Dosage. Child 1 month to 18 years1: The licensed dosing schedule (children of 3 years and over#) for glycopyrronium is based on the weight of the child, starting with approximately 12.8 micrograms/kg per dose three times per day and increasing by the doses listed in the SPC every 7 days. Dose titration should be continued until efficacy is balanced with undesirable effects and amended up or down as appropriate, to a maximum individual dose of 64 micrograms/kg body weight glycopyrronium or 6 ml (1.9 mg glycopyrronium) three times a day, whichever is less. Following the dose titration period, the child's sialorrhoea should be monitored, in conjunction with the carer at no longer than 3 monthly intervals, to assess changes in efficacy and/or tolerability over time, and the dose adjusted accordingly. # Sialanar is not recommended in children below the age of 3 years since there is very limited data on the efficacy and safety of glycopyrronium in this age group Adult population - Sialanar® is indicated for the paediatric population only. There is limited clinical trial evidence on the use of glycopyrronium in the adult population with pathological drooling. Prescribers may consider the unlicensed use of Sialanar for the treatment of hypersalivation in this population following current evidence based guidance3,4 Dosing should be at ≥1 hour before or at least 2 hours after meals or at consistent times with respect to food intake. Avoid high fat food. Monitoring1: The SPC advises that the efficacy of the medicinal product should be balanced against the adverse reactions and the dose monitored regularly and adjusted as necessary. The SPC specifically highlights the importance of monitoring for anticholinergic effects such as urinary retention, constipation and overheating due to inhibition of sweating, which may be dose dependent and difficult to assess in a disabled child. Behavioural changes should also be monitored. In accordance with good practice guidelines annual review would be expected. Contraindications1: Hypersensitivity to the active substance or to any of the excipients. Pregnancy and breast-feeding. Glaucoma. Urinary retention. Severe renal impairment (eGFR <30 ml/min/1.73m2), including those with end-stage renal disease requiring dialysis. History of intestinal obstruction, ulcerative colitis, paralytic ileus, pyloric stenosis and myasthenia gravis. Concomitant treatment with potassium chloride solid oral dose and/or anticholinergics. Cautions1: In the event ...
Dosage. The regulated articles must receive the minimum absorbed ionizing radiation dose specified in the PPQ Treatment Manual.
Dosage. Depression1/anxiety2: The starting dose is 10mg/day. After one to two weeks, the dose may be increased to 20mg/day. Dose adjustments should be made carefully, on an individual basis, to maintain at the lowest effective dose. Lower-weight children: Due to higher plasma levels in lower-weight children, the therapeutic effect may be achieved with lower doses. If there is no clinical benefit within 9 weeks, treatment should be reconsidered. For patients who respond to treatment, the need for continued treatment after 6 months should be reviewed.1 In depression, higher doses may be considered in older children of higher body weight and/or when, in severe illness, an early clinical response is considered a priority.3 OCD/BDD4: Fluoxetine has been shown to be effective5 in children/adolescents with OCD (NB products licensed in this population are sertraline and fluvoxamine). It is the medicine of choice for BDD and in children/adolescents with significant comorbid depression and OCD. Low starting doses (5 to 10mg daily) in week 1 are recommended; increase as above. Repetitive behaviours5 Autistic Spectrum Disorders: 2.5mg/day for 1 week; titrate slowly up to a maximum dose of 0.8mg/kg/day (e.g. 0.3mg/kg/day for week 2, 0.5mg/kg/day week 3, 0.8mg/kg/day subsequently). Monitoring: Consultant Baseline and at regular intervals: height, weight, XXXXXX staging (where appropriate); emergence of mania/hypomania1 GP: no specific monitoring; to review and act on adverse physical reactions which emerge between consultant appointments Contraindications and cautions for use1: Contraindications: patients with hypersensitivity to fluoxetine/formulation excipients; in combination with a non-selective irreversible mono aminoxidase inhibitor (MAOI) (or within 2 weeks of treatment with a non-selective irreversible MAOI e.g. phenelzine) (NB fluoxetine should be discontinued for 5 weeks before starting a non-selective irreversible MAOI); in combination with metoprolol Cautions: In paediatric clinical trials, suicide-related behaviours (suicide attempt and suicidal thoughts), and hostility were more frequently observed among children and adolescents treated with antidepressants compared to those treated with placebo. Monitor carefully for the appearance of suicidal symptoms, particularly in early treatment/following dose changes. Carers should be alerted about the need to monitor for any clinical worsening, suicidal behaviour or thoughts and unusual changes in behaviour, and to seek m...
