, otitis media, skin and soft- tissue infections
BY MOUTH
Child 6 months–17 years: 10 mg/kg once daily (max. per dose 500 mg) for 3days
Child 6 months–17 years (body-weight 15–25 kg): 200 mg once daily for 3 days
Child 6 months–17 years (body-weight 26–35 kg): 300 mg once daily for 3days
Child 6 months–17 years (body-weight 36–45 kg): 400 mg once daily for 3 days
Child 6 months–17 years (body-weight 46 kg and above): 500mg once daily for 3 days
*Infection in cystic fibrosis
BY MOUTH
Child 6 months–17 years: 10 mg/kg once daily (max. per dose 500 mg) for 3days,
repeated after 1 week to complete course, treatment may be repeated as necessary
*Chronic Pseudomonas aeruginosa infection in cystic fibrosis
BY MOUTH
Child 6–17 years (body-weight 25–40 kg): 250 mg 3 times a week
Child 6–17 years (body-weight 41 kg and above): 500 mg 3 times a week
*Uncomplicated genital chlamydial infections|Non- gonococcal urethritis
BY MOUTH
Child 12–17 years: 1 g for 1 dose
Side effects
See notes above; also anorexia, dyspepsia, flatulence, syncope, dizziness, headache,
drowsiness, convulsions, arthralgia, and disturbances in taste and smell; rarely
constipation, hypotension, insomnia, agitation, anxiety, asthenia, paraesthesia,
hyperactivity, thrombocytopenia, haemolytic anaemia, insterstitial nephritis, acute renal
failure, photosensitivity, tooth and tongue discoloration
Preparation
Inj & Susp. 500mg & 200mg/5ml
Azomax
5.1.6 SULPHONAMIDES AND TRIMETHOPRIM

Co-trimoxazole
Cautions
Maintain adequate fluid intake; avoid in blood disorders (unless under specialist
supervision); monitor blood counts on prolonged treatment; discontinue immediately if
blood disorders or rash develop; predisposition to folate deficiency; asthma; G6PD
deficiency; avoid in infants under 6 weeks (except for treatment or prophylaxis of
pneumocystis pneumonia)

Indication & Doses
*Treatment of susceptible infections
BY MOUTH
Child 6 weeks–5 months: 120 mg twice daily, alternatively 24mg/kg twice daily
Child 6 months–5 years: 240 mg twice daily, alternatively 24 mg/kg twice daily
Child 6–11 years: 480 mg twice daily, alternatively 24 mg/kg twice daily
Child 6 weeks–17 years: 18 mg/kg every 12 hours; increased to 27 mg/kg every 12
hours (max. per dose 1.44g), increased dose used in severe infection
*Treatment of Pneumocystis jirovecii (Pneumocystis carinii) infections (undertaken
where facilities for appropriate monitoring available—consult microbiologist and
product literature)
Child: 120 mg/kg daily in 2–4 divided doses for 14–21 days, oral route preferred for
children
*Prophylaxis of Pneumocystis jirovecii (Pneumocystis carinii) infections
BY MOUTH
Child: 450 mg/m2 twice daily (max. per dose 960 mg twice daily) for 3 days of the week
(either consecutively or on alternate days), dose regimens may vary, consult local
guidelines
Contraindication
Acute porphyria
Side effects
nausea, diarrhoea; headache, hyperkalaemia; rash (very rarely including Stevens-Johnson
syndrome, toxic epidermal necrolysis, photosensitivity)— discontinue immediately; less
commonly vomiting; very rarely glossitis, stomatitis, anorexia, liver damage (including
jaundice and hepatic necrosis), pancreatitis, antibiotic-associated colitis, myocarditis,
cough and shortness of breath, pulmonary infiltrates, aseptic meningitis, depression,
convulsions, peripheral neuropathy, ataxia, tinnitus, vertigo, hallucinations,
hypoglycaemia, blood disorders (including leucopenia, thrombocytopenia, megaloblastic
anaemia, eosinophilia), hyponatraemia, renal disorders including interstitial nephritis,
arthralgia, myalgia, vasculitis, systemic lupus erythematosus, and uveitis;
rhabdomyolysis reported in HIV-infected patients
Preparation
Susp. 40:200/5ml
Septran
5.1.7 QUINOLONES
Cautions
Should be used with caution in children with a history of epilepsy or conditions that
predispose to seizures, in G6PD deficiency, myasthenia gravis (risk of exacerbation).
Exposure to excessive sunlight should be avoided (discontinue if photosensitivity
occurs). The CSM has warned that quinolones may induce convulsions in patients with or
without a history of convulsions; taking NSAIDs at the same time may also induce them.
Cause arthropathy in the weight-bearing joints of immature animals and are therefore
generally not recommended in children and growing adolescents. However, the

significance of this effect in humans is uncertain and in some specific circumstances
short term use of a quinolone in children is justified.
Contraindications
Quinolones hypersensitivity
Side effects
Nausea, vomiting, dyspepsia, abdominal pain, diarrhea (rarely antibiotic-associated
colitis), headache, dizziness, rash (very rarely Stevens-Johnson syndrome and toxic
epidermal necrolysis). Less frequent side-effects include anorexia, sleep disturbances,
asthenia, confusion, anxiety, depression, hallucinations, tremor, blood disorders
(including eosinophilia, leucopenia, and thrombocytopenia), arthralgia, myalgia,
disturbances in vision and taste. Other side-effects reported rarely or very rarely include
hepatic dysfunction (including jaundice and hepatitis), hypotension, vasculitis, dyspnoea,
convulsions, psychoses, paraesthesia, renal failure, interstitial nephritis, tendon
inflammation and damage (see also Tendon Damage above), photosensitivity,
disturbances in hearing and smell. The drug should be discontinued if psychiatric,
neurological or hypersensitivity reactions (including severe rash) occur.
5.1.7.1 Ciprofloxacin
Cautions
Avoid excessive alkalinity of urine and ensure adequate fluid intake (risk of crystalluria
Indication & Doses
*Fistulating Crohn’s disease
BY MOUTH
Child: 5 mg/kg twice daily
*Severe respiratory-tract infections, gastro-intestinal infection
BY MOUTH
Child: 20 mg/kg twice daily (max. per dose 750 mg)
Neonate: 10 mg/kg every 12 hours, to be given over 60 minutes.
Child: 10 mg/kg every 8 hours (max. per dose 400 mg), to be given over 60 minutes
*Acute exacerbation of bronchiectasis (administered on expert advice)
BY MOUTH
Child 1–17 years: 20 mg/kg twice daily (max. per dose 750 mg) for 7–14 days
Child 1–17 years: 10 mg/kg every8hours (max. per dose 400 mg), to be given over 60
minutes
*Pseudomonal lower respiratory-tract infection in cystic fibrosis
BY MOUTH
Child: 10 mg/kg every8hours (max. per dose 400 mg), to be given over 60 minutes
*Complicated urinary-tract infections
BY MOUTH
Child: 10 mg/kg twice daily, dose to be doubled in severe infection (max.750mg twice
daily)

Neonate: 6mg/kg every12 hours, to be given over 60minutes.
Child: 6 mg/kg every 8 hours; increased to 10 mg/kg every 8 hours (max. per dose 400
mg), in severe infection
*Gonorrhoea
BY MOUTH
*Anthrax (treatment and post-exposure prophylaxis)
BY MOUTH
Child: 10 mg/kg every 12 hours (max. per dose 400 mg)
BY MOUTH
Neonate: 30 mg/kg (max. per dose 125 mg) for 1 dose.
Child 1 month–4 years: 30 mg/kg (max. per dose 125 mg) for 1 dose
*Acute pyelonephritis, Urinary tract infection (catheter- associated)
BY MOUTH
Child 16–17 years: 500 mg twice daily for 7days
Side effects
pain and phlebitis at injection site; rarely dysphagia, pancreatitis, chest pain, tachycardia,
syncope, oedema, hot flushes, abnormal dreams, sweating, hyperglycaemia, and
erythema nodosum; very rarely movement disorders, tinnitus, vasculitis, and
tenosynovitis
Preparation
Inj. 2mg/ml (100ml)
Ciproxin
5.1.7.2 Levofloxacin
Cautions
Predisposition to QT interval prolongation (including cardiac disease, congenital long QT
syndrome, electrolyte disturbances, concomitant use with other drugs known to prolong
QT interval); history of psychiatric illness
Doses
> 6 month and 5 years: 8- 10mg/kg/dose every 12 hours max dose 750mg
5 years and above: 8-10mg/kg/dose every 24 hours max 750mg
Side effects
Flatulence, constipation; rarely tachycardia; very rarely pneumonitis, peripheral
neuropathy, and hypoglycaemia; also reported, rhabdomyolysis and potentially life-
threatening hepatic failure; local reactions and transient hypotension reported with
infusion
Preparation
Inj. 500mg
Tavanic

5.1.7.3 Moxifloxacin
Cautions
Conditions pre-disposing to arrhythmias, including myocardial ischaemia
Contraindications
History of QTinterval prolongation, bradycardia, history of symptomatic arrhythmias,
heart failure with reduced left ventricular ejection fraction, electrolyte disturbances,
concomitant use with other drugs known to prolong QT-interval
Side effects
Gastritis, flatulence, constipation, arrhythmias, palpitation, angina, vasodilatation,
hyperlipidaemia, and sweating; rarely oedema, hypertension, syncope, dysphagia,
abnormal dreams, incoordination, amnesia, hyperglycaemia, hyperuricaemia, and
stomatitis; very rarely rhabdomyolysis and potentially life-threatening hepatic failure; on
intravenous infusion, pain and phlebitis at injection site
Preparation
Injection 400mg
Avelox
5.1.8 ANAEROBIC INFECTION

Metronidazole
Cautions
Disulfiram-like reaction with alcohol, clinical and laboratory monitoring advised if
treatment exceeds 10 days
Indication & Doses
*Anaerobic infections
BY MOUTH
Child 1 month: 7.5mg/kg every 12 hours usually treated for 7 days (for 10–14 days in
Clostridioides difficile infection)
Child 2 months–11 years: 7.5mg/kg every 8 hours (max. per dose 400 mg) usually
treated for7 days (for 10–14 days in Clostridioides difficile infection)
Child 12–17 years: 400 mg every 8 hours usually treated for 7 days (for 10–14 days in
BY RECTUM
Child 1–11 months: 125 mg 3times a day for3 days, then 125 mg twice daily, for usual
total treatment duration of 7 days
Child 1–4 years: 250 mg3 times a day for 3days, then 250 mg twice daily, for usual total
treatment duration of 7 days
Child 5–9 years: 500 mg 3 times a day for 3 days, then 500 mg twice daily, for usual
total treatment duration of 7 days
Child 10–17 years: 1g 3 times a day for3 days, then1 g twice daily, for usual total
treatment duration of 7 days
Neonate up to 26 weeks corrected gestational age: Loading dose 15 mg/kg, followed
by 7.5mg/kg after24 hours, then 7.5 mg/kg daily usually treated for a total duration of 7
days (for10–14 days in Clostridioides difficile infection).
Neonate 26 weeks to 34 weeks corrected gestational age: Loading dose 15 mg/kg,
followed by 7.5mg/kg after 12 hours, then 7.5 mg/kg every12 hours usually treated for a
total duration of 7 days (for 10–14 days in Clostridioides difficile infection).

Neonate 34 weeks corrected gestational age and above: Loading dose 15 mg/kg,
followed by 7.5mg/kg after 8 hours, then 7.5 mg/kg every 8 hours usually treated for a
total duration of 7 days (for 10–14 days in Clostridioides difficile infection).
Child 1 month: Loading dose 15 mg/kg, followed by 7.5 mg/kg after 8 hours, then
7.5mg/kg every 8 hours usually treated for a total duration of 7 days (for 10–14 days in
Child 2 months–17 years: 7.5 mg/kg every8 hours (max. per dose 500 mg) usually
treated for 7days (for 10–14 days in Clostridioides difficile infection)
BY MOUTH
Child 1 month: 7.5mg/kg every 12 hours for 7 days then review
Child 2 months–11 years: 7.5mg/kg every 8 hours (max. per dose 400 mg) for 7 days
then review
Child 12–17 years: 400 mg every 8 hours for 7 days then review
Child 1 month: Loading dose15 mg/kg, followed by 7.5mg/kg after 8 hours, then
7.5mg/kg every 8 hours
Child 2 months–17 years: 7.5 mg/kg every 8 hours (max. per dose 500 mg)
*Helicobacter pylori eradication; in combination with clarithromycin and omeprazole
BY MOUTH
*Helicobacter pylori eradication; in combination with amoxicillin and omeprazole
BY MOUTH
*Fistulating Crohn’s disease
BY MOUTH
Child: 7.5 mg/kg 3 times a day usually given for 1 month but should not be used for
longer than 3 months because of concerns about peripheral neuropathy
*Bacterial vaginosis
BY VAGINA USING VAGINAL GEL
Child: 1 applicatorful daily for 5 days, dose to be administered at night
*Pelvic inflammatory disease
BY MOUTH
Child 12–17 years: 400 mg twice daily for14 days
*Acute ulcerative gingivitis
BY MOUTH
Child 1–2 years: 50mg every 8 hours for 3 days
Child 3–6 years: 100 mg every 12 hours for 3 days
Child 10–17 years: 200–250 mg every 8 hours for 3 days
*Acute oral infections
BY MOUTH
Child 1–2 years: 50mg every 8 hours for 3–7 days
Child 3–6 years: 100 mg every 12 hours for 3–7 days

Child 7–9 years: 100 mg every 8 hours for 3–7 days
Child 10–17 years: 200–250 mg every 8 hours for 3–7 days
BY MOUTH
Child 1 month–11 years: 30 mg/kg (max. per dose 500 mg), to be administered 2 hours
before surgery.
Child 12–17 years: 400–500 mg, to be administered 2 hours before surgery, then 400–
500 mg every 8 hours if required for up to 3 doses (in high-risk procedures)
BY RECTUM
Child 5–9 years: 500 mg, to be administered2 hours before surgery, then 500 mg every 8
hours if required for up to 3 doses (in high-risk procedures)
Child 10–17 years: 1 g, to be administered 2 hours before surgery, then 1g every 8 hours
if required for up to 3 doses (in high-risk procedures)
Neonate up to 40 weeks corrected gestational age: 10mg/kg, to be administered up to
30 minutes before the procedure.
Neonate 40 weeks corrected gestational age and above: 20–30mg/kg, to be
administered up to 30 minutes before the procedure.
Child 1 month–11 years: 30 mg/kg (max. per dose 500 mg), to be administered up to 30
minutes before the procedure
Child 12–17 years: 500 mg, to be administered up to 30 minutes before the procedure,
then500 mg every 8hours if required for up to 3 further doses (in high- risk procedures)
*Invasive intestinal amoebiasis|Extra-intestinal amoebiasis (including liver abscess)
BY MOUTH
Child 1–2 years: 200 mg 3times a day for 5 days in intestinal infection (for 5–10 days in
extra-intestinal infection)
Child 3–6 years: 200 mg 4times a day for 5 days in intestinal infection (for 5–10 days in
Child 7–9 years: 400 mg 3times a day for 5days in intestinal infection (for 5–10 days in
Child 10–17 years: 800 mg3 times a day for 5days in intestinal infection (for 5–10 days
in extra-intestinal infection)
*Urogenital trichomoniasis
BY MOUTH
Child 1–2 years: 50 mg3 times a day for 7 days
Child 7–9 years: 100 mg 3times a day for 7days
Child 10–17 years: 200 mg 3 times a day for 7 days, alternatively 400–500 mg twice
daily for 5–7 days, alternatively 2 g for 1 dose
*Giardiasis
BY MOUTH
Child 1–2 years: 500 mg once daily for 3days
Child 3–6 years: 600–800 mg once daily for3 days
Child 7–9 years: 1g once daily for 3days
Child 10–17 years: 2 g once daily for 3days, alternatively 400 mg 3times a day for 5
days, alternatively 500 mg twice daily for 7–10 days
*Established case of tetanus

Child: (consult product literature)
Side effects
Gastro-intestinal disturbances (including nausea and vomiting), taste disturbances, furred
tongue, oral mucositis, anorexia; very rarely hepatitis, Jaundice, pancreatitis, drowsiness,
dizziness, headache, ataxia, psychotic disorders, darkening of urine, thrombocytopenia,
pancytopenia, myalgia, arthralgia, visual disturbances, rash, pruritus, and erythema
multiforme; on prolonged or intensive therapy peripheralneuropathy, transient
epileptiform seizures, and leucopenia
Preparation
Inj & suspension 500mg/100ml & 200mg/5ml
Flagyl
5.1.9 OTHER ANTIBIOTICS

5.1.9.1 Vancomycin
Cautions
Avoid rapid infusion (risk of anaphylactoid reactions, see Side-effects); rotate infusion
sites; avoid if history of deafness; all patients require plasmavancomycin measurement
(after 3 or 4 doses if renal function normal, earlier if renal impairment), blood counts,
urinalysis, and renal function tests; monitor auditory function in renal impairment;
teicoplanin sensitivity; systemic absorption may follow oral administration especially in
inflammatory bowel disorders or following multiple doses;
Indication & Doses
*Clostridioides difficile infection
BY MOUTH
Neonate: 10 mg/kg every6hours for 10days, treatment duration may need to be tailored
to the clinical course of individual patients.
Child 1 month–11 years: 10 mg/kg every 6 hours for 10days, treatment duration may
need to be tailored to the clinical course of individual patients; maximum 2g per day
*Clostridioides difficile infection [first episode]
BY MOUTH
Child 12–17 years: 125 mg every 6 hours for 10 days; increased if necessary to 500 mg
every 6 hours for 10 days, increased dose if severe or complicated infection
*Clostridioides difficile infection [multiple recurrences]
BY MOUTH
Child 12–17 years: 125 mg every6hours for 10 days, followed by, either tapering the
dose (gradually reducing until 125mg daily) or a pulse regimen (125–500mg every 2–3
days for at least 3 weeks)
Child 1 month–11 years: 10–15 mg/kg every6hours adjusted according to plasma-
concentration monitoring
Child 12–17 years: 15–20 mg/kg every8–12 hours (max. per dose 2 g) adjusted
according to plasma- concentration monitoring
*Complicated skin and soft tissue infections, Bone infections, Joint infections,
Community-acquired pneumonia, Hospital-acquired pneumonia [including ventilator-
associated pneumonia], Infective endocarditis, Acute bacterial meningitis, Bacteraemia

[occurring in association with or suspected to be associated with the licensed
indications]
Neonate up to 29 weeks corrected gestational age (administered on expert advice):
15 mg/kg every 24 hours adjusted according to plasma-concentration monitoring,
duration should be tailored to type and severity of infection and the individual clinical
response
Neonate 29 weeks to 35 weeks corrected gestational age (administered on expert
advice): 15 mg/kg every 12 hours adjusted according to plasma concentration
monitoring, duration should be tailored to type and severity of infection and the
individual clinical response
Neonate 35 weeks corrected gestational age and above (administered on expert
advice): 15 mg/kg every 8hours adjusted according to plasma-concentration monitoring,
duration should be tailored to type and severity of infection and the individual clinical
response
Child 1 month–11 years: 10–15 mg/kg every 6 hours adjusted according to plasma-
concentration monitoring, duration should be tailored to type and severity of infection
and the individual clinical response—consult product literature for further information,
doses higher than 60mg/kg/day cannot be generally recommended as the safety of
increased dosing has not been fully assessed
Child 12–17 years: 15–20 mg/kg every 8–12 hours (max. per dose 2 g) adjusted
according to plasma- concentration monitoring, duration should be tailored to type and
severity of infection and the individual clinical response—consult product literature for
further information, in seriously ill patients, a loading dose of 25–30mg/kg (usual max.
2g) can be used to facilitate rapid attainment of the target trough serum- vancomycin
concentration
*Perioperative prophylaxis of bacterial endocarditis [in patients at high risk of
developing bacterial endocarditis when undergoing major surgical procedures]
Neonate: 15 mg/kg, to be given prior to induction of anaesthesia, a second dose may be
required depending on duration of surgery.
Child: 15 mg/kg, to be given prior to induction of anaesthesia, a second dose may be
required depending on duration of surgery
*Surgical prophylaxis (when high risk of MRSA)
Child: (consult local protocol) CNS infection e.g.ventriculitis (on expert advice)
BY INTRAVENTRICULAR ADMINISTRATION
Neonate: 10 mg every24hours.
Child: 10 mg every24 hours, for all children reduce to 5mg daily if ventricular size
reduced or increase to 15–20mg once daily if ventricular size increased, adjust dose
according to CSF concentration after 3–4 days; aim for pre-dose (’trough’) concentration
less than 10mg/litre. If CSF not draining free reduce dose frequency to once every 2–3
days
*Peritonitis associated with peritoneal dialysis
BY INTRAPERITONEAL ADMINISTRATION
Child: Add to each bag of dialysis fluid to achieve a concentration of 20–25mg/litre
*Eradication of meticillin-resistant Staphylococcus aureus from the respiratory tract in
cystic fibrosis

Child: 4 mg/kg twice daily (max. per dose 250 mg) for 5 days, alternatively 4 mg/kg4
times a day (max. per dose250 mg) for 5 days
Side effects
After parenteral administration: nephrotoxicity including renal failure and interstitial
nephritis; ototoxicity (discontinue if tinnitus occurs); blood disorders including
neutropenia (usually after 1 week or high cumulative dose), rarely agranulocytosis and
thrombocytopenia; nausea; chills, fever; eosinophilia, anaphylaxis, rashes (including
exfoliative dermatitis, Stevens-Johnson syndrome, toxic epidermal necrolysis, and
vasculitis); phlebitis (irritant to tissue); on rapid infusion, severe hypotension (including
shock and cardiac arrest), wheezing, dyspnoea, urticaria, pruritus, flushing of the upper
body (‘red man’ syndrome), pain and muscle spasm of back and chest
Preparation
Inj. 500mg / 1gm
Vancocin
5.1.9.2 Teicoplanin
Cautions
vancomycin sensitivity; blood counts and liver and kidney function tests required—
monitor renal and auditory function on prolonged administration during renal impairment
or if other nephrotoxic or neurotoxic drugs given; monitor plasma teicoplanin
concentration if severe sepsis or burns, deep-seated staphylococcal infection (including
bone and joint infection), endocarditis, renal impairment, and in intravenous drug abusers
Indication & Doses
*Clostridioides difficile infection
BY MOUTH
Child 12–17 years: 100–200 mg twice daily for 7–14 days
Child 1 month: Initially 16 mg/kg for 1dose, followed by 8 mg/kg once daily,
subsequent dose to be administered24hours after initial dose, doses to be given by
intravenous infusion
Child 2 months–11 years: Initially 10 mg/kg every 12 hours for 3 doses, then 6–10
mg/kg once daily
Child 12–17 years: Initially 6 mg/kg every12 hours for 3 doses, then 6 mg/kg once daily
*Serious infections caused by Gram-positive bacteria (e.g. complicated skin and soft-
tissue infections, pneumonia, complicated urinary tract infections)
Child 12–17 years: Initially 6 mg/kg every 12 hours for 3 doses, then 6mg/kg once daily
*Streptococcal or enterococcal endocarditis (in combination with another
antibacterial), Bone and joint infections
INITIALLY BY INTRAVENOUS INJECTION, OR BY INTRAVENOUS INFUSION
Child 12–17 years: 12mg/kg every 12 hours for 3–5 doses, then (by intravenous
injection or by intravenous infusion or by intramuscular injection) 12 mg/kg once daily
Child: (consult local protocol)

*Serious infections caused by Gram-positive bacteria (including endocarditis,
complicated skin and soft-tissue infections, pneumonia, complicated urinary tract
infections, bone and joint infections)
Neonate: Initially 16 mg/kg for 1 dose, followed by 8 mg/kg once daily, subsequent dose
to be administered 24 hours after initial dose, doses to be given by intravenous infusion.
Child 1 month: Initially 16 mg/kg for 1dose, followed by 8 mg/kg once daily,
subsequent dose to be administered 24 hours after initial dose, doses to be given by
intravenous infusion
Child 2 months–11 years: Initially 10 mg/kg every 12 hours for 3 doses, then 6–10
mg/kg once daily
*Peritonitis associated with peritoneal dialysis (added to dialysis fluid)
BY INTRAPERITONEAL INFUSION
Child 12–17 years: (consult local protocol)
Side effects
rash, pruritus; less commonly nausea, vomiting, diarrhoea, bronchospasm, dizziness,
headache, fever, leucopenia, thrombocytopenia, eosinophilia, tinnitus, mild hearing loss,
vestibular disorders, thrombophlebitis; also reported renal failure, exfoliative dermatitis,
Stevens-Johnson syndrome, toxic epidermal necrolysis
Preparation
Injection 200mg
Targocid
5.1.9.3 Linezolid
Cautions
Monitor full blood count (including platelet count) weekly (see also Blood Disorders
below); unless close observation and blood-pressure monitoring possible, avoid in
uncontrolled hypertension, phaeochromocytoma, carcinoid tumour, thyrotoxicosis,
bipolar depression, schizophrenia, or acute confusional states;
Indication & Doses
*Pneumonia (when other antibacterials e.g. a glycopetide, such as vancomycin, cannot
be used) (initiated under specialist supervision), Complicated skin and soft-tissue
infections caused by Gram-positive bacteria when other antibacterials cannot be used
(initiated under specialist supervision)
every 8 hours, increased dose can be used if poor response.
Neonate 7 days to 28 days: 10 mg/kg every8hours.
Child 1 month–11 years: 10 mg/kg every 8 hours (max. per dose 600 mg)
*Cellulitis (specialist use only), Erysipelas (specialist use only)
Child 1 month–11 years: 10 mg/kg every 8 hours (max. per dose 600 mg)
Side effects
Diarrhoea (antibiotic-associated colitis reported), nausea, vomiting, taste disturbances,
headache; less commonly thirst, dry mouth, glossitis,Stomatitis, tongue discoloration,
abdominal pain, dyspepsia, gastritis, constipation, pancreatitis, hypertension, fever,

fatigue, dizziness, insomnia,hypoaesthesia, paraesthesia, tinnitus, polyuria, leucopenia,
thrombocytopenia, eosinophilia, electrolyte disturbances, blurred vision, rash, pruritus,
diaphoresis, injection-site reactions; rarely tachycardia, transient ischaemic attacks, renal
failure; also reported tooth discoloration, convulsions, lactic acidosis, pancytopenia,
anaemia, Stevens-Johnson syndrome, toxic epidermal necrolysis; peripheral and optic
neuropathy reported on prolonged therapy
Preparation
Injection 200mg
Nezocin
5.1.9.4 Colistimethate Sodium

Indication & Doses
*Serious infections due to selected aerobic Gram-negative bacteria in patients with
limited treatment options
Child (body-weight up to 41 kg): 75000–150000 units/kg daily in 3 divided doses, the
data supporting the dose regimen are very limited—consult product literature for
available information, including recommendation to use lean body-weight for dosing
Child (body-weight 41 kg and above): 9 million units daily in 2–3 divided doses, the
data supporting the dose regimen are very limited—consult product literature for
available information, including recommendation to use lean body-weight for dosing
*Management of chronic pulmonary infections due to Pseudomonas aeruginosa in
patients with cystic fibrosis
Child 1–23 months: 0.5–1 million units twice daily, for specfic advice on administration
using nebulisers— consult product literature; maximum 2 million units per day
Child 2–17 years: 1–2million units 2–3 times a day, for specific advice on administration
using nebulisers— consult product literature; maximum 6 million units per day
Child 6–17 years: 1.66 million units twice daily
Preparation
Injection 1 million IU
Colistim
5.1.9.5 Fosfomycin
Indication & Doses
*Acute uncomplicated lower urinary-tract infections (in females)
BY MOUTH USING GRANULES
Child 12–17 years (female): 3g for1dose.
*Osteomyelitis when first-line treatments are inappropriate or ineffective, Hospital-
acquired lower respiratory-tract infections when first-line treatments are inappropriate
or ineffective
Neonate up to 40 weeks corrected gestational age: 100 mg/kg daily in 2 divided doses.
Neonate 40 weeks to 44 weeks corrected gestational age: 200 mg/kg/day in 3 divided
doses.
Child 1–11 months (body weight up to 10 kg):200–300 mg/kg daily in 3 divided doses,
consider using the high-dose regimen in severe infection, particularly when suspected

or known to be caused by less sensitive organisms
Child 1–11 years (body-weight 10–39 kg): 200–400 mg/kg daily in 3–4 divided doses,
consider using the high- dose regimen in severe infection, particularly when suspected or
known to be caused by less sensitive organisms
Child 12–17 years (body-weight 40 kg and above): 12–24 g daily in 2–3 divided doses
(max. per dose 8g), use the high-dose regimen in severe infection, particularly when
suspected or known to be caused by less sensitive organisms
*Complicated urinary-tract infections when first-line treatment ineffective or
inappropriate
Neonate 40 weeks to 44 weeks corrected gestational age: 200 mg/kg daily in 3 divided
doses.
Child 1–11 months (body-weight up to 10 kg): 200–300 mg/kg daily in 3 divided
doses, consider using the high-dose regimen in severe infection, particularly when
(max. per dose 8g), use the high-dose regimen in severe infection, particularly when
*Bacterial meningitis when first-line treatment ineffective or inappropriate
Neonate 40 weeks to 44 weeks corrected gestational age: 200 mg/kg daily in 3 divided
doses.
Child 1–11 months (body-weight up to 10 kg): 200–300 mg/kg daily in 3 divided
doses, consider using the high-dose regimen in severe infection, particularly when
(max. per dose 8g), use the high-dose regimen in severe infection suspected or known to
be caused by less sensitive organisms
Preparation
susp 250mg
Focin
5.2 ANTIFUNGAL DRUGS

5.2.1 Fluconazole
Cautions
Concomitant use with hepatotoxic drugs, monitor liver function with high doses or
extended courses—discontinue if signs or symptoms of hepaticm disease (risk of hepatic
necrosis); susceptibility to QT interval prolongation;
Indication & Doses

*Candidal balanitis
BY MOUTH
*Vaginal candidiasis
BY MOUTH
Child: 150 mg for 1 dose, for use in patients who are post-puberty
*Vulvovaginal candidiasis (recurrent)
BY MOUTH
Child: Initially 150 mg every72 hours for 3doses, then 150 mg once weekly for 6 months,
for use in patients who are post-puberty
*Mucosal candidiasis (except genital)
Neonate up to 14 days: 3–6 mg/kg, dose to be given on first day, then 3 mg/kg every 72
hours.
Neonate 14 days to 28 days: 3–6 mg/kg, dose to be given on fi rst day, then 3 mg/kg
every 48 hours.
Child 1 month–11 years: 3–6 mg/kg, dose to be given on first day, then 3 mg/kg daily
7–14 days in oropharyngeal candidiasis (max. 14 days except in severely
immunocompromised patients); for 14–30 days in other mucosal infections (e.g.
oesophagitis, candiduria, non-invasive bronchopulmonary infections)
Child 12–17 years: 50mg daily for 7–14 days in oropharyngeal candidiasis (max. 14
days except in severely immunocompromised patients); for 14–30 days in other mucosal
infections (e.g. oesophagitis, candiduria, non-invasive bronchopulmonary infections);
increased to 100 mg daily, increased dose only for unusually difficult infections
*Tinea capitis
BY MOUTH
Child 1–17 years: 6 mg/kg daily (max. per dose 300 mg) for 2–4 weeks
*Tinea pedis, corporis, cruris, pityriasis versicolo|, Dermal candidiasis
BY MOUTH
Child: 3mg/kg daily (max. per dose 50mg) for 2–4weeks (for up to 6 weeks in tinea
pedis); max.duration of treatment 6 weeks
*Invasive candidal infections (including candidaemia and disseminated candidiasis)
and cryptococcal infections (including meningitis)
Neonate up to 14 days: 6–12mg/kg every 72 hours, treatment continued according to
response (at least 8 weeks for cryptococcal meningitis).
Neonate 14 days to 28 days: 6–12 mg/kg every 48 hours, treatment continued according
to response (at least 8 weeks for cryptococcal meningitis).
Child: 6–12 mg/kg daily (max. per dose800 mg), treatment continued according to
response (at least 8 weeks for cryptococcal meningitis)
*Prevention of fungal infections in immunocompromised patients
Neonate up to 14 days: 3–12mg/kg every 72 hours, dose given according to extent and
duration of neutropenia.
Neonate 14 days to 28 days: 3–12 mg/kg every48 hours, dose given according to extent
and duration of neutropenia.

