Pediatric Drug Doses GL Chattri
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Analgesics1

 
ANALGESIC—NON-NARCOTIC
 
1. Acetylsalicylic acid
Use: Treatment of inflammation, fever and mild to moderate pain
Dosage: PO
  • Pain and fever: 10–15 mg/kg/dose q 4 – 6 h.
  • Anti-inflammatory: 60–90 mg/kg/ day in divided doses.
  • Anti-platelet effect: 3–10 mg/kg/day, single daily dose.
  • Kawasaki disease: 80–100 mg/kg/day divided q 6 h.
  • Rheumatic fever: 60–100 mg/kg/ day divided q 6 h.
Brands: Ecosprin Tab; 75, 150 and 325 mg. Delisprin Tab; 75 and 150 mg. Zosprin Tab; 100 and 150 mg.
  • Contraindicated in Chicken Pox or if there is flu-like symptoms, hepatic failure, bleeding disorder, erosive gastritis, peptic ulcer, bronchial asthma. Discontinue the drug if hearing loss or tinnitus occurs.
 
2. Auranofin
Use: Management of active stage of classic or definite rheumatoid, psoriatic arthritis.
Dosage: PO. Starting 0.1 mg/kg/day in 2 divided doses.
Maintenance: 0.15 mg/kg/day. (Max: 0.2 mg/kg/day)2
Brand: Cap. Ridaura 3 mg, Tab. Goldar 3 mg.
  • Contraindicated in blood dyscrasias, CHF, NEC, SLE, leucopenia, urticaria etc. Stop therapy if platelet count < 100,000/mm3, WBC < 4,000/mm3.
 
3. Diclofenac Sodium
Use: Mild to moderate pain, juvenile rheumatoid arthritis.
Dosage: PO. 2–3 mg/kg/day divided q 4 h.
Brands: 50 and 100 mg Tab; Agile, Diclofam, Diclomax.
  • Also available in topical formulation as gel; Diclonac, Nac, Voveran 1% gel; transdermal patch, Nupatch. Contraindicated in GI bleeding, ulcer disease, aspirin triad. Use with caution in HT, BA, CHF, fluid retention, dehydration etc.
 
4. Ibuprofen
Use: Fever, pain, JRA, cystic fibrosis, PDA.
Dosage: PO
  • Fever, Pain: 4–10 mg/kg/dose q 6–8 hr (Max: 40 mg/kg/day)
  • JRA: 30–50 mg/kg/day in 4 divided doses (Max: 2.4 gm/day)
  • Cystic Fibrosis: 20–30 mg/kg twice daily for 4 yrs
  • PDA: IV: Initial dose of 10 mg/kg, followed at 24 hour intervals by two doses of 5 mg/kg.
Brands: 100 mg/5 ml Susp; Bren, Ibugesic, Febrilix. 200 and 400 mg. Tab; Brufen, Emflam, Ibugesic, Ibugin.
Combinations: Ibuprofen + Paracetamol: 400 + 325 mg Tab, 100+162.5 mg/5 ml susp; Anaflam, Combiflam, Ibucin.
  • Contraindicated in GI bleeding, ulcer disease, aspirin triad. Use with caution in CHF, HT, dehydration, hepatic and renal patients.
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5. Indomethacin
Use: PDA closure in neonates, rheumatoid arthritis, nephrogenic diabetes insipidus.
Dosage:
  • Neonates: PDA: IV; 0.2 mg/kg initially followed by 2 doses at 12–24 hours intervals.
  • Rheumatoid/Inflammatory disorders: PO; 1–2 mg/kg/day in 2–4 doses. (Max: 4 mg/kg/day).
  • Nephrogenic diabetes insipidus: PO; 2 mg/kg/day.
    (for patients having inadequate response to diuretics alone may benefit from its addition).
Brands: 25 and 50 mg Cap; Artisid, Indocap, Microcid etc.
  • Contraindicated in premature neonates with NEC, impaired renal functions, IVH, bleeding, thrombocytopenia. It may decrease the antihypertensive effect of diuretics.
 
6. Ketorolac
Use: Treatment of ocular itch associated with seasonal allergic conjunctivitis.
Dosage: Children > 3yrs: 1 drop in eyes 4 times/ day; upto 7 days.
Brands: 0.5% drop; Acular, Doloket, Ketanav, Ketodrop etc.
Administration: Apply pressure over Lacrimal sac for 2 minutes after application to avoid absorption and systemic effects.
 
