Drugs used in Constipation

Senna in paediatrics

Indication:
Treatment of constipation
Bowel prep prior to colonoscopy

Formulation:
Tablets 7.5mg/tablet as total sennoside
Liquid 7.5mg/5ml as total sennoside

Dose:
1ml/kg (maximum 60ml daily)
1 to 2 tablets at night for children over 6 years of age.

Counselling:
Dose can be taken in the morning if necessary.

Side effects:
Griping pains

Interactions:
None reported.

Notes:
Liquid contains 3.3g of sucrose in 5ml and 7%v/v alcohol.

Licensing status:
Syrup is licensed for children or children 2 years and above
Tablets not recommended for children under 6 years of age.

Written: Feb 2001
Review: Feb 2002

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Docusate sodium in paediatrics

Stimulant laxative and faecal softner.

Indication:
To prevent and treat chronic constipation.

Formulation:
Capsule 100mg
Paediatric solution 12.5mg/5ml, Adult solution 50mg/5ml

Dose:
2.5mg/kg tds
Or
< 1 year 12.5mg (bd - tds)
1 - 4 years: 12.5mg - 25mg (bd - tds)
5 - 12 years: 25 - 50mg (bd-tds) Max 200mg daily

Counselling:
Using milk or orange squash can mask the bitter flavour.

Contra-Indications:
Capsules should not be taken in the presence of abdominal pain, nausea, vomiting or intestinal obstruction.

Side effects:
Anal or rectal burning and pain, diarrhoea and rash.

Interactions:
Should not be used concurrently with mineral oil. Anthraquinone derivatives (e.g. senna) should be taken in reduced doses if administered with docusate sodium as their absorption is increased.

Notes:
Acts within 1 to 2 days.

Written: Feb 2001
Review: Feb 2002

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Lactulose in paediatrics

A semi synthetic disaccharide that is not absorbed from the gastrointestinal tract.

Indication:
Treatment of constipation

Formulation:
Syrup

Dose:
1ml/kg BD (max 45ml BD) titrate to effect

Counselling:
Syrup can be taken with water or other drinks

Contra-Indications:
Galactosaemia where there is evidence of gastrointestinal obstruction.

Side effects:
Flatulence may occur but this disappears within a couple of days and diarrhoea may occur when using higher doses.

Notes:
May take upto 48 hours to work.

Licensing status:
Licensed for all ages.

Written: Feb 2001
Review: Feb 2002

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Liquid Paraffin in paediatrics

Faecal softner

Indication:
Treatment of constipation

Formulation:
Oral emulsion

Dose:
 0.5ml/kg BD (TITRATE TO EFFECT)

Counselling:
Take at night but not immediately before going to bed.

Contra-Indications:
Nausea, vomiting and when abdominal pain is present.

Side effects:
Anal seepage and irritation may occur upon prolonged usage.
Aspiration pneumonia

Interactions:
Theoretical reduction in the absorption of vitamins and minerals but in reality, not seen as an issue. No dosage adjustments required.

Notes:
May interfere with the absorption of fat soluble vitamins, though there is no evidence that it interferes with the absorption of fat soluble vitamin.


Written: Feb 2001
Review: Feb 2002

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Klean Prep in paediatrics

Indication:
Bowel prep prior to colonoscopy, faecal impaction.

Formulation:
Oral powder

Dose:
Add contents of 1 sachet to 1 litre of water.
Then 10ml/kg/hr for 30min then 20ml/kg/hr for 30min.
If tolerated , increase to 25ml/kg/hr.
Maximum volume is 100ml/kg or 4000ml (whichever is smaller) over 4 hours.

Side effects:
Nausea, abdominal fullness, bloating, abdominal cramps and anal irritation.
Fluid overload or dehydration may occur.
Electrolyte disturbance and hypoglycaemia (see notes)
Urticaria and allergic reactions occur rarely.

Interactions:
Any medication given within one hour of administration of klean prep maybe flushed from the GI tract and not absorbed.