Child: 3–12 mg/kg daily (max. per dose 400 mg), commence treatment before
anticipated onset of neutropenia and continue for 7 days after neutrophil count in
desirable range, dose given according to extent and duration of neutropenia
*Prevention of fungal infections in immunocompromised patients (for patients with
high risk of systemic infections e.g. following bone-marrow transplantation)
Child: 12 mg/kg daily (max. per dose 400 mg), commence treatment before anticipated
onset of neutropenia and continue for 7days after neutrophil count in desirable range
*Prevention of relapse of cryptococcal meningitis in HIV- infected patients after
completion of primary therapy
Child: 6mg/kg daily (max. per dose 200 mg)
Contraindication
Acute porphyria
Side effects
Nausea, abdominal discomfort, diarrhoea, flatulence, headache, rash (discontinue
treatment or monitor closely if infection invasive or systemic);
less frequently dyspepsia, vomiting, taste disturbance, hepatic disorders, angioedema,
anaphylaxis, dizziness, seizures, alopecia, pruritus, toxic epidermal necrolysis, Stevens-
Johnson syndrome (severe cutaneous reactions more likely in AIDS patients), hyper
lipidaemia, leucopenia, thrombocytopenia, and hypo kalaemia reported
Preparation
Inj & susp 500mg
Diflucain
5.2.2 Amphotericin-B
Cautions
When given parenterally, toxicity common (close supervision necessary and close
observation required for at least 30 minutes after test dose; hepatic and renal function
tests, blood counts and plasma electrolyte (including plasma-potassium and magnesium
concentration) monitoring required; corticosteroids (avoid except to control reactions);
avoid rapid infusion (risk of arrhythmias);
Indication & Doses
*Visceral leishmaniasis (unresponsive to the antimonial alone)
Child: 1–3mg/kg daily for 10–21 days to a cumulative dose of 21–30 mg/kg,
alternatively 3mg/kg for 5 consecutive days, followed by 3mg/kg after 6 days for 1 dose
*Systemic fungal infections
Neonate: 1mg/kg once daily, increased if necessary to 1.5mg/kg daily for 7 days, then
reduced to 1–1.5mg/kg once daily on alternate days if required.
Child: Test dose 100 micrograms/kg (max. per dose 1 mg), included as part of first dose
of 250 micrograms/kg daily, then increased if tolerated to 1 mg/kg daily, dose is
gradually increased over 2–4 days; in severe infection max. 1.5mg/kg daily or on
alternate days. Prolonged treatment usually necessary; if interrupted for longer than 7
days recommence at 250 micrograms/kg daily and increase gradually.
Side effects

when given parenterally, anorexia, nausea and vomiting, diarrhoea, epigastric pain;
febrile reactions, headache, muscle and joint pain; anaemia; disturbances in renal
function (including hypokalaemia and hypomagnesaemia) and renal toxicity; also
cardiovascular toxicity (including arrhythmias, blood pressure changes), blood disorders,
neurological disorders (including hearing loss, diplopia, convulsions, peripheral
neuropathy, encephalopathy), abnormal liver function (discontinue treatment), rash,
anaphylactoid reactions; pain and thrombophlebitis at injection site
Preparation
Inj. 50mg
Fungizone
5.2.3 Voriconazole
Indication & Doses
*Invasive aspergillosis|Serious infections caused by Scedosporium spp., Fusarium spp.,
or invasive fluconazole-resistant Candida spp. (including Ckrusei)
BY MOUTH
Child 2–11 years: Treatment should be initiated with intravenous regimen, and oral
regimen should be considered only after there is a significant clinical improvement,
maintenance 9 mg/kg every 12 hours, adjusted in steps of 1 mg/kg and increased if
necessary up to350 mg every 12 hours, then adjusted in steps of 50 mg as required
Child 12–14 years (body-weight up to 50 kg): Treatment should be initiated with
intravenous regimen, and oral regimen should be considered only after there is a
significant clinical improvement; maintenance 9mg/kg every 12 hours, adjusted in steps
of 1 mg/kg and increased if necessary up to 350 mg every 12 hours, then adjusted in steps
of 50 mg as required
Child 12–14 years (body-weight 50 kg and above): Initially 400 mg every 12 hours for
2 doses, then 200 mg every 12hours, increased if necessary to 300 mg every 12 hours
Child 15–17 years (body-weight up to 40 kg): Initially 200 mg every 12 hours for 2
doses, then 100 mg every 12 hours, increased if necessary to 150 mg every 12 hours
Child 15–17 years (body-weight 40 kg and above): Initially 400 mg every 12 hours for
2 doses, then 200 mg every 12 hours, increased if necessary to 300 mg every 12 hours
Child 2–11 years: Initially 9 mg/kg every 12 hours for 2 doses, then 8 mg/kg every 12
hours; adjusted in steps of 1mg/kg as required; for max.6 months
Child 12–14 years (body-weight up to 50 kg): Initially 9mg/kg every 12 hours for 2
doses, then 8mg/kg every 12 hours; adjusted in steps of 1 mg/kg as required; for
max.6months
Child 12–14 years (body-weight 50 kg and above): Initially 6mg/kg every 12 hours for
2 doses, then 4mg/kg every 12 hours; reduced if not tolerated to 3mg/kg every 12 hours;
for max. 6 months
Child 15–17 years: Initially6mg/kg every12 hours for 2doses, then 4 mg/kg every 12
hours; reduced if not tolerated to3 mg/kg every12 hours; for max.6 months
Preparation
Tab 200 mg
Vorif

5.3 ANTIVIRAL DRUGS
5.3.1 Acyclovir
Cautions
Maintain adequate hydration (especially with infusion or high doses, or during renal
impairment)
Indication & Doses
*Herpes simplex treatment
Neonate 20 mg/kg every 8 hours for 14 days (21 days if CNS involvement)
Child 1–3 months 20 mg/kg every 8 hours for 14 days (21 days if CNS involvement)
Child 3 months–12 years 250 mg/m2 every 8 hours usually for 5 days, doubled to 500
mg/m2 every 8 hours if CNS involvement (given for up to 21 days) or if
immunocompromised
Child 12–18 years 5 mg/kg every 8 hours usually for 5 days, doubled to 10 mg/kg every
8 hours if CNS involvement (given for up to 21 days) or if immunocompromised
*Chickenpox and herpes zoster infection
.BY INTRAVENOUS INFUSION
Neonate 10–20 mg/kg every 8 hours for at least 7 days
Child 1–3 months 10–20 mg/kg every 8 hours for at least 7 days
Child 3 months–12 years 250 mg/m2 every 8 hours usually for 5 days, dose doubled if
immunocompromised
Child 12–18 years 5 mg/kg every 8 hours usually for 5 days, dose doubled if
immunocompromised
*Prophylaxis of chickenpox after delivery
Neonate 10 mg/kg every 8 hours; continued until serological tests confirm absence of
virus
Side effects
Nausea, vomiting, abdominal pain, diarrhoea, headache, fatigue, rash, urticaria, pruritus,
photosensitivity; very rarely hepatitis, jaundice, dyspnoea, neurological reactions
(including dizziness, confusion, hallucinations, convulsions, ataxia, dysarthria, and
drowsiness), acute renal failure, anaemia, thrombocytopenia, and leucopenia; on
intravenous infusion, severe local inflammation (sometimes leading to ulceration), and
very rarely agitation, tremors, psychosis and fever
Preparation
Inj 500mg
Zovirex
5.3.2 Ganciclovir
Indication & Doses
*Prevention of cytomegalovirus disease [pre-emptive therapy in patients with drug-
induced immunosuppression]
Child 12–17 years: Initially 5mg/kg every 12 hours for 7–14 days, then maintenance
6mg/kg once daily, on 5days of the week, alternatively maintenance 5 mg/kg once daily
*Prevention of cytomegalovirus disease [universal prophylaxis in patients with drug-
induced immunosuppression]

Neonate: (consult product literature).
Child 1 month–16 years: (consult product literature)
Child 17 years: 6 mg/kg once daily, on 5 days of the week, alternatively 5 mg/kg once
daily
*Treatment of cytomegalovirus disease [in immunocompromised patients]
Child: Initially 5mg/kg every 12 hours for 14–21 days, then maintenance 6mg/kg once
daily, on 5 days of the week, alternatively maintenance 5mg/kg once daily, maintenance
only for patients at risk of relapse; if disease progresses initial induction treatment may be
repeated
*Congenital cytomegalovirus infection of the CNS
Neonate: 6mg/kg every 12 hours for 6 weeks.
Preparation
Inj 250mg
Ganvir
5.4 ANTI TB DRUGS

5.4.1 Ethambutol
Cautions
Test visual acuity before treatment and warn patients to report visual changes—see notes
above; young children—routine ophthalmological monitoring recommended
Doses
*Tuberculosis, in combination with other drugs (standard unsupervised6-month
treatment)
BY MOUTH
Child: 20 mg/kg once daily for 2 months (initial phase)
*Tuberculosis, in combination with other drugs (intermittent supervised6-month
treatment) (under expert supervision)
BY MOUTH
Child: 30 mg/kg3 times a week for 2 months (initial phase)
*Congenital tuberculosis, in combination with other drugs
BY MOUTH
Neonate: 20mg/kg once daily for 2 months (initial phase).
Contraindications
Optic neuritis, poor vision
Side effects
Optic neuritis, red/green colour blindness, peripheral neuritis, rarely rash, pruritus,
urticaria, thrombocytopenia
Preparation
Tab 400mg
Shazobutol
5.4.2 Isoniazid
Cautions
Epilepsy; history of psychosis; alcohol dependence, malnutrition, diabetes mellitus, HIV
infection (risk of peripheral neuritis); acute porphyria

Indicatin & Doses
*Tuberculosis, in combination with other drugs (standard unsupervised 6-month
treatment)
BY MOUTH, OR BY INTRAMUSCULAR INJECTION, OR BY INTRAVENOUS
INJECTION
Child: 10 mg/kg once daily (max. per dose 300 mg) for 6 months (initial and
continuation phases)
*Tuberculosis, in combination with other drugs (intermittent supervised 6-month
INJECTION
Child: 15 mg/kg 3times a week (max. per dose 900 mg) for 6 months (initial and
INJECTION
Neonate: 10 mg/kg daily for 6 months (initial and continuation phases).
*Prevention of tuberculosis in susceptible close contacts or those who have become
tuberculin positive
INITIALLY BY MOUTH, OR BY INTRAMUSCULAR INJECTION, OR BY
INTRAVENOUS INJECTION
Neonate: 10 mg/kg daily for 6months.
Child 1 month–11 years: 10 mg/kg daily (max. per dose 300 mg) for 6 months,
alternatively (by mouth) 10mg/kg daily (max. per dose 300 mg) for 3 months, to be taken
in combination with rifampicin
Child 12–17 years: 300 mg daily for 6 months, alternatively (by mouth) 300 mg daily
for 3 months, to be taken in combination with rifampicin
Contraindications
Drug-induced liver disease
Side effects
nausea, vomiting, constipation, dry mouth; peripheral neuritis with high doses
(pyridoxine prophylaxis, see notes above), optic neuritis, convulsions, psychotic
episodes, vertigo; hypersensitivity reactions including fever, Stevens-Johnson syndrome,
purpura; blood disorders including agranulocytosis, haemolytic anaemia, aplastic
anaemia; hepatitis; pancreatitis; interstitial pneumonitis; systemic lupus erythematosus-
like syndrome, pellagra, hyperreflexia, difficulty with micturition, hyper glycaemia, and
gynaecomastia reported; hearing loss and tinnitus (in children with end-stage renal
impairment); when used with tyramine or histamine rich foods, tachycardia, palpitation,
hypotension, flushing, headache, dizziness, and sweating also reported
Preparations
Syp/tab 50mg/5ml & 100mg
Isoniazide
5.4.3 Pyrazinamide
Cautions
Diabetes;
Indication & Doses

treatment)
BY MOUTH
Child (body-weight up to 50 kg): 35 mg/kg once daily for 2 months (initial phase);
maximum 1.5g per day
Child (body-weight 50 kg and above): 35mg/kg once daily for 2 months (initial phase);
maximum 2g per day
*Tuberculosis, in combination with other drugs (intermittent supervised 6-month
BY MOUTH
Child (body-weight up to 50 kg): 50 mg/kg 3times a week (max. per dose 2 g 3 times a
week) for 2 months (initial phase)
Child (body-weight 50 kg and above): 50mg/kg 3times a week (max. per dose 2.5g 3
times a week) for 2 months (initial phase)
BY MOUTH
Neonate: 35 mg/kg once daily for 2months (initial phase).
Contraindication
Acute porphyria
Side effects
Hepatotoxicity including fever, anorexia, hepatomegaly, splenomegaly, jaundice, liver
failure; nausea, vomiting, dysuria, arthralgia, sideroblastic anaemia, thrombocytopenia,
rash and occasionally photosensitivity
Preparation
Syp & tab 250mg & 250/500mg
PZA CIBA
5.4.4 Rifampicin
Cautions
Liver function tests and blood counts in hepatic disorders and on prolonged therapy,
acute porphyria, effectiveness of hormonal contraceptives is reduced and alternative
family planning advice should be offered; discolours soft contact lenses
Indication & Doses
*Brucellosis in combination with other antibacterials| Legionnaires disease in
combination with other antibacterials|Serious staphylococcal infections in combination
with other antibacterials
Neonate: 5–10 mg/kg twice daily.
Child 1–11 months: 5–10 mg/kg twice daily
Child 1–17 years: 10 mg/kg twice daily (max. per dose 600 mg)
*Tuberculosis, in combination with other drugs (intermittent supervised6-month
BY MOUTH
Child: 15 mg/kg3 times a week (max. per dose 900 mg) for 6months (initial and
treatment)
BY MOUTH

Child (body-weight up to 50 kg): 15 mg/kg once daily for 6 months (initial and
continuation phases); maximum 450 mg per day
Child (body-weight 50 kg and above): 15mg/kg once daily for 6 months (initial and
continuation phases); maximum 600 mg per day
*Congenital tuberculosis
BY MOUTH
Neonate: 15 mg/kg once daily for 6months (initial and continuation phases).
tuberculin positive, in combination with isoniazid
BY MOUTH
Child 1 month–11 years (body-weight up to 50 kg): 15 mg/kg daily for 3 months;
Child 1 month–11 years (body-weight 50 kg and above): 15 mg/kg daily for 3 months;
Child 12–17 years (body-weight up to 50 kg): 450 mg daily for 3 months
Child 12–17 years (body-weight 50 kg and above): 600 mg daily for 3 months
tuberculin positive, who are isoniazid-resistant
BY MOUTH
Child 1 month–11 years (body-weight up to 50 kg): 15 mg/kg daily for 6 months;
Child 1 month–11 years (body-weight 50 kg and above): 15 mg/kg daily for 6 months;
Child 12–17 years (body-weight up to 50 kg): 450 mg daily for 6 months
Child 12–17 years (body-weight 50 kg and above): 600 mg daily for 6 months
*Prevention of secondary case of Haemophilus influenzae type B disease
BY MOUTH
Child 1–2 months: 10mg/kg once daily for 4 days
Child 3 months–11 years: 20mg/kg once daily (max. per dose 600 mg) for 4 days
Child 12–17 years: 600 mg once daily for 4 days
BY MOUTH
Neonate: 5mg/kg every12 hours for 2 days.
Child 1–11 months: 5mg/kg every 12 hours for 2 days
Child 1–11 years: 10 mg/kg every12 hours (max. per dose 600 mg), for 2 days
*Pruritus due to cholestasis
BY MOUTH
Child: 5–10mg/kg once daily (max. per dose 600 mg)
Contraindication
Jaundice
Side effects
gastro-intestinal symptoms including anorexia, nausea, vomiting, diarrhoea (antibiotic
associated colitis reported); headache, drowsiness; those occurring mainly on intermittent
therapy include influenza-like symptoms (with chills, fever, dizziness, bone pain),
respiratory symptoms (including shortness of breath), collapse and shock, haemolytic
anaemia, disseminated intravascular coagulation and acute renal failure,
thrombocytopenic purpura; alterations of liver function, jaundice; flushing, urticaria, and

rashes; other side-effects reported include oedema, psychoses, adrenal insufficiency,
muscular weakness and myopathy, exfoliative dermatitis, toxic epidermal necrolysis,
Stevens-Johnson syndrome, pemphigoid reactions, leucopenia, eosinophilia, menstrual
disturbances; urine, saliva, and other body secretions coloured orange-red;
thrombophlebitis reported if infusion used for prolonged period
Preparation
syp & tab 100mg/5ml, 150/300mg
Lederrif
5.4.5 Rifampicin + isoniazid

Doses
Upto 20mg/kg daily
Preparation
syp, tab 100 + 50mg/5ml & 150 + 100mg
Leferrif INH
5.5 ANTIPROTOZOAL DRUGS

5.5.1 ANTIMALARIALS
5.5.1.1 Chloroquine
Cautions
May exacerbate psoriasis, neurological disorders (avoid for prophylaxis if history of
epilepsy), may aggravate myasthenia gravis, severe gastro-intestinal disorders, G6PD
deficiency; ophthalmic examination with longterm therapy; avoid concurrent therapy
with hepatotoxic drugs
Indication & Doses
INITIALLY BY MOUTH USING SYRUP
Child 4–5 weeks (body-weight up to 4.5 kg): 25mg once weekly, started 1 week before
entering endemic area and continued for 4 weeks after leaving
Child 6 weeks–5 months (body-weight 4.5–7 kg): 50 mg once weekly, started 1 week
before entering endemic area and continued for 4 weeks after leaving
Child 6–11 months (body-weight 8–10 kg): 75 mg once weekly, started 1 week before
entering endemic area and continued for 4weeks after leaving
Child 1–2 years (body-weight 11–14 kg): 100 mg once weekly, started 1 week before
Child 3–4 years (body-weight 15–16.4 kg): 125 mg once weekly, started 1 week before
Child 5–7 years (body-weight 16.5–24 kg): 150 mg once weekly, alternatively (by
mouth using tablets) 155 mg once weekly, started 1 week before entering endemic area
and continued for 4 weeks after leaving
Child 8–13 years (body-weight 25–44 kg): 225 mg once weekly, alternatively (by
mouth using tablets) 232.5 mg once weekly, started 1 week before entering endemic area
and continued for 4 weeks after leaving
INITIALLY BY MOUTH USING TABLETS
Child 14–17 years (body-weight 45 kg and above): 310 mg once weekly, alternatively
(by mouth using syrup) 300 mg once weekly, started 1 week before entering endemic
area and continued for 4 weeks after leaving
*Treatment of non-falciparum malaria

BY MOUTH
Child: Initially 10 mg/kg (max. per dose620 mg), then 5mg/kg after6–8 hours (max. per
dose310 mg), then 5mg/kg daily (max. per dose310 mg) for 2days
*P.vivax or P.ovale infection during pregnancy while radical cure is postponed
BY MOUTH
Child: 10 mg/kg once weekly (max. per dose 310 mg)
Side effects
Gastro-intestinal disturbances, headache; also hypotension, convulsions, visual
disturbances, depigmentation or loss of hair, skin reactions (rashes, pruritus); rarely,
bone-marrow suppression, hypersensitivity reactions such as urticaria and angioedema;
other side-effects (not usually associated with malaria prophylaxis or treatment), very
toxic in over dosage— immediate advice from poisons centres essential
Preparation
Tab & Syp. 250mg & 50mg/ml
Cloquin
5.5.1.2 Artemether
Indication & Doses
*For treatment of chloroquin resistant Falciparim Malaria including cereberal
malaria
3.2mg/kg followed by 1.6mg/kg/day from day 2 to day 5
Preparation
inj 80mg
Mecinin
5.5.1.3 Artemether + Lumefantrine

Cautions
Electrolyte disturbances, concomitant use with other drugs known to cause QT-interval
prolongation; monitor patients unable to take food (greater risk of recrudescence); avoid
in acute porphyria
Indication & Doses
*Malaria due to Plasmodium Falciparium resistant or mixed infection
5-15 kg weight: 20mg/120mg at 0hr, 8th hr, 24th hr and 48th hour
Contraindications
History of arrhythmias, of clinically relevant bradycardia, and of congestive heart failure
accompanied by reduced left ventricular ejection fraction; family history of sudden death
or of congenital QT interval prolongation
Side effects
abdominal pain, anorexia, diarrhoea, vomiting, nausea; palpitation, prolonged QT
interval; cough; headache, dizziness, sleep disturbances, asthenia, paraesthesia;
arthralgia, myalgia; pruritus, rash; less commonly ataxia, hypoaesthesia, clonus
Preparation
syp 15mg+90mg/5ml
Antmal

5.5.1.4 Sulfadoxine & pyrimethamine
Preparation
Tab / syp 500/25mg & 500/25mg
Fansidar
5.5.2 ANTHELMINTICS
5.5.2.1 Albendazole
Indication & Doses
Chronic
*Strongyloides infection
BY MOUTH
Child 2–17 years: 400 mg twice daily for 3 days, dose may be repeated after 3 weeks if
necessary
*Hydatid disease, in conjunction with surgery to reduce the risk of recurrence or as
primary treatment in inoperable cases
BY MOUTH
Child 2–17 years: 7.5mg/kg twice daily (max. per dose 400 mg twice daily) for 28 days
followed by 14-day break, repeated for up to 2–3 cycles
*Hookworm infections
BY MOUTH
Child 2–17 years: 400 mg for 1dose
Preparation
syp 100mg
Zentel
5.5.2.2 Mebendazole
Indication & Doses
*Threadworm infections
BY MOUTH
Child 6 months–17 years: 100 mg for 1 dose, if reinfection occurs, second dose may be
needed after 2 weeks
*Whipworm infections|Hookworm infections
BY MOUTH
*Roundworm infections
BY MOUTH
Child 1 year: 100 mg twice daily for 3 days
Child 2–17 years: 100 mg twice daily for 3 days, alternatively 500 mg for 1 dose
*Threadworm infections (dose approved for use by community practitioner nurse
prescribers)
BY MOUTH
Child 2–17 years: 100 mg for 1 dose, if reinfection occurs, second dose may be needed
after 2 weeks
Preparation
syp 100mg
Vermox

SECTION 6: DRUGS ACTING ON ENDOCRINE SYSTEM
6.1 DRUGS USED IN DIABETES

6.1.1 INSULIN
6.1.1.1 Human Insulin R
Side effects
Transient oedema; localreactions and fat hypertrophy at injection site; rarely
hypersensitivity reactions including urticaria, rash; overdose causes hypoglycaemia
Indication & Doses
*Type 1 Diabetes Mellitus
Initially 0.2 to 0.4 units/kg/day SC divided 8 hrly or more frequently
Maintenance: 0.5 to 1 unit/kg/day SC divided 8 hrly or more frequently
Preparation
Vial 100 International Units/ml (10ml)
Humulin R
6.1.1.2 Human Insulin NPH

Indication & Doses
*Type 1 Diabetes Mellitus
12 years and above 0.5 to 1 unit/kg/day SC. Usual daily maintenance dose in aldoscents
should not be more than 1.2 units/kg during growth spurts
Preparation
Vial 100units/ml
Humulin N
6.1.2 TREATMENT OF HYPOGLYCEMIA

Octreotide Acetate
Cautions
Avoid abrupt withdrawal of short-acting octreotide; in insulinoma (risk of increased
depth and duration of hypoglycaemia— monitor closely when initiating treatment and
changing doses); diabetes mellitus (antidiabetic requirements may be reduced); monitor
thyroid function on long-term therapy
Indication & Doses
*Persistent hyperinsulinaemic hypoglycaemia unresponsive to diazoxide and glucose
Neonate: Initially 2–5 micrograms/kg every 6–8 hours, adjusted according to response;
increased if necessary up to 7 micrograms/kg every 4 hours, dosing up to 7
micrograms/kg may rarely be required.
Child: Initially 1–2 micrograms/kg every 4–6 hours, adjusted according to response;
increased if necessary up to 7 micrograms/kg every 4 hours, dosing up to 7
micrograms/kg may rarely be required
*Bleeding from oesophageal or gastric varices
Child: 1microgram/kg/hour, higher doses may be required initially, when no active
bleeding reduce dose over 24 hours; Usual maximum 50 micrograms/hour
Side effects

Anorexia, nausea, vomiting, abdominal pain, bloating, flatulence, diarrhoea, constipation,
and steatorrhoea (administer between meals or at bedtime to reduce gastro-intestinal side-
effects); bradycardia, dyspnoea, headache, dizziness; postprandial glucose tolerance may
be impaired, rarely persistent hyperglycaemia with chronic administration;
hypoglycaemia has also been reported; reduced gall bladder motility and bile flow;
gallstones reported after longterm treatment; abrupt withdrawal of subcutaneous
octreotide is associated with biliary colic and pancreatitis; rash, alopecia; pain and
irritation at injection site—sites should be rotated; rarely pancreatitis shortly after
administration; hepatitis also reported
Preparation
Inj 0.05mg / 0.1mg
Sandostatin
6.2 THYROID HARMONE

Levo Thyroxine Sodium
Cautions
Panhypopituitarism or predisposition to adrenal insufficiency (initiate corticosteroid
therapy before starting levothyroxine); cardiac disorders (monitor ECG; start at low dose
and carefully titrate); long-standing hypothyroidism, diabetes insipidus, diabetes mellitus
(dose of antidiabetic drugs including insulin may need to be increased)
Indication & Doses
*Hypothyroidism
Note Levothyroxine equivalent to 100 micrograms/m2/ day can be used as a guide to the
requirements in children
BY MOUTH
Neonate initially 10–15 micrograms/kg once daily (max. 50 micrograms daily), adjusted
in steps of 5 micrograms/kg every 2 weeks or as necessary; usual maintenance dose 20–
50 micrograms daily
Child 1 month–1 year initially 5 micrograms/kg once daily (max. 50 micrograms daily)
adjusted in steps of 10–25 micrograms daily every 2–4 weeks until metabolism
normalised; usual maintenance dose 25–75 micrograms daily
Child 2–11 years initially 50 micrograms once daily adjusted in steps of 25 micrograms
daily every 2–4 weeks until metabolism normalised; usual maintenance dose 75–100
micrograms daily
Child 12–17 years initially 50 micrograms once daily adjusted in steps of 25–50
micrograms daily every 3–4 weeks until metabolism normalised; usual maintenance dose
100–200 micrograms daily
Side effects
usually at excessive dosage include diarrhoea, vomiting; anginal pain, arrhythmias,
palpitation, tachycardia, benign intracranial hypertension; tremor, restlessness,
excitability, insomnia, headache, flushing, sweating, fever, heat intolerance, weight loss,
nervousness; craniosynostosis and premature closure of epiphyses; menstrual
irregularities; eosinophilia, liver dysfunction; muscle cramps, muscular weakness;
transient hair loss; hypersensitivity reactions including rash, pruritus and oedema also
reported
Preparation
Tab 50 mcg

Thyroxin
6.3 CORTICOSTEROIDS
Cautions & contraindications
Adrenal suppression, infections, Chickenpox, Measles, Systemic corticosteroids should
be prescribed with care in those predisposed to psychiatric reactions, including those who
have previously suffered corticosteroid induced psychosis, or who have a personal or
family history of psychiatric disorders. growth restriction—possibly irreversible, frequent
monitoring required if history of tuberculosis (or X-ray changes), hypertension,
congestive heart failure, diabetes mellitus including family history, osteoporosis,
susceptibility to angle-closure glaucoma (including family history), ocular herpes
simplex— risk of corneal perforation, severe affective disorders (particularly if history of
steroid-induced psychosis— see also Psychiatric Reactions above), epilepsy, peptic ulcer,
hypothyroidism, history of steroid myopathy, ulcerative colitis, diverticulitis, recent
intestinal anastomoses, thromboembolic disorders, myasthenia gravis. Systemic infection
(unless specific therapy given); avoid live virus vaccines in those receiving
immunosuppressive doses (serum antibody response diminished)
Side effects
Overdosage or prolonged use can exaggerate some of the normal physiological actions of
corticosteroids leading to mineralocorticoid and glucocorticoid side-effects.
Corticosteroids suppress growth and can affect the development of puberty. It is
important to use the lowest effective dose; alternate-day regimens may be appropriate and
limit growth reduction. Mineralocorticoid side-effects include hypertension, sodium and
water retention, and potassium, and calcium loss. They are most marked with
fludrocortisone, but are significant with cortisone, hydrocortisone, corticotropin, and
tetracosactide (tetracosactrin). Mineralocorticoid actions are negligible with the high
potency glucocorticoids, betamethasone and dexamethasone, and occur only slightly with
methylprednisolone, prednisolone, and triamcinolone. Glucocorticoid side-effects include
diabetes and osteoporosis; in addition high doses are associated with avascular necrosis
of the femoral head. Muscle wasting (proximal myopathy) can also occur. Corticosteroid
therapy is also weakly linked with peptic ulceration; there is no conclusive evidence that
the use of enteric-coated preparations of prednisolone reduces the risk of peptic
ulceration. High doses of corticosteroids can cause Cushing’s syndrome, with moon face,
striae, and acne; it is usually reversible on withdrawal of treatment, but this must always
be gradually tapered to avoid symptoms of acute adrenal insufficiency. Side-effects can
be minimised by using the lowest effective dose for the minimum period possible. Other
side effects include: gastro-intestinal effects: dyspepsia, abdominal distension, acute
pancreatitis, oesophageal ulceration and candidiasis; musculoskeletal effects: muscle
weakness, vertebral and long bone fractures, tendon rupture; endocrine effects: menstrual
irregularities and amenorrhoea, hirsutism, weight gain, negative nitrogen and calcium
balance, increased appetite; increased susceptibility to and severity of infection,
reactivation of dormant tuberculosis; neuropsychiatric effects: psychological dependence,
insomnia, increased intracranial pressure with papilloedema (usually after withdrawal),
aggravation of schizophrenia, aggravation of epilepsy; ophthalmic effects: papilloedema,
posterior subcapsular cataracts, corneal or scleral thinning and exacerbation of
ophthalmic viral or fungal disease, increased intra-ocular pressure, exophthalmos, very
rarely angle-closure glaucoma; also impaired healing, petechiae, ecchymoses, facial
erythema, suppression of skin test reactions, urticaria, hyperhidrosis, skin atrophy,

bruising, telangiectasia, myocardial rupture following recent myocardial infarction,
congestive heart failure, leucocytosis, hyperglycaemia, hypersensitivity reactions
(including anaphylaxis), thromboembolism, nausea, malaise, hiccups, headache, vertigo.
6.3.1 Dexamethasone
Indication & Doses
*Physiological replacement
BY MOUTH, OR BY SLOW INTRAVENOUS INJECTION
Child: 250–500 micrograms/m2 every 1 2 hours, adjusted according to response
*Suppression of inflammatory and allergic disorders
BY MOUTH
Child: 10–100 micrograms/kg daily in 1–2 divided doses, adjusted according to
response; up to 300 micrograms/kg daily may be required in emergency situations
Child 1 month–11 years: 83–333 micrograms/kg daily in 1–2 divided doses; maximum
20 mg per day
Child 12–17 years: Initially 0.4–20 mg daily
*Mild croup
BY MOUTH
Child: 150 micrograms/kg for 1 dose
*Severe croup (or mild croup that might cause complications)
INITIALLY BY MOUTH
Child: Initially 150 micrograms/kg for 1 dose, to be given before transfer to hospital,
then (by mouth or by intravenous injection) 150 micrograms/kg, then (by mouth or by
intravenous injection) 150 micrograms/kg after 12 hours if required
*Adjunctive treatment of bacterial meningitis (starting before or with first dose of
antibacterial)
Child 3 months–17 years: 150 micrograms/kg every 6 hours (max. per dose 10 mg) for
4 days
*Life-threatening cerebral oedema
Child (body-weight up to 35 kg): Initially 16.7 mg, then 3.3 mg every 3 hours for 3
days, then 3.3mg every 6 hours for 1 day, then 1.7 mg every 6 hours for 4 days, then
reduced in steps of 0.8 mg daily
Child (body-weight 35 kg and above): Initially 20.8mg, then 3.3 mg every 2 hours for 3
days, then 3.3 mg every 4 hours for 1 day, then 3.3 mg every 6 hours for 4 days, then
reduced in steps of 1.7 mg daily
Side effects
Perineal irritation may follow intravenous administration of the phosphate ester
Preparation
Inj & tab 4mg/ml & 0.5mg
Decadrone
6.3.2 Fludorocortisone
Indication & Doses
*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: Initially50–100 micrograms once daily; maintenance50–300 micrograms once
daily, adjusted according to response, dose adjustment may be required if salt
supplements are administered
Preparation
Tab 0.1mg
(Florinef)
6.3.3 Hydrocortisone sodium