7. Mefenamic acid
Use: Fever, pain, rheumatoid disorders.
Dosage: PO. Should not be given for more than 7 days.
  • Fever: 3mg/kg/dose.
  • Rheumatoid disorder: 10–25 mg/kg/day q 6 hr.
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Brands: 100, 250 and 500 mg Tab; 100 and 50 mg/5ml susp; Meftal, Ponstan.
Combinations:
Mefenamic + Paracetamol: 500 + 450 mg Tab – Meftal Forte.
Mefenamic + Dicyclomine: 250 + 10 mg Tab- Meftal Spas.
 
8. Naproxen
Use: Fever, pain, inflammation and rheumatoid disorders.
Dosage: PO. For children > 2 yrs of age.
  • Pain: 5–7 mg/kg/dose q 8–12 hrs.
  • JRA/Inflammatory disease: 10–15 mg/kg/day in two divided doses. (Max: 1000 mg/day)
Brands: 250 mg Tab; Astagen, Nalyxan, Napryn.
 
9. Nimesulide
Use: Fever, pain and inflammatory conditions.
Dosage: PO. 5 mg/kg/day in 2–3 divided doses.
Brands: 50 and 100 mg Tab; 50 mg / 5 ml susp; Emsulide, Neosaid, Nimegesic, Pronim etc.
Combinations: Nimesulide + Paracetamol: 100 + 500 mg Tab; 50 + 125 mg susp; Sumo, Emsulide – P, Dolomide.
 
10. Paracetamol/Acetaminophen
Use: Mild to moderate pain and fever. Do not have an anti-inflammatory or anti-rheumatic effect.
Dosage:
  • Neonates: PO, rectal: 10–15 mg/kg/dose q 6–8hours.
  • Infants and children: PO: 10–15 mg/kg/dose q 4–6 hr; Rectal: 10–20 mg/kg/dose q 4–6 hrs; IM: 5 mg/kg/dose.
Brands: 150 mg/ml drops; 125 mg/5 ml and 250 mg/5 ml susp; 500 mg Tab; Calpol, Crocin, Febrex, Metacin, Pacimol. 580 and 170 mg. suppository, Anamol. 150 mg/ml Inj.; Fevastin, Febrinil, Mol.
  • Overdoses of paracetamol can be treated with acetylcysteine.
 
11. Piroxicam
Use: Rheumatoid and inflammatory disorders.
Dosage: PO. 0.2–0.3 mg/kg/day as single dose (Max: 15 mg/kg/day).
Brands: 10 and 20 mg Tab and Cap; Brexic, Minicam, Paricam. Use with caution in infants and children.
 
12. Tolmetin
Use: Inflammatory and rheumatoid disorders (JRA).
Dosage: Children > 2 yrs. of age: PO
  • Anti-inflammatory: 15–20 mg/kg/day in 3–4 divided doses; (Max: 30 mg/kg/day)
  • Analgesic: 5–7 mg/kg/dose q 6–8 h.
Brands: 200 mg Tab; 400 mg Cap; Tolectin.6
 
ANALGESIC—NARCOTIC
 
1. Codeine
Use: Mild to moderate pain; for non-productive cough use in lower doses.
Dosage:
  • Pain: 0.5–1 mg/kg/dose q 4–6 hour (Max: 60 mg/dose).
  • Cough: 1–1.5 mg/kg/day divided q 4–6 hour (Not recommended in children < 2 yrs of age).
Brands: Codine linctus: Codeine sulphate 15 mg + Menthol 0.2 mg/5 ml. Phensedyl, Codokuff: Codeine Phosphate 10 mg + Chlorpheniramine 4 mg/5 ml. Lincotuss: Codeine Phosphate 15 mg/5 ml.
  • Increase fluid and fibre intake to avoid constipation.
  • Contraindicated in pre-existing respiratory illness, asthma and raised ICP. Causes constipation, nausea, anorexia, vomiting, sedation, dizziness.
 
2. Fentanyl
Use: Sedation, pain relief, preoperative medication, adjunct to anesthesia.
Dosage:
  • Neonates and infants: IV: Intermittent doses: 1–4 mcg/kg/dose; may be repeated q 2–4 h; continuous infusion: 0.5–5 mcg/kg/h.
  • Older infants and children: 1–12 yrs: Pain: IM, IV: 1–3 mcg/kg/dose; may be repeated after 30 minutes; continuous infusion: 1–5 mcg/kg/h.
  • Children > 12yrs.: Pain: IM, IV: 0.5–1 mcg/kg/dose; may be repeated after ½ to 1 hour.
  • Anesthesia: IM, IV: 2–50 mcg/kg.
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Brands: 50 mcg/ml Inj., Fendrop, Fenilate, Fent, Trofentyl. Patch of 25, 50 and 100 mcg/hr, Duragesic.
Administration: For IV administer slowly over 5–10 minutes. Rapid IV infusion may cause skeletal muscle rigidity, impaired ventilation, apnea, laryngospasm.
  • Contraindicated in raised ICP, severe respiratory depression, hepatic or renal problems. Physical and psychological dependence may occur with prolonged use.
 