Dosage. The dosing of aminophylline varies based on the age and smoking status of the patient. Look it up each time you administer it to ensure proper dosing. Route: Oral or intravenous Nursing Administration Considerations: IV administration should be given over 20 minutes. A smoker is unable to clear aminophylline at the same rate as a non-smoker. It will take the smoker longer to get aminophylline out of the system. Also, patient with heart failure will take longer to clear the medication as well. Common Side Effects: Tachycardia, headaches, restlessness. Overdose can result in acute MI. Drug Interactions: Interacts with propofol and neuromuscular blockers. Propofol and the neuromuscular blockers may be less effective. (Wolters Kluwer Health, 2009) (Xxx, Xxxxxx, & Xxx, 2009) Sedation & Analgesia
Dosage. Children: 1 mcg/kg per dose or 1 mcg/kg/hr as continuous infusion Adult: 50-100 mcg per dose or 1 mcg/kg/hr as continuous infusion Route: IV Nursing Administration Considerations: Give IV dose slowly over 1-2 minutes.
Dosage. Children: 10 mg/kg/dose every 4-6 hours, not to exceed 4 doses daily. Adults: 500-1000 mg per dose every 4-6 hours, not to exceed 4 g per day. Route: IV, oral, and rectal Nursing Administration Considerations: Give slowly over 15 minutes. Side Effects: Jaundice, leukopenia, signs of overdose are signs of liver failure. Drug Interactions: Increased bleeding time for patients on warfarin. (National Health Service, 2007) (Wolters Kluwer Health, 2009) Diuretic
Dosage. Children: 1 mg/kg Adults: 20-80 mg daily Route: IV and oral Nursing Administration Considerations: Intravenous infusion should be given slowly (over 10- 30 minutes), rapid injection can cause hearing loss and tinnitus. Side Effects: hypokalemia, hyponatremia, mild GI upset, hypotension, hyperglycemia, metabolic alkalosis, vertigo Drug Interactions: Use furosemide with caution in patients also on antihypertensives. Deafness may be worse if furosemide is given with aminogylcosides (Gentamicin). (National Health Service, 2007) (Wolters Kluwer Health, 2009)
Dosage. Children: 1 mg/kg in 24 hours given once daily or twice a day. Adult: 20 or 40 mg daily Route: IV or oral Nursing Administration Considerations: Intravenous infusion should be given over 5 minutes. Side Effects: Headache, diarrhea, nausea, vomiting, and dizziness; fever in children (33%) Drug Interactions: Omeprazole increases the effectiveness of warfarin. (National Health Service, 2007) (Wolters Kluwer Health, 2009) (Xxx, Xxxxxx, & Xxx, 2009) Antiarrhythmics Amiodarone Uses: Class III antiarrythmic, used to treat ventricular tachycardia and ventricular fibrillation, has also been used to treat supraventricular tachycardia that does not respond to adenosine. Dosage: Children: Load 5 mg/kg over 30 minutes, then follow with a continuous infusion at 5 mcg/kg/min up to 15 mcg/kg/min Adults: Load 150 mg over 10 minutes (15 mg/min) followed by 360 mg over 6 hours (1 mg/min) followed by a maintenance dose of 0.5 mcg/kg/min. Supplemental boluses of 150 mg given over 10 minutes may be given for breakthrough VF or VT. Route: IV and oral Nursing Administration Considerations: The continuous infusion must be diluted in D5W to a concentration of 2 mg/ml. Side Effects: Hypotension, sinus arrest, cardiac arrhythmias, photosensitivity. Drug Interactions: Increased risk of cardiac toxicity if hypokalemia occurs when given with furosemide. Increased effect of warfarin.
Dosage. Your doctor will evaluate your condition and only prescribe medication of the strength necessary for you. This may be different than what another doctor may have given you in the past. If the decision to prescribe is made after a shared discussion of goals, plans, risks and benefits, you may be required to confirm your consent in writing. Provision of Undertaking and Acknowledgment By You You may be asked to provide an undertaking that will detail our practice’s expectations when prescribing drugs of dependence. This undertaking will include:
Dosage. Ovex: 1 tablet. If re-infection occurs, a second dose can be taken after 14 days. Advice and Follow up: All other members of household over 2 years old should be treated simultaneously. Hygiene measures should be taken for 14 days after treatment: Wash hands and scrub nails first thing every morning, after using the toilet or changing nappies, and immediately before eating (even snacks) or preparing food Have a bath or wash around the anus each morning immediately on rising Keep fingernails short Change and wash underwear, nightwear, and bed linen the morning after treatment Vacuum all carpets and clean bathroom surfaces daily Wear clean underwear daily Children can wear cotton underwear at night to help prevent scratching or spreading eggs General Advice: Avoidance of re-infection = personal hygiene Pharmacy First Protocol