Indication & Doses
*Acute adrenocortical insufficiency (Addisonian crisis)
Neonate: Initially 10 mg, then (by continuous intravenous infusion) 100 mg/m2 daily,
alternatively (by intravenous infusion )100 mg/m2 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.
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
*Congenital adrenal hyperplasia
Neonate: 9–15 mg/m2 in 3 divided doses, adjusted according to response.
Child: 9–15mg/m2 in 3 divided doses, adjusted according to response
*Adrenal hypoplasia, Addison’s disease, chronic maintenance or replacement therapy
Neonate: 8–10 mg/m2 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: 8–10mg/m2 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
Child 2–17 years: 2.5 mg/kg every 6 hours (max. per dose 100 mg)
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
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 3times 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)
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 every6hours (max. per dose 100 mg)
*Severe acute asthma, Life-threatening acute asthma
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 every6hours (max. per dose 100 mg), alternatively 50mg
every 6 hours until conversion to oral prednisolone is possible, dose given, preferably, as
sodium succinate
Child 5–11 years: 4mg/kg every 6 hours (max. per dose 100 mg), alternatively 100 mg
sodium succinate
Child 12–17 years: 4 mg/kg every 6 hours (max. per dose 100 mg), alternatively 100 mg
sodium succinate
Side effects
Phosphate ester associated with paraesthesia and pain (particularly in the perineal region)
Preparation
Tab & Inj. 10 & 250mg.
Solu Cortef
6.3.4 Methyl Prednisolone

Cautions
Rapid intravenous administration of large doses associated with cardiovascular collapse
Indication & Doses
*Inflammatory and allergic disorders
BY MOUTH, OR BY SLOW INTRAVENOUS INJECTION, OR BY INTRAVENOUS
INFUSION
Child: 0.5–1.7 mg/kg daily in 2–4 divided doses, divide doses depending on condition
and response
*Treatment of graft rejection reactions
Child: 10–20 mg/kg once daily for 3 days, alternatively 400–600 mg/m2 once daily
(max. per dose 1g) for 3 days
*Severe erythema multiforme, Lupus nephritis, Systemic onset juvenile idiopathic
arthritis
Child: 10–30 mg/kg once daily or on alternate days (max. per dose1 g) for up to 3 doses
Preparation
Inj 500mg
Solu Medrol

6.3.5 Prednisolone
Cautions
Duchenne’s muscular dystrophy (possible transient rhabdomyolysis and myoglobinuria
following strenuous physical activity)
Indication & Doses
*Severe croup (before transfer to hospital), Mild croup that might cause complications
(before transfer to hospital)
BY MOUTH
Child: 1–2mg/kg Mild to moderate acute asthma (when oral corticosteroid taken for
more than a few days)
*Severe or life- threatening acute asthma (when oral corticosteroid taken for more
than a few days)
BY MOUTH
Child 1 month–11 years: 2 mg/kg once daily (max. per dose 60 mg) for up to 3 days,
longer if necessary
*Mild to moderate acute asthma, Severe or life-threatening acute asthma
BY MOUTH
Child 1 month–11 years: 1–2 mg/kg once daily (max. per dose 40 mg) for up to 3 days,
longer if necessary
Child 12–17 years: 40–50 mg daily for at least 5 days
*Autoimmune inflammatory disorders (including juvenile idiopathic arthritis,
connective tissue disorders and systemic lupus erythematosus)
BY MOUTH
Child: Initially 1–2 mg/kg once daily, to be reduced after a few days if appropriate;
*Autoimmune hepatitis
BY MOUTH
Child: Initially 2mg/kg once daily, to then be reduced to minimum effective dose;
*Corticosteroid replacement therapy
BY MOUTH
Child 12–17 years: 2–2.5mg/m2 daily in 1–2 divided doses, adjusted according to
response
*Infantile spasms
BY MOUTH
Child 1 month–1 year: Initially 10 mg 4 times a day for 14 days; increased to 20 mg 3
times a day for 7 days if seizures not controlled after initial 7 days, reduce dose gradually
over 15 days until stopped
*Infantile spasms (dose reduction in patient taking 40mg daily)
BY MOUTH
Child 1 month–1 year: Reduced in steps of 10mg every 5 days, then stop
*Infantile spasms (dose reduction in patient taking 60mg daily)
BY MOUTH
Child 1 month–1 year: Reduced to 40 mg daily for 5 days, then reduced to 20 mg daily
for 5 days, then reduced to 10mg daily for 5 days and then stop
*Idiopathic thrombocytopenic purpura
BY MOUTH

Child 1–9 years: 1–2mg/kg daily for maximum of 14 days, alternatively 4 mg/kg daily
for a maximum of 4 days
*Nephrotic syndrome
BY MOUTH
Child: Initially 60 mg/m2 once daily for 4–6 weeks until proteinuria ceases, then reduced
to 40mg/m2 once daily on alternate days for 4–6 weeks, then withdraw by reducing dose
gradually; maximum 80 mg per day
*Nephrotic syndrome (prevention of relapse)
BY MOUTH
Child: 0.5–1mg/kg once daily or on alternate days for 3–6 months
*Ulcerative colitis|Crohn’s disease
BY MOUTH
Child 2–17 years: 2 mg/kg once daily (max. per dose 60mg) until remission occurs,
followed by reducing doses
*Pneumocystis pneumonia in moderate to severe infections associated with HIV
infection
BY MOUTH
Child: 2 mg/kg daily for 5 days, the dose is then reduced over the next 16 days and then
stopped, corticosteroid treatment should ideally be started at the same time as the anti-
pneumocystis therapy and certainly no later than 24–72 hours afterwards, the
corticosteroid should be withdrawn before anti-pneumocystis treatment is complete;
maximum 80 mg per day Proctitis
Child 12–17 years: 1 metered application 1–2 times a day for 2 weeks, continued for
further 2 weeks if good response, to be inserted into the rectum, 1metered application
contains 20mg prednisolone
BY RECTUM USING SUPPOSITORIES
Child 2–17 years: 5 mg twice daily, to be inserted in to the rectum morning and night,
after a bowel movement
*Distal ulcerative colitis
Child 12–17 years: 1 metered application 1–2 times a day for 2weeks, continued for
further 2 weeks if good response, to be inserted into the rectum, 1 metered application
contains 20mg prednisolone
*Rectal complications of Crohn’s disease
BY RECTUM USING SUPPOSITORIES
Child 2–17 years: 5 mg twice daily, to be inserted in to the rectum morning and night,
after a bowel movement
Preparation
Tab 5mg
Deltacortril
6.4 HYPOTHALAMIC AND PITUITARY HORMONES

6.4.1 Somatropin
Cautions
Diabetes mellitus (adjustment of antidiabetic therapy may be necessary), papilloedema,
relative deficiencies of other pituitary hormones (notably hypothyroidism—

manufacturers recommend periodic thyroid function tests but limited evidence of clinical
value), history of malignant disease, disorders of the epiphysis of the hip (monitor for
limping), resolved intracranial hypertension (monitor closely), initiation of treatment
close to puberty not recommended in child born small for gestational age; Silver-Russell
syndrome; rotate subcutaneous injection sites to prevent lipoatrophy;
Indication & Doses
*Gonadal dysgenesis (Turner syndrome)
Child: 1.4 mg/m2 daily, alternatively 45–50 micrograms/kg daily
*Deficiency of growth hormone
Child: 23–39 micrograms/kg daily, alternatively 0.7–1 mg/m2 daily
*Growth disturbance in children born small for gestational age whose growth has not
caught up by 4 years or later, Noonan syndrome
Child 4–17 years: 35 micrograms/kg daily, alternatively 1mg/m2 daily
*Prader-Willi syndrome, in children with growth velocity greater than 1cm/year, in
combination with energy- restricted diet
Child: 1 mg/m2 daily, alternatively 35 micrograms/kg daily; maximum 2.7mg per day
*Chronic renal insufficiency (renal function decreased to less than 50%)
Child: 45–50 micrograms/kg daily, alternatively 1.4 mg/m2 daily, higher doses may be
needed, adjust if necessary after 6 months
*SHOX deficiency
Child: 45–50 micrograms/kg daily
Contraindication
Evidence of tumour activity (complete antitumour therapy and ensure intracranial lesions
inactive before starting); not to be used after renal transplantation or for growth
promotion in children with closed epiphyses (or near closure in Prader-Willi syndrome);
severe obesity or severe respiratory syndrome in Prader-Willi syndrome
Side effects
Headache, funduscopy for papilloedema recommended if severe or recurrent headache,
visual problems, nausea and vomiting occur—if papilloedema confirmed consider benign
intracranial hypertension (rare cases reported); fluid retention (peripheral oedema),
arthralgia, myalgia, carpal tunnel syndrome, paraesthesia, antibody formation,
hypothyroidism, insulin resistance, hyperglycaemia, hypoglycaemia, reactions at
injection site; leukaemia in children with growth hormone deficiency also reported
Preparation
Vial / pen. 15 IU (5mg)
Norditropin
6.4.2 Terlipressin
Caution
Heart failure, hypertension, asthma, epilepsy, migraine or other conditions which might
be aggravated by water retention; avoid fluid overload
Indication & Doses

*Adjunct in acute massive haemorrhage of gastro- intestinal tract or oesophageal
varices (specialist use only)
Child 12–17 years (body-weight up to 50 kg): Initially 2mg every4hours until bleeding
controlled, then reduced to 1mg every 4 hours if required, maximum duration 48 hours
Child 12–17 years (body-weight 50 kg and above): Initially 2 mg every 4 hours until
bleeding controlled, reduced if not tolerated to 1 mg every 4 hours, maximum duration 48
hours
*Adjunct in acute massive haemorrhage of gastro- intestinal tract or oesophageal
varices (specialist use only)
Child 12–17 years (body-weight up to 50 kg): Initially 1mg, then 1mg every 4–6 hours
for up to 72 hours, to be administered over 1 minute
Child 12–17 years (body-weight 50–69 kg): Initially 1.5mg, then 1mg every 4–6 hours
for up to 72 hours, to be administered over 1 minute
Child 12–17 years (body-weight 70 kg and above): Initially 2 mg, then 1 mg every 4–6
hours for up to 72 hours, to be administered over 1 minute
Contraindications
Vascular disease (especially disease of coronary arteries) unless extreme caution, chronic
nephritis (until reasonable blood nitrogen concentrations attained)
Side effects
fluid retention, pallor, tremor, sweating, vertigo, headache, nausea, vomiting, belching,
abdominal cramps, desire to defaecate, hypersensitivity reactions (including
anaphylaxis), constriction of coronary arteries (may cause anginal attacks and myocardial
ischaemia), peripheral ischaemia and rarely gangrene
Preparation
inj 1mg
Nova pressin

SECTION7: MALIGNANT DISEASE AND IMMUNO
SUPPRESSION
7.1 CYTOTOXIC DRUGS

Side effects
Local tissue irritation and necrosis after extravassion of IV drugs, ulcers, constipation,
oral mucositis, nausea and vomiting. Bone merrow suppression, alopecia, tretogenic
effects, thrombo embolism and tumour lysis syndrome
7.1.1ALKYLATING DRUGS
7.1.1.1 Cyclophosphamide
Cautions
Previous or concurrent mediastinal irradiation—risk of cardiotoxicity; diabetes mellitus;
avoid in acute porphyria
Contraindications
Hemorrhagic cystitis
Side effects
anorexia; pancreatitis; cardiotoxicity at high doses; interstitial pulmonary fibrosis;
inappropriate secretion of anti-diuretic hormone, disturbances of carbohydrate
metabolism; urothelial toxicity; pigmentation of palms, nails and soles; rarely
hepatotoxicity and renal dysfunction
Preparation
Vial 1g
Zycram
7.1.1.2 Ifosfamide
Cautions
Ensure satisfactory electrolyte balance, and renal function before each course (risk of
tubular dysfunction, Fanconi’s syndrome, or diabetes insipidus if renal toxicity not
treated promptly); avoid in acute porphyria
Contraindications
Urinary tract obstruction; acute infection (including urinary-tract infection); urothelial
damage
Side effects
Drowsiness, confusion, disorientation, restlessness, psychosis; urothelial toxicity causing
haemorrhagic cystitis and dysuria, renal toxicity; less commonly severe encephalopathy;
rarely diarrhoea, constipation, convulsions, anorexia; very rarely jaundice,
thrombophlebitis, syndrome of inappropriate antidiuretic hormone secretion
Preparation
Inj. 1g
Ifos
7.1.1.3 Oxaliplatin
Preparation
Vial 100mg/20ml
Oxaliplatin

7.1.2 CYTOTOXIC ANTIBIOTICS
7.1.2.1 Dactinomycin
Cautions
Caution in handling—irritant to tissues
Side effects
Less commonly cheilitis, dysphagia; fever, malaise, lethargy; anaemia, hypoglycaemia;
myalgia; acne; rarely hepatotoxicity (possibly dose-related)
Preparation
Inj. 500mcg
Dactinomycin
7.1.2.2 Daunorubicin
Cautions
Contraindications
Myocardial insufficiency, recent myocardial infarction, severe arrhythmia; previous
treatment with maximum cumulative doses of daunorubicin or other anthracycline
Side effects
Leucopenia, less commonly mucositis; cardiac toxicity (usually 1–6 months after
initiation of therapy); fever; red urine discolouration
Preparation
Inj. 20mg /vial
Daunoblastina
7.1.2.3 Doxorubicin
Cautions
Cautions
Severe myocardial insufficiency, recent myocardial infarction, severe arrhythmia;
previous treatment with maximum cumulative doses of Doxorubicin or other
anthracycline
Side effects
Urine discoloration; thrombophlebitis over injection site; less commonly bronchospasm,
fever, amenorrhoea, and skin rash
Preparation
Inj. 10mg
Adriblastina
7.1.2.4 Bleomycin
Cautions
Ensure monitoring of pulmonary function—investigate any shortness of breath before
initiation; caution in handling—irritant to tissues
Contraindications
Acute pulmonary infection or significantly reduced lung function
Side effects
less bone marrow suppression; anorexia; pulmonary toxicity e.g. pulmonary fibrosis
(usually dose-related and delayed); fever (directly following administration), fatigue;

dermatological and mucous membrane toxicity, localised skin hyperpigmentation; rarely
cardiorespiratory collapse and hyperpyrexia
Preparation
Inj. 15mg/ampoule
Blecip
7.1.3 ANTIMETABOLITES
7.1.3.1 Methotrexate
Cautions
Monitor renal and hepatic function; peptic ulceration, ulcerative colitis, diarrhoea, and
ulcerative stomatitis; porphyria
Side effects
anorexia, abdominal discomfort, dyspepsia, gastro-intestinal ulceration and bleeding,
diarrhoea, toxic megacolon, hepatotoxicity hypotension, pericarditis, pericardial
tamponade, thrombosis; pulmonary oedema, pleuritic pain, pulmonary fibrosis, interstitial
pneumonitis anaphylactic reactions, urticaria; dizziness, fatigue, chills, fever, drowsiness,
malaise, headache, mood changes, abnormal cranial sensations, neurotoxicity, confusion,
psychosis, paraesthesia, cerebral oedema; precipitation of diabetes; menstrual
disturbances, vaginitis, cystitis, reduced libido, impotence; haematuria, dysuria, renal
failure; osteoporosis, arthralgia, myalgia, vasculitis; conjunctivitis, blepharitis, visual
disturbances; rash, pruritus, Stevens-Johnson syndrome, toxic epidermal necrolysis,
photosensitivity, changes in nail and skin pigmentation, telangiectasia, acne, furunculosis,
ecchymosis; injectionsite reactions
Preparation
Tab & inj 2.5/10mg & 500mg
Unitrexate
7.1.3.2 Cytarabine
Side effects
cytarabine syndrome’—6–12 hours after intravenous administration—characterized by
fever and malaise, myalgia, bone pain, maculopapular rash, and occasionally chest pain;
less commonly conjunctivitis (consider prophylactic corticosteroid eye drops),
neurotoxicity, renal and hepatic dysfunction, jaundice; rarely severe spinal cord toxicity
following intrathecal administration
Preparations
Inj. 500mg
Cytosar
7.1.3.3 Gemcitabine
Preparation
Inj 1gm
Gemzar
7.1.3.4 Mercaptopurine
Cautions
Thiopurine methyltransferase status; monitor liver function—discontinue if jaundice
develops;

Side effects:
Gastrointestinal effects less common; hepatotoxicity (more frequent at higher doses);
rarely intestinal ulceration, pancreatitis, fever, crystalluria with haematuria, rash, and
hyperpigmentation; very rarely lymphoma
Contraindications
Hemolytic anaemia
Preparation
Tab. 50mg
Purinetone
7.1.3.5 Thioguinine
Cautions
Thiopurine methyl transferase status; monitor liver function weekly—discontinue if liver
toxicity develops
Side effects
Stomatitis, hepatotoxicity; rarely intestinal necrosis and perforation
Preparation
Tab 40mg
Thioguinine
7.1.3.6 5 Fluorouracil
Preparation
Inj 250mg
Utoral
7.1.3.7 Fludarabine
Preparation
Inj 50mg
Fludara
7.1.4 VINCA ALKALOIDS & ETOPOSID

7.1.4.1 Vincristine sulphate
Cautions
Neuromuscular disease; ileus; caution in handling
Side effects
Constipation, diarrhoea, intestinal necrosis, paralytic ileus may occur in young children;
doselimiting neuromuscular effects; urinary retention, rarely convulsions followed by
coma; inappropriate secretion of antidiuretic hormone; irritant to tissues if extravasated
Preparation
Inj. 2mg /vial
Vinracine
7.1.4.2 Vinblastine
Side effects
Abdominal pain, constipation, leucopenia, muscle pain; less commonly peripheral
neuropathy; rarely paralytic ileus; irritant to tissues if extravasated
Preparation

Inj. 10mg/ vial
Velbastine
7.1.4.3 Vinoralbine
Preparation
Inj 10mg
Vinelbine
ETOPOSIDE
Side effects
Dose limiting myelosuppression, mucositis more common if given with doxorubicin;
anaphylaxis associated with concentrated infusions; hypotension associated with rapid
infusion; irritant to tissues if extravasated
Preparation
Inj. 20mg/ml (5ml)
Vepesid
7.1.5 OTHER ANTINEOPLASTIC DRUGS

7.1.5.1 L - Asparaginase
Preparation
Inj 10,000 IU /vial
Perginase
7.1.5.2 Peg Asparaginase

Preparation
(Inj 37500 IU /vial)
PEG-L-Asperginase
7.1.5.3 Dacarbazine
Side effects
Anorexia; less commonly facial flushing, confusion, headache, seizures, facial
paraesthesia, influenza-like symptoms, blurred vision, renal impairment, rash; rarely
diarrhoea, hepatotoxicity including liver necrosis and hepatic vein thrombosis,
photosensitivity, irritant to skin and tissues, injection-site reactions
Preparation
Inj. 200mg /vial
Duticin
7.1.5.4 Cisplatin
Cautions
Monitor full blood count, renal function, audiology, and plasma electrolytes;
Side effects
Peripheral neuropathy; hypophosphataemia, hypocalcaemia, hyperuricaemia also
reported
Preparation
Inj. 25mg /vial
Cisplasol

7.1.5.5 Carboplatin
Cautions
Consider therapeutic drug monitoring;
Preparation
Inj. 150, 450mg
Carpsol
7.1.5.6 Hydroxy Urea

Preparation
Cap 50mg
Hydrea
7.1.5.7 Idarubicin
Preparation
Vial 10mg
Zavedos
7.2 DRUGS FOR CYTOTOXIC INDUCED SIDE EFFECTS

7.2.1 Folinic Acid
Cautions
Avoid simultaneous administration of methotrexate; not indicated for pernicious anaemia
or other megaloblastic anaemias due to vitamin B12 deficiency;
Side effects
Rarely pyrexia after parenteral use; gastro- intestinal disturbances, insomnia, agitation,
and depression after high doses
Preparation
Inj 15mg
Kunyrin
7.2.2 Mesna
Contraindication
Hypersensitivity to thiol-containing compounds
Side effects
Nausea, vomiting, colic, diarrhoea, fatigue, headache, limb and joint pains, depression,
irritability, rash, hypotension and tachycardia; rarely hypersensitivity reactions (more
common in patients with auto-immune disorders)
Preparation
Inj. 400mg
Mesnal
7.2.3 Allopurinol
Cautions
Ensure adequate fluid intake; for hyperuricaemia associated with cancer therapy,
allopurinol treatment should be started before cancer therapy
Side effects
Rashes (withdraw therapy; if rash mild re-introduce cautiously but discontinue

immediately if recurrence—hypersensitivity reactions occur rarely and include
exfoliation, fever, lymphadenopathy, arthralgia, and eosinophilia resembling Stevens-
Johnson or toxic epidermal necrolysis, vasculitis, hepatitis, renal impairment, and very
rarely seizures); gastro-intestinal disorders; rarely malaise, headache, vertigo, drowsiness,
visual and taste disturbances, hypertension, alopecia, hepatotoxicity, paraesthesia and
neuropathy, blood disorders (including leucopenia, thrombocytopenia, haemolytic
anaemia and aplastic anaemia)
Preparation
Tab 100mg
Zyloric
Oprelvekin
Preparation
Inj 1.5mg
Thrombomax
7.3 DRUGS EFFECTING IMMUNE SYSTEM

7.3.1 IMMUNESERA & IMMUNOGLOBULINS
Antithymocytes Immunoglobulins
Indication & Doses
*Prophylaxis of organ rejection in heart allograft recipients
Child: 1–2.5 mg/kg daily for 3–5 days, start treatment on day of transplantation, to be
given over at least 6 hours
*Prophylaxis of organ rejection in renal allograft recipients
Child 1–17 years: 1–1.5mg/kg daily for 3–9 days, start treatment on day of
transplantation, to be given over at least 6 hours
*Treatment of corticosteroid-resistant allograft rejection in renal transplantation
Child 1–17 years: 1.5 mg/kg daily for 7–14 days, to be given over at least 6 hours
Preparation
Vial 25mg
Thymoglobuline
7.3.2 IMMUNOSUPPRESSANTS
7.3.2.1 Azathioprine
Cautions
thiopurine methyltransferase status (see notes above); monitor for toxicity throughout
treatment; monitor full blood count weekly (more frequently with higher doses or if
severe hepatic or renal impairment) for first 4 weeks (manufacturer advises weekly
monitoring for 8 weeks but evidence of practical value unsatisfactory), thereafter reduce
frequency of monitoring to at least every 3 months
Indication & Doses
*Severe ulcerative colitis, Severe Crohn’s disease
BY MOUTH
Child 2–17 years: Initially 2mg/kg daily, then increased if necessary upto 2.5mg/kg daily

*Systemic lupus erythematosus, Vasculitis, Autoimmune conditions usually when
corticosteroid therapy alone has proved inadequate
BY MOUTH
Child: Initially 1mg/kg daily, then adjusted according to response to 3 mg/kg daily,
consider withdrawal if no improvement within 3months; maximum3mg/kg per day
*Suppression of transplant rejection
Child: Maintenance 1–3 mg/kg daily, adjusted according to response, consult local
treatment protocol for details, oral route preferred, but if oral route is not possible then
can be given by intravenous infusion, the total daily dose may alternatively be given in 2
divided dose
Contraindications
Hypersensitivity to mercaptopurine
Side effects
Hypersensitivity reactions (including malaise, dizziness, vomiting, diarrhoea, fever,
rigors, myalgia, arthralgia, rash, hypotension and interstitial Nephritis—calling for
immediate withdrawal); doserelated bone marrow suppression (see also Cautions); liver
impairment, cholestatic jaundice, hair loss and increased susceptibility to infections and
colitis in patients also receiving corticosteroids; nausea; rarely pancreatitis, pneumonitis,
hepatic veno-occlusive disease, lymphoma
Preparation
Tab 50mg
Imuran
7.3.2.2 Mycophenolate Moftil

Cautions
full blood counts every week for 4 weeks then twice a month for 2 months then every
month in the first year (consider interrupting treatment if neutropenia develops); active
gastro-intestinal disease (risk of haemorrhage, ulceration and perforation); delayed graft
function; increased susceptibility to skin cancer (avoid exposure to strong sunlight);
possible decreased effectiveness of vaccination—avoid live vaccines
Indication & Doses
*Prophylaxis of acute rejection in renal transplantation (in combination with a
corticosteroid and ciclosporin) (under expert supervision)
BY MOUTH
Child: 600 mg/m2 twice daily, consult local protocol for details; maximum 2g per day
*Prophylaxis of acute rejection in renal transplantation (in combination with a
corticosteroid and tacrolimus) (under expert supervision)
BY MOUTH
Child: 300 mg/m2 twice daily, consult local protocol for details; maximum 2g per day
*Prophylaxis of acute rejection in hepatic transplantation (in combination with a
corticosteroid and ciclosporin or tacrolimus) (under expert supervision)
BY MOUTH
Child: 10 mg/kg twice daily, increased to20 mg/kg twice daily, consult local protocol for
details; maximum 2 g per day
Side effects
taste disturbance, gingival hyperplasia, nausea, constipation, flatulence, anorexia, weight
loss, diarrhoea, vomiting, abdominal pain, gastrointestinal inflammation, ulceration, and

bleeding, hepatitis, jaundice, pancreatitis, stomatitis, ileus, pleural effusion, oedema,
tachycardia, hypertension, hypotension, vasodilatation, cough, dyspnoea, insomnia,
agitation, confusion, depression, anxiety, convulsions, paraesthesia, myasthenic
syndrome, tremor, dizziness, headache, influenza-like syndrome, infections,
hyperglycaemia, renal impairment, malignancy (particularly of the skin), blood disorders
(including leucopenia, anaemia, thrombocytopenia, pancytopenia, and red cell aplasia),
disturbances of electrolytes and blood lipids, arthralgia, alopecia, acne, skin hypertrophy,
and rash; also reported intestinal villous atrophy, progressive multifocal
leucoencephalopathy, interstitial lung disease, pulmonary fibrosis
Preparation
Cap 500mg
CellCept
7.3.2.3 Ciclosporins
Cautions
Monitor kidney function—dose dependent increase in serum creatinine and urea during
first few weeks may necessitate discontinuation (exclude rejection of kidney transplant);
monitor liver function; monitor blood pressure—discontinue if hypertension develops
that cannot be controlled by antihypertensives; hyperuricaemia; monitor serum potassium
especially in renal dysfunction (risk of hyperkalaemia); monitor serum magnesium;
measure blood lipids before treatment and thereafter as appropriate; monitor whole blood
ciclosporin concentration (trough level dependent on indication—consult local treatment
protocol for details); use with tacrolimus specifically contra-indicated; for patients other
than transplant recipients, preferably avoid other immunosuppressants increased risk of
infection and malignancies, including lymphoma and skin cancer); avoid excessive
exposure to UV light, including sunlight
Indication & Doses
*Refractory ulcerative colitis
BY MOUTH
Child 2–17 years: Initially 2mg/kg twice daily (max. per dose 5 mg/kg twice daily),
dose adjusted according to blood-ciclosporin concentration and response
Child 3–17 years: Initially 0.5–1 mg/kg twice daily, dose adjusted according to
blood-ciclosporin concentration and response
*Short-term treatment of severe atopic dermatitis where conventional therapy
ineffective or inappropriate (administered on expert advice)
BY MOUTH
Child: Initially 1.25mg/kg twice daily (max. per dose 2.5 mg/kg twice daily) usual
maximum duration of 8 weeks but may be used for longer under specialist supervision, if
good initial response not achieved within2 weeks, increase dose rapidly up to maximum
*Short-term treatment of very severe atopic dermatitis where conventional therapy
ineffective or inappropriate (administered on expert advice)
BY MOUTH
Child: 2.5mg/kg twice daily usual maximum duration of 8 weeks but may be used for
longer under specialist supervision
*Severe psoriasis where conventional therapy ineffective or inappropriate
(administered on expert advice)
BY MOUTH

Child: Initially 1.25mg/kg twice daily (max. per dose 2.5 mg/kg twice daily), increased
gradually to maximum if no improvement within 1 month, initial dose of 2.5mg/kg twice
daily justified if condition requires rapid improvement; discontinue if inadequate
response after 3 months at the optimum dose; max duration of treatment usually 1 year
unless other treatments cannot be used
*Prevention of graft rejection following bone-marrow, kidney, liver, pancreas, heart,
lung, and heart-lung transplantation, Prevention and treatment of graft- versus-host
disease
Child: (consult local protocol) Nephrotic syndrome
BY MOUTH
Child: 3mg/kg twice daily, dose can be increased if necessary in corticosteroid-resistant
disease; for maintenance reduce to lowest effective dose according to whole blood-
ciclosporin concentrations, proteinuria, and renal function
Side effects
Anorexia, nausea, vomiting, abdominal pain, diarrhoea, gingival hyperplasia, hepatic
dysfunction, hypertension, tremor, headache, paraesthesia, fatigue, renal dysfunction
(renal structural changes on long-term administration, hyperuricaemia, hyperkalaemia,
hypomagnesaemia, hyperlipidaemia, hypercholesterolaemia, muscle cramps, myalgia,
hypertrichosis; less commonly oedema, weight gain, signs of encephalopathy, anaemia,
thrombocytopenia; rarely pancreatitis, motor polyneuropathy, menstrual disturbances,
gynaecomastia, micro-angiopathic haemolytic anaemia, haemolytic uraemic syndrome,
hyperglycaemia, muscle weakness, myopathy, visual disturbances secondary to benign
intracranial hypertension (discontinue); also reported with infusion anaphylaxis
Preparation
Inj, Syp & cap 100mg & 25/100mg
Sandimmum Neoral
7.3.2.4 Tacrolimus
Cautions
Monitor blood pressure, ECG (important: see cardiomyopathy below), fasting blood-
glucose concentration, haematological and neurological (including visual) parameters,
electrolytes, hepatic and renal function; monitor whole blood-tacrolimus trough
concentration (especially during episodes of diarrhoea)—consult local treatment protocol
for details; QT-interval prolongation; neurotoxicity; increased risk of infections,
malignancies, and lymphoproliferative disorders; avoid excessive exposure to UV light
(including sunlight); pregnancy (exclude before starting)
Indication & Doses
*Prophylaxis of graft rejection following liver transplantation, starting 12hours after
transplantation
BY MOUTH
Neonate: Initially 150 micrograms/kg twice daily.
Child: Initially150 micrograms/kg twice daily
*Prophylaxis of graft rejection following kidney transplantation, starting within 24
hours of transplantation
BY MOUTH
Neonate: Initially150 micrograms/kg twice daily.

