Pediatric Drug Doses GL Chattri
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AnalgesicsCHAPTER 1

 
NON-NARCOTIC ANALGESIC
 
1. Acetylsalicylic Acid
Use: Treatment of inflammation, fever and mild to moderate pain.
Dosage: PO:
  • Pain and fever: 10–15 mg/kg/dose q4–6h
  • Anti-inflammatory: 60–90 mg/kg/day in divided doses
  • Antiplatelet effect: 3–10 mg/kg/day, single daily dose
  • Kawasaki disease: 80–100 mg/kg/day divided q6h
  • Rheumatic fever: 60–100 mg/kg/day divided q6h.
Brands: Ecosprin tablet; 75 mg, 150 mg and 325 mg. Delisprin tablet; 75 mg and 150 mg. Zosprin tablet; 100 mg and 150 mg:
  • Contraindicated in chickenpox or if there is flu-like symptom, 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.2
Dosage: PO:
  • Starting: 0.1 mg/kg/day in two divided doses
  • Maintenance: 0.15 mg/kg/day (maximum: 0.2 mg/kg/day).
Brands: Capsule; Ridaura 3 mg; tablet; Goldar 3 mg:
  • Contraindicated in blood dyscrasias, CHF, NEC, SLE, leukopenia, urticaria, etc. Stop therapy if platelet count < 100,000/mm3, white blood count (WBC) < 4,000/mm3.
 
3. Diclofenac Sodium
Use: Mild to moderate pain, juvenile rheumatoid arthritis.
Dosage: PO; 2–3 mg/kg/day divided q4h.
Brands: 50 mg and 100 mg tablet; Agile MR, 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, migraine.
Dosage: PO:
  • Fever, pain: 4–10 mg/kg/dose q6–8h (maximum: 40 mg/kg/day)
  • JRA: 30–50 mg/kg/day in four divided doses (maximum: 2.4 g/day)
  • Cystic fibrosis: 20–30 mg/kg twice daily for 4 year
  • PDA: IV: initial dose of 10 mg/kg, followed at 24 hours intervals by two doses of 5 mg/kg
  • Migraine: 7.5–10 mg/kg/dose.3
Brands: 100 mg/5 mL suspension; Bren, Ibugesic, Febrilix. 200 mg and 400 mg tablet; Brufen, Emflam, Ibugesic, Ibugin.
Combinations: Ibuprofen + Paracetamol:
  • 400 mg + 325 mg tablet—Anaflam, Combiflam, Ibucin, Zupar
  • 100 mg + 125/5 mL suspension—Anaflam, Zupar
  • 100 mg + 162.5 mg/5 mL suspension—Combiflam, Ibucin
  • Contraindicated in GI bleeding, ulcer disease, aspirin triad. Use with caution in CHF, HT, dehydration, hepatic and renal patients.
 
5. Indomethacin
Use: PDA closure in neonates, rheumatoid arthritis, nephrogenic diabetes insipidus.
Dosage:
  • Neonates (PDA): IV; 0.2 mg/kg initially followed by two doses at 12–24 hours intervals
  • Rheumatoid/Inflammatory disorders: PO; 1–2 mg/kg/day in 2–4 doses (maximum: 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 mg and 50 mg capsule; Artisid, Indocap, Microcid, etc.:
  • Contraindicated in premature neonates with NEC, impaired renal functions, IVH, bleeding, thrombocytopenia. It may decrease the antihypertensive effect of diuretics. Hold enteral feeds for 12 hours after last dose.
 
6. Ketorolac
Use: Treatment of ocular itch associated with seasonal allergic conjunctivitis.4
Dosage: Children > 3 year: 1 drop in eyes 4 times/day; up to 7 days.
Brands: 0.5% drop; Acular, Doloket, Ketanov, KetoDrop, etc.
Administration: Apply pressure over lacrimal sac for 2 minute 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: 3 mg/kg/dose
  • Rheumatoid disorder: 10–25 mg/kg/day q6h.
Brands: 100 mg, 250 mg and 500 mg tablet; 100 mg and 50 mg/5 mL suspension; Meftal, Ponstan.
Combinations:
  • Mefenamic + Paracetamol: 500 mg + 450 mg tablet; Meftal Forte.
  • Mefenamic + Dicyclomine: 250 mg + 10 mg tablet; Meftal spas.
 
8. Naproxen
Use: Fever, pain, inflammation and rheumatoid disorders.
Dosage: PO; for children > 2 year of age.
  • Pain: 5–7 mg/kg/dose q8–12h
  • JRA/Inflammatory disease: 10–15 mg/kg/day in two divided doses (maximum: 1,000 mg/day).
Brands: 250 mg tablet; Artagen, Nalyxan, Naprosyn.
 
9. Paracetamol/Acetaminophen
Use: Mild to moderate pain and fever; migraine. Do not have an anti-inflammatory or antirheumatic effect.5
Dosage:
  • Neonates: PO, rectal; 10–15 mg/kg/dose q6–8h
  • Infants and children:
    • PO; 10–15 mg/kg/dose q4–6h
    • Rectal: 10–20 mg/kg/dose q4–6h
    • IM: 5 mg/kg/dose.
Brands: 150 mg/mL drops; 120 mg/5 mL syprup; 500 mg and 650 mg tablet; Calpol, Lanol. 80 mg and 170 mg suppository; Anamol, Junimol. 150 mg/mL injection; Fevastin, Febrinil, Mol:
  • Overdoses of paracetamol can be treated with acetylcysteine.
Combinations: Paracetamol 325 mg + Tramadol 7.5 mg; Calpol-T tablet.
 