Contra-Indications:
GI obstruction or perforation, ileus, gastric retention, acute gastritis or intestinal ulceration, toxic colitis or megacolon.
Caution in patients with impaired gag reflex or those with gastro-oesphageal relux.
Caution in patients <20kg

Notes:
If adverse effects are suspected, U+E's and glucose should be monitored or if treatment is to continue beyond 4 hours.
1 sachet / 1000ml water = 125mmol Na+, 10mmol K+, 4mmol SO42-, 35mmol Cl-

Licensing status:
Not licensed


Written: Feb 2001
Review: Feb 2002

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Sodium Picosulphate in paediatrics

Stimulant laxative

Indication:
Treatment of acute or chronic constipation
Bowel clearance prior to colonoscopy

Formulation:
Liquid 5mg/5ml

Dose:
2 - 5 years: 2.5 - 5ml daily
5 - 10 years: 5 - 10ml daily
>10 years: 10 - 15ml daily

Counselling:
Give doses at night if possible.

Contra-Indication:
Undiagnosed abdominal pain or suspected / proven intestinal obstruction.

Side effects:
Mild abdominal discomfort

Interactions:
Sodium picosulphate is broken down by bacteria in the large intestine so it is possible that patients taking broad spectrum antibiotics may experience some loss of laxative action.

Notes:
Onset of action is normally 10 to 14 hours after administration.

Licensing status:
Licensed for children over 2 years of age.

Written: Feb 2001
Review: Feb 2002

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Picolax in paediatrics

Indication:
Clearance of bowel prior to examinationby colonoscopy
Weekend therapy for patients with chronic constipation

Formulation:
Oral powder. Active ingredients are sodium picosulphate 10mg with magnesium citrate formed in solution.

Dose:
< 1 year: None
1 - 4 years: 1/4 sachet
4 - 6 years: 1/2 sachet
over 6 years: 1 sachet

Counselling:
Explain preparation of liquid

Side effects:
Griping pains may occur.

Contra-Indications:
Patients with undiagnosed abdominal pain or where intestinal obstruction is suspected.

Interactions:
Sodium picosulphate increases the rate of gastrointestinal transit and absorption of other oral medication may require modification during the treatment period.

Notes:
Provide dosage sheet. Low residue diet recommended for 2 days prior to administration.
Liberal intake of clear fluids during treatment.
Frequent bowel movements 3 hours after the first dose.

Licensing status:
Licensed in children of 1 year or above

Written: Feb 2001
Review: Feb 2002

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Movicol in paediatrics

Indication:
Treatment of chronic constipation
Bowel prep prior to colonoscopy.

Formulation:
Powder for oral solution

Dose:
Bowel prep
< 10 years or < 35kg 1/2 sachet every 3 hours for 2 doses and then review
> 10 years or >35kg 1 sachet every 3 hours for 2 doses and then review.

For weekend therapy
Currently there is no information regarding this. Paediatric gastroenterology are currently studying this.
A general rule is <3yrs 1/4 sachet sat/sun
3-8 yrs 1/2 sachet sat/sun
>8 years 1 sachet sat/sun

Counselling:

Side effects:
Abdominal distension and pain, nausea and fluid/electrolyte shifts.

Contra-Indications:
Intestinal perforation or obstruction due to structural or functional disorder of the gut wall, ileus, SEVERE inflammatory conditions of the intestinal tract such as Crohn's disease and ulcerative colitis (seek senior advice) and toxic megacolon.
Interactions: No clinical interactions have been reported.

Notes:
Has an advantage over Klean-Prep in that less volume is required for administration.
Each sachet should be dissolved in 125ml of water.
The content of electrolyte ions per sachet when made up to 125ml of solution is as follows: Na+ 8mmol, K+ 0.68mmol, Cl- 6.6mmol and bicarbonate 2mmol.

Licensing Status:
Not licensed in children under 12 years of age.

Written: Feb 2001
Review: Feb 2002

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Drug therapy of gastro-oesphageal reflux in children.

Gastro-oesphageal reflux disease (GORD) occurs due to the inappropriate relaxation of the lower oesophageal sphincter. This permits the contents of the stomach to pass into the oesphagus. Reflux may lead to oesphagitis which while disrupting oesphageal motility, can reduce sphincter tone further, thus leading to a worsening of reflux.

Depending upon the severity of symptoms, the presence of complications and any associated illness, the active drug treatment of GORD generally begins after milk thickening agents and feeding advice have failed.

Pro-kinetic agents increase the oesphageal sphincter pressure and promote gastric emptying. In general, cisapride is used first line with domperidone introduced if this does not work as monotherapy.

H2 antagonists or proton pump inhibitors are sometimes introduced to patients who have severe disease in order to reduce gastric acid secretion.

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Cisapride in paediatrics

This is now no longer available since July 2005 in the United Kingdom.

Increases the gastric motility, improves antroduodenal coordination and improves lower oesphageal sphincter tone.