Child: Initially 150 micrograms/kg twice daily, a lower initial dose of 100
micrograms/kg twice daily has been used in adolescents to prevent very high
‘trough’ concentrations
*Prophylaxis of graft rejection following heart transplantation following antibody
induction, starting within 5 days of transplantation
BY MOUTH
Neonate: Initially50–150 micrograms/kg twice daily.
Child: Initially 50–150 micrograms/kg twice daily
*Prophylaxis of graft rejection following heart transplantation without antibody
induction, starting within 12 hours of transplantation
BY MOUTH
Neonate: Initially150 micrograms/kg twice daily, dose to be given as soon as clinically
possible (8–12 hours after discontinuation of intravenous infusion).
Child: Initially 150 micrograms/kg twice daily, dose to be given as soon as clinically
possible (8–12 hours after discontinuation of intravenous infusion)
Side effects
Nausea, vomiting, diarrhoea, constipation, dyspepsia, flatulence, bloating, weight
changes, anorexia, gastro-intestinal inflammation, ulceration,and perforation, hepatic
dysfunction, jaundice, cholestasis, ascites, bile-duct abnormalities, oedema, tachycardia,
hypertension, haemorrhage, thromboembolic and ischaemic events, dyspnoea, pleural
effusion, parenchymal lung disorders, sleep disturbances, tremor, headache, peripheral
neuropathy, mood changes, depression, confusion, anxiety, psychosis, seizures,
paraesthesia, dizziness, renal impairment, renal failure, renal tubular necrosis, urinary
abnormalities, hyperglycaemia, electrolyte disturbances (including hyperkalaemia,
hypokalaemia, and hyperuricaemia), blood disorders (including anaemia, leucopenia,
pancytopenia, and thrombocytopenia), arthralgia, muscle cramp, visual disturbances,
photophobia, tinnitus, impaired hearing, alopecia, sweating, acne; less commonly
paralytic ileus, gastro-intestinal reflux disease, peritonitis, pancreatitis, heart failure,
arrhythmia, cardiac arrest, cerebrovascular accident, cardiomyopathy, palpitation,
respiratory failure, coma, speech disorder, amnesia, paralysis, influenza-like symptoms,
encephalopathy, coagulation disorders, cataract, photosensitivity, hypoglycaemia,
dysmenorrhoea, hypertonia, dermatitis; rarely pericardial effusion, respiratory distress
syndrome, posterior reversible encephalopathy syndrome, dehydration, thrombotic
thrombocytopenic purpura, blindness, toxic epidermal necrolysis, hirsutism; very rarely
myasthenia, haemorrhagic cystitis, Stevens Johnson syndrome
Preparation
Cap 0.5/1mg
Inograf
7.3.3 IMMUNOSUPPRESSANT MONOCOLONAL ANTIBODIES

Rituximab
Cauions
Rituximab should be used with caution in children receiving cardiotoxic chemotherapy or
with a history of cardiovascular disease; in adults’ exacerbation of angina, arrhythmia,
and heart failure have been reported. Transient hypotension occurs frequently during
infusion and antihypertensives may need to be withheld for 12 hours before infusion.
Progressive multifocal leucoencephalopathy (which is usually fatal or causes severe

disability) has been reported in association with rituximab; children treated with
rituximab should be monitored for cognitive, neurological, or psychiatric signs and
symptoms. If progressive multifocal leucoencephalopathy is suspected, suspend treatment
until it has been excluded.
Indication & Doses
*Post-transplantation lymphoproliferative disease (under expert supervision), Non-
Hodgkin’s lymphoma (under expert supervision), Hodgkin’s lymphoma (under expert
supervision), severe cases of resistant immune modulated disease including idiopathic
thrombocytopenia purpura, haemolytic anaemia, and systemic lupus erythematosus
(under expert supervision)
Child: Patients should receive premedication before each dose (consult product literature
for details) (consult local protocol)
Side effects
Infusion-related side-effects (including cytokine release syndrome) are reported
commonly with rituximab and occur predominantly during the first infusion; they include
fever and chills, nausea and vomiting, allergic reactions (such as rash, pruritus,
angioedema, bronchospasm and dyspnoea), flushing and tumour pain. Children should be
given paracetamol and an antihistamine before each dose of rituximab to reduce these
effects. Premedication with a corticosteroid should also be considered. The infusion may
have to be stopped temporarily and the infusion-related effects treated—consult product
literature or local treatment protocol for appropriate management. Evidence of pulmonary
infiltration and features of tumour lysis syndrome should be sought if infusion-related
effects occur.
Preparation
Inj 500mg
Mabthera

SECTION 8: NUTRITION AND BLOOD
8.1.1 DURGS USED FOR IRON CHELATION

8.1.1 Desferroxamine
Cautions
Eye and ear examinations before treatment and at 3-month intervals during treatment;
monitor body-weight and height in children at 3-month intervals— risk of growth
restriction with excessive doses; aluminium-related encephalopathy (may exacerbate
neurological dysfunction);
Indication & Doses
*Iron poisoning
Neonate: Initially up to 15 mg/kg/hour, max. 80 mg/kg in 24 hours, dose to be reduced
after 4–6 hours, in severe cases, higher doses may be given on advice from the National
Poisons Information Service.
Child: Initially up to 15 mg/kg/hour, max. 80 mg/kg in 24 hours, dose to be reduced after
4–6 hours, in severe cases, higher doses may be given on advice from the National
Poisons Information Service
*Aluminium overload in dialysis patients
Child: 5 mg/kg once weekly
*Chronic iron overload (low iron over load)
BY SUBCUTANEOUS INFUSION
Child: Initially up to 30 mg/kg3–7times a week, to be given over 8–12 hours, the dose
should reflect the degree of iron overload
*Chronic iron overload (established overload)
Child: 20–50 mg/kg daily
Side effects
Nausea, vomiting, abdominal pain, headache, pyrexia, growth retardation and bone
disorders (see Cautions), arthralgia, myalgia, hearing disturbances, injection-site
reactions; rarely diarrhoea, hepatic impairment, hypotension (especially when given too
rapidly by intravenous injection), anaphylaxis, Yersinia and mucormycosis infections,
blood dyscrasias (including thrombocytopenia and leucopenia), leg cramps, bone pain,
visual disturbances (including lens opacity and retinopathy), rash; very rarely acute
respiratory distress, neurological disturbances (including dizziness, neuropathy, con-
vulsions, and paraesthesia), renal impairment; muscle spasms also reported
Preparation
Inj. 500mg /vial
Desferal
8.1.2 Defriprone
Cautions
Monitor neutrophil count weekly and discontinue treatment if neutropenia develops.
Indication & Doses
*Treatment of iron overload in patients with thalassaemia major in whom
desferrioxamine is contra-indicated or is inadequate
BY MOUTH

Child 6–17 years: 25 mg/kg 3 times a day; maximum 100 mg/kg per day
Contraindications
History of agranulocytosis or recurrent neutropenia
Side effects
Gastro-intestinal disturbances (reducing dose and increasing gradually may improve
tolerance), increased appetite; headache; red-brown urinediscoloration; neutropenia,
agranulocytosis; zinc deficiency; arthropathy
Preparation
Cap 500mg
Kelfer
8.1.3 Deferasirox
Caution
Eye and ear examinations required before treatment and annually during treatment;
monitor body-weight, height and sexual development annually; monitor serum-ferritin
concentration monthly; risk of gastro-intestinal ulceration and haemorrhage; platelet
count less than 50 _ 109/litre; consider treatment interruption if unexplained cytopenia
occurs; not recommended in conditions which may reduce life expectancy (e.g. high-risk
myelodysplastic syndromes); history of liver cirrhosis; test liver function before
treatment, then every 2 weeks during the first month, and then monthly; measure baseline
serum-creatinine and monitor renal function weekly during the first month of treatment
and monthly thereafter; test for proteinuria monthly
Indication & Doses
*Transfusion-related chronic iron overload when desferrioxamine is contra-indicated
or inadequate in patients with beta thalassaemia major who receive frequent blood
transfusions (7mL/kg/month or more of packed red blood cells) (specialist use only)
BY MOUTH
Child 2–5 years: Initially 7–21 mg/kg once daily, dose adjusted according to serum-
ferritin concentration and amount of transfused blood—consult product literature, then
adjusted in steps of 3.5–7 mg/kg every 3–6 months, maintenance dose adjusted according
to serum-ferritin concentration; maximum28 mg/kg per day; Usual maximum 21mg/kg
*Transfusion-related chronic iron overload in patients with beta thalassaemia major
who receive frequent blood transfusions (7mL/kg/month or more of packed red blood
cells) (specialist use only)
BY MOUTH
to serum-ferritin concentration; maximum 28 mg/kg per day; Usual maximum 21mg/kg
*Transfusion-related chronic iron overload when desferrioxamine is contra-indicated
or inadequate in patients with beta thalassaemia major who receive infrequent blood
transfusions (less than 7mL/kg/month of packed red blood cells) (specialist use only),
Transfusion-related chronic iron overload when desferrioxamine is contra-indicated or
inadequate in patients with other anaemias (specialist use only)
BY MOUTH

to serum-ferritin concentration; maximum 28 mg/kg per day; Usual maximum 21mg/kg
*Chronic iron overload when desferrioxamine is contra- indicated or inadequate in
non-transfusion-dependent thalassaemia syndromes (specialist use only)
BY MOUTH
Child 10–17 years: Initially 7mg/kg once daily, maintenance dose adjusted according to
serum-ferritin concentration and liver-iron concentration (consult product literature);
maximum 7mg/kg per day
Side effects
gastro-intestinal disturbances (including ulceration and fatal haemorrhage); headache;
proteinuria; pruritus, rash; less commonly oedema, hepatitis, cholelithiasis, fatigue,
anxiety, sleep disorder, dizziness, pyrexia, pharyngitis, glucosuria, renal tubulopathy,
disturbances of hearing and vision (including lens opacity and maculopathy), and skin
pigmentation; hepatic failure, acute renal failure, blood disorders (including
agranulocytosis, neutropenia, pancytopenia, and thrombocytopenia), hypersensitivity
reactions (including anaphylaxis and angioedema) and alopecia also reported
Preparation
Tab 100/400 mg, 250/500mg, 90/180/360mg
Asunra
8.2 DRUGS USED IN IDIOPATHIC THROBMOCYTOPENIC PURPURA

Eltrombopag
Indication & Doses
*Chronic immune (idiopathic) thrombocytopenic purpura in patient’s refractory to
other treatments (such as corticosteroids or immunoglobulins) (under expert
supervision)
BY MOUTH
Child 1–5 years: Initially 25mg once daily, dose to be adjusted to achieve a platelet
count of 50x109/litre or more—consult product literature for dose adjustments,
discontinue if inadequate response after 4 weeks treatment at maximum dose;
Child 6–17 years: Initially 50 mg once daily, dose to be adjusted to achieve a platelet
count of 50x109/litre or more—consult product literature for dose adjustments,
discontinue if inadequate response after4weeks treatment at maximum dose; maximum
75 mg per day
Child 6–17 years (patients of East Asian origin): Initially 25mg once daily, dose to be
adjusted to achieve a platelet count of 50x109/litre or more—consult product literature
for dose adjustments, discontinue if inadequate response after4weeks treatment at
maximum dose; maximum 75 mg per day.
Preparation
Tab 25 mg
Revolade
8.3 DRUGS USED IN NEUTROPENIA

Filgrastim
Cautions

Regular morphological and cytogenetic bone-marrow examinations recommended in
severe congenital neutropenia (possible risk of myelodysplastic syndromes or
leukaemia); secondary acute myeloid leukaemia; osteoporotic bone disease (monitor
bone density if given for more than 6 months)
Indication & Doses
*Reduction in duration of neutropenia and incidence of febrile neutropenia in
cytotoxic chemotherapy for malignancy (except chronic myeloid leukaemia and
myelodysplastic syndromes) (specialist use only)
BY SUBCUTANEOUS INJECTION, OR BY INTRAVENOUS INFUSION
Child: 5 micrograms/kg daily until neutrophil count in normal range, usually for up to 14
days (up to 38 days in acute myeloid leukaemia), to be started at least 24 hours after
cytotoxic chemotherapy. Preferably given by subcutaneous injection; if given by
intravenous infusion, administer over 30 minutes
*Reduction in duration of neutropenia (and associated sequelae) in myeloablative
therapy followed by bone- marrow transplantation (specialist use only)
BY SUBCUTANEOUS INFUSION, OR BY INTRAVENOUS INFUSION
Child: 10 micrograms/kg daily, to be started at least 24 hours following cytotoxic
chemotherapy and within 24 hours of bone-marrow infusion, then adjusted according to
neutrophil count— consult product literature, doses administered over 30 minutes or 24
hours via intravenous route and over 24 hours via subcutaneous route
*Mobilisation of peripheral blood progenitor cells for autologous infusion, used alone
BY SUBCUTANEOUS INFUSION, OR BY SUBCUTANEOUS INJECTION
Child: 10 micrograms/kg daily for 5–7 days, to be administered over 24 hours if given by
subcutaneous infusion
*Mobilisation of peripheral blood progenitor cells for autologous infusion, used
following adjunctive myelosuppressive chemotherapy—to improve yield (specialist use
only)
Child: 5 micrograms/kg daily until neutrophil count in normal range, to be started the
day after completing chemotherapy, for timing of leucopheresis, consult product
literature
*Mobilisation of peripheral blood progenitor cells in normal donors for allogeneic
infusion (specialist use only)
Child 16–17 years: 10 micrograms/kg daily for 4–5 days, for timing of leucopheresis,
consult product literature
*Severe congenital neutropenia and history of severe or recurrent infections
(distinguish carefully from other haematological disorders) (specialist use only)
Child: Initially12 micrograms/kg daily, adjusted according to response, can be given in
single or divided doses, consult product literature and local protocol
*Severe cyclic neutropenia, or idiopathic neutropenia and history of severe or
recurrent infections (distinguish carefully from other haematological disorders)
Child: Initially 5 micrograms/kg daily, adjusted according to response, can be given in
single or divided doses, consult product literature and local protocol

*Persistent neutropenia in HIV infection (specialist use only)
Child: Initially 1 microgram/kg daily, subsequent doses increased as necessary until
neutrophil count in normal range, then adjusted to maintain neutrophil count in normal
range—consult product literature; maximum 4 micrograms/kg per day
*Neonatal neutropenia (specialist use only)
Neonate: 10 micrograms/kg daily, to be discontinued if white cell count exceeds
50x109/litre.
*Glycogen storage disease type 1b (specialist use only)
Child: Initially5 micrograms/kg daily, dose to be adjusted as necessary
Contraindications
Severe congenital neutropenia (Kostman’s syndrome) with abnormal cytogenetics
Side effects
mucositis, splenic enlargement, hepatomegaly, transient hypotension, epistaxis, urinary
abnormalities (including dysuria, proteinuria, and haematuria), osteoporosis, exacerbation
of rheumatoid arthritis, anaemia, transient decrease in blood glucose, pseudogout, and
raised uric acid; very rarely splenic rupture
Preparation
Inj 300mcg
Neupogen
8.4 DRUGS USED IN ANAEMIAS

8.4.1 HAEMOLYTIC & RENAL ANEMIAS
Erythropoietins
Cautions
inadequately treated or poorly controlled blood pressure (monitor closely blood pressure,
reticulocyte counts, haemoglobin, and electrolytes), interrupt treatment if blood pressure
uncontrolled; sudden stabbing migraine-like pain is warning of hypertensive crisis;
sickle-cell disease (lower target haemoglobin concentration may be appropriate);
ischaemic vascular disease; thrombocytosis (monitor platelet count for first 8 weeks);
epilepsy; malignant disease; increase in unfractionated or low molecular weight heparin
dose may be needed during dialysis
Indication & Doses
*Symptomatic anaemia associated with chronic renal failure in patients on
haemodialysis
Child (body-weight up to 10 kg): Initially 50 units/kg 3 times a week, adjusted in steps
of 25 units/kg 3 times a week, dose adjusted according to response at intervals of at least
4 weeks; maintenance 75–150 units/kg 3 times a week, intravenous injection to be given
over 1–5 minutes, reduce dose by approximately 25% if rise in haemoglobin
concentration exceeds 2g/100 mL over 4 weeks or if haemoglobin concentration exceeds
12g/100mL; if haemoglobin concentration continues to rise, despite dose reduction,
suspend treatment until haemoglobin concentration decreases and then restart at a dose
approximately 25% lower than the previous dose

Child (body-weight 10–30 kg): Initially 50units/kg 3 times a week, adjusted in steps of
25 units/kg 3 times a week, dose adjusted according to response at intervals of at least 4
weeks; maintenance 60–150 units/kg 3 times a week, intravenous injection to be given
over 1–5 minutes, reduce dose by approximately 25% if rise in haemoglobin
concentration exceeds 2g/100mL over 4 weeks or if haemoglobin concentration exceeds
12g/100mL; if haemoglobin concentration continues to rise, despite dose reduction,
suspend treatment until haemoglobin concentration decreases and then restart at a dose
approximately 25% lower than the previous dose
Child (body-weight 31–60 kg): Initially 50 units/kg 3 times a week, adjusted in steps of
25 units/kg 3times a week, dose adjusted according to response at intervals of at least
4weeks; maintenance 30–100 units/kg 3 times a week, intravenous injection to be given
over1–5minutes, reduce dose by approximately 25% if rise in haemoglobin concentration
exceeds 2g/100mL over 4 weeks or if haemoglobin concentration exceeds 12g/100mL; if
haemoglobin concentration continues to rise, despite dose reduction, suspend treatment
until haemoglobin concentration decreases and then restart at a dose approximately 25%
lower than the previous dose
Child (body-weight 61 kg and above): Initially 50 units/kg 3 times a week, adjusted in
steps of 25 units/kg 3 times a week, dose adjusted according to response at intervals of at
least 4weeks; maintenance 75–300 units/kg once weekly, maintenance dose can be given
as a single dose or in divided doses, intravenous injection to be given over 1–5 minutes,
reduce dose by approximately 25% if rise in haemoglobin concentration exceeds
2g/100mL over 4 weeks or if haemoglobin concentration exceeds 12g/100mL; if
haemoglobin concentration continues to rise, despite dose reduction, suspend treatment
until haemoglobin concentration decreases and then restart at a dose approximately 25%
lower than the previous dose
Contraindications
Pure red cell aplasia following erythropoietin therapy; uncontrolled hypertension; avoid
injections containing benzyl alcohol in neonates, Hepatic impairment
Side effects
Diarrhoea, nausea, vomiting; dosedependent increase in blood pressure or aggravation of
hypertension; in isolated patients with normal or
low blood pressure, hypertensive crisis withencephalopathy-like symptoms and
generalised tonicclonic seizures requiring immediate medical attention; dose-dependent
increase in platelet count (but thrombocytosis rare) regressing during treatment;
influenza-like symptoms (may be reduced if intravenous injection given over 5 minutes);
cardiovascular events; shunt thrombosis especially if tendency to hypotension or
arteriovenous shunt complications; very rarely sudden loss of efficacy because of pure
red cell aplasia, particularly following subcutaneous administration in patients with
chronic renal failure (discontinue erythropoietin therapy), hyperkalaemia hypersensitivity
reactions (including anaphylaxis and angioedema), skin reactions, injection-site reactions,
and peripheral oedema also reported
Preparation
Inj. 2000 units
Eprex
8.4.2 IRON DEFICIENCY ANEMIA

8.4.2.1 Iron Sucrose

Indication & Doses
*Iron-deficiency anaemia
Child (body-weight up to 67 kg): Dose calculated according to body-weight and iron
deficit, each divided dose should not exceed 3mg/kg/dose (consult product literature)
Child (body-weight 67 kg and above): Dose calculated according to body-weight and
iron deficit, each divided dose should not exceed max.200mg/dose (consult product
literature)
Preparation
Inj. 100mg
I-Tose S
8.4.2.2 Iron Polymaltose

Preparation
Syp 120ml
Maltofer
8.4.3 MEGALOBLASTIC ANEMIAS

Folic acid
Caution
Should never be given alone for vitamin B12 deficiency states (may precipitate subacute
combined degeneration of the spinal cord)
Indication & Doses
*Folate-deficient megaloblastic anaemia
BY MOUTH
Neonate: Initially 500 micrograms/kg once daily for up to 4 months.
Child 1–11 months: Initially 500 micrograms/kg once daily (max. per dose 5mg) for up
to4 months, doses up to 10mg daily may be required in malabsorption states
Child 1–17 years: 5 mg daily for 4 months (until term in pregnant women), doses up to
15mg daily may be required in malabsorption states
*Folate supplementation in neonates
BY MOUTH
Neonate: 50micrograms once daily.
*Prevention of neural tube defects (in those at a low risk of conceiving a child with a
neural tube defect
BY MOUTH
Females of childbearing potential: 400 micrograms daily, to be taken before conception
and until week 12 of pregnancy
*Prevention of neural tube defects (in those in the high- risk group who wish to
become pregnant or who are at risk of becoming pregnant)
BY MOUTH
Females of childbearing potential: 5 mg daily, to be taken before conception and until
week 12 of pregnancy
*Prevention of neural tube defects (in those with sickle-cell disease)
BY MOUTH
Females of child bearing potential: 5 mg daily, patient should continue taking their

normal dose of folic acid 5mg daily (or increase the dose to5mg daily) before conception
and continue this throughout pregnancy
*Prevention of methotrexate side-effects in severe Crohn’s disease & in severe
psoriasis
BY MOUTH
Child: 5 mg once weekly, dose to be taken on a different day to methotrexate dose
*Prophylaxis of folate deficiency in dialysis
BY MOUTH
Child 1 month–11 years: 250 micrograms/kg once daily (max. per dose 10mg)
Child 12–17 years: 5–10mg once daily
*Haemolytic anaemia, metabolic disorders
BY MOUTH
Child 1 month–11 years: 2.5–5mg once daily
Child 12–17 years: 5–10mg once daily
*Prevention of methotrexate side-effects in juvenile idiopathic arthritis
BY MOUTH
Child: 1 mg daily, alternatively5mg once weekly, dose to be adjusted according to local
guidelines, weekly dose to be taken on a different day to methotrexate dose
Side effects
Rarely gastro-intestinal disturbances
Preparation
Tab 5mg
Follic Acid
8.5 ELECTROLYTES
8.5.1 ORAL PREPARATIONS
8.5.1.1 Potassium Chloride
Cautions
Cardiac disease; with modified-release preparations, intestinal stricture, history of peptic
ulcer, hiatus hernia;
Indication & Doses
*Potassium depletion
.BY MOUTH
Neonate 0.5–1 mmol/kg K+ twice daily (total daily dose may alternatively be given in 3
divided doses), adjusted according to plasma-potassium concentration
Child 1 month–17 years 0.5–1 mmol/kg K+ twice daily (total daily dose may
alternatively be given in 3 divided doses), adjusted according to plasma-potassium
concentration
Contraindications
Plasma-potassium concentration above 5 mmol/litre
Side effects
Nausea, vomiting, abdominal pain, diarrhoea, flatulence; with modified-release
preparations, gastro-intestinal obstruction, ulceration, and bleeding also reported
Preparation
Syp. 40meq/5ml
K-Lyte

8.5.1.2 Oral Rehydration Salts
Indication & Doses
*Fluid and electrolyte loss in diarrhoea
BY MOUTH
Child 1 month–11 months 1–1½ times usual feed volume
Child 1–11 years 200mL after every loose motion
Child 12–17 years 200–400 mL after every loose motion
Preparation
Sachet
Peditral
8.5.1.3 Sodium Bicarbonate

Cautions
Avoid in respiratory acidosis
Indication & Doses
*Chronic acidotic states such as uraemic acidosis or renal tubular acidosis
BY MOUTH
Neonate: Initially 1–2 mmol/kg daily in divided doses, adjusted according to response.
Child: Initially1–2mmol/kg daily in divided doses, adjusted according to response
Preparation
Tab. 300mg
Soda mint
8.5.2 PARENTERAL PREPARATIONS

8.5.2.1 Sodium Bicarbonate
Inj. 8.4%
8.5.2.2 Potassium Chloride

Inj. 7.45%
8.5.2.3 Albumin
Infusion 20%
8.5.2.4 Normal Saline (B.P)

(0.9% Sodium Chloride W/V) 500 ml
8.5.2.5 Haemodialysis Bicarbonate Solution

(AC+BC) 4L
8.5.2.6 5 Dextrose Solution. B.P 5%

Infusion 500 ml
8.5.2.7 Dextrose Solution B.P 25%

Infusion 1000 ml
8.5.2.8 Dextrose Solution (B.P) 10%

infusion 500 ml
8.5.2.9 N/2 with 5% Dextrose

(0.45%N/S) infusion 500 ml
8.5.2.10 Hydroxyethyl Starch 3%

infusion 500 ml
8.5.2.11 Isotonic Solution

infusion 1000 ml
8.5.2.12 Dextrose 4.5%+0.18% Sodium Chloride (B.P)

infusion 500 ml
8.5.2.13 Ringer Lactate (Sodium Lactate B.P)

infusion 500 ml
8.5.2.14 Balanced Electrolyte Solution for eye (B.E.S)

infusion 500 ml
8.5.2.15 Dextrose 5% + Sodium Chloride 0.9% B.P

infusion 500 ml
8.5.2.16 Hypertonic Dialysate Solution

infusion 1000 ml
8.5.2.17 Dextran 40 in Saline

infusion 500 ml
8.5.2.18 Dextran 40 in Dextrose

infusion 500 ml
8.6 INTRAVENOUS NUTRITION

8.6.1 Amino acid solution
Preparation
Inf. without sorbitol 10% 500ml
Aminoplasmal
8.6.2 Lipid
Preparation
Infusion 20% 250ml
Lipofundin
8.7 MINERALS
8.7.1 Calcium salts
Cautions

Sarcoidosis; history of nephrolithiasis; avoid calcium chloride in respiratory acidosis
Indication & Doses
*Calcium deficiency, Mild asymptomatic hypocalcaemia
BY MOUTH
Neonate: 0.25mmol/kg 4 times a day, adjusted according to response.
Child 1 month–4 years: 0.25 mmol/kg 4times a day, adjusted according to response
Child 5–11 years: 0.2mmol/kg4times a day, adjusted according to response
Child 12–17 years: 10 mmol4times a day, adjusted according to response
*Acute hypocalcaemia, urgent correction, Hyperkalaemia (prevention of arrhythmias)
Neonate: 0.11 mmol/kg for 1 dose, to be given over 5–10 minutes, some units use a dose
of 0.46 mmol/kg (2mL/kg calcium gluconate 10%) for hypocalcaemia in line with US
practice.
Child: 0.11 mmol/kg, to be given over5–10 minutes, maximum4.5mmol (20mL calcium
gluconate 10%)
*Acute hypocalcaemia, maintenance
Neonate: 0.5mmol/kg daily, adjusted according to response, dose to be given over 24
hours, use oral route as soon as possible due to risk of extravasation.
Child 1 month–1 year: 1 mmol/kg daily, adjusted according to response, dose to be
given over 24 hours, use oral route as soon as possible due to risk of extravasation; Usual
maximum 8.8 mmol
Child 2–17 years: 8.8 mmol daily, adjusted according to response, dose to be given over
24 hours, use oral route as soon as possible due to risk of extravasation
Contraindications
Conditions associated with hypercalcaemia and hypercalciuria (e.g. some forms of
malignant disease)
Side effects
Gastro-intestinal disturbances, constipation; bradycardia, arrhythmias; with injection,
peripheral vasodilatation, fall in blood pressure, injection site reactions, severe tissue
damage with extravasation
Prepararation
Inj. 10% Soln. & tab 10ml & 500mg
Calcium Gluconate, Calcium P & Qalsan
8.7.2 Magnesium Sulphate

Caution
in severe hypomagnesaemia administer initially via controlled infusion device (preferably
syringe pump); monitor blood pressure, respiratory rate, urinary output and for signs of
overdosage (loss of patellar reflexes, weakness, nausea, sensation of warmth, flushing,
drowsiness, double vision, and slurred speech)
Indication & Doses
*Severe acute asthma, continuing respiratory deterioration in anaphylaxis
Child 2–17 years: 40 mg/kg (max. per dose2 g), to be given over 20 minutes
*Persistent pulmonary hypertension of the newborn
INITIALLY BY INTRAVENOUS INFUSION

Neonate: Initially 200 mg/kg, to be given over 20–30 minutes, then (by continuous
intravenous infusion) 20–75 mg/kg/hour for up to 5 days if response occurs after initial
dose (to maintain plasma magnesium concentration between3.5–5.5mmol/litre).
*Hypomagnesaemia
Neonate: 100 mg/kg every 6–12 hours as required, to be given over at least 10 minutes.
Child 1 month–11 years: 50mg/kg every 12 hours as required, to be given over at least
10 minutes
Child 12–17 years: 1g every12hours as required, to be given over at least 10 minutes
*Hypomagnesaemia maintenance (e.g. in intravenous nutrition)
BY INTRAVENOUS INFUSION, OR BY INTRAMUSCULAR INJECTION
Child: 50–100 mg/kg daily; maximum 5g per day
*Neonatal hypocalaemia
BY DEEP INTRAMUSCULAR INJECTION, OR BY INTRAVENOUS INFUSION
Neonate: 100 mg/kg every 12 hours for 2–3 doses.
*Torsade de pointes
Child: 25–50 mg/kg (max. per dose2 g), to be given over10–15 minutes, dose may be
repeated once if necessary (consult local protocol)
Preparation
Inj 500mg/ml
Magnesium Sulphate
8.7.3 Zinc Sulphate

Indication & Doses
*Zinc deficiency or supplementation in zinc-losing conditions
BY MOUTH USING EFFERVESCENT TABLETS
Neonate: 1 mg/kg daily, dose expressed as elemental zinc, to be dissolved in water and
taken after food.
Child (body-weight up to 10 kg): 22.5 mg daily, dose to be adjusted as necessary, to be
dissolved in water and taken after food, dose expressed as elemental zinc
Child (body-weight 10–30 kg): 22.5 mg 1–3 times a day, dose to be adjusted as
necessary, to be dissolved in water and taken after food, dose expressed as elemental zinc
Child (body-weight 31 kg and above): 45mg 1–3 times a day, dose to be adjusted as
necessary, to be dissolved in water and taken after food, dose expressed as elemental zinc
*Acrodermatitis enteropathica
BY MOUTH USING EFFERVESCENT TABLETS
Neonate: 0.5–1 mg/kg twice daily, dose to be adjusted as necessary, total daily dose may
alternatively be given in 3 divided doses, dose expressed as elemental zinc.
Child: 0.5–1mg/kg twice daily, dose to be adjusted as necessary, total daily dose may
alternatively be given in 3 divided doses, dose expressed as elemental zinc
Preparation
Sachet & Syp 10/20/50/100 mg elemental & 20mg/5ml
8.7.3 Zinc Acetate

Indication & Doses
*Wilson’s disease (initiated under specialist supervision)

BY MOUTH
Child 6–15 years (body-weight up to 57 kg): 25 mg 3times a day
Child 6–15 years (body-weight 57 kg and above): 50mg 3 times a day
Child 16–17 years: 50 mg 3times a day
Preparation
Sachet 50 mg elemental
8.8 VITAMINS
8.8.1 Multi Vitamin (B complex)
Indication & Doses
*Treatment of deficiency
BY MOUTH USING SYRUP
Child 1–11 months: 5 mL3times a day,
Child 1–11 years: 10 mL3times a day
Child 12–17 years: 10–15 mL3times a day
*Prophylaxis of deficiency
BY MOUTH USING SYRUP
Child 1–11 months: 5 mL once daily
Child 1–11 years: 5 mL twice daily
Child 12–17 years: 5 mL3times a day
Preparation
Syp 120ml
Vidaylin
8.8.2 Vitamin A
Indication & Doses
*Vitamin A deficiency
BY MOUTH
Neonate: 5000 units daily, higher doses may be used initially for treatment of severe
deficiency.
Child 1–11 months: 5000 units daily, to be taken with or after food, higher doses may be
used initially for treatment of severe deficiency
Child 1–17 years: 10000 units daily, to be taken with or after food, higher doses may be
used initially for treatment of severe deficiency
*Prevention of deficiency in complete biliary obstruction
Neonate: 50000 units once a month.
Child 1–11 months: 50000 units once a month
Preparation
drops
Ora A drops
8.8.4 Vitamin K
Caution
Intravenous injections should be given very slowly—risk of vascular collapse
Indication & Doses

*Neonatal prophylaxis of vitamin-K deficiency bleeding
Preterm neonate: 400 micrograms/kg (max. per dose 1mg) for 1 dose, to be given at
birth, the intravenous route may be used in preterm neonates with very low birth-weight
if intramuscular injection is not possible, however, it may not provide the prolonged
protection of the intramuscular injection, any neonate receiving intravenous vitamin K
should be given subsequent oral doses.
Neonate: 1mg for 1dose, to be given at birth.
*Neonatal hypoprothrombinaemia, Vitamin-K deficiency bleeding
Neonate: 1mg every 8 hours if required.
*Neonatal biliary atresia and liver disease
BY MOUTH
Neonate: 1mg daily.
*Reversal of coumarin anticoagulation when continued anticoagulation required or if
no significant bleeding— seek specialist advice
Child: 15–30 micrograms/kg (max. per dose 1mg) for 1 dose, dose may be repeated as
necessary
*Reversal of coumarin anticoagulation when anticoagulation not required or if
significant bleeding— seek specialist advice, Treatment of haemorrhage associated
with vitamin-K deficiency—seek specialist advice
Child: 250–300 micrograms/kg (max. per dose10 mg) for 1 dose
*Neonatal prophylaxis of vitamin-K deficiency bleeding in healthy babies who are not
at risk of bleeding disorders
BY MOUTH
Neonate: Initially 2 mg for1 dose at birth, then 2 mg after 4–7 days.
*Neonatal prophylaxis of vitamin-K deficiency bleeding in healthy babies who are not
at risk of bleeding disorders (exclusively breast fed babies)
BY MOUTH
Neonate: Initially 2 mg for 1 dose at birth, then 2mg after 4–7 days for a further 1 dose,
then 2mg for a further 1 dose 1 month after birth
Preparation
Inj. 10mg/ml
Konakoin
8.8.5 Cholecalciferol
Cautions
Monitor plasma-calcium concentration in patients receiving high doses and in renal
impairment
Indication & Doses
*Prevention of vitamin D deficiency
BY MOUTH
Child: 400 units daily
Contraindication
Hypercalcaemia; metastatic calcification
Side effects