10. Piroxicam
Use: Rheumatoid and inflammatory disorders.
Dosage: PO; 0.2–0.3 mg/kg/day as single dose (maximum: 15 mg/kg/day).
Brands: 10 mg and 20 mg tablet and capsule; Brexic, Minicam, Paricam. Use with caution in infants and children.
 
11. Tolmetin
Use: Inflammatory and rheumatoid disorders (JRA).
Dosage: Children > 2 year of age: PO:
  • Anti-inflammatory: 15–20 mg/kg/day in 3–4 divided doses (maximum: 30 mg/kg/day)
  • Analgesic: 5–7 mg/kg/dose q 6–8 hour.
Brands: 200 mg tablet; 400 mg capsule; Tolectin.6
 
NARCOTIC ANALGESIC
 
1. Codeine
Use: Mild to moderate pain; for non-productive cough use in lower doses.
Dosage:
  • Pain: 0.5–1 mg/kg/dose q4–6h (maximum: 60 mg/dose)
  • Cough: 1–1.5 mg/kg/day divided q4–6h (not recommended in children < 2 year of age).
Brands: Codeine linctus; Codeine sulfate 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 fiber intake to avoid constipation
  • Contraindicated in pre-existing respiratory illness, asthma and raised ICP. It can 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 are 1–4 µg/kg/dose; may be repeated q2–4hr; continuous infusion: 0.5–5 µg/kg/h
  • Older infants and children (1–12 year) Pain; IM, IV; 1–3 µg/kg/dose; may be repeated after 30 min; continuous infusion: 1–5 µg/kg/h
  • Children > 12 year; Pain: IM, IV; 0.5–1 µg/kg/dose; may be repeated after ½ to 1 hour
  • Anesthesia: IM, IV; 2–50 µg/kg.7
Brands: 50 µg/mL injection; Fendrop, Fenilate, Fent, Trofentyl. Patch of 25 µg, 50 µg and 100 µg/h, Duragesic.
Administration: For IV administer slowly over 5–10 min. 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 Sulfate
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 q2–4h
  • Infants and children: IV, IM, SC; 0.1–0.2 mg/kg/dose q2–4h (maximum: 15 mg/dose). PO; 0.2–0.5 mg/kg/dose q4–6h
  • > 12 year: 3–4 mg; may be repeated after 5 minute as required.
Brands: 10 and 30 mg tablet; Duramor, Morcontin. 10 mg/mL injection; Morphine Sulfate.
Administration: Administer IV over 15–30 minute 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 year Children > 12 year: PO 50 mg/dose q3–4h; (maximum: 600 mg/day). IV or IM dose is 1/3rd of PO dose.
Brands: 25 mg tablet; Fortwin. 30 mg/mL injection; Fortwin, Pentawin, Susevin.
Combinations: Pentazocine + PCM: 15 mg + 500 mg tablet; Expergesic, Fortagesic.
 
5. Pethidine/Meperidine
Use: Pain, adjunct to anesthesia and preoperative sedation.
Dosage: IV, IM; 1–1.5 mg/kg/dose q3–4h as needed; 1–2 mg/kg as preoperative medication single dose (maximum: 100 mg/dose).
Brands: 50 mg/mL injection; 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.9
 
TOPICAL ANALGESIC
 
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 postherpetic neuralgia, ventricular arrhythmias.
Dosage:
  • Topical: Apply as needed but maximum dose is 3 mg/kg/dose; do not repeat within 2 hour
  • Injectable local anesthetic: As needed but maximum dose is 4.5 mg/kg/dose; do not repeat within 2 hour
  • Arrhythmias: Loading dose 1 mg/kg; continuous infusion 20–50 µg/kg/min (20 µg/kg/min in patients with shock, mild CHF, liver disease, cardiac arrest)
  • Postherpetic neuralgia: Apply patch to affected areas (maximum: 3 patch).
Brands: Gesicain, Lignox: 5% injection; 2% jelly, 5% ointment, 4% topical solution. Xylocaine: 1%, 2% and 5% injection; 2% jelly, 5% ointment, spray, 4% topical solution, 2% viscous. Xylocard: 50 mL vial (1 mL = 21.3 mg), shield ointment.
Combinations: Shield Ointment contains lidocaine 3%, Hydrocortisone acetate 0.25%, zinc oxide 5%, allantoin 0.5%.
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
 
URINARY ANALGESIC
 
 
Phenazopyridine
Use: Symptomatic relief of urinary burning, frequency and urgency associated with UTI or urologic procedures.
Dosage: PO; 12 mg/kg/day divided q8h.
Brands: Pyridium 200 mg tablet.
Combinations: Phenazopyridine + Nitrofurantoin: 200 mg + 50 mg tablet; Nephrogesic.
  • It is not an antibiotic and do not treat infections. May discoloration of urine to orange or red.