Indication:
Treatment of gastro-oesphageal reflux disease (GORD)

Formulation:
Suspension 1mg/ml
Tablets 10mg

Dose:
0.2mg/kg per dose QDS (max 10mg QDS)

Counselling:
Administer 15 minutes prior to feeds.

Side-effects:
Abdominal cramps, diarrhoea and increased gastric emptying

Interactions:
Erythromycin, clarithromycin, cimetidine, fluconazole, itraconazole and ketoconazole all increase the plasma levels of cisapride. This can lead to prolongation of the QTc interval.
Co-administration of anticoagulants can lead to an increase in the prothrombin time.
Opiates and anti-muscarinics can lead to a decrease in the cisapride effect.

Notes:
Increased gastric emptying may lead to a decreased absorption of anticonvulsants.
This may lead to an increase in the anticonvulsant dose.
May need to keep a fit chart in order to identify any increase in fitting.

Written: May 1999
Reviewed: Feb 2001
Review: May 2002

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Domperidone in paediatrics

Especially useful if vomiting is a problem, neurologically abnormal children or if cisapride is not workingas monotherapy.

Indication:
Treatemnt of GORD

Formulation:
Suspension 1mg/ml
Tablet 10mg
Suppository 30mg

Dose:
Oral 0.2-0.4mg/kg tds - qds (can increase to 0.6mg/kg tds - qds)
Rectal 1mg/kg (max tds) round to nearest possible dose

Side-effects:
Rash, extra pyramidal effects

Interactions:
Opiates decrease the effect of domperidone
Antimuscarinics decrease the effect of domperidone

Notes:
Domperidone is less likely to cause extrapyramidal side effects

Written: May 1999
Reviewed: Feb 2001
Review: May 2002

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Metoclopramide in paediatrics

Indication:
Anti emetic use only.

Formulations:
Solution 1mg/ml
Tablets 10mg

Dose:
0.1-0.2mg/kg 6-8 hrly.

Side effects:
Increased gastric motility, extrapyramidal side effects, drowsiness and restlessness.

Interactions:
Increased effects of paracetamol
Opiates and antimuscarinics decrease the effects of metoclopramide
Increased risk of extrapyramidal effects with tetrabenazine.

Written: May 1999
Reviewed: Feb 2001
Review: May 2002

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Ranitidine in paediatrics

Indication:
Reduces gastric acid secretion

Formulations:
Tablets 150mg, 300mg
Dispersible tabs 150mg
Syrup 15mg/ml
Injection 50mg/2ml

Dose:
Oral <6 months 1- 3mg/kg tds
6 months - 8 years 2-4mg/kg either bd or tds (max total daily dose 300mg)
>8 yrs 150mg bd

Side-effects:
Headache, rash, altered bowel habits and LFT changes.

Interactions:
None

Notes:
Liquid contains alcohol

Written: May 1999
Reviewed: October 2010
Review: October 2011

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Omeprazole in paediatrics

Indication:
Proton pump inhibitor
Reduces gastric acid secretion

Formulation:
Dispersible tablet 10mg, 20mg
Injection 40mg (named patient)
Suspension 2mg/ml (special in 8.4% sodium bicarbonate with a 30 day expiry if stored in the fridge)

Dose:
0.7-1.4mg/kg (max 40mg) od to bd
May increase to 3.5mg/kg daily
Twice daily dosing maybe more effective in some patients.
<2ys: 5mg od (not licensed therefore discuss with paeds gastro
team)
2-6yrs: 10mg od
>6yrs: 20mg od
RFH may use quite aggressive doses in order to suppress acid secretion

Side-effects:
Rash, alopecia, diarrhoea, headache, nausea, constipation, flatulence and dizziness.

Interactions:
Warfarin, phenytoin and diazepam will have increased levels.
Decreased levels seen in ketoconazole.

Written: May 1999
Reviewed: Feb 2001
Review: May 2002

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Sucralfate in paediatrics

Indication:
Prophylaxis of stress ulceration

Formulation:
Suspension 1g/5ml
Tablets 1g

Dose:
0-2yrs 250mg 4-6hrly
3-12yrs 500mg 4-6hrly
>12yrs 1g 4-6hrly

Side-effects:
Constipation, diarrhoea, nausea, indigestion, dry mouth, rash and dizziness

Interactions:
Decreased levels of tetracyclines, ciprofloxacin, phenytoin, cimetidine, digoxin, warfarin, thyroxine and ketoconazole.