Symptoms of overdosage include anorexia, lassitude, nausea and vomiting, diarrhoea,
constipation, weight loss, polyuria, sweating, headache, thirst, vertigo, and raised
concentrations of calcium and phosphate in plasma and urine
Preparation
Ampoule 6,00000 IU/ml
Indrop D
8.8.6 Alfa Calcidiol

Cautions
impairment, nephrolithiasis
Indication & Doses
*Hypophosphataemic rickets, Persistent hypocalcaemia due to hypo parathyroidism or
pseudo hypo parathyroidism
BY MOUTH, OR BY INTRAVENOUS INJECTION
Child 1 month–11 years: 25–50nanograms/kg once daily, dose to be adjusted as
necessary; maximum 1 microgram per day
Child 12–17 years: 1 microgram once daily, dose to be adjusted as necessary
*Persistent neonatal hypocalcaemia
Neonate: 50–100 nanograms/kg once daily, dose to be adjusted as necessary, in resistant
cases higher doses may be needed; increased if necessary up to 2 micrograms/kg daily.
*Prevention of vitamin D deficiency in renal or cholestatic liver disease
Neonate: 20 nanograms/kg once daily, dose to be adjusted as necessary.
Child 1 month–11 years (body-weight up to 20 kg): 15–30 nanograms/kg once daily
(max. per dose 500 nanograms)
Child 1 month–11 years (body-weight 20 kg and above): 250–500 nanograms once
daily, dose to be adjusted as necessary
Child 12–17 years: 250–500 nanograms once daily, dose to be adjusted as necessary
Contraindication
Side effects
concentrations of calcium and phosphate in plasma and urine, rarelymNephrocalcinosis,
pruritus, rash, and urticaria
Preparation
Cap 0.25mcg
One Alpha
8.8.7 Calcitriol
Cautions
impairment, monitor plasma calcium, phosphate, and creatinine during dosage titration
Indication & Doses

*Vitamin D dependent rickets, Hypophosphataemic rickets, Persistent hypocalcaemia
due to hypoparathyroidism, Pseudo-hypoparathyroidism (limited experience)
BY MOUTH
Child 1 month–11 years: Initially 15 nanograms/kg once daily (max. per dose 250
nanograms), increased in steps of 5nanograms/kg daily (max. per dose 250 nanograms) if
required, dose to be increased every 2–4 weeks
Child 12–17 years: Initially 250 nanograms once daily, increased in steps of 5
nanograms/kg daily (max. per dose250 nanograms) if required, dose to be increased
every 2–4 weeks; usual dose 0.5–1 microgram daily
Contraindication
Side effects
concentrations of calcium and phosphate in plasma and urine
Preparation
cap 0.5/0.25mcg
Rocaltrol
8.8.8 Pyridoxime (Vitamin B6)

Cautions
Risk of cardiovascular collapse with intravenous injection—resuscitation facilities must
be available, monitor closely;
Indication & Doses
*Isoniazid-induced neuropathy (prophylaxis)
BY MOUTH
Neonate: 5 mg daily.
Child 1 month–11 years: 5–10 mg daily
Child 12–17 years: 10mg daily
*Isoniazid-induced neuropathy (treatment)
BY MOUTH
Neonate: 5–10 mg daily.
Child 1 month–11 years: 10–20 mg 2–3times 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: 10mg daily
*Metabolic diseases Cystathioninuria, Homocystinuria
BY MOUTH
Neonate: 50–100 mg 1–2times a day.
Child: 50–250 mg 1–2 times a day
*Pyridoxine-dependent seizures
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
Side effects
Sensory neuropathy reported with high doses given for extended periods
Preparation
Tab 50mg
Vita 6
8.9 METABOLIC DISORDERS
Penicillamine
Cautions
Concomitant nephrotoxic drugs (increased risk of toxicity); monitor urine for proteinuria;
monitor blood and platelet count regularly (see below); neurological involvement in
Wilson’s disease;
Indication & Doses
*Wilson’s disease
BY MOUTH
Child 1 month–11 years: 20mg/kg daily in 2–3 divided doses, to be taken 1hour before
food; maximum 2 g per day
Child 12–17 years: Initially 20 mg/kg daily in 2–3 divided doses, maintenance 0.75–1 g
daily, to be taken 1hour before food; maximum 2 g per day
*Cystinuria
BY MOUTH
Child: 20–30 mg/kg daily in 2–3 divided doses, lower doses may be used initially and
increased gradually, doses to be adjusted to maintain 24-hour urinary cystine
below1mmol/litre, maintain adequate fluid intake, to be taken 1 hour before food;
maximum 3 g per day
Contraindications
Lupus erythematosus
Side effects
Initially nausea, anorexia, fever, and skin reactions; taste loss (mineral supplements not
recommended); blood disorders including thrombocytopenia, leucopenia, agranulocytosis
and aplastic anaemia; proteinuria, rarely haematuria (withdraw immediately and seek
specialist advice); haemolytic anaemia, pancreatitis, cholestatic jaundice, nephrotic
syndrome, lupus erythematosus-like syndrome, myasthenia gravis-like syndrome,
neuropathy (especially if neurological involvement in Wilson’s disease— prophylactic
pyridoxine recommended, polymyositis (rarely with cardiac involvement),
dermatomyositis, mouth ulcers, stomatitis, alopecia, bronchiolitis and pneumonitis,
pemphigus, Goodpasture’s syndrome, and Stevens-Johnson syndrome also reported; male
and female breast enlargement reported; in non-rheumatoid conditions rheumatoid
arthritis-like syndrome also reported; late rashes (consider withdrawing treatment)
Preparation
Tab. 125, 250mg
Vistamin

SECTION 9: DRUGS USED IN MUSCULOSKELETAL AND JOIN
DISEASES
9.1 DRUGS USED IN RHEUMATIC DISEASES AND GOUT
9.1.1 NSAIDS
NSAIDs should be used with caution in children with a history of hypersensitivity to any
NSAID—which includes those in whom attacks of asthma, angioedema, urticaria or
rhinitis have been precipitated by any NSAID. NSAIDs should also be used with caution
in coagulation defects. Caution may also be required in children with allergic disorders,
and also in children with connective-tissue disorders. In children with cardiac
impairment, caution is required since NSAIDs may impair renal function. All NSAIDs
are contra-indicated in severe heart failure. Non-selective NSAIDs should be used with
caution in uncontrolled hypertension, heart failure, ischaemic heart disease, peripheral
arterial disease, cerebrovascular disease, and when used long term in children with risk
factors for cardiovascular events. The selective inhibitor of cyclo-oxygenase-2,
etoricoxib, is contra-indicated in ischaemic heart disease, cerebrovascular disease,
peripheral arterial disease, and mild to severe heart failure. Etoricoxib should be used
with caution in children with a history of cardiac failure, left ventricular dysfunction,
hypertension, in children with oedema for any other reason, and in children with risk
factors for cardiovascular events. NSAIDs are generally contra-indicated if there is active
or previous gastro-intestinal ulceration or bleeding; however, some children may require
NSAIDs for effective relief of pain and stiffness. For advice on the prophylaxis and
treatment of NSAID-associated gastro- intestinal ulcers,
Side effects
The side-effects of NSAIDs vary in severity and frequency. Gastro-intestinal
disturbances including discomfort, nausea, diarrhoea, and occasionally bleeding and
ulceration may occur. Other side-effects include hypersensitivity reactions (particularly
rashes, angioedema, and bronchospasm), headache, dizziness, nervousness, depression,
drowsiness, and insomnia, vertigo, and hearing disturbances such as tinnitus,
photosensitivity, and haematuria. Blood disorders have also occurred. Fluid retention
may occur (rarely precipitating congestive heart failure); blood pressure may be raised.
Renal failure may be provoked by NSAIDs, especially in patients with pre-existing renal
impairment. Rarely, papillary necrosis or interstitial fibrosis associated with NSAIDs can
lead to renal failure. Hepatic damage, alveolitis, pulmonary eosinophilia, pancreatitis,
visual disturbances, Stevens- Johnson syndrome, and toxic epidermal necrolysis are other
rare side-effects. Induction of or exacerbation of colitis or Crohn’s disease has been
reported. Aseptic meningitis has been reported rarely with NSAIDs— children with
connective tissue disorders such as systemic lupus erythematosus may be especially
susceptible.
9.1.1.1 Ibuprofen
Indication & Doses
*Closure of ductus arteriosus
Neonate: Initially 10mg/kg for 1 dose, followed by 5mg/kg every 24 hours for 2 doses,
the course may be repeated after 48 hours if necessary.

*Mild to moderate pain, Pain and inflammation of soft- tissue injuries, Pyrexia with
discomfort
Child 1–2 months: 5mg/kg 3–4times a day
Child 3–5 months: 50 mg 3 times a day, maximum daily dose to be given in 3–4 divided
doses; maximum 30mg/kg per day
Child 6–11 months: 50 mg3–4times a day, maximum daily dose to be given in 3–4
divided doses; maximum 30mg/kg per day
Child 1–3 years: 100 mg 3 times a day, maximum daily dose to be given in 3–4 divided
Child 4–6 years: 150 mg 3 times a day, maximum daily dose to be given in 3–4divided
Child 7–9 years: 200 mg 3 times a day, maximum daily dose to be given in 3–4divided
doses; maximum 30mg/kg per day; maximum2.4g per day
Child 10–11 years: 300 mg 3 times a day, maximum daily dose to be given in 3–4
divided doses; maximum 30mg/kg per day; maximum 2.4g per day
Child 12–17 years: Initially 300–400 mg 3–4 times a day; increased if necessary up to
600 mg 4times a day; maintenance 200–400 mg3 times a day, may be adequate
*Pain and inflammation
Child 12–17 years: 1.6g once daily, dose preferably taken in the early evening, increased
to 2.4g daily in 2 divided doses, dose to be increased only in severe cases
*Pain and inflammation in rheumatic disease including juvenile idiopathic arthritis
Child 3 months–17 years: 30–40mg/kg daily in 3–4 divided doses; maximum 2.4 g per
*Pain and inflammation in systemic juvenile idiopathic arthritis
Child 3 months–17 years: Up to 60 mg/kg daily in 4–6divided doses; maximum 2.4g
per day
*Post-immunisation pyrexia in infants (on doctor’s advice only)
Child 2–3 months: 50 mg for1 dose, followed by 50 mg after 6 hours if required
*Pain and inflammation in rheumatic disease and other musculoskeletal disorders,
Mild to moderate pain including dysmenorrhea, Dental pain, Headache, Fever,
Symptoms of colds and influenza, Neuralgia
Child 12–17 years: 200–400 mg 3times a day, if symptoms worsen or persist for more
than 3 days refer to doctor
*Mild to moderate pain, Pain and inflammation of soft-tissue injuries, Pyrexia with
discomfort
Child 3–5 months (body-weight 5 kg and above): 20–30 mg/kg daily in divided doses,
alternatively 50 mg 3 times a day for maximum of 24 hours, refer to doctor if symptoms
persist for more than 24 hours
Child 6–11 months: 50 mg 3–4 times a day, refer to doctor if symptoms persist for more
than 3 days
Child 1–3 years: 100 mg 3 times a day, refer to doctor if symptoms persist for more than
3 days

Child 4–6 years: 150 mg 3 times a day, refer to doctor if symptoms persist for more than
3 days
Child 7–9 years: 200 mg 3times a day, refer to doctor if symptoms persist for more than
3days
Child 10–11 years: 300 mg 3 times a day, refer to doctor if symptoms persist for more
than 3 days
*Post-immunisation pyrexia in infants (dose approved for use by community
practitioner nurse prescribers) (on doctor’s advice only)
Child 3 months: 50 mg for 1 dose, followed by 50 mg after 6 hours if required, if
pyrexia persists refer to doctor
Preparation
Susp & tab 100mg/5ml & 200mg
Brufen
9.1.1.2 Mefenamic Acid
Indication & Doses
*Acute pain including dysmenorrhea, Menorrhagia
BY MOUTH
Preparation
Tab 250/500 mg
Ponstan
9.1.1.3 Naproxen Sodium

Indication & Doses
*Pain and inflammation in musculoskeletal disorders, Dysmenorrhoea
BY MOUTH
Child: 5 mg/kg twice daily; maximum 1 g per day
*Pain and inflammation in juvenile idiopathic arthritis
BY MOUTH
Child 2–17 years: 5–7.5mg/kg twice daily; maximum 1 g per day
Preparation
Tab 250/500mg
Flexin
9.1.1.4 Diclofenac Sodium
Indication & Doses
*Pain and inflammation in rheumatic disease including juvenile idiopathic arthritis
Child 6 months–17 years: 1.5–2.5 mg/kg twice daily, total daily dose may alternatively
be given in 3 divided doses; maximum150 mg per day
*Postoperative pain
BY RECTUM
Child 6 months–17 years (body-weight 8–11 kg): 12.5 mg twice daily for maximum 4
days
Child 6 months–17 years (body-weight 12 kg and above): 1 mg/kg3 times a day (max.
per dose 50 mg) for maximum 4 days
*Inflammation, Mild to moderate pain

BY MOUTH USING IMMEDIATE-RELEASE MEDICINES, OR BY RECTUM
Child 6 months–17 years: 0.3–1 mg/kg 3 times a day (max. per dose 50 mg)
Preparation
Tab, inj, Gel & suppositories
Voltral
9.1.2 DRUGS WHICH SUPPRESS THE RHEUMATIC DISEASE PROCESS
9.1.2.1 Azathiaprione
Cautions
thiopurine methyltransferase status (see notes above); monitor for toxicity throughout
treatment; monitor full blood count weekly (more frequently with higher doses or if
severe hepatic or renal impairment) for first 4 weeks (manufacturer advises weekly
monitoring for 8 weeks but evidence of practical value unsatisfactory), thereafter reduce
frequency of monitoring to at least every 3 months; bone marrow suppression e.g.
inexplicable bruising or bleeding, infection
Indication & Doses
*Systemic lupus erythematosus, Vasculitis, Autoimmune conditions usually when
corticosteroid therapy alone has proved inadequate
BY MOUTH
Child: Initially 1mg/kg daily, then adjusted according to response to 3mg/kg daily,
consider withdrawal if no improvement within 3 months; maximum 3 mg/kg per day
Contraindications
Hypersensitivity to mercaptopurine
Side effects
Hypersensitivity reactions (including malaise, dizziness, vomiting, diarrhoea, fever,
rigors, myalgia, arthralgia, rash, hypotension and interstitial, Nephritis—calling for
immediate withdrawal); doserelated bone marrow suppression (see also Cautions); liver
impairment, cholestatic jaundice, hair loss and increased susceptibility to infections and
colitis in patients also receiving corticosteroids; nausea; rarely pancreatitis, pneumonitis
Preparation
Tab 50mg
Imuran
9.1.2.2 Methotrexate
Cautions
(blood count, gastro-intestinal, liver, and pulmonary toxicity); extreme caution in blood
disorders (avoid if severe); risk of accumulation in pleural effusion or ascites— drain
before treatment; full blood count and liver function tests before starting treatment
repeated fortnightly for at least the first 4 weeks and at this frequency after any change in
dose until therapy stabilised, thereafter monthly; renal function tests before starting
treatment and then regularly during treatment; children or their carers should report all
symptoms and signs suggestive of infection, especially sore throat; treatment with folinic
acid (as calcium folinate) may be required in acute toxicity; check immunity to varicella-
zoster and consider vaccination before initiating therapy; acute porphyria;
Indication & Doses
*Juvenile idiopathic arthritis, Juvenile dermatomyositis, Vasculitis, Uveitis, Systemic
lupus erythematosus, Localised scleroderma, Sarcoidosis
BY MOUTH, BY SUBCUTANEOUS OR BY INTRAMUSCULAR INJECTION

Child: Initially 10–15 mg/m2 once weekly, then increased if necessary up to 25 mg/m2
once weekly
Contraindications
Active infection and immunodeficiency syndromes
Side effects
Chronic pulmonary fibrosis; blood dyscrasias (including fatalities); liver cirrhosis
Preparation
Tab 2.5mg/10mg
Unitrexate
9.2 DRUGS USED IN NEUROMUSCULAR DISORDERS

9.2.1DRUGS WHICH ENHANCES NEURIMUSCULAR TRANSMISSION
Neostigmine
Cautions
Asthma (extreme caution), bradycardia, arrhythmias, recent myocardial infarction,
epilepsy, hypotension, Parkinsonism, vagotonia, peptic ulceration, hyperthyroidism;
atropine or other antidote to muscarinic effects may be necessary (particularly when
neostigmine is given by injection), but not given routinely because it may mask signs of
overdosage
Indication & Doses
*Treatment of myasthenia gravis
BY MOUTH
Neonate: Initially 1–2mg, then 1–5 mg every4hours, given 30 minutes before feeds.
Child 1 month–5 years: Initially 7.5mg, dose repeated at suitable intervals throughout
the day, total daily dose 15–90mg
Child 6–11 years: Initially 15 mg, dose repeated at suitable intervals throughout the day,
total daily dose 15–90mg
Child 12–17 year initially 15–30mg, dose repeated at suitable intervals throughout day,
Total daily dose 75–300mg, the maximum that most patients can tolerate is 180 mg daily
Neonate: 150 micrograms/kg every6–8hours, to be given30 minutes before feeds, then
increased if necessary up to 300 micrograms/kg every4 hours.
Child 1 month–11 years: 200–500 micrograms, dose repeated at suitable intervals
throughout the day
Child 12–17 years: 1–2.5mg, dose repeated at suitable intervals throughout the day
*Reversal of non-depolarising (competitive) neuromuscular blockade
Neonate: 50 micrograms/kg, to be given over 1 minute after or with glycopyrronium or
atropine, followed by 25 micrograms/kg if required.
Child 1 month–11 years: 50 micrograms/kg (max. per dose 2.5mg), to be given
over1minute after or with glycopyrronium or atropine, then 25 micrograms/kg if required
Child 12–17 years: 50 micrograms/kg (max. per dose 2.5mg), to be given over 1 minute
after or with glycopyrronium or atropine, then 25 micrograms/kg (max. per dose 2.5mg)
if required
Contraindication
Intestinal or urinary obstruction
Side effects

nausea, vomiting, increased salivation, diarrhoea, abdominal cramps (more marked with
higher doses); signs of overdosage include bronchoconstriction, increased bronchial
secretions, lacrimation, excessive sweating, involuntary defaecation and micturition,
miosis, nystagmus, bradycardia, heart block, arrhythmias, hypotension, agitation,
excessive dreaming, and weaknes
Preparation
Inj 2.5 mg/ml
Neo-Choline
9.2.2 SKELETAL MUSCLE RELAXANTS

9.2.2.1 Baclofen
Cautions
Psychiatric illness; respiratory impairment; epilepsy; history of peptic ulcer (avoid oral
route in active peptic ulceration); diabetes; hypertonic bladder sphincter; avoid abrupt
withdrawal (risk of hyperactive state, may exacerbate spasticity, and precipitate
autonomic dysfunction
Indication & Doses
*Chronic severe spasticity of voluntary muscle
BY MOUTH
Child 1 month–7 years: Initially 300 micrograms/kg daily in 4 divided doses, increased
gradually at weekly intervals until satisfactory response; maintenance 0.75–2 mg/kg daily
in divided doses, review treatment if no benefit within6weeks of achieving maximum
dose; maximum 40 mg per day
Child 8–17 years: Initially 300 micrograms/kg daily in 4 divided doses, increased
gradually at weekly intervals until satisfactory response; maintenance0.75–2mg/kg daily
in divided doses, review treatment if no benefit within 6 weeks of achieving maximum
dose; maximum 60mg per day
*Severe chronic spasticity of cerebral or spinal origin unresponsive to oral antispastic
drugs (or oral therapy not tolerated) (specialist use only)
BY INTRATHECAL INJECTION
Child 4–17 years: Test dose 25–50 micrograms, to be given over at least 1minute via
catheter or lumbar puncture, then increased in steps of 25 micrograms (max. per dose 100
micrograms), not more often than every24 hours to determine initial maintenance dose;
maintenance 25–200 micrograms daily, adjusted according to response, dose-titration
phase, most often using infusion pump (implanted into chest wall or abdominal wall
tissues) to establish maintenance dose retaining some spasticity to avoid sensation of
paralysis
Side effects
Gastro-intestinal disturbances, dry mouth; hypotension, respiratory or cardiovascular
depression; sedation, drowsiness, confusion, dizziness, ataxia, hallucinations, nightmares,
headache, euphoria, insomnia, depression, anxiety, agitation, tremor; seizure; urinary
disturbances; myalgia; visual disorders; rash, hyperhidrosis; rarely taste disturbances,
abdominal pain, changes in hepatic function, paraesthesia, erectile dysfunction,
dysarthria; very rarely hypothermia
Preparation
Tab. 10mg
Baclast

9.2.2.2 Tizanidine
Cautions
elderly; monitor liver function monthly for first 4 months and in those who develop
unexplained nausea, anorexia or fatigue; concomitant administration of drugs that
prolong QT interval; avoid abrupt withdrawal
Side effects
dry mouth, nausea, gastro-intestinal disturbance, altered liver enzymes (discontinue if
persistently raised—consult product literature), hypotension, drowsiness, fatigue,
dizziness; less commonly bradycardia; also reported hepatitis, liver failure, insomnia,
hallucinations, confusion, convulsions, syncope, asthenia, blurred vision
Preparation
Tab & SR tab 2/4mg & 6mg
Ternelin
9.2.2.3 Trihexyphenidyl
Cautions
Should be used with caution in cardiovascular disease, hypertension, psychotic disorders,
pyrexia, and in those susceptible to angle-closure glaucoma. Should not be withdrawn
abruptly in children taking long-term treatment. Liable to abuse.
Indication & Doses
*Dystonia
BY MOUTH
Child 3 months–17 years: Initially 1–2mg daily in 1–2 divided doses, then increased in
steps of 1 mg every 3–7 days, dose to be adjusted according to response and side-effects;
maximum 2 mg/kg per day
Contraindication
Should be avoided in gastro-intestinal obstruction and myasthenia gravis.
Side effects
Constipation, dry mouth, nausea, vomiting, tachycardia, dizziness, confusion, euphoria,
hallucinations, impaired memory, anxiety, restlessness, urinary retention, blurred vision,
and rash. Angle-closure glaucoma occurs very rarely.
Preparation
Tab 2mg
Hexidyl
9.2.2.4 Thiocolchicoside
Preparation
Tab/cap 4mg
Muscoril

SECTION 10: DRUGS ACTING ON EYE
10.1 ANTI INFECTIVES

10.1.1 ANTI BACTERIALS
10.1.1.1 Ofloxacin
Eye Drops 0.30%
Exocin
10.1.1.2 Tobramycin
Eye Drops 0.30%
Eyebrex
10.1.1.3 Gentamicin
Eye ointment 0.10%
Optagen
10.1.1.4 Polymyxin B Sulphate + Zinc + Bacitracin

Cream 10,000:500 Units
Polyfax eye
10.1.1.5 Ciprofloxacin
Eye Drops 0.30%
Ciloxan
10.1.2 ANTI VIRALS

Acyclovir
Eye Ointment 3%
Zovirex
10.2 STEROIDS & OTHER ANTI INFLAMATORY

10.2.1 Prednisolone Acetate
Eye Drops 1%
Predforte
10.2.2 Diclofenac Sodium

Eye Drops 0.10%
Oclonac
10.3 MYDRIATICS & CYCLOPLEGICS

10.3.1 Tropicamide
Eye Drops 1%
Mydriacyl
10.3.2 Atropine Sulphate

Eye Drops 1%
Opta atropine

10.3.3 Phenylephrine
Eye Drops 10%
Mediphrine
10.3.4 Cyclopentolate
Eye Drops 1%
Cyclogyl
10.4 TREATMENT OF GLUCOMA

10.4.1 Timolol Maleate
Eye Drops 0.50%
Blotim
10.4.2 Dorzolamide HCl+Timolol maleate

Eye Drops 2%+0.5%
Synigan
10.4.3 Pilocarpine
Eye Drops 2%
Medicarpine
10.4.4 Latanoprost
Eye Drops 0.01%
Xalatan
10.5 OTHER PREPARATIONS

10.5.1 Hydroxypropyl Methylcellulose
Surgical Gel 2%
Hicel
10.5.2 Naphazoline
Eye Drops 0.01%
Eyeclear
10.5.3 Tobramycin + Dexamethasone

Eye Drops 0.3 %+0.1 %
Eyebradex
10.5.4 Pica Gel

SECTION 11: DRUGS ACTING ON EAR , NOSE &
OROPHARYNX
11.1 ANTI INFECTIVE PREPARATIONS
11.1.1 Chloramphenicol
Ear Drops 1%
Biomycine
11.1.2 Ciprofloxacin
Ear Drops 0.30%
Cipotic
11.1.3 Gentamicin
Ear Drops 0.30%
Otogen
11.1.4 Tobramycin
Ear Drops 0.3%
Tobec-D
11.1.5 Ofloxacin
Ear Drops 0.3%
Kunoxy
11.2 ANTI INFECTIVE & STERIODAL PREPARATIONS

11.2.1 Ciprofloxacin + Dexamethasone
Ear Drops 0.3%+1mg
Cipotic D
11.2.2 Gentamicin + Hydrocortisone

Ear Drops 0.3%+ 0.1%
Otogen-HC
11.2.3 Tobramycin + Dexamethasone

Ear Drop 0.3%+0.1%
Dexatob
11.3 ANTI INFECTIVE & LOCAL ANASTHETICS

Ciprofloxacin + Lignocaine
Ear Drops 0.30%
Lignocip
11.4 REMOVAL OF EAR WAX

Soda Glycerin
Ear Drops 2%
11.5 DRUGS EFFECTING ON OROPHARYNX

11.5.1 Miconazole

Indication & Doses
*Oral candidiasis
BY MOUTH USING ORAL GEL
Neonate: 1mL 2–4 times a day treatment should be continued for at least 7 days after
lesions have healed or symptoms have cleared, to be smeared around the inside of the
mouth after feeds.
Child 1–23 months: 1.25 mL 4 times a day treatment should be continued for at least 7
days after lesions have healed or symptoms have cleared, to be smeared around the inside
of the mouth after feeds
Child 2–17 years: 2.5 mL4times a day treatment should be continued for at least 7 days
after lesions have healed or symptoms have cleared, to be administered after meals, retain
near oral lesions before swallowing (dental prostheses and orthodontic appliances should
be removed at night and brushed with gel)
*Intestinal candidiasis
Child 4 months–17 years: 5 mg/kg 4times a day (max. per dose 250 mg) treatment
should be continued for at least 7days after lesions have healed or symptoms have cleared
*Prevention and treatment of oral candidiasis (dose approved for use by community
practitioner nurse prescribers)
Child 4–23 months: 1.25 mL4times a day treatment should be continued for at least
7days after lesions have healed or symptoms have cleared, to be smeared around the
inside of the mouth after feeds
Child 2–17 years: 2.5 mL 4 times a day treatment should be continued for at least7 days
after lesions have healed or symptoms have cleared, to be administered after meals, retain
near oral lesions before swallowing (dental prostheses and orthodontic appliances should
be removed at night and brushed with gel)
Preparation
Oral gel 20mg/g (20gm)
Daktarin
11.5.2 Nystatin
Indication & Doses
*Oral candidiasis
BY MOUTH
Neonate: 100000 units 4 times a day usually for 7 days, and continued for 48 hours after lesions
have resolved, to be given after feeds.
Child: 100000 units 4times a day usually for 7 days, and continued for 48 hours after lesions have
resolved
*Oral and perioral fungal infections (dose approved for use by community practitioner nurse
prescribers)
BY MOUTH
Neonate: 100000 units 4times a day usually for 7days, and continued for 48 hours after lesions have
resolved, to be given after feeds.
Child: 100000 units 4 times a day usually for 7 days, and continued for 48 hours after lesions have
resolved
Preparation
Drops 100,000 Units/ml
Nilstat

SECTION 12: DRUGS ACTING ON SKIN
12.1 ANTI INFECTIVE

12.1.1 ANTIBACTERIAL
12.1.1.1 Fusidic Acid
Cream (5 gm) 2%
Fucidin
12.1.1.2 Silver Sulphazine

cream (15 gm) 1%
Dermazin
12.1.1.3 Mupirocin
Oint. (15 gm) 2%
Bactroban
12.1.1.4 Benzoyl Peroxide

cream (40 gm) 4%
Brevoxyl
12.1.2 ANTIFUNGAL
12.1.2.1 Clotrimazole USP
cream & lotion (10 gm & 60ml) 1%
Canesten
12.1.3 ANTI PARASITES

12.1.3.1 Permethrin
Cream (30 gm) 5%
Lotrix
12.1.3.2 Dexpanthenol
Lotion 5%
Bepanthol
12.2 STEROIDS
12.2.1 Methyl Prednisolone Aceponate
Cream / Ointment (10 gm) 0.10%
Advantan
12.2.2 Fluticasone Propionate

Cream & ointment (10 gm) 0.05%
Cutivate
12.3 ANTIINFECTIVE AND STEROIDS

12.3.1 Clotrimazole + Hydrocortisone
Cream (10 gm) 1% + 1%

Hydrozole
12.3.2 Fluticasone Propionate+ Mupirocin

Ointment (10 gm) 0.05%
Cultivate M
12.3.3 Isoconazole Nitrate+Diflucortolone Valerate

Cream (10 gm) 1 x 10 g
Travocort
12.3.4 Polymyxin B Sulphate + Bacitracin Zinc

Ointment (20 gm)
Polyfax
12.3.5 Hydrocortisone + Fucidic Acid

Fucidin H
12.3.6 Betamethasone + Fucidic Acid

Fucicort
12.4 OTHER PREPARATIONS

12.4.1 Ciclopirox Olamine
Lotion (60 ml) 1.50%
Stieprox
12.4.2 Salicylic Acid + Lactic Acid

15 ml 16.7% + 16.7%

SECTION 13: IMMUNOLOGICAL PRODUCTS AND VACCINES
13.1 VACCINES AND ANTISERA

Cautions
Most children can safely receive the majority of vaccines. Vaccination may be postponed
if the child is suffering from an acute illness; however, it is not necessary to postpone
immunisation in children with minor illnesses without fever or systemic upset. See also
Predisposition to Neurological Problems, below. For individuals with bleeding disorders,
see Route of Administration, below. If alcohol or disinfectant is used for cleansing the
skin it should be allowed to evaporate before vaccination to prevent possible inactivation
of live vaccines. When 2 or more vaccines are required (and are not available as a
combined preparation), they should be given simultaneously at different sites, preferably
in a different limb; if more than one injection is to be given in the same limb, they should
be administered at least 2.5 cm apart. When 2 live vaccines cannot be given at the same
time, they should be separated by an interval of at least 4 weeks.
Contraindications
Vaccines are contra-indicated in children who have a confirmed anaphylactic reaction to
a preceding dose of a vaccine containing the same antigens or vaccine component (such
as antibacterials in viral vaccines). Hypersensitivity to egg with evidence of previous
anaphylactic reaction, contra-indicates influenza vaccine (prepared in hens’ eggs), tick-
borne encephalitis vaccine, and yellow fever vaccine. Live vaccines may be contra-
indicated temporarily in children who are immunocompromised
Side effects
Injection of a vaccine may be followed by local reactions such as pain, inflammation,
redness, and lymphangitis. An induration or sterile abscess may develop at the injection
site. Gastro-intestinal disturbances, fever, headache, irritability, loss of appetite, fatigue,
myalgia, and malaise are among the most commonly reported side-effects. Other side-
effects include influenza-like symptoms, dizziness, paraesthesia, asthenia, drowsiness,
arthralgia, rash, and lymphadenopathy. Hypersensitivity reactions, such as
bronchospasm, angioedema, urticaria, and anaphylaxis, are very rare but can be fatal
Oral vaccines, such as cholera, live poliomyelitis, rotavirus, and live typhoid, can also
cause gastro-intestinal disturbances such as nausea, omiting, abdominal pain and cramps,
and diarrheaSome vaccines (e.g. poliomyelitis) produce very few reactions, while others.
(e.g. measles, mumps and rubella) may cause a very mild form of the disease.
13.1.1 Tetanus toxoid.
Doses
0.5ml IM inj at any age
Preparation
inj 40IU/ 0.5ml
Tetavax
13.1.2 Hepatitis B vaccine