3. Morphine Sulphate
Use: Pain relief; relieves dyspnea of left ventricular failure and pulmonary edema; preanesthetic medication.
Dosage:
  • Neonates: IV, IM, SC: Continuous infusion: 0.01–0.03 mg/kg/h; Intermittent dose: 0.05 – 0.1 mg/kg/dose q 2–4 h.
  • Infants and children: IV, IM, SC: 0.1–0.2 mg/kg/dose q 2–4 hrs. (Max: 15 mg/dose); PO: 0.2–0.5 mg/kg/dose q 4–6 hr.
  • > 12yrs: 3–4 mg; may be repeated after 5 min as required.
Brands: 10 and 30 mg Tab; Duramor, Morcontin. 10 mg/ml Inj., Morphine Sulphate.
Administration: Administer IV over 15–30 min at a final concentration of 0.5–5 mg/ml.
  • Contraindicated in respiratory depression, GI obstruction, acute or severe asthma, liver or renal problems. Neonates and infants < 3 months are more susceptible to respiratory depression.
 
4. Pentazocine
Use: Relief of moderate to severe pain, sedative prior to surgery.8
Dosage: Efficacy and safety not confirmed below 12 yrs Children> 12yrs: PO: 50 mg/dose q 3–4h; (Max: 600 mg/day). IV or IM dose is 1/3 of PO dose.
Brands: 25 mg Tab; Fortwin. 30 mg/ml Inj; Fortwin, Pentawin, Susevin.
Combinations: Pentazocine + PCM: 15 + 500 mg Tab; Expergesic, Fortagesic.
 
5. Pethidine / Meperidine
Use: Pain, adjunct to anesthesia and preoperative sedation.
Dosage: IV, IM: 1–1.5 mg/kg/dose q 3–4 hr as needed; 1–2 mg/kg as preoperative medication single dose (Max: 100 mg/dose).
Brands: 50mg/ml Inj; Pethidine hydrochloride.
Administration: For IV, dilute to 1–10 mg/ml and to be given over 15–30 minutes.
  • Use with caution in head injury, raised ICP and in young children. Pethidine though used in combination with chlorpromazine and promethazine in lytic cocktail; this mixture may have a higher rate of adverse effects compared to alternative sedatives and analgesics.
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ANALGESIC—TOPICAL
 
1. Benzocaine
Use: Toothache, sore throat pain, hemorrhoids, rectal fissures, minor burns etc.
Dosage: Apply to affected area as needed. Mouth/throat, usage should not exceed 2 days.
Brand: 7.5% gel, T-JEL.
 
2. Lidocaine
Use: Local anesthetic, relief of pain in post herpetic neuralgia, ventricular arrhythmias.
Dosage:
  • Topical: Apply as needed but maximum dose is 3 mg /kg /dose; do not repeat within 2 hrs.
  • Injectable local anesthetic: As needed but maximum dose is 4.5 mg/kg/dose; do not repeat within 2 hrs.
  • Arrhythmias: Loading dose: 1 mg / kg; Continuous infusion 20–50 mcg / kg / minute (20 mcg / kg /minute in patients with shock, mild CHF, liver disease, cardiac arrest).
  • Post herpetic neuralgia: Apply patch to affected areas (Max: 3 patch).
Brands: Gesicain, lignox: 5% Inj., 2% Jelly, 5% Ointment, 4% topical solution. Xylocain: 1, 2 and 5% Inj., 2% Jelly, 5% Ointment, Spray, 4% Topical solution, 2% Viscous. Xylocard: 50 ml vial (1ml = 21.3 mg)
Administration: For IV, dilution should be 8–20 mg/ml. Lidocaine solutions containing epinephrine should not be used for treatment of arrhythmias and preservative containing solutions should not be used for IV.10
 
ANALGESIC—URINARY
 
Phenazopyridine
Use: Symptomatic relief of urinary burning, frequency and urgency associated with UTI or urologic procedures.
Dosage: PO: 12 mg/kg/day divided q 8hrs.
Brands: Pyridium 200 mg Tab.
Combinations: Phenazopyridine + Nitrofurantoin: 200 + 50 mg Tab, Nephrogesic.
  • It is not an antibiotic and don't treat infections. May discolor urine to orange or red.