Written: May 1999
Reviewed: Feb 2001
Review: May 2002

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Mesalazine (Asacol®) in paediatrics

Indication:
Treatment of mild to moderate Ulcerative colitis and Crohns disease

Site of action:
Terminal ileum and proximal colon

Formulations:
- Tablets 400mg
- Suppositories 250mg, 500mg

Dose:
- Acute 15mg/kg BD 
- or 10mg/kg TDS             ( max 2.4g as a total daily dose )

Doses will or should be adjusted to ensure ease of administration with the above formulations

Side-effects:
Nausea, vomiting, diarrhoea, abdominal pain, headache, exacerbation of colitis symptoms, rarely reversible pancreatitis, hepatitis and interstitial nephritis, bone marrow suppression, fibrosing alveolitis.
Caution if salicylate hypersensitive

Interactions:
Lactulose may lower stool pH (? affecting release profile of Asacol) but this is not thought to be clinically significant.

Notes:
Indigestion remedies should not be taken at the same time.
Tablets should be swallowed whole, never crushed.
Tablets coated with a pH sensitive acrylic based resin.
Patients should be advised to report any unexplained bleeding, bruising, purpura, sore throat, fever or malaise that occurs during therapy.
Blood count should be performed and therapy stopped immediately if there is a suspicion of a blood dyscrasia.

Written: June 1999
Reviewed: Feb 2001
Review: June 2002

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Mesalazine (Pentasa®) in paediatrics

Indication:
Treatment of mild to moderate Ulcerative colitis and Crohns disease

Site of action:
Duodenum, jejunum, ileum and colon.

Formulations:
Tablets 250mg, 500mg
Enema 1g/100ml
Suppositories 1g

Dose:
Acute 25mg/kg BD
or 17mg/kg TDS                  ( max 3g-4g as total daily dose)

Doses will be adjusted to ensure ease of administration with the above formulations

Side-effects:
Nausea, vomiting, diarrhoea, abdominal pain, headache, exacerbation of colitis symptoms, rarely reversible pancreatitis, hepatitis and interstitial nephritis, bone marrow suppression, fibrosing alveolitis.
Caution if salicylate hypersensitive

Interactions:
None known

Notes:
Pentasa tablets disintegrate in the stomach to form coated slow release granules. Mesalazine is released from these granules at all the physiological pH values but is slower in the acidic conditions.
Tablets can be dispersed in water but they should not be chewed.

Written: June 1999
Reviewed: Feb 2001
Review: June 2002

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Olsalazine in paediatrics

Indication:
Treatment of mild to moderate Ulcerative colitis and Crohns disease

Site of action:
Colon

Olsalazine consists of two molecules of mesalazine bound together. Colonic bacteria cleave this bond to release mesalazine.

Formulations:
Capsules 250mg, 500mg

Dose:
Acute 20mg/kg BD
or 13mg/kg TDS                           ( max 3g as a total daily dose )

Doses will be adjusted to ensure ease of administration with the above formulations

Side-effects:
Diarrhoea, arthralgia, rash and blood dyscrasias.

Interactions:
None known

Notes:
Gastrointestinal side-effects such as diarrhoea are the most commonest side-effects and these can be reduced if the dose is taken with meals.

Written: June 1999
Reviewed: Feb 2001
Review: June 2002

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Sulphasalazine in paediatrics

Indication:
Treatment of mild to moderate Ulcerative colitis and Crohns disease

Formulation:
Suspension 250mg/5ml
Tablets 500mg, 500mg E/C

Dose:
Acute 10-15mg/kg QDS (max 4-8g daily)

Doses will be adjusted to ensure ease of administration with the above formulations

Side-effects:
Nausea, vomiting, diarrhoea, abdominal pain, headache, exacerbation of colitis symptoms, rarely reversible pancreatitis, hepatitis and interstitial nephritis, bone marrow suppression, fibrosing alveolitis.
Anaemia, folate deficiency and reversible oligospermia.
Stevens-Johnson syndrome, neurotoxicity, photosensitivity, proteinuria, haematuria, nephrotic syndrome.
Urine and contact lenses maybe stained orange.
Caution with G6PD deficiency and slow acetylators.
Caution if salicylate hypersensitive

Interactions:
May reduce the absorption of folic acid and digoxin

Notes:
Blood and LFT's should be performed regularly at the start of therapy.

Written: June 1999
Reviewed: Feb 2001
Review: June 2002

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Cyclosporin in paediatrics
For further information, see protocol for cyclosporin in treatment resistant Crohn's.