Indication & Doses
*Immunisation against hepatitis B infection
Neonate: 10 micrograms for 1 dose, then 10 micrograms after 1 month for 1 dose,
followed by 10 micrograms after 5 months for 1 dose, anterolateral thigh is preferred site

in neonates; not to be injected into the buttock (vaccine efficacy reduced), this dose
should not be given to neonates born to hepatitis B surface antigen positive mother.
Child 1 month–15 years: 10 micrograms for 1 dose, then 10 micrograms after 1 month
for 1 dose, followed by 10 micrograms after 5 months for 1 dose, deltoid muscle is
preferred site of injection in older children; anterolateral thigh is preferred site in infants
and young children; not to be injected into the buttock (vaccine efficacy reduced)
Child 16–17 years: 20 micrograms for 1 dose, then 20 micrograms after 1 month for 1
dose, followed by 20 micrograms after 5 months for 1 dose, deltoid muscle is preferred
site of injection; not to be injected into the buttock (vaccine efficacy reduced)
*Immunisation against hepatitis B infection (accelerated schedule)
Neonate: 10 micrograms every month for 3 doses, followed by 10 micrograms after 10
months for 1 dose, anterolateral thigh is preferred site in neonates; not to be injected into
the buttock (vaccine efficacy reduced), this dose should not be given to neonates born to
hepatitis B surface antigen positive mother.
Child 1 month–15 years: 10 micrograms every month for 3 doses, followed by 10
micrograms after 10 months for 1 dose, deltoid muscle is preferred site of injection in
older children; anterolateral thigh is preferred site in infants and young children; not to be
injected into the buttock (vaccine efficacy reduced)
Child 16–17 years: 20 micrograms every month for 3 doses, followed by 20 micrograms
after 10 months for 1 dose, deltoid muscle is preferred site of injection; not to be injected
into the buttock (vaccine efficacy reduced)
*Immunisation against hepatitis B infection, alternative accelerated schedule
Child 11–15 years: 20 micrograms for1 dose, followed by 20 micrograms after 6
months, this schedule is not suitable if high risk of infection between doses or if
compliance with second dose uncertain, deltoid muscle is preferred site of injection; not
to be injected into the buttock (vaccine efficacy reduced)
*Immunisation against hepatitis B infection (for neonates born to hepatitis B surface
antigen positive mother)
Neonate: 10 micrograms once a month for 3doses,
first dose to be given at birth with hepatitis B immunoglobulin injection (separate site),
followed by 10 micrograms after 10 months for 1 dose, anterolateral thigh is preferred
site in neonates; not to be injected into the buttock (vaccine efficacy reduced)
*Immunisation against hepatitis B infection (in renal insufficiency, including
haemodialysis patients)
Neonate: 10 micrograms every month for 2 doses, followed by 10 micrograms after 5
months for 1 dose, immunisation schedule and booster doses may need to be adjusted in
those with low antibody concentration, anterolateral thigh is preferred site in neonates;
not to be injected into the buttock (vaccine efficacy reduced), this dose should not be
given to neonates born to hepatitis B surface antigen positive mother.
micrograms after5 months for 1 dose, immunisation schedule and booster doses may
need to be adjusted in those with low antibody concentration, deltoid muscle is preferred
site of injection in older children; anterolateral thigh is preferred site in infants and young
children; not to be injected into the buttock (vaccine efficacy reduced)

Child 16–17 years: 40 micrograms every month for 3 doses, followed by 40 micrograms
after 4 months for 1 dose, immunisation schedule and booster doses may need to be
adjusted in those with low antibody concentration, deltoid muscle is preferred site of
injection; not to be injected into the buttock (vaccine efficacy reduced)
*Immunisation against hepatitis B infection (in renal insufficiency, including
haemodialysis patients (accelerated schedule)
Neonate: 10 micrograms every month for 3doses, followed by 10 micrograms after10
months for 1dose, immunisation schedule and booster doses may need to be adjusted in
those with low antibody concentration, anterolateral thigh is preferred site in neonates;
not to be injected into the buttock (vaccine efficacy reduced), this dose should not be
given to neonates born to hepatitis B surface antigen positive mother.
micrograms after10 months for 1 dose, immunisation schedule and booster doses may
need to be adjusted in those with low antibody concentration, deltoid muscle is preferred
site of injection in older children; anterolateral thigh is preferred site in infants and young
children; not to be injected into the buttock (vaccine efficacy reduced)
Preparation
Inj. 20mcg/ml
Engerix B
13.1.3 Rabies vaccine

Cautions
Diarrhoea or vomiting (postpone vaccination); immunosuppressed close contacts
Indication & Doses
*Pre-exposure prophylaxis
Child: 1mL for2 doses (on days 0 and 7), followed by 1 mL for 1 dose (on day 28), to be
administered in deltoid region or anterolateral thigh in infants, for those at continuous
risk, measure plasma- concentration of antirabies antibodies every 6 months and give a
booster dose if the titre is less than 0.5 units/mL, final dose may be given from day 21, if
insufficient time before travel
*Pre-exposure prophylaxis booster dose (for patients at frequent risk of exposure)
Child: 1 mL after1 year for 1 dose, to be given 1 year after primary course is completed,
then 1 mL every 3–5 years, to be administered in deltoid region or anterolateral thigh in
infants, the frequency of booster doses may alternatively be determined according to
plasma-concentration of antirabies antibodies
*Pre-exposure prophylaxis booster dose (for patients at infrequent risk of exposure)
Child: 1 mL for 1dose, to be given 10years after primary course is completed,
administered in deltoid region or anterolateral thigh in infants
*Post-exposure prophylaxis of fully immunised individuals (who have previously
received pre-exposure or post- exposure prophylaxis with cell-derived rabies vaccine)
Child (administered on expert advice): 1mL for 1dose, followed by1 mL after 3–7 days
for 1 dose, to be administered in deltoid region or anterolateral thigh in infants, rabies
immunoglobulin is not necessary

*Post-exposure treatment for unimmunised individuals (or those whose prophylaxis is
possibly incomplete)
Child (administered on expert advice): 1mL 5 times a month for 1 month, doses should
be given on days0, 3, 7, 14, and the fifth dose is given between day 28–30, to be
administered in deltoid region or anterolateral thigh in infants, depending on the level of
risk (determined by factors such as the nature of the bite and the country where it was
sustained), rabies immunoglobulin is given to unimmunised individuals on day 0 or
within 7 days of starting the course of rabies vaccine, the immunisation course can be
discontinued if it is proved that the individual was not at risk
Contraindications
Predisposition to, or history of, intussusception
Preparation
Inj. 2.5 IU/ml
Rabipur
13.1.4 Pneumococcal vaccine

Indication & Doses
*Primary immunisation against pneumococcal infection— first dose [infants born on
or after 1 January 2020]
Child 12 weeks: 0.5mL for 1 dose, anterolateral thigh is preferred site of injection in
infants under 1 year
*Primary immunisation against pneumococcal infection— booster dose [infants born
on or after 1 January 2020]
Child 1 year: 0.5 mL for 1dose, anterolateral thigh is preferred site of injection in infants
under 1 year; deltoid muscle is preferred in older children
*Primary immunisation against pneumococcal infection—in those with asplenia,
splenic dysfunction, complement disorder or severe immunocompromise [infants born
on or after 1 January 2020]
Child 6 weeks–11 months: 0.5mL for 4 doses, the first two doses to be given at least8
weeks apart, the third dose to be given on or after their first birthday, and the fourth dose
to be given at least 8 weeks later. Anterolateral thigh is preferred site of injection in
infants under 1year; deltoid muscle is preferred in children
Child 1–2 years: 0.5mL for 2 doses, the first dose to be given on or after their first
birthday and the second dose to be given at least 8 weeks later. Deltoid muscle is
preferred site of injection in children
*Immunisation against pneumococcal infection— unimmunised or partially
immunised patients [infants born on or after 1 January 2020]
Child 3–11 months: 0.5 mL for 1dose, followed by 0.5 mL for 1 dose on or after their
first birthday, given at least 4 weeks after the first dose. Anterolateral thigh is preferred
site of injection in infants under 1 year
Child 12–23 months: 0.5mL for 1 dose, deltoid muscle is preferred site of injection in
children

*Immunisation against pneumococcal infection— unimmunised or partially
immunised patients at increased risk [born on or after 1 January 2020]
Child 2–9 years: 0.5mL for 1 dose, deltoid muscle is preferred site of injection in
children
*Immunisation against pneumococcal infection— immunised patients with severe
immunocompromise [born on or after 1 January 2020]
Child 2–17 years: 0.5 mL for 1dose, deltoid muscle is preferred site of injection in
children
Preparation
Inj 0.5ml
Pravinar 13
13.2 IMMUNOGLOBULINS, INTERFERONS & ANTITOXINS

13.2.1 Diphtheria antitoxin
Indication & Doses
*localized pharyngeal Diphtheria
10,000 to 20,000 units as single dose
*Toxic Diphtheria
40,000 to 50,000 units
*1st Degree Toxic Diphtheria
50,000 to 70,000 units
*2nd Degree Toxic Diphtheria
60,000 to 80,000 units
*3rd Degree Toxic Diphtheria
100,000 to 120,000 units
Preparation
Inj. 10000 units
13.2.2 Intravenous Immune Globulin

Cautions
Hypo- or agammaglobulinaemia with or without IgA deficiency; interference with live
virus vaccines. Thrombophilic disorders, or risk factors for arterial or venous
thromboembolic events; obesity; ensure adequate hydration, renal insufficiency
Indication & Doses
*GBS
2gm/kg given in 2, 4 or 5 days
Contraindications
Patients with selective IgA deficiency who have known antibody against IgA
Side effects
nausea, diarrhoea, chills, fever, headache, dizziness, arthralgia, myalgia, muscle spasms,
low back pain; rarely hypotension, anaphylaxis, cutaneous skin reactions, aseptic
meningitis, acute renal failure; also reported with intravenous use, injection site reactions,
abdominal pain and distension, blood pressure fluctuations, haemolytic anaemia,
thromboembolic events including myocardial infarction, stroke, pulmonary embolism,
and deep vein thrombosis

Preparation
Vial 10ml & 2.5gms/50ml
Gama Ras & Pentaglobin
13.2.3 Tetnus Immunoglobulins (TIG)

Cautions
IgA deficiency; interference with live virus vaccines
Indications & Doses
*Post-exposure prophylaxis
Child: Initially 250 units, then increased to 500 units, dose is only increased if more than
24 hours have elapsed or there is risk of heavy contamination or following burns
*Treatment of tetanus infection
Child: 150 units/kg, dose may be given over multiple sites
Contraindications
Injection site swelling and pain; rarely anaphylaxis; buccal ulceration; glossitis, chest
tightness, dyspnoea, tremor, dizziness, arthralgia, and facial oedema also reported
Preparation
Inj 250 units
Tetagum P
13.2.4 Rhesus antibody (Anti-D)

Inj 300mcg/2ml
Winrho
13.2.5 Hepatitis B Immunoglobulins

Cautions
IgA deficiency; interference with live virus vaccines
Indications & Doses
*Prophylaxis against hepatitis B infection
Neonate: 200 units, dose to be administered as soon as possible after exposure; ideally
within 12–48 hours, but no later than 7 days after exposure.
Child 1 month–4 years: 200 units, dose to be administered as soon as possible after
exposure; ideally within 12–48 hours, but no later than 7 days after exposure
Child 5–9 years: 300 units, dose to be administered as soon as possible after exposure;
ideally within 12–48 hours, but no later than 7 days after exposure
Child 10–17 years: 500 units, dose to be administered as soon as possible after exposure;
ideally within 12–48 hours, but no later than 7 days after exposure
*Prevention of transmitted infection at birth
Neonate: 200 units, dose to be administered as soon as possible after birth; for full details
consult Immunisation against Infectious Disease
Neonate: (consult product literature).

*Prophylaxis against hepatitis B infection, after exposure to hepatitis B virus-
contaminated material
Child: Dose to be administered as soon as possible after exposure, but no later than 72
hours (consult product literature)
Side effects
Injection site swelling and pain, arthralgia; rarely anaphylaxis chest tightness, dyspnoea;
also reported tremor, dizziness, facial oedema, glossitis, and buccal ulceration; for side-
effects associated with intravenous immunoglobulins,
Preparation
Inj. 2ml
Hepatact
13.2.6 Rabies Immunoglobulins

Indication & Doses
*Post-exposure prophylaxis against rabies infection
BY LOCAL INFILTRATION, OR BY INTRAMUSCULAR INJECTION
Child: 20 units/kg, dose administered by infiltration in and around the cleansed wound; if
the wound not visible or healed or if infiltration of whole volume not possible, give
remainder by intramuscular injection into anterolateral thigh (remote from vaccination
site)
Preparation
Inj
Berirab-P

SECTION 14: DRUGS USED IN ANAESTHESIA
14.1 GENERAL ANAESTHESIA

14.1.1 GENERAL ANAESTHESTIC (INJECTABLES)
14.1.1.1 Propofol
Cautions
cardiac impairment; respiratory impairment; hypovolaemia; epilepsy; hypotension; raised
intracranial pressure; monitor blood lipid concentration if risk of fat overload or if
sedation longer than 3 days;
Indication & Doses
*Induction of anaesthesia using 0.5% or1% injection
Child 1 month–16 years: Usual dose 2.5–4 mg/kg, dose adjusted according to age,
body-weight and response
Child 17 years: Usual dose 1.5–2.5mg/kg, to be administered at a rate of 20–40 mg
every 10 seconds until response
*Induction of anaesthesia using 2% injection
Child 3–16 years: Usual dose 2.5–4mg/kg, dose adjusted according to age, body-weight
and response
Child 17 years: Usual dose 1.5–2.5mg/kg, to be administered at a rate of 20–40mg
every10 seconds until response
*Maintenance of anaesthesia using 1% injection
Child 1 month–16 years: Usual dose 9–15 mg/kg/hour, dose adjusted according to age,
body-weight and response
Child 17 years: Usual dose 4–12 mg/kg/hour, adjusted according to response
*Maintenance of anaesthesia using 2% injection
Child 3–16 years: Usual dose 9–15 mg/kg/hour, dose adjusted according to age, body-
weight and response
Child 17 years: Usual dose 4–12 mg/kg/hour, adjusted according to response
*Sedation of ventilated patients in intensive care using 1% or 2% injection
Child 16–17 years: Usual dose 0.3–4 mg/kg/hour, adjusted according to response
*Induction of sedation for surgical and diagnostic procedures using 0.5% or 1%
injection
Child 1 month–16 years: Initially 1–2 mg/kg, dose and rate of administration adjusted
according to desired level of sedation and response
Child 17 years: Initially 0.5–1 mg/kg, to be administered over 1–5 minutes, dose and
rate of administration adjusted according to desired level of sedation and response
*Maintenance of sedation for surgical and diagnostic procedures using 0.5% injection
Child 17 years: Initially 1.5–4.5 mg/kg/hour, dose and rate of administration adjusted
according to desired level of sedation and response, followed by (by slow intravenous
injection) 10–20 mg, (if rapid increase in sedation required)

*Maintenance of sedation for surgical and diagnostic procedures using 1% injection
Child 1 month–16 years: Usual dose 1.5–9 mg/kg/hour, dose and rate of administration
adjusted according to desired level of sedation and response, followed by (by slow
intravenous injection) up to 1mg/kg, (if rapid increase in sedation required)
Child 17 years: Initially 1.5–4.5 mg/kg/hour, dose and rate of administration adjusted
according to desired level of sedation and response, followed by intravenous injection)
10–20 mg, (if rapid increase in sedation required)
*Maintenance of sedation for surgical and diagnostic procedures using2% injection
Child 3–16 years: Usual dose 1.5–9mg/kg/hour, dose and rate of administration adjusted
according to desired level of sedation and response
Child 17 years: Initially 1.5–4.5mg/kg/hour, dose and rate of administration adjusted
according to desired level of sedation and response, followed by (by slow intravenous
injection) 10–20 mg, using 0.5% or1% injection (if rapid increase in sedation required)
Side effects
hypotension, tachycardia, flushing; transient apnoea, hyperventilation, coughing, and
hiccup during induction; headache; less commonly thrombosis, phlebitis; rarely
arrhythmia, headache, vertigo, shivering, euphoria; very rarely pancreatitis, pulmonary
oedema, sexual disinhibition, and discoloration of urine; serious and sometimes fatal
side-effects reported with prolonged infusion of doses exceeding 5 mg/kg/hour, including
metabolic acidosis, rhabdomyolysis, hyperkalaemia, and cardiac failure, dystonia and
dyskinesia also reported
Preparation
Inj. 10mg/ml
Diprivan
14.1.2 INHALATION ANAESTHESIA

14.1.2.1 Sevoflurane
Indication & Doses
*Induction of anaesthesia (in oxygen or nitrous oxide– oxygen)
BY INHALATION
Neonate: Up to 4%, adjusted according to response, to be administered using specifically
calibrated vaporiser.
Child: Initially 0.5–1%, then increased to up to 8%, increased gradually, according to
response, to be administered using specifically calibrated vaporiser
*Maintenance of anaesthesia (in oxygen or nitrous oxide– oxygen)
BY INHALATION
Neonate: 0.5–2%, adjusted according to response, to be administered using specifically
calibrated vaporiser.
Child: 0.5–3 %, adjusted according to response, to be administered using speci
Preparation
Solution 250ml
Sevorane
14.1.2.2 Isoflurane
Indication & Doses

*Induction of anaesthesia (in oxygen or nitrous oxide– oxygen) (but indication not
recommended in infants and children of all ages)
BY INHALATION
Neonate: Initially 0.5 %, increased to 3%, adjusted according to response, administered
using specifically calibrated vaporiser.
Child: Initially 0.5%, increased to 3 %, adjusted according to response, administered
using specifically calibrated vaporiser
*Maintenance of anaesthesia (in nitrous oxide–oxygen)
BY INHALATION
Neonate: 1–2.5 %, to be administered using specifically calibrated vaporiser; an
additional 0.5–1% may be required when given with oxygen alone.
Child: 1–2.5%, to be administered using specifically calibrated vaporiser; an additional
0.5–1% may be required when given with oxygen alone
*Maintenance of anaesthesia in caesarean section (in nitrous oxide–oxygen)
BY INHALATION
Child: 0.5–0.75 %, to be
Preparation
Solution 100ml
Forane
14.2 Anasthesia Adjuvants

14.2.1 ANTI MUSCRANIC DRUGS
Cautions
Should be used with caution in children (especially children with Down’s syndrome) due
to increased risk of side-effects; they should also be used with caution in autonomic
neuropathy, hypertension, conditions characterised by tachycardia (including
hyperthyroidism, cardiac insufficiency, cardiac surgery), pyrexia, and in children
susceptible to angle-closure glaucoma. Antimuscarinics are not used in children with
gastro-oesophageal reflux disease, diarrhoea or ulcerative colitis.
Contraindications
Contra-indicated in myasthenia gravis (but may be used to decrease muscarinic side-
effects of anticholinesterases, paralytic ileus, pyloric stenosis, and toxic megacolon.
Side effects
Constipation, transient bradycardia (followed by tachycardia, palpitation and
arrhythmias), reduced bronchial secretions, urinary urgency and retention, dilatation of
the pupils with loss of accommodation, photophobia, dry mouth, flushing and dryness of
the skin. Side-effects that occur occasionally include nausea, vomiting, and giddiness;
very rarely, angle closure glaucoma may occur.
14.2.1.1 Atropine
Indication & Doses
*Bradycardia due to acute massive overdosage of beta- blockers
Child: 40 micrograms/kg (max. per dose 3mg)
*Treatment of poisoning by organophosphorus insecticide or nerve agent (in
combination with pralidoxime chloride)

Child: 20 micrograms/kg every 5–10 minutes (max. per dose 2 mg) until the skin
becomes flushed and dry, the pupils dilate, and bradycardia is abolished, frequency of
administration dependent on the severity of poisoning
*Premedication
Neonate: 10 micrograms/kg, to be administered immediately before induction of
anaesthesia.
Child 1 month–11 years: 20 micrograms/kg, to be administered immediately before
induction of anaesthesia (minimum 100 micrograms, max. 600 micrograms)
Child 12–17 years: 300–600 micrograms, to be administered immediately before
induction of anaesthesia
Neonate: 10 micrograms/kg, to be administered 30–60 minutes before induction of
anaesthesia.
Child 1 month–11 years: 10–30 micrograms/kg, to be administered30–60 minutes
before induction of anaesthesia (minimum 100 micrograms, max. 600 micrograms)
Child 12–17 years: 300–600 micrograms, to be administered 30–60 minutes before
induction of anaesthesia
BY MOUTH
Neonate: 20–40micrograms/kg, to be administered 1–2 hours before induction of
anaesthesia.
Child: 20–40 micrograms/kg (max. per dose 900 micrograms), to be administered 1–2
hours before induction of anaesthesia
*Intra-operative bradycardia
Neonate: 10–20micrograms/kg.
Child 1 month–11 years: 10–20 micrograms/kg
Child 12–17 years: 300–600 micrograms, larger doses may be used in emergencies
*Control of muscarinic side-effects of neostigmine in reversal of competitive
neuromuscular block
Neonate: 20 micrograms/kg.
Child 1 month–11 years: 20 micrograms/kg (max. per dose 1.2mg)
Child 12–17 years: 0.6–1.2 mg
Preparation
Inj 1mg/ml
Elitopine
14.2.1.2 Glycopyrolate
Indication & Doses
*Premedication at induction
Child 1 month–11 years: 4–8 micrograms/kg (max. per dose 200 micrograms)
Child 12–17 years: 200–400 micrograms, alternatively 4–5 micrograms/kg (max. per
dose 400 micrograms)
*Intra-operative bradycardia

Neonate: 10 micrograms/kg, repeated if necessary.
Child: 4–8 micrograms/kg (max. per dose 200 micrograms), repeated if necessary
*Control of muscarinic side-effects of neostigmine in reversal of non-depolarising
neuromuscular block
Child 1 month–11 years: 10 micrograms/kg (max. per dose 500 micrograms)
Child 12–17 years: 10–15micrograms/kg, alternatively, 200 micrograms per 1mg of
neostigmine to be administered
*Control of upper airways secretion, Hypersalivation
BY MOUTH
Child: 40–100 micrograms/kg 3–4 times a day (max. per dose 2mg), adjusted according
to response, dose to be administered using tablets or injection solution,
Child 1 month–11 years: 12–40 micrograms/kg (max. per dose 1.2mg) over 24 hours
Child 12–17 years: 0.6–1.2mg/24 hours
BY SUBCUTANEOUS INJECTION, OR BY INTRAMUSCULAR INJECTION, OR
Child 1 month–11 years: 4–10 micrograms/kg 4 times a day (max. per dose 200
micrograms) as required
Child 12–17 years: 200 micrograms every 4 hours as required
Preparation
Inj 0.2mg/ml
Pyrolate
14.2.1.3 Glycopyrolate & Neo Stigmine

Preparation
Inj 0.5/2.5mg
Neopyrolate
14.2.2 NEUROMUSCULAR BLOCKINH DRUGS

14.2.2.1 Atracurium
Cautions
Allergic cross-reactivity between neuromuscular blocking drugs has been reported;
caution is advised in cases of hypersensitivity to these drugs. Their activity is prolonged
in children with myasthenia gravis and in hypothermia, therefore lower doses are
required. Non-depolarising neuromuscular blocking drugs should\be used with great care
in those with other neuromuscular disorders and those with fluid and electrolyte
disturbances, as response in these children is unpredictable.Resistance may develop in
children with burns who may require increased doses; low plasma cholinesterase activity
in these children requires dose titration for mivacurium. The rate of administration of
neuromuscular blocking drugs should be reduced in children with cardiovascular disease.
Inddication & Doses
*Neuromuscular blockade (short to intermediate duration) for surgery
Neonate: Initially300–500 micrograms/kg, followed by (by IV injection) 100–200
micrograms/kg, repeated if necessary, alternatively (by IV infusion) 300–400 mcg/kg/hr

adjusted according to response.
Child: Initially 300–600 micrograms/kg, then (by intravenous injection) 100–200
micrograms/kg, repeated if necessary, alternatively (by intravenous injection) initially
300–600 micrograms/kg, followed by (by intravenous infusion) 300–600
*Neuromuscular blockade during intensive care
Neonate: Initially 300–500 micrograms/kg, followed by (by intravenous injection) 100–
200 micrograms/kg, repeated if necessary, alternatively (by intravenous infusion) 300–
400 micrograms/kg/hour, adjusted according to response, higher doses may be necessary.
Child: Initially 300–600 micrograms/kg, initial dose is optional, then (by intravenous
infusion) 270–1770 micrograms/kg/hour; (by intravenous infusion) usual dose 650–780
micrograms/kg/hour
Side effects
Associated with histamine release, which can cause skin flushing, hypotension,
tachycardia, bronchospasm, and very rarely, anaphylactoid reactions.
Preparation
Inj 25mg/2.5ml
Tracrium
14.2.2.2 Cis-Atracurium
Indication & Doses
*Neuromuscular blockade (intermediate duration) during surgery
Child 1 month–1 year: Initially150 micrograms/kg, then (by intravenous injection) 30
micrograms/kg every 20minutes as required
Child 2–11 years: Initially150 micrograms/kg, 80–100micrograms/kg if not for
intubation, then (by intravenous injection) 20 micrograms/kg every 10minutes as
required, alternatively (by intravenous injection) initially 150 micrograms/kg, followed
by (by intravenous infusion)180 micrograms/kg/hour, (by intravenous infusion) reduced
to 60–120 micrograms/kg/hour, adjusted according to response
Child 12–17 years: Initially 150 micrograms/kg, then (by intravenous injection) 30
micrograms/kg every 20minutes as required, alternatively (by intravenous injection)
initially 150 micrograms/kg, followed by (by intravenous infusion) 180
micrograms/kg/hour, (by intravenous infusion) reduced to 60–120 micrograms/kg/hour,
adjusted according to response
Preparation
Inj 2mg/ml
Cis-Curan
14.2.2.3 Rocurionium
Cautions

Indication & Doses
*Neuromuscular blockade (intermediate duration) during surgery
Neonate: Initially 600 micrograms/kg, then (by intravenous injection) 150
micrograms/kg, repeated if necessary, alternatively (by intravenous infusion) 300–600
micrograms/kg/hour, adjusted according to response.
Child: Initially 600 micrograms/kg, then (by intravenous injection) 150 micrograms/kg,
repeated if necessary, alternatively (by intravenous infusion) 300–600
*Assisted ventilation in intensive care
Child: Initially 600 micrograms/kg, initial dose is optional, then (by intravenous
infusion) 300–600 micrograms/kg/hour for first hour, then (by intravenous infusion),
adjusted according to response
Side effects
tachycardia, bronchospasm, and very rarely, anaphylactic reactions.
Preparation
Inj 50mg
Rescuron
14.2.2.4 Pancronium
Cautions
Indication & Doses
*Neuromuscular blockade (long duration) during surgery
Neonate: Initially 100 micrograms/kg, then 50 micrograms/kg, repeated if necessary.
Child: Initially 100 micrograms/kg, then 20 micrograms/kg, repeated if necessary
DOSES AT EXTREMES OF BODY-WEIGHT
To avoid excessive dosage in obese patients, dose should be calculated on the basis of
ideal body-weight
Side effects
tachycardia, bronchospasm, and very rarely, anaphylactic reactions.
Preparation

Inj 4mg
Pancron
14.2.2.5 Suxamethonium
Cautions
Hypersensitivity to other neuromuscular blocking drugs; patients with cardiac, respiratory
or neuromuscular disease; raised intraocular pressure (avoid in penetrating eye injury);
severe sepsis (risk of hyperkalaemia)
Indication & Doses
*Neuromuscular blockade (short duration) during surgery
Neonate: 2 mg/kg, produces 5–10 minutes neuromuscular blockade.
Child 1–11 months: 2mg/kg
Child 1–17 years: 1 mg/kg
Neonate: Up to 4mg/kg, produces 10–30 minutes neuromuscular blockade.
Child 1–11 months: Up to 5mg/kg
Child 1–11 years: Up to 4 mg/kg (max. per dose 150 mg)
Contraindications
Family history of malignant hyperthermia, hyperkalaemia; major trauma, severe burns,
neurological disease involving acute wasting of major muscle, prolonged
immobilisation—risk of hyperkalaemia; personal or family history of congenital
myotonic disease, Duchenne muscular dystrophy; low plasma-cholinesterase activity
Side effects
increased gastric pressure; hyperkalaemia; postoperative muscle pain, myoglobinuria,
myoglobinaemia; increased intraocular pressure; flushing, rash; rarely arrhythmias,
cardiac arrest; bronchospasm, apnoea, prolonged respiratory depression; limited jaw
mobility; very rarely anaphylactic reactions, malignant hyperthermia; also reported
hypertension, hypotension, rhabdomyolysis
Preparation
Inj 50mg/ml
S-Choline
14.2.3 PRE OPERATIVE ANALGESICS

Ketorolac
NSAIDs should be used with caution in children with a history of hypersensitivity to any
NSAID—which includes those in whom attacks of asthma, angioedema, urticaria or
rhinitis have been precipitated by any NSAID. NSAIDs should also be used with caution
in coagulation defects. Caution may also be required in children with allergic disorders,
and also in children with connective-tissue disorders. In children with cardiac
impairment, caution is required since NSAIDs may impair renal function. All NSAIDs
are contra-indicated in severe heart failure. Non-selective NSAIDs should be used with
caution in uncontrolled hypertension, heart failure, ischaemic heart disease, peripheral
arterial disease, cerebrovascular disease, and when used long term in children with risk
factors for cardiovascular events. The selective inhibitor of cyclo-oxygenase-2,
etoricoxib, is contra-indicated in ischaemic heart disease, cerebrovascular disease,

peripheral arterial disease, and mild to severe heart failure. Etoricoxib should be used
with caution in children with a history of cardiac failure, left ventricular dysfunction,
hypertension, in children with oedema for any other reason, and in children with risk
factors for cardiovascular events. NSAIDs are generally contra-indicated if there is active
or previous gastro-intestinal ulceration or bleeding; however, some children may require
NSAIDs for effective relief of pain and stiffness. For advice on the prophylaxis and
treatment of NSAID-associated gastro- intestinal ulcers,
Indication & Doses
*Short-term management of moderate to severe acute postoperative pain only
Child 16–17 years (body-weight up to 50 kg): Initially 10 mg, then 10–30 mg every 4–
6 hours as required for maximum duration of treatment 2 days, frequency may be
increased to up to every2 hours during initial postoperative period; maximum 60 mg per
day
Child 16–17 years (body-weight 50 kg and above): Initially 10 mg, then 10–30 mg
every 4–6 hours as required for maximum duration of treatment 2 days, frequency may
be increased to up to every2 hours during initial postoperative period; maximum 90 mg
per day
Child 6 months–15 years: Initially 0.5–1mg/kg (max. per dose 15 mg), then 500
micrograms/kg every6hours (max. per dose15 mg) as required for maximum duration of
treatment 2 days; maximum 60 mg per day
Side effects
The side-effects of NSAIDs vary in severity and frequency. Gastro-intestinal
disturbances including discomfort, nausea, diarrhoea, and occasionally bleeding and
ulceration may occur. Other side-effects include hypersensitivity reactions (particularly
rashes, angioedema, and bronchospasm), headache, dizziness, nervousness, depression,
drowsiness, and insomnia, vertigo, and hearing disturbances such as tinnitus,
photosensitivity, and haematuria. Blood disorders have also occurred. Fluid retention
may occur (rarely precipitating congestive heart failure); blood pressure may be raised.
Renal failure may be provoked by NSAIDs, especially in patients with pre-existing renal
impairment. Rarely, papillary necrosis or interstitial fibrosis associated with NSAIDs can
lead to renal failure. Hepatic damage, alveolitis, pulmonary eosinophilia, pancreatitis,
visual disturbances, Stevens- Johnson syndrome, and toxic epidermal necrolysis are other
rare side-effects. Induction of or exacerbation of colitis or Crohn’s disease has been
reported. Aseptic meningitis has been reported rarely with NSAIDs— children with
connective tissue disorders such as systemic lupus erythematosus may be especially
susceptible.
Preparation
Inj. 30mg/ml
Toradol
14.2.4 PRE OPERATIVE SEDATION

14.2.4.1 Ketamine
Cautions
Dehydration; hypertension; respiratory tract infection; increased cerebrospinal fluid
pressure; predisposition to seizures, hallucinations, or nightmares; psychotic disorders;

Head injury or intracranial mass lesions; thyroid dysfunction; raised intraocular pressure
Indication & Doses
*Induction and maintenance of anaesthesia for short procedures
Neonate: 4mg/kg, adjusted according to response, a dose of 4mg/kg usually produces15
minutes of surgical anaesthesia.
Child: 4–13 mg/kg, adjusted according to response, a dose of 4mg/kg sufficient for some
diagnostic procedures, a dose of 10mg/kg usually produces 12–25 minutes of surgical
anaesthesia
Neonate: 1–2 mg/kg, adjusted according to response, to be given over at least 60
seconds, a dose of 1–2mg/kg produces5–10 minutes of surgical anaesthesia.
Child 1 month–11 years: 1–2 mg/kg, adjusted according to response, to be given over at
least 60 seconds, a dose of 1–2 mg/kg produces 5–10 minutes of surgical anaesthesia
Child 12–17 years: 1–4.5 mg/kg, adjusted according to response, to be given over at
least 60 seconds, a dose of 2mg/kg usually produces 5–10 minutes of surgical anaesthesia
*Induction and maintenance of anaesthesia for long procedures
Neonate: Initially 0.5–2 mg/kg, followed by (by continuous intravenous infusion) 8
micrograms /kg /minute, adjusted according to response, doses up to 30 micrograms /
kg/minute may be used to produce deep anaesthesia.
Child: Initially 0.5–2mg/kg, followed by (by continuous intravenous infusion) 10–45
micrograms/kg/minute, adjusted according to response
*Sedation prior to invasive or painful procedures
Child: 1–2mg/kg for 1dose
Contraindications
Hypertension, pre-eclampsia or eclampsia, severe cardiac disease, stroke; raised
intracranial pressure; head trauma; acute porphyria
Side effects
Vomiting, tachycardia, hypertension, arrhythmias, hypotension, bradycardia,
hypersalivation, laryngospasm, anxiety, insomnia, diplopia, nystagmus, raised intra-
ocular pressure; rashes, apnoea, and respiratory depression also reported
Preparation
Inj. 50mg/ml, 10ml
Ketlar
14.2.4.2 Dexmedetomidine
Preparation
Injection
Percedex
14.2 LOCAL ANAESTHETICS.