Indication:
Immunosuppressive therapy in Ulcerative colitis or Crohns disease.

Formulations:
Capsules 25mg, 50mg, 100mg
Injection 50mg/ml
Liquid 100mg/ml
Enema (manufactured special) 50ml enema

Dose:
IV 1mg/kg BD adjust dosage according to levels

Oral 2.5mg/kg BD adjust dosage according to levels

Rectal 5mg/kg of cyclosporin suspension (Neoral) in 50ml of suspending agent
(the oral solution is added to the suspending agent prior to administration)
Leave in for at least 60 mins OD or BD reducing frequency as necessary.
Cyclosporin is absorbed so a level should be taken after 7 days

Side-effects:
Dose dependant increase in serum creatinine and urea.
Fatigue, gingival hypertrophy, GI disturbances, burning sensation in hands and feet, tremor, headache, hypertension, weight increase, pancreatitis, dysmenorrhoea or amenorrhoea and neuropathy.

Interactions:
* Cyclosporin levels increased by concomittant administration of grapefruit juice, erythromycin, cimetidine, methylprednisolone, metoclopramide, tacrolimus (FK506), ketoconazole, itraconazole and fluconazole.
* Cyclosporin levels decreased by concomittant administration of rifampicin, phenobarbitone, phenytoin, carbamazepine and heparin.
* Nephrotoxicity is enhanced by concomittant administration of aminoglycosides, amphotericin, ciprofloxacin, diclofenac and frusemide.

Notes:
Cyclosporin injection contains polyethoxylated castor oil which has been associated with anaphylaxis. Observe patient for at least 30 minutes after starting infusion and at frequent intervals thereafter.
Trough whole blood levels 100-150 microgram/L.
Oral liquid should not be administered down NG tube nor mixed with grapefruit juice. Can be mixed with orange juice(or squash) or apple juice.
Cyclosporin injection can be administered via a Y site with intralipid 10% or 20%.

Written: June 1999
Reviewed: Feb 2001
Review: June 2002

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Azathioprine in paediatrics

Indication:
Immunosuppresive therapy in Ulcerative colitis or Crohns disease.

Formulation:
Injection 25mg
Tablet 25mg, 50mg

Dose:
PO/IV 1-3mg/kg

Dose between 2-3mg per kilogram is used, sometimes with initial 5 day intravenous duration.
Manipulate oral dose to multiples of 25mg if possible to save handling broken or crushed tablets.

Side-effects:
Hypersensitivity, dizziness, fever, rigors, muscular pain, disturbed LFT's and hypotension. STOP DRUG
Bone marrow suppression - dose related.
FBC weekly for first eight weeks then decrease to monthly for 3 months and then to 3 monthly

Interactions:
Reduce dose of azathioprine by 25% if on concomittant allopurinol.
Manufacturers report interaction with rifampacin.

Notes:
Thought that 5 day course of IV azathioprine will put patient into remission earlier than 4 to 6 weeks if course is started with oral medication.
Infuse IV dose in dextrose/saline over 1-3 hours.
Each patient on Azathioprine and their GP and, if appropriate Paediatrician, will receive an Azathioprine protocol sheet detailing side effects and investigations such as blood tests

Written: June 1999
Reviewed: Feb 2001
Review: June 2002

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Steroids in Paediatric Gastroenterology

Prednisolone in Paediatrics

Indication:
Reduce inflammation in acute attacks of Crohns and Ulcerative colitis.
Maintain remission of the above.

Formulations:
Prednisolone Tabs 1mg, 5mg, 25mg
Soluble 5mg
Methylprednisolone succinate Inj 40mg, 125mg, 500mg, 1g

Dose:
Acute inflammation.
Prednisolone 2mg/kg daily (max 40mg)
(if used >7days, decrease over 14 days)

Hydrocortisone is required to cover periods where the patient is to be nil by mouth or in the post operative period.
Acute inflammation: 50mg qds
Peri-operative cover: 20mg qds
Side effects: Dyspepsia, peptic ulceration, myopathy, osteoporosis, adrenal suppression, hirsutism, weight gain, negative nitrogen and calcium balance, increased appetite, immunosupression, fluid and electrolyte disturbances.

Interactions:
NSAID's - increased risk of bleeding
Carbamazepine, Phenobarbitone, Phenytoin - increased rate of metabolism of steroid.
Cyclosporin - increased prednisolone levels with increased cyclosporin levels with high dose methylprednisolone.
Diuretics - increased risk of hypokalaemia.

Notes:
Methylprednisolone succinate is indicated for IV therapy, not methylprednisolone acetate.
Converting methylprednisolone to prednisolone, reduce dose by 20%.

Written: June 1999
Reviewed: Feb 2001
Review: Feb 2002

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Prednisolone enemas in children

Indication:
Reduce inflammation in acute attacks of Crohns and Ulcerative colitis.
Maintain remission of the above.

Formulation:
Predfoam (Foam enema 20mg - 14 applications)
Predsol retention enema (20mg in 100ml - single nozzle application)
Prednisolone soluble tablets 5mg
Dissolve the dose in 20 to 50ml of water and administer rectally.
(useful in pts with rectal stump - see below)

Dose:
Usually 10 to 20mg nocte or BD

Side effects:
Local irritation reported

Interactions:
None recorded

Notes:
Patients with a rectal stump will benefit from the use of the prednisolone soluble tablets rather than the high volume retention enema.
Care must be taken with the nozzles in children.
e.g. 1cm inserted for 1 to 2 years
2cm for 2 to 3 years

Written: June 1999
Reviewed: Feb 2001
Review: Feb 2002

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Budesonide (Entocort CR) in paediatrics

Indication:
Mild to moderate Crohns disease affecting the ileum or ascending colon.

Formulation:
Capsules 3mg EC

Dose: 1-5 years 3mg OD
6-10 years 6mg OD
>10 years 9mg OD
Give for 8 weeks, reducing the dose over the last 2 weeks.

Side effects:
Rare but include the following; Dyspepsia, peptic ulceration, myopathy, osteoporosis, adrenal supression, hirsutism, weight gain, negative nitrogen and calcium balance, increased appetite, immunosupression, fluid and electrolyte disturbances.

Interactions:
Rare but include the following; NSAID's - increased risk of bleeding
Carbamazepine, Phenobarbitone, Phenytoin - increased rate of metabolism of steroid.
Cyclosporin - increased prednisolone levels with increased cyclosporin levels with high dose methylprednisolone.
Diuretics - increased risk of hypokalaemia.

Notes:
The contents of the capsule may be emptied and swallowed whole.

Written: June 1999
Reviewed: Feb 2001
Review: Feb 2002

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Infliximab Infusion for Paediatrics

Introduction

Infliximab is a monoclonal antibody which is used in the treatment of moderately to severe Crohns for the reduction of signs and symptoms which have shown an inadequate response to conventional therapy. It is also indicated for the treatment of fistulising Crohns disease in the reduction of the number of draining enterocutaneous fistula(s).
Infliximab acts by binding to and neutralising Tumour Necrosis Factor ( (TNF() and so interrupts the inflammatory signalling pathways that are affected by this cytokine.

Dosage and administration

Patients with fistulising Crohns disease are prescribed infusions of 5mg/kg infliximab at 0, 2 and 6 weeks.
The infliximab formulation does not contain a preservative and it is recommended that infliximab is administered to the patient immediately after reconstitution.
The infusion should run for a minimum of 2 hours and a maximum of 3 hours.
The treating doctor must be present for at least 10 minutes following the initiation of any infusion.

Pre-medication

The decision to pre-medicate is at the discretion of the medical staff.
Consider chlorpheniramine, hydrocortisone and paracetamol.
All prophylactic medication administered should be documented in the patients notes.

Monitoring
 

	Blood pressure	Pulse	Temperature
Prior to infusion	4	4	4
Start infusion
30min	4	4	4
60min	4	4	4
90min	4	4	4
120 min	4	4	4
Stop infusion
30 min	4	4	4
60 min	4	4	4
90 min	4	4	4
120 min	4	4	4

Side -effects

Flu like symptoms.
Headache, hypotension, transient fever, chills.
GI symptoms, skin rashes.
Anaphylaxis

Concomitant medication

Immunosuppressants and corticosteroids
The following drugs have been used during treatment with infliximab
- cyclosporin, aminosalicylates, 6-mercaptopurine, azathioprine and corticosteroids.

Anti-diarrhoeal agents
Anti-diarrhoeal and antispasmodic drugs maybe taken as required.


Written: March 1999
Reviewed: Feb 2001
Review: Feb 2002

A British National Formulary for Children has recently been published and this can be accessed at www.pharmpress.com which gives details of all drugs available for prescription in childhood

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