Cautions
Local anaesthetics should be administered with caution in children, especially if
debilitated (consider dose reduction) or those with impaired cardiac conduction,
cardiovascular disease, hypovolaemia, shock, impaired respiratory function, epilepsy, or
myasthenia gravis.

Contraindications
Local anaesthetics should not be injected into inflamed or infected tissues nor should they
be applied to damaged skin. In such circumstances, increased absorption into the blood
increases the possibility of systemic sideeffects, and the local anaesthetic effect may also
be reduced by altered local pH. See also Use of Vasoconstrictors, p. 649.
Local anaesthetic preparations containing preservatives should not be used for caudal,
epidural, or spinal block, or for intravenous regional anaesthesia (Bier’s block). Local
anaesthetics can cause ototoxicity and should not be applied to the middle ear. They are
also contraindicated in children with complete heart block.
Side effects
A single application of a topical lidocaine preparation does not generally cause systemic
side-effects. Toxic effects after administration of local anaesthetics are a result of
excessively high plasma concentrations; severe toxicity usually results from inadvertent
intravascular injection or too rapid injection. The systemic toxicity of local anaesthetics
mainly involves the central nervous and cardiovascular systems. CNS effects include a
feeling of inebriation and lightheadedness followed by drowsiness, numbness of the
tongue and perioral region, restlessness, paraesthesia (including sensations of hot and
cold), dizziness, blurred vision, nausea and vomiting, muscle twitching, tremors, and
convulsions. Transient excitation may also occur, followed by depression with
drowsiness, respiratory failure, unconsciousness, and coma. Effects on the cardiovascular
system include myocardial depression and peripheral vasodilatation resulting in
hypotension and bradycardia; arrhythmias and cardiac arrest can occur. Hypersensitivity
reactions occur mainly with the estertype local anaesthetics, such as tetracaine; reactions
are less frequent with the amide types, such as articaine, bupivacaine, levobupivacaine,
lidocaine, mepivacaine, prilocaine, and ropivacaine. Cross-sensitivity reactions may be
avoided by using the alternative chemical type.
14.2.1 Lignocaine
Cautions
Hypertension; topical preparations can damage plastic cuffs of endotracheal tubes
Indication & Doses
* Infiltration anaesthesia
BY LOCAL INFILTRATION
Neonate: Up to 3 mg/kg, dose to be given according to patient’s weight and nature of
procedure, dose may be repeated not more often than every 4 hours, 3mg/kg equivalent to
0.3mL/kg of 1% solution.
Child 1 month–11 years: Up to 3mg/kg, dose to be given according to patient’s weight
and nature of procedure, dose may be repeated not more often than every 4 hours,
3mg/kg equivalent to 0.3mL/kg of 1% solution
Child 12–17 years: (max. per dose 200 mg), dose to be given according to child’s weight
and nature of procedure, dose may be repeated not more often than every 4 hours
*When used by local infiltration to avoid excessive dosage in obese patients, weight-
based doses for non-emergency indications may need to be calculated on the basis of
ideal body-weight. Intravenous regional anaesthesia and nerve block
BY REGIONAL ADMINISTRATION
Child: Seek expert advice Dental anaesthesia
BY REGIONAL ADMINISTRATION
Child: Seek expert advice

*Pain relief (in anal fissures, haemorrhoids, pruritus ani, pruritus vulvae, herpes
zoster, or herpes labialis), Lubricant in cystoscopy|Lubricant in proctoscopy
TO THE SKIN USING OINTMENT
Child: Apply 1–2mL as required, avoid long-term use
Side effects
Methaemoglobinaemia, nystagmus, rash; hypoglycaemia also reported following
intrathecal or extradural administration
Preparation
Inj, solution & gel 2% (10ml), 4%(50ml), 2%
Xylocain
14.2.2 Bupivacaine
Cautions
Myocardial depression may be more severe and more resistant to treatment;
cardiovascular disease; hypertension; hypotension; cerebral atheroma;
Preparation
Inj. 5mg/ml
Abocain
14.2.3 Ropivacaine
Preparation
Inj 50mg/10ml
Ropicain
14.2.4 Lignocaine + Epinephrine

Preparation
inj. 2% + 1:10,0000 10ml
Xylocain with Adrenaline

SECTION 15: CONTRAST MEDIA
15.1 Ionic
15.1.1 Meglumine Diatrizoate
Infusion & oral solution 76% 20ml & 100ml
Urografin / Gastrografin
15.1.2 Dimeglumine Gadopentetate

Inj
Magnevist
15.1.3 Gadobutrol
Vial 604.72mg
Gadovist
15.2 Non Ionic

15.2.1 Iohexol
Vial 300mg, 50ml
Omnipaque
15.2.2 Iopamidol
Vial 370mg/30ml, 50ml
Iopamiro
15.2.3 Iopromide
Vial 300mg/ 50ml
Ultravisit

SECTION 16: ANTIDOTES & OTHER SUBSTANCES USED IN
POISONING
16.1 FOR GASTRIC LAVAGE

0.9% Sodium Chloride (Normal saline)
16.2 PREVENTION OF ABSORPTION AND ACTIVE ELIMINATION OF

DRUGS/ CHEMICALS
16.2.1 ADSORBENTS
Charcoal activated
Cautions
Drowsy or comatose child (risk of aspiration— ensure airway protected); reduced
gastrointestinal motility (risk of obstruction); not for poisoning with petroleum distillates,
corrosive substances, alcohols, Malathion, and metal salts including iron and lithium salts
Indication & Doses
*Reduction of absorption of poisons in the gastro-intestinal system
BY MOUTH
Neonate: 1g/kg.
Child 1 month–11 years: 1g/kg (max. per dose 50g)
Child 12–17 years: 50 g
*Active elimination of poisons
BY MOUTH
Neonate: 1g/kg every 4 hours, dose may be reduced and the frequency increased if not
tolerated, reduced dose may compromise effi cacy.
Child 1 month–11 years: 1g/kg every 4 hours (max. per dose 50 g), dose may be
reduced and the frequency increased if not tolerated, reduced dose may compromise
efficacy
Child 12–17 years: Initially 50 g, then 50g every4hours, reduced if not tolerated to 25 g
every 2 hours, alternatively 12.5 g every 1 hour, reduced dose may compromise efficacy
Side effects
Black stools
Preparation
Powder Sachet
16.3 SPECIFIC ANTIDOTES

16.3.1 FOR NSAIDs (PARACETAMOL)
Acetyl cysteine
Cautions
Asthma (see Side-effects below, but do not delay acetylcysteine treatment);
acetylcysteine may mildly increase INR and prothrombin time
Indication & doses
*Paracetamol overdosage
Neonate: Initially150 mg/kg over 1 hour, dose to be administered in 3mL/kg glucose 5%,
followed by 50 mg/kg over 4 hours, dose to be administered in 7mL/kg glucose 5%, then

100 mg/kg over 16 hours, dose to be administered in 14mL/kg glucose 5%.
Child (body-weight up to 20 kg): Initially 150 mg/kg over 1 hour, dose to be
administered in 3mL/kg glucose5%, followed by 50 mg/kg over 4 hours, dose to be
administered in 7mL/kg glucose 5%, then 100 mg/kg over 16 hours, dose to be
administered in 14mL/kg glucose 5%
Child (body-weight 20–39 kg): Initially 150 mg/kg over 1 hour, dose to be administered
in 100mL glucose 5%, followed by 50 mg/kg over 4 hours, dose to be administered in
250 mL glucose 5%, then 100 mg/kg over 16 hours, dose to be administered in 500mL
glucose 5%
Child (body-weight 40 kg and above): 150 mg/kg over 1 hour, dose to be administered
in 200mL Glucose Intravenous Infusion 5%, then 50 mg/kg over 4 hours, to be started
immediately after completion offirst infusion, dose to be administered in 500mL Glucose
Intravenous Infusion5%, then 100 mg/kg over 16 hours, to be started immediately after
completion of second infusion, dose to be administered in 1 litre Glucose Intravenous
Infusion5%
*Meconium ileus
BY MOUTH
Neonate: 200–400 mg up to 3times a day if required.
*Treatment of distal intestinal obstructive syndrome
BY MOUTH
Child 1 month–1 year: 0.4–3 g as a single dose
Child 2–6 years: 2–3g as a single dose
Child 7–17 years: 4–6 g as a single dose
*Prevention of distal intestinal obstruction syndrome
BY MOUTH
Child 1 month–1 year: 100–200 mg3 times a day
Child 2–11 years: 200 mg3 times a day
Child 12–17 years: 200–400 mg 3 times a day
Side effects
Hypersensitivity-like reactions managed by reducing infusion rate or suspending until
reaction settled (rash also managed by giving antihistamine; acute asthma managed by
giving nebulised shortacting beta2 agonist)—contact the National Poisons Information
Service if reaction severe; mild increase in INR and prothrombin time
Preparation
Sachet
Mucolator
16.3.2 FOR ANALGESICS (OPIODS)

Naloxone
Cautions
Cardiovascular disease or those receiving cardiotoxic drugs (serious adverse
cardiovascular effects reported); maternal physical dependence on opioids (may
precipitate withdrawal in newborn); pain has short duration of action
Indication & Doses
*Overdosage with opioids
Neonate: Initially 100 micrograms/kg, if no response, repeat at intervals of 1 minute to a

max. of 2mg, then review diagnosis; further doses may be required if respiratory function
deteriorates, doses can be given by subcutaneous or intramuscular routes but only if
intravenous route is not feasible; intravenous administration has more rapid onset of
action.
Child 1 month–11 years: Initially 100 micrograms/kg (max. per dose 2mg), if no
response, repeat at intervals of 1minute to a max. of 2mg, then review diagnosis; further
doses may be required if respiratory function deteriorates, doses can be given by
subcutaneous or intramuscular routes but only if intravenous route is not feasible;
intravenous administration has more rapid onset of action
Child 12–17 years: Initially 400 micrograms, then 800 micrograms for up to 2 doses at
1minute intervals if no response to preceding dose, then increased to 2mg for 1 dose if
still no response (4mg dose may be required in seriously poisoned patients), then review
diagnosis; further doses may be required if respiratory function deteriorates, doses can be
given by subcutaneous or intramuscular routes but only if intravenous route is not
feasible; intravenous administration has more rapid onset of action
Neonate: Using an infusion pump, adjust rate according to response (initially, rate may
be set at 60% of the initial resuscitative intravenous injection dose per hour). The initial
resuscitative intravenousinjection dose is that which maintained satisfactory ventilation
for at least 15 minutes.
Child: Using an infusion pump, adjust rate according to response (initially, rate may be
set at 60% of the initial resuscitative intravenous injection dose per hour). The initial
resuscitativeintravenousinjection dose is that which maintained satisfactory ventilation
for at least 15 minutes
BY INTRANASAL ADMINISTRATION
Child 14–17 years: 1.8 mg, administered into one nostril, if no response, give a second
dose after 2–3 minutes. If the patient responds to the first dose then relapses into
respiratory depression, give the second dose immediately. Further doses should be
administered into alternate nostrils
*Overdosage with opioids in a non-medical setting
BY INTRANASAL ADMINISTRATION
Child 14–17 years: 1.8 mg, administered into one nostril, if no response, give a second
dose after 2–3minutes. If the patient responds to the
first dose then relapses into respiratory depression, give the second dose immediately.
Further doses should be administered into alternate nostrils
*Reversal of postoperative respiratory depression
Neonate: 1microgram/kg, repeated every 2–3 minutes if required.
Child 1 month–11 years: 1 microgram/kg, repeated every 2–3 minutes if required
Child 12–17 years: Initially 100–200 micrograms, alternatively (by intravenous
injection) initially 1.5–3 micrograms/kg, if response inadequate, give subsequent doses,
(by intravenous injection) 100 micrograms every2 minutes, alternatively (by
intramuscular injection) 100 micrograms every 1–2 hours
*Reversal of respiratory and CNS depression resulting from opioid administration to
mother during labour
Neonate: 200 micrograms, alternatively 60micrograms/kg, to be given as a single dose at
birth.

BY INTRAVENOUS INJECTION, OR BY SUBCUTANEOUS INJECTION
Neonate: 10 micrograms/kg, repeated every2–3 minutes if required.
Side effects
Nausea, vomiting; hypotension, hypertension, ventricular tachycardia and fibrilation,
cardiac arrest; hyperventilation, dyspnoea, pulmonary
Preparation
Inj. 0.4 mg/ml
Nalox
16.3.4 FOR BENZODIAZEPINES

Flumazenil
Cautions
short-acting (repeat doses may be necessary— benzodiazepine effects may persist for at
least 24 hours); benzodiazepine dependence (may precipitate withdrawal symptoms);
prolonged benzodiazepine therapy for epilepsy (risk of convulsions); history of panic
disorders (risk of recurrence); ensure neuromuscular blockade cleared before giving;
avoid rapid injection in high-risk or anxious children and following major surgery; head
injury (rapid reversal of benzodiazepine sedation may cause convulsions)
Indication & Doses
*Reversal of sedative effects of benzodiazepines
Neonate: 10 micrograms/kg every 1 minute if required, dose to be administered over 15
seconds.
Child: 10 micrograms/kg every 1 minute (max. per dose 200 micrograms) if required,
dose to be administered over 15seconds; maximum 1 mg per course; maximum 50
micrograms/kg per course
*Reversal of sedative effects of benzodiazepines (if drowsiness recurs after injection)
Neonate: 2–10 micrograms/kg/hour, adjusted according to response.
Child: 2–10 micrograms/kg/hour (max. per dose 400 micrograms/hour), adjusted
*Reversal of sedative effects of benzodiazepines in intensive care
Child: 10 micrograms/kg every1minute (max. per dose 200 micrograms) if required,
dose to be administered over 15 seconds; maximum 2mg per course; maximum 50
micrograms/kg per course
Contraindication
Life-threatening condition (e.g. raised intracranial pressure, status epilepticus) controlled
by benzodiazepines
Side effects
Nausea and vomiting; less commonly palpitation, anxiety, fear; also reported transient
hypertension, tachycardia, flushing, agitation, convulsions (particularly in those with
epilepsy), dizziness, sensory disturbance, chills, sweating
Preparation
Inj. 0.1/ml
Anexate

16.3.6 FOR PESTICIDES
Pralidoxime
Cautions
Myasthenia gravis
Indication & Doses
*Adjunct to atropine in the treatment of poisoning by organophosphorus insecticide or
nerve agent
Child: Initially 30 mg/kg, to be given over 20 minutes, followed by 8mg/kg/hour;
maximum 12 g per day
Contraindications
Poisoning with carbamates or organophosphorus compounds without anticholinesterase
activity
Side effects
Drowsiness, dizziness, disturbances of vision, nausea, tachycardia, headache,
hyperventilation, and muscular weakness
Preparation
Inj 20mg/ml (10ml)
Contrathione
16.3.9 SNAKE BITE

ANTI SNAKE VENUM (polyvallent) 10/20ml
Indication & Doses
*Systemic envenoming from snake bites, Marked local envenoming
Child: Initially 10 mL for 1 dose, then 10 mL after 1–2hours if required, the second dose
should only be given if symptoms of systemic envenoming persist after the first dose, if
symptoms of systemic envenoming persist contact the National Poisons Information
Service
*Severe systemic envenoming from snake bites in patients presenting with clinical
features
Child: Initially 20 mL for 1 dose, if symptoms of systemic envenoming persist contact
the National Poisons Information Servic
Preparation
inj. 10/20ml
Refrences
 CBNF 2020-21
 Nelsons Text Book of Pediatrics
 Product Leaflets
 Up to Date
 Pharmaguide

Disposables / Medicines Items
1 Air ways 000, 00, 0, 1, 2, 3 & 4

2 Ambu Bag ( disposable) Neonates, Peads & Adults
3 Blood Bag (sterile 1's)
a). Single 500ml
b). Tripple 500ml
4 Blood ketostiks
5 Blood Sugar Strips
6 Blood Transfusion Set (sterile)
7 Disposable Syringe (sterile)
a) Insulin (with leur lock) 1ml
b) Non Insulin 1ml, auto disposable 3 & 5ml,10ml
c) with Needle/without needle 50ml
d) with nozel 60ml
8 ECG Electrode Peads
9 ECG Paper Six Channel 20 x 110 mm
10 ECG Paper Six Channel 108 x 140 mm
11 ECG paper Twelve Channel 210 x 300 mm
12 Endotracheal tube (ETT) with soft cuff, high volume 4, 4.5, 5, 5.5, 6
low pressure cuff (Sterile)
13 Endotracheal tube (ETT) without cuff (sterile) 2.5, 3, 3.5, 4, 4.5, 5, 5.5
14 Foley's Balloon Catheter (sterile) 6,8,10,12,14 & 16FR
15 Foley's Balloon Silicon Catheter (sterile) 6,8,10,12,14 & 16FR
16 Hollow fiber Dialyzer with blood tubing and AVF 0.2m2 3FR & 0.8m2 4FR
needle 16/17Fr complete set (sterile)
17 IV Cannula with wings & inj port (Sterile) 16,18,20 & 22G
18 IV Cannula with wings & without inj. port (Sterile) 24G
19 Latex Examination Gloves
20 Lumber Puncture Needle (Sterile) 16,22, 24, 25G with 30 & 90mm length
21 Micro Burette without flow meter for non blood 100ml
products,60dops / ml (Sterilize) Y-site with rotatable
Leur Lock
22 Micro Drip Extention Tube,20 Drops≈1ml (sterile)
23 Name Tag Identification
24 Nasogastric feeding tube (sterile) 4,6,8,10,12,14G
25 Nelton Tube (sterile) 6,8,10,12,14,16,18,20,22,24 & 26G
26 Scalp vein infusion needle (sterile)
27 Silicon Nasogastric feeding tube (sterile) 4,6,8,10,12,14G
28 Soft Care Splint Small, medium, large
29 Suction Tube / Catheter (Sterile) 6,8,10 & 12FR
30 Surgical Blade (sterile) 10,11,15 & 22
31 Surgical Gloves Powder Free 6, 6.5, 7, 7.5 & 8
32 Surgical Gloves Powdered 6, 6.5, 7, 7.5 & 8
33 Three Way Stopcock without tubing (sterile)
34 Urine Bag (leak proof)
35 Urine Collector (leak proof) with proper calibration
36 Vented standard infusion set, (sterile) with Y-site with
rotatable Leur Lock (Sterile)
37 Yellow Stoper

Sutures & Ligature Materials (Registered Items)
1 Bone wax (Sterile)

2 Ethibond 4/0 RB (Sterile) 17 mm
3 Ethilon 10/0 (Sterile) 6.5mm
4 Nylon Tape (Sterile )
5 PDS 2/0 (Sterile)
6 PDS 3/0 (Sterile)
7 PDS 4/0 (Sterile)
8 PDS 5/0 (Sterile) Single & Double ended
9 PDS 6/0 (Sterile) Single & Double ended
10 Polyglactin/ Polyglycolic acid 0 RB (Sterile) 30 mm
11 Polyglactin/ Polyglycolic acid 1 RB (Sterile) 30 mm
12 Polyglactin/ Polyglycolic acid 2/0 RB 30 mm
(Sterile)
13 Polyglactin/ Polyglycolic acid 2/0 Cutting 26 mm
(Strile)
14 Polyglactin/ Polyglycolic acid 3/0 Cutting 26/13/16 mm
(Sterile)
(Sterile)
16 Polyglactin/ Polyglycolic acid 4/0 cutting 22/26 mm
(Sterile)
17 Polyglactin/ Polyglycolic acid 4/0 RB 22/16 mm
(Sterile)
(Sterile)
(Sterile) (Single & Double Needle)
20 Polyglactin/ Polyglycolic acid rapid 4/0 26 mm
Cutting (Sterile)
Cutting (Sterile) Tapper cut 75cm
Cutting (Sterile)
23 Rapid Polyglactin/ Polyglycolic acid rapid
4/0
5/0
6/0
26 Polypropylene 0 RB (Sterile) 40 mm
27 Polypropylene 1 RB (Sterile) 40 mm
28 Polypropylene 2/0 Cutting (Sterile) 60/40 mm
29 Polypropylene 2/0 RB (Sterile) 30 mm
30 Polypropylene 3/0 Cutting (Sterile) 24 mm

31 Polypropylene 3/0 RB (Sterile) 26/17 mm
32 Polypropylene 4 /0 Cutting (Sterile) 19 mm
33 Polypropylene 4 /0 RB Silver Needle 17 mm
(Sterile)
34 Polypropylene 5 /0 Cutting (Sterile) 16 mm
35 Polypropylene 5 /0 RB Silver Needle 13 mm
(Sterile)
36 Polypropylene 5 /0 RB Silver Needle 17 mm Single & Double
(Sterile) ended
37 Polypropylene 6 /0 RB (Sterile) 13 mm & 9mm
38 Polypropylene 7/0 RB (Sterile) 9.3 mm
41 Silk 0 RB (Sterile) 30 mm
42 Silk 1 RB (Sterile) 30 mm
43 Silk 2/0 Cutting (Sterile) 16 mm
44 Silk 2/0 RB (Sterile) 30 mm
45 Silk 3/0 RB (Sterile) 25/16 mm
47 Silk 4/0 RB (Sterile) 17 mm
49 Steel Wire (Sterile) 4 No.
50 Surgicell (Sterile) 5 x 7.5 cm
51 Surgicell Fibrillar (Sterile) 1x2" & 2x4"
52 Teflon Pleget (Sterile) 1/4 x 1/8x1/16
53 Proline Mesh 10*15, 15*15 & 15*20
54 Lega Clips Small, medium & Large
55 Haemo Locks All sizes

Surgical Cotton Gauze & Bandages
1 Absorbent Cotton wool B.P.C. 500g

2 Adhesive Absorbent Dressing (sterile) 6*7cm, 9/10*15cm &
9/10*25cm
3 Adhesive Paper surgical Tape
4 Adhesive Zincoxide Tape Paragone like
5 Alcohal Swab
6 Alginate Dressing
7 Autoclaveable Tape 3/4" (Sterile) 30 meters
8 Bactigrass
9 Cotton Bandages BPC 2.5''
10 Crepe Bandage BPC 4'' & 6”
11 Disposable caps
12 Disposable Face Masks
13 Disposable Gowns
14 Disposable Under Sheets for Babies (Double 60 * 90 cm
Lining one side absorbent fabrics and other side
water proof material)
15 Framycetin sulphate B.P 1% Anti-Bacterial
Gauze Dressing
16 IV Cannula Dressing (Sterile)
17 Lantor 4'' & 6”
18 Non-Sterilized Absorbent Cotton Gauze Roll 1×30 M
19 Non-Sterilized Surgical Guaze Swabs (8PLY) 10×10 cm
20 Opsite like transparent poly urethrane Dressing 30 * 28cm
(sterile)
21 Orthopedic Casting Tape (Sterile) 3, 4 & 5’
22 Plaster of Paris Bandage BPC Roll 4” & 6”
23 Steri Strips (Sterile) 1/2’ & 1/4’
24 Tegaderm Dressing
25 X-ray detectable gauze

Anasthesia Disposable Items
1 Aneasthesia face mask (Sterile) All sizes

2 Bacterial and viral Filters for anesthesia Machine
3 Bougie (Sterile, 1's) Pediatric size
4 Breathing Circuit (sterile) Ayeris-T Piece
5 Breathing Circuit (sterile) Standard
6 CO2 Oral /Nasal set with O2 Tubing
7 CVP Line Double Lumen (Paeds) Length 6cm,with 3FR
Nutrinol, J-Tip wire
8 CVP Line double lumen (Paeds) Length 8cm,with 5 & 6FR
Nutrinol, J-Tip wire
9 CVP Line Triple Lumen (Paeds) Length 6cm, with 4 & 4.5FR
Nutrinol, J-Tip wire (Size 6cm & 8 cm)
10 Diasafe Plus (Endotoxin Filter) for haemodialysis
Machine
11 Disposable Breathing Circuit with heated wire Infant & Pediatric
12 Disposable Breathing for SiPAP Neonatal Size
13 Disposable SPO2 Probe Dragger compatable
14 ECO Face Mask All sizes
15 Forced air warmer blanket Neonate & Paeds
16 Guedels Air way 000, 00, 0, 1, 2, 3 & 4
17 Intra-Osseous Needle
18 LMA Lyrangeal Face Mask (sterile) 1.0, 1.5, 2, 2.5, 3.0 Fr
19 Nasal air way (Sterile) all sizes
20 Nasal Cannulas for Hipap Pre term, neonatal,
infant/medium,
pediatric/Large size
21 Nasal CPAP Breathing circuit forHipap
22 Nasal CPAP Cannula Set (Hudson Type) 10,12,13,15 & 16 FR
23 Nasal high flow breathing circiut for Hipap
24 Nasal Prong (sterile) Neonate & Paeds
25 Nebulizer Kit Paeds with tubing (sterile) Paeds
26 Oxygen Mask Paeds (Sterile) Paeds
27 Oxygen tubing without mask (Sterile) Paeds
28 RAE Nasal Tube plain 4, 4.5, 5 & 5.5
29 RAE Nasal Tube with cuff 4, 4.5, 5 & 5.5
29 Reservoir bag 0.5, 1 & 1.5 liter
30 Reusable Disposable Breathing circuit for SiPAP Neonatal Size
31 Reuseable Nasal CPAP breathing Circuit for HIPAP
32 Sample Line (Must be compatible with Drager
Anesthesia Machine and Agent Monitor.
33 Stylet (Sterile) Neonate & Paeds
34 T. Piece (Sterile)
35 Water Lock (Must be compatible with Drager
Anesthesia Machine and Agent Monitor. Must have
pore size of a mere 0.2 micro meter of hydrophobic
membrane technology for stops any condensed water,
bacteria or germs from etting into the gas measurment
system. Twin membrane protection system must keep
condensation out of the sampling gas and purge gas.

Cardiac Surgery Disposable Items
1 ACT Cartridge (Sterile)

2 Aortic Cannula (sterile) plastic tip, angled wire 12, 14, 16, 18, 20, 22 FR
3 Bovine Pericardium 10*15
4 Cardiac Graft (sterile) soft skin, stretchable 4, 5, 6 mm x 10 cm
5 Cardiac Sump (sterile) 12 Fr
6 Cardioplegia Delivery System (sterile) Paeds
7 Chest U-Water seal bottle with tubing 1800 ml 1800 ml
8 Coronary Ostial Cannula 10 FR
9 Diathermy Lead (sterile)
10 Disposable chest drainage (Sterile)
11 Femoral Aortic Cannula 8,10,12,14, 15,17,21,23
FR
12 Femoral Venous Cannula 8,10,12,14,15,17,21,23,25
FR
13 Hemofilter with MUF kit Peads/Infants
14 Infant membrane Oxygenator with tubing Infant
Set,(sterile)
15 Maleable single stage venous cannula 12, 14, 16, 18, 20, 22, 28,
34
16 Manometer line 200cm (sterile) 1.0-2.0 mm
17 Oxygenator with tubing set for ECMO Infant, Pediatric and Adult
18 Pacing wire (sterile) Standard
19 Paeds membrane Oxygenator with tubing Set, Paeds
(sterile)
20 Pericardial Membrane 6*10 6*6
21 Permanent Pace Maker with lead (Sterile) Peads
22 RCSP Cannula 10FR & 15FR
23 Straight Connector Leur Lock (Sterile) 1/4 x 1/4 LL, 1/4 x 3/8 LL
& 3/8 x 3/8 LL
24 Transducer kit (sterile) compatible with
Biosensor cable
25 Two Satge venous cannula 28/36, 36/46, 32/40,
34/46, 36/51
26 Venous steel tip Cannula (sterile) Right angled 12, 14, 16, 18, 20, 22, 24,
wire 28, 31 Fr
27 VSD Patch 6x6
28 Y-Connctor (sterile, blister pack 1’s) 1/4 x 1/4 x 3/8, 1/4 x 1/4 x
¼ & 1/4 x 3/8 x 3/8

Angiography Disposable Items
1 Baloons
a.Septostomy Balloon (Sterile 2cc & 1cc
b. sizing baloon sterile 24 & 34
c. Valvoplasty Baloon (mini low 6*3, 7*3, 8*3, 9*3, 10*3, 12*3
profile baloon for neonate & infant)
d. Valvoplasty Baloons for children 14*4, 15*4, 16*4, 18*4, 20*4,
only 22*4, 25*4
2 Catheters
a. JR4 4, 5 & 6FR
b. MPA2 4, 5 & 6FR
c. NIH Hard 5 & 6FR
d. Pigital 4 & 5FR
e. Tiger Catheter 5FR
f. Wedge Pressure Catheter 5FR
3 Devies
a. ASD Device with delivery system wt <15kg & wt > 15kg
b. Inflation Device
c. MFO Device
d. PDA Device with delivery system Infant / child < 10kg & child >
10kg
e. VSD Device with delivery system Muscular Device
4 Sheets
a. Angiography sterlized sheet Peads
b. Transradial Sheath Long Length 4, 5, 6, 7, 8, 9, 10, 11, 12FR
11cm), Soft sheath with Paediatric
Needle +Wire
5 Wires
a. Guide Wire (Sterile) 0.021 x 260cm & 0.035 x 150 cm
b. J. tip Guide Wire 0.035x150cm & 0.035x260cm
c. J.Tip super stiff / Extra stiff guide 0.035 X 260cm
wire
6 Miscellaneous
a. gel foam/ sticking sponge
b. Injector syringe compatible with 150ml
angio graphy machine
c. Manifold 2 way

d. Pressure line compatible with
angiography machine
e. PVA Particles 1000 micrones
f. Snares (sterile) 10 & 15
G Tip Exchange length 0.014
h. TPM Lead (Sterile) 5FR

Reconstructive Surgery Disposable Items
1 Steel Wire Straight Double needle 5/0 2cm

2 Nylon Straight Double needle 5/0 2cm
3 Suction Drains Dynavac (collapsible) 8 & 10FR
4 Vacutainers tube drains 15ml with flexible 6 & 8FR
tubing side hole Stryker
5 Tissue expander silicon
6 Silicon Rod (hunter rod) 3,4 & 6FR
7 Silicon scar care sheet 15*5cm
8 Silicon scar care gel 15ml
9 Ligaclips applicator Small, medium & large
10 Disposable ligaclip applicator with preloaded 25 Small & medium
clips
11 Derma carrier masher plate 1.5:1, 3:1
12 Dermatone Blade
13 Silicon Nasal retainer 1,2,3,4,5
14 Kohlar Microscope’s disposable Drapes
15 Kohlar Microscope’s disposable hand piece
cover
16 Disposable sponges and comb
17 Disposable marker and ruler pack
18 Cynoacralate glue (skin adhesive glue)
19 Arm sling Pediatric size
20 Chin band
21 Philadelphia skin collar
22 Silicon urinary catheter 6, 8, 10 & 12FR
23 Skin Stepler Standerd and small size
24 Disposable drapes for limbs, head & neck and
Cleft surgeries
25 Disposable microvascular clamps single/double Small size

Other Specialized Disposable Itemes
1 Amplats Sheet with Dialator 14, 16, 22FR

2 AO External Fixator 2.5, 3.0, 3.5 & 4.0mm
3 Arterial Leader cath (sterile) 18, 20 & 22G
4 Band Ligation Device (Saeed Six-Shooter Paeds (GI) (4,6 bands)
sterile
5 Band Tips
6 Bands (For Ligation)
7 Biopsy Forcep with needle (colonoscope) 2.8 channel
8 Biopsy Forcep without needle 2.8 channel
9 Bone marrow Needle (sterile) 11 & 13G
10 Bovie Pad monopolar Pediatric / Child size
11 Camera Sleeve
12 Chemo Safety Luer Lock connector Male & female
13 Chest Tube (Soft) sterile.Soft rubber Chest tube
14 collin Knife for Rescetoscope Richard wolf
15 Colostomy Bags with wafers and tails All size
16 Cover Sleeves for Camerahead
17 CPAP mask with Fixation Harness for non 2, 3, 4, 5
invassive ventilation
18 CT Injector Dual Pack Syringe Set 200ml 200ml
/200ml for Model Medrad Salient
19 Cutting Burs 5, 4, 3, 2, 1, 0.8 &
0.5mm
20 Cutting loupe for Resectoscope
21 Dexel Implant (1ml) with needle
22 Diamond Tapper Burs 6mm(15cm), 5, 4, 3, 2,
1, 0.8 & 0.5mm
23 Disposable Concetric EMG Needle 25 mm 27 & 30G
24 DJ Stents with guide wire(0.018 & 3FR 12cm, 4FR 16cm,
0.021mm)(Sterile) 6FR (multi length both
side open with guide
wire 0.035)
25 dormia Basket 2.8 channel (3cm*6cm)
26 Double Luman Umblical Catheter with 4.0FR 200mm
integrated Anti Biotic technology
27 Dual lumen uretral Access Catheter with
Hydrophillic coating
28 Echogenic NS Needle
29 Electrosurgical snares (polypctomy snare) 2.8 channel (3cm*6cm)
30 Endo Bag for Specimen Retrieval 10mm
31 Flexable uretro renoscope(FUS) 9/10FR
32 Flexible Nail 2.5, 3.0 & 3.5mm
33 0.018, 0.025 & 0.035
Glide Wire (nitinol Hydrophillic coated)
inches

34 Groumets (Sterile) With out wire
35 Guide Wire PTFE Coated 0.035 & 0.038 inches
36 Harmonic ACE + Shears a) 5mm diameter shears
Laproscopic 36cm length
Adaptive Tissue Technology b)5mm diameter shears
23 cm length
37 Harmonic Focus + Shears Cuts to Distal Tip Jaw aperature 23.4mm
Adaptive Tissue Technology jaw height Distal
5.99mm proxixal
2.82mm active blade.
Distal 1.37mm,
proximal 2.24mm.
clamp arm distal
1.98mm proximal
3.12mm
38 Hepa Filter Portable Sharp unique Airflow
Technology quickly collects Dust particles
from all directions with Powerful Suction
Make/Model: Sharp Health Care Solutions
Japan FP-F305A-H
39 Hicman Line 4.2, 6.6 & 9FR
40 Hieno clip Medium & large
41 HME Filter (sterile) Neonates & peads
42 Humby’s Knife Blade (Sterile)
43 Intra-Ossular Lenses (I.O.L) 15 to 30DS
44 Karo Spray
45 K-Wires 0.75, 1, 1.5, 2, 2.5 &
3.0mm
46 Laproscopic Clip Applier (sterile) 5mm
47 Laser Fiber Quanta 200, 272 & 550um
48 Liga Sure Blunt Tip Laproscopic Sealer / 5mm diameter
Divider 37cm(14.6 inches)
length 18 degree shaft
rotation blunt ja, double
action with
counteredtips design.
Texture 3D jaw with
ceremics stops hand or
foot switching
49 Liga sure Maryland Jaw laproscopic Sealer / 5mm diameter
divider 37cm(14.6 inches)
length
50 Liga sure Maryland Jaw laproscopic Sealer / 5mm diameter 23cm
divider length
51 Ligasure Small Jaw Instrument 18.8cm instrument
length

52 Lige Clip Medium & large
53 Liver/ Semi Automatic Biopsy Needle (sterile) 16 & 18G
54 Malecot Catheter 8 & 10FR
55 Mesher plates 1.5:1, 1.3:1, 6 to 1 & 9
to 1
56 Micro Sponges
57 Mucous Extractor (sterile,)
58 Multiband Ligator 6 bands
59 Nasojejunal tube feeding (weighted) 10 & 12FR
60 Needle free connector (sterile) With extension line,
with spike & without
tubing
61 Nephrostome Tract Baloon Dilator 6mm (15cm) & 8mm
(15cm)
62 Nerve Simulator Needle All sizes
63 Nutrisafe Feeding Syringe (sterile) 5 & 10ml
64 Nutrisafe Feeding Tube (sterile) 6 & 8FR
65 Octopus (sterile) Double / triple lumen
66 P.D Catheter (sterile) Neonates and peads
67 PCN Set 6 & 8FR
68 PCNL Drap Sheet
69 Pig Tail Catheter 8, 10 & 12FR
70 Pneumatic Baloon Dilator CRE 10—12, 12-15 & 15-18
71 Proximate Linear Cutter Gun (sterile) 55-60, 75-80, 100-
105mm
72 Proximate Linear Cutter reload (sterile) 55-60, 75-80, 100-
105mm
73 Pump Tubing Set
74 raptor grasping device 2.8 channel
75 Redvic Drain Bottle All sizes
76 Renal / Automatic Biopsy Needle (sterile) 16 & 18G
77 Reuseable EEG Disc Electrodes (10 mm
Diameter, Gold Plated Discs) 48" Lead wire
78 Roth net 2.8 channel
79 Scikle Knife for Rescetoscope Richard wolf
80 Sclerotheraphy Injection Needle 21G
81 Semi rigid Catheter for MIST Technique 6FR 200mm
82 Single Luman Catheter with impregnated Anti 28G/1FR 20cm
Biotic & Antifungal technology
83 Single Luman Umblical Catheter with 3.5FR 400mm & 2.5FR
integrated Anti Biotic technology 300mm
84 Skin Adhensive Glue
85 Skin Traction Kit Small and medium
86 Spongstone (Sterile, 1's)
87 Stomahesive Paste 1's
88 Stomahesive Powder 1's

89 Stone cone 8mm & 10mm
90 Sub Clavian Catheter for Haemodialysis 8.5 & 9FR
(sterile) (Double Lumen)
91 Subpra pubic catheter set silicon 8, 10, 12FR
92 Suction Tubing Standerd
93 Surfacth Catheater 6FR
94 Synthetic surgical Glue (sealant) 1ml
95 Syringe cutter
96 Theater Set (Sterile)
97 Thoracic Drainage Catheter/ Easy Drain 6. 8. 10FR
(sterile)
98 Tracheostomy tube with & without cuff 3.0, 3.5, 4.0, 4.5, 5.0,
(sterile) 5.5, 6.0, 6.5, 7.0, 7.5,
8.0
99 Two way cystometry Catheter 6FR
100 Two way Rectal Baloon Catheter 9FR
101 Ultrasound Guided Needle All sizes
102 Ureteric Access Sheath 10FR (35cm) & 10FR
(45cm)
103 Ureteric catheter (Sterile) 4, 5, 6FR
104 10FR 35cm &
Uretic Access Sheath
10FR45cm
105 Visilon Gel Alcon (Prefilled Syringe) 3ml
106 Vitrectomy Cutter 23G
107 Y Pressure Connecting Tube with dual check 150ml
valve length 150cm for dual head CT Injector

LIST OF CHEMICALS
1. Activated Charcoal
2. Benzoic acid powder
3. Boric acid (Pharmaceutical grade)
4. Cirtic acid (Pharmaceutical grade)
5. Disodium hydrogen phosphate (Pharmaceutical grade)
6. Dextrose (Pharmaceutical grade)
7. Formaline
8. Glutaraldehyde Solution 2% (corrosion Inhibitor)
9. Hand Disinfectant (Alcoholic Based)
10. Instruments Disinfectant
11. Lactose (Pharmaceutical grade)
12. Labomat KS Mild acidic ringing agent
13. Labomat MA (liquid) Mild alkaline liquid cleaner
14. Liquid Paraffin
15. Methylated Spirit (Ethanol 99.9% Pure)
16. Orthophosphoric acid (Pharmaceutical grade)
17. Potassium citrate (Pharmaceutical grade)
18. Povidone Iodine Solution 10%
19. Povidone Iodine Scrub 7.5%
20. Salicylic acid powder
21. Soda Lime
22. Sodium benzoate (Pharmaceutical grade)
23. Sodium citrate (Pharmaceutical grade)
24. Sodium chloride (Pharmaceutical grade)
25. Starch chloride (Pharmaceutical grade)
26. Sulphur powder
27. Surface / Floor Disinfectant Solution
28. White soft paraffin
29. Zinc acetate (Pharmaceutical grade)
30. Zinc sulphate (Pharmaceutical grade)

SUSPECTED ADVERSE DRUG REACTION REPORTING FORM
This form is for voluntary reporting of adverse drug reactions caused by therapeutic goods marketed in Pakistan.
For Healthcare Professionals
Provincial Pharma covigilance Centre (PPC)

Direcorate of Drugs Control, Punjab For Healthcare
Primary & Secondary Healthcare Department, Punjab facility Use Only
48/1, Kacha Lawrence Road, Lahore. Report No.
Telephone No: 042-99206209-10 ________________
A. PATIENT DETAILS
Patient’s Initials or Name: ____________________ Identification No (Medical/Hospital Ref): _____________Sex: Male / Female
If Female, pregnant or not: __________ Age (at the time of reaction): _________ Weight (kg) ___________________
B. SUSPECTED DRUG(S)/VACCINE(S)/ALTERNATIVE MEDICINE(S) (use additional pages if necessary):
Route of Dosage
Drug/Vaccine/Alternative Medicine Manufacturer Stop
Batch No: Administration & & Start Date Prescribed For
(Brand Name & Generic Name) /importer Date
Daily Doses Strength
C. SUSPECTED REACTION(S) (use additional pages if necessary):

1. When reaction started (DD/MM/YY): __________________ 2. When recovery started (DD/MM/YY):
_________________________________
3. Describe the reaction(s): (use additional pages if necessary): 6. Do you consider the reaction(s) to be serious?
Yes/No
If yes, please tick all that apply of the following:
-Patient died due to reaction:
-Life Threatening:
-Involved or prolonged inpatient hospitalization
-Involved persistent/significant disability or incapacity:
-Congenital anomaly/Birth Defects:
4. Other relevant history of the patient (Allergies, Smoking, Alcohol Use, -Other Serious (Medically Important Condition):
Hepatic/Renal Problems, and Pre-Existing Medical Problems etc.: please give details:
________________________
7. Reaction abated after use stopped or dose reduced?
Yes No Doesn’t apply
________________________
8. Reaction reappeared after reintroduction?
____________
Yes No Doesn’t apply
5. Relevant tests/Laboratory data with dates: (use additional pages if necessary):
_________________________________
____________________________
9. Outcomes:
Fatal Recovering Unknown
Continuing Recovered
Other___________________________________________
10. You consider the problem related to which of the

following:
Quality Problem Medication Error
Adverse Event/Reaction
If other, please specify________________
D. OTHER CONCOMITANT DRUG(S)/VACCINE(S)/ALTERNATIVE MEDICINE(S) (use additional pages if

necessary):
Drug/Vaccine/Alternative
Route of
Medicine Batch Manufacturer Dosage & Start Prescribed
Administration & Dd Stop date
(Brand Name & Generic No: /importer Strength Date For
Daily Doses
Name)

E. SUSPECTED MEDICAL DEVICE(S) fill this area for suspected Device only (use additional pages if necessary)
Lot If Explanted
Medical Device No/ Manufacturer Model Unique Serial If Implanted enter date
Common Name / Brand Name Batch /importer No: Identifier No: No: enter date
No:
F. REPORTER DETAILS
Name: ____________________________________ Professional Address: _________________________________________________________

Specialty: __________________________________Tel No: __________________________, Email Address: ____________________________
Date of this report: ___________________________ Signature__________________________________________________________________
Have you reported this problem to Provincial Pharmacovigilance Centre or Manufacturer? If yes, please specify: ______________________
“This form neither has any legal value nor can be presented before any Court of Law as an Evidence.”
SECOND FOLD HERE
GUIDELINES FOR ADVERSE DRUG REACTION (ADR) REPORTING
“ADVERSE DRUG REACTION (ADR) REPORTING IS ETHICAL AND MORAL DUTY OF HEALTH CARE
PROFESSIONALS”
Please use this form for reporting:

 Suspected Adverse Drug Reactions with THERAPEUTIC GOODS
 Suspected Adverse Drug Reactions with NEW THERAPEUTIC GOODS
 Suspected Adverse Drug Reactions for ALL VACCINES
 LACK OF EFFICACY in the case of vaccines, contraceptives, antibiotics, and lifesaving
medicines.
 Adverse outcome due to suspected QUALITY PROBLEM in therapeutic good.
 Adverse outcomes as a result of an overdose, abuse, misuse, off-label use or medication errors.
 THERAPEUTIC GOODS include the following: Drugs, Vaccine, Biological or alternative medicine or medical
devices or biologicals or other related product as may be notified by DRAP
 Fatal reactions, life-threatening, disabling or incapacitating, result in or prolong hospitalization, congenital anomaly or
birth defect and other serious medically important conditions are considered serious.
 Health care professionals shall comment on the causal relationship of each suspected drug/vaccine/alternative medicine
with each reaction as per the World Health Organization (WHO) causality assessment scale which comprises of the
following six categories, namely:
i. Certain ii. Probable iii. Possible iv. Unlikely v. Unclassified vi. Unclassifiable
For the Greater Good & in Public Interest, Please Report ADRs to DRAP even if you are unsure.
For More Information/Queries, please contact:
Provincial Pharmacovigilance Centre (PPC), Directorate of Drugs Control, Punjab, 48/1, Kacha Lawrence Road, Lahore,
Pakistan.
Website: www.mss.pshealthpunjab.gov.pk Email: pdcu.pshealth@gmail.com
Phone No: 042-99206209-10
FIRST FOLD HERE

SUSPECTED ADVERSE DRUG REACTION REPORTING FORM
This form is for voluntary reporting of adverse drug reactions caused by therapeutic goods marketed in Pakistan.
For Health Care Professionals (Additional page)
B. SUSPECTED DRUG(S)/VACCINE(S)/ALTERNATIVE MEDICINE(S) (continued):

Route of Dosage
Medicine Manufacturer Prescribed
Batch No Administration & & Start Date Stop Date
(Brand Name & Generic / importer For
Name)
C. SUSPECTED REACTION(S) (continued):

3. Describe the reaction(s) (continued):
4. Other relevant history of the patient (Allergies, Smoking, Alcohol Use, Hepatic/Renal Problems, and Pre-Existing Medical Problems etc.
(Continued) :
5. Relevant Tests/Laboratory Data with Dates (continued):
D. OTHER CONCOMITANT DRUG(S)/VACCINE(S)/ALTERNATIVE MEDICINE(S) (continued):

Route of Dosage
Medicine Manufacturer
Batch No: Administration & & Start Date Stop Date Prescribed For
( Brand Name & /importer
GenericName)
E. SUSPECTED MEDICAL DEVICE(S) (continued):

If
Medical Device Lot No/ Unique Explanted
Model Serial If Implanted
Common Name / Brand Batch Manufacturer/importer Identifier enter date
No: No: enter date
Name No: No:

Drug Information Query Form
The Childrens Hospital &
University of Child Health Sciences, Lahore
Query No: _______________ Date: _______________ Receiving Time: ______________

Received By: _________________________ Replying Time: ________________________
ENQUIRER IDENTIFICATION: -
Category: _________Professional:__________________Non-Professional: ______________
Name: _______________________Code #: ____________ Designation: _______________
Location/Origin: _________________Address/Phone #: ____________________________
Contact Method: ______________________Type of Query: _________________________
Text: _____________________________________________________________________
__________________________________________________________________________
Sex Age B.Wt Height BSA Na+ K+ LFT S.Creatinine CBC Blood Allergies
Glucose
Any Special Feature: ____________________________________________________

Medication History: _____________________________________________________
Present Medication: _____________________________________________________
Search Method; _________________________________________________________
Mode of Reply: _________________________________________________________
Total Time Taken: ___________________________________________
Inquirer’s Response: Satisfied Not satisfied
If not satisfied, action taken: ___________________________________
D.I Pharmacist

Performa for Product Recall
The Childrens Hospital &
Name of Problem -----------------------------------------------------------------------------

Problem occurred in (Location) ------------------------------------------------------------
Date of receiving complaint ----------------------------------------------------------------
Source of Complain
Pharmacist Doctor Staff nurse
Patient Other
Number of similar reports received --------------------------------------------------------
---------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------------------
Description of Problem ----------------------------------------------------------------------
---------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------------------
Product Description
Name of product------------------------------------------------------------------------------
Registration No-------------------------------------Active Ingredient-----------------
Dosage form ----------------------------------------Pack Size---------------------------
Batch No -------------------------------------------Mfg Date---------------------------
Expiry date------------------------------------------
Manufecturer
Name -------------------------------------------------------------------------------------
Address ---------------------------------------------------------------------------------
Telephone no -----------------------------Quantity on hold ------------------------
Authority Sign _________________

Specialized Medicines Performa
The Childrens’ Hospital &
Call no ------------------------------ Date----------------------------------
Name of Patient--------------------------------- MR No. ---------------------

Ward ------------------------------------------- Age/weight---------------------
Diagnosis ---------------------------------------------------------------------------
Diagnosis by-------------------------------------------------------------------------
Dose / Quantity required ----------------------------------------------------------
Duration of treatment---------------------------------------------------------------
Advised by---------------------------------------------------------------------------
Cost of treatment--------------------------------------------------------------------
Consultants Remarks---------------------------------------------------------------
(with sign & stamp)
Pharmacists remarks---------------------------------------------------------------
(with sign)
Recommended by Chief Pharmacist---------------------------------------------
Approved by Medical Director----------------------------------------------------

Controlled Drugs Issuance and Administration Form
The Children Hospital &
Drug: _______________ Ward: _______________
Date Patient Description of Dose Ordered Administered Time of

name & Drug ordered by Doctor by Nurse dose
MR. # and strength given
Total no of injections------------------------ Quantity used ---------------------------
Balance in hand------------------------------ Date of issuance----------------------
New Demand------------------------- Signature of Nurse--------------------
Signature of Pharmacist------------------------ Chief Pharmacist-------------------------
Medical Director---------------------------------

Index Calcitriol 168
Calcium Salts 163
A Captopril 22
Acetyl Cysteine 204 Carbamazepine 65
Acyclovir 124 Carboplatin 147
Acyclovir eye 178 Carvedilol 19
Adrenaline 33, 50 Cefepime 99
Albendazole 131 Cefixime 98
Albumin 162 Cefoparazone & Salbactam 99
Alfa Calcidiol 168 Cefotaxime 97
Allopurinol 147 Ceftazidime 97
Alprostadil 41 Ceftriaxone 92
Amiodarone 16 Cefuroxime 91
Amlodipine Besylate 32 Cephradine 91
Amikacin 102 Charcoal Activated 204
Amino Acid Solution 163 Chloral Hydrate 53
Aminophylline 46 Chloramphenicol 180
Amoxicillin 82 Chloroquine 129
Amphotericin B 122 Cholecalciferol 167
Ampicillin 85 Ciclopirox Olamine 183
Antisnake Venum 208 Ciclosporins 150
Antithymocytes Immunoglobulins 148 Ciprofloxacin 110
Aprepitant 58 Ciprofloxacin eye 178
Artemether 130 Ciplofloxacin ear 180
Artemether & lumefantrine 130 Ciprofloxacin&Dexamethasone 180
Asparaginase 146 Ciprofloxacin&Lignocaine 180
Aspirin 39 Cis-Atracurium 196
Atracurium 195 Cisplatin 146
Atenolol 18 Clarithromycin 105
Atomoxetine 79 Clobazam 74
Atropine 193 Clotrimazole 182
Atropine eye 178 Clotrimazole&Hydrocortisone 182
Azathioprine 148, 174 Co Amoxiclav 86
Azithromycin 108 Colistimethate Sodium 119
Co Trimoxazole 108
B Cyclopentolate 179
Bacillus Clausii 10 Cyclophosphamide 142
Baclofen 176 Cytarabine 144
Balanced Electrolyte Solution 163
Beclomethasone Dipropionate 48 D
Benzyl Pencillin 81 Dacarbazine 146
Benzyl Peroxide 182 Dactinomycin 143
Beractant 51 Daunorubicin 143
Beraprost 40 Deferasirox 155
Betamethasone&FucidicAcid 183 Defriprone 154
Bosentan Monohydrate 28 Desferroxamine 154
Bleomycin 143 Dexamethasone 135
Bupivacaine 202 Dexmedetomidine 200
Dexpanthenol 182
C Dextran 40 in Dextrose 163
Caffeine 52 Dextran 40 in Saline 163
Dextrose Solution 5%, 162

Dextrse solution 10% 162 Glycerin suppositories 9
Dextrose solution 25% 162 Glyceryl Trinitrate 30
Dextrose 4.5% & 0.18% NaCl 163 Glycopyrolate 194
Dextrose 5% & 0.9% Nacl 163 Glycopyrolate&Neostigmine 195
Diazepam 75
Diclofenac Sodium 173 H
Diclofenac eye 178 Haemodialysis Bicarbonate Solution 162
Digoxin 11 Heparin 36
Dimeglumine Gadopentetate 203 Hepatitis B Immunoglobulins 189
Dimenhydrinate 55 Hepatitis B Vaccine 184
Diphtheria Antitoxin 188 Human Insulin NPH 132
Dobutamine 32 Human Insulin R 132
Domperidone 56 Hydralazine 29
Dopamine 33 Hydrocortisone 136
Dorzolamide & Timolol 179 Hydrocortisone + Fucidic Acid 183
Doxorubicin 143 Hydrochlor thiazide 15
Hydroxyethyl Starch 3% 163
E Hypertonic Dialysate Solution 163
Eltrombopag 156 Hydroxypropyl Methylcellulose 179
Enalpril Maleate 24 Hydroxy Urea 147
Enoxaparin 38 Hyoscine Butyl Bromide 6
Erythropoietins 158
Ethambutol 125 I
Etoposide 146 Ibuprofen 171
Idarubicin 147
F Ifosfamide 142
Factor VIIa 41 Imipenam & Cilastin 101
Factor VIII 41 Immunoglobulins intravenous 188
Fentanyl 60 Iopamidol 203
Filgrastim 156 Iopromide 203
Fluconazole 120 Iohexol 203
Fludarabine 145 Ipratropium Bromide 45
Fludorocortisone 135 Iron Polymaltose 161
Flumazenil 207 Iron Succrose 159
Fluorouracil 145 Isoconazole&Diflocortolone 183
Fluticasone propionate 48 Isoflurane 192
Fluticasone propionate topical 182 Isoniazid 125
Fluticasone & Mupirocin 183 Isotonic Solution 163
Folic Acid 160
Folinic Acid 147 K
Fosfomycin 119 Ketamine 199
Frusemide 12 Ketorolac 198
Fusidic Acid 182
L
G Labetolol 20
Gadobutrol 203 Lacosamide 66
Ganciclovir 124 Lactulose 9
Gemcitabine 144 Lamotrigine 67
Gentamicin 102 Latanoprost 179
Gentamicin eye 178 Levetiracetam 69
Gentamicin ear 180 Levocetirizine 50
Gentamicin&Hydrocartisone 180 Levofloxacin 111

Levo Tyroxin Sodium 133 Ondansterone 56
Lignocaine 17, 201 Oprelvekin 148
Lignocaine & Epinephrine 202 Oral Rehydration Salts 161
Linezolid 118 Oxaliplatin 142
Lipid 163 Oxethazine 6
Lisinopril 26
Loratadine 50 P
Losartan Potassium 27 Pancronium 197
Paracetamol 62
M Peg Asperginase 146
Magnesium Sulphate 164 Penicillamine 170
Mannitol 14 Pentazocin 62
Mebendazole 131 Permethrin 182
Mefenamic Acid 173 Pheniramine Maleate 49
Meglumine Diatrizoate 203 Phenobarbitone 73
Mercaptopurine 144 Phenylephrine 35
Meropenem 100 Phenylephrine eye 179
Mesalazine 5 Phenytoin Sodium 70
Mesna 147 Pica Gel 179
Methotrexate 144, 174 Pilocarpine 179
Methylphenidate 79 Pipracillin & Tazobactam 89
Methyl Prednisolone 137 Pneumococcal Vaccine 187
Methyl Prednisolone Topical 182 Polymixin B & Bacitracin Zinc eye 178
Metronidazole 112 Polymixin B & Bacitracin Zinc skin183
Miconazole 180 Potassium Chloride 161, 162
Midazolam 76 Pralidoxime 208
Milrinone 12 Prazosin 21
Monteleukast 47 Prednisolone 138
Morphine Sulphate 58 Prednisolone eye 178
Moxifloxacin 112 Proactant Alfa 52
Multi Vitamin (B complex) 166 Promethazine 49, 55
Mupirocin 182 Propofol 191
Mycofenolate Moftil 149 Propranolol 19
Protamine Sulphate 38
N Pyrazinnamide 126
N/2 with 5% Dextrose 163 Pyridoxime 169
Nalbuphine 62
Naloxone 205 R
Naphazoline 179 Rabies Vaccine 186
Naproxen Sodium 173 Rabies Immunoglobulins 190
Neostigmine 175 Ramipril 25
Nitrazepam 76 Rhesus Antibody (Anti D) 189
Nifedipine 31 Rifampicin 127
Nor Adrenaline 34 Rifampicin & Isoniazid 129
Normal saline 162, 204 Ringer Lactate 163
Nystatin 181 Risperidone 53
Rituximab 152
O Rocurionium 196
Octreotide 132 Ropivacaine 202
Ofloxacin eye 178
Ofloxacin ear 180 S
Omeprazole 7 Saccharomyces Baulardii 10

Salbutamol 43
Salicylic Acid & Lactic Acid 183 W
Salmetrole& Fluticasone propionate 48 Warfarin Sodium 37
Sevoflurane 192
Silver Sulphazine 182 Z
Soda Glycerine 180 Zinc Sulphate 165
Sodium Bicarbonate 162 Zinc Acetate 165
Sodium Nitropruside 29
Sodium Phosphate enema 9
Sodium Valproate 71
Somatropin 139
Spironolactone 14
Spironolactone & Frusemide 16
Streptomycin 104
Sulfadoxine & Pyrimethamine 131
Sulphasalazine 5
Suxamethonium 198
T
Tacrolimus 151
Teicoplanin 117
Terbutaline 45
Terlipressin 140
Tetanus Immunoglobulin (TIG) 189
Tetanus Toxoid 184
Thiocolchicoside 177
Thioguinine 145
Timolol Maleate 179
Tizanidine 177
Tobramycin 103
Tobramycin eye 178
Tobramycin ear 180
Tobramycin & Dexamethasone eye 179
Tobramycin & Dexamethasone ear 180
Topiramate 72
Tramadol 61
Tranexamic Acid 40
Trihexyphenidyl 177
Tropicamide 178
U
Ursodeoxycholic Acid 10
V
Valsartan 27
Vancomycin 115
Vinblastine 145
Vincristine 145
Vinoralbine 146
Vitamin A 166
Vitamin K 166
Voriconazole 123

Children Hospital Formulary

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Children Hospital Formulary

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THE CHILDREN’S HOSPITAL

The Children’s Hospital & University of Child Health Sciences, Lahore

CH & UCHS, LAHORE I

PROF. DR. MASOOD SADIQ FRCP

CH & UCHS, LAHORE II

The purpose of this formulary is to ensure the availability of safe,

Usama Sardar Gorsi

CH & UCHS, LAHORE III

CH & UCHS, LAHORE 1

CH & UCHS, LAHORE 2

CH & UCHS, LAHORE 3

The following are guidelines for prescription writing in an attempt to help

2. Approved or generic names, should be used whenever possible and in order to

8. Always specify the route and time of administration, standard drug

9. When writing antibiotics prescriptions, frequency of dose should be mentioned in

ALWAYS WRITE THE DATE ON WHICH THE DRUG WAS STARTED,

CH & UCHS, LAHORE 4

CH & UCHS, LAHORE 5

1.2 ANTACIDS AND OTHER DRUGS FOR DYSPEPSIA

CH & UCHS, LAHORE 6

1.4 PROTON PUMP INHIBITORS

CH & UCHS, LAHORE 7

CH & UCHS, LAHORE 8

1.5.2 OSMOTIC LAXATIVES

1.5.3 FAECAL SOFTNER

CH & UCHS, LAHORE 9

1.6 DRUGS ACTING ON HEPATOBILIARY SYSTEM

1.7 PRO BIOTICS

1.7.2 Saccharomyces Baulardii

CH & UCHS, LAHORE 10

2.1 POSITIVE INOTROPIC DRUGS

CH & UCHS, LAHORE 11

2.1.2 PHOSPHODIESTRASES INHIBITORS

CH & UCHS, LAHORE 12

CH & UCHS, LAHORE 13

2.2.2 POTASSIUM SPARING DIURETICS

2.2.3 OSMOTIC DIURETICS

CH & UCHS, LAHORE 14

2.2.4 THIAZIDE DIURETIC

CH & UCHS, LAHORE 15

2.2.5 COMBINATION DIURETICS

2.3 ANTI-ARRHYTHMIC DRUGS

CH & UCHS, LAHORE 16

CH & UCHS, LAHORE 17

2.4 BETA-ADRENORECEPTOR BLOCKING DRUGS

CH & UCHS, LAHORE 18

CH & UCHS, LAHORE 19

CH & UCHS, LAHORE 20

2.5 ANTI HYPERTENSIVE DRUGS

CH & UCHS, LAHORE 21

2.5.2 DRUGS AFFECTING THE RENIN-ANGIOTENSIN SYSTEM

CH & UCHS, LAHORE 22

CH & UCHS, LAHORE 23

2.5.2.1.2 Enalapril Maleate

CH & UCHS, LAHORE 24

CH & UCHS, LAHORE 25

CH & UCHS, LAHORE 26

2.5.2.2 Angiotensin II Receptor Antagonist

2.5.2.2.1 Losartan Potassium

CH & UCHS, LAHORE 27

2.5.3 ENDOTHELIN RECEPTOR ANTAGONIST

CH & UCHS, LAHORE 28

2.5.4 VASODILATOR ANTI HYPERTENSIVE