page219
1
Anapen
c
300
(delivering a single dose of adrenaline
300 micrograms), adrenaline 1 mg/mL (1 in 1000), net
price 1.05-mL auto-injector device = £30.67
Excipients
include sulphites
Note
0.75 mL of the solution remains in the auto-injector device
after use
Dose
by intramuscular injection,
ADULT and CHILD body-weight
over 30 kg, 300 micrograms repeated after 10–15 minutes as
necessary
Anapen
c
150
(delivering a single dose of adrenaline
150 micrograms),
adrenaline 500 micrograms/mL (1
in 2000),
net price 1.05-mL auto-injector device =
£30.67
Excipients
include sulphites
Note
0.75 mL of the solution remains in the auto-injector device
after use
Dose
by intramuscular injection,
CHILD body–weight 15–30 kg,
150 micrograms repeated after 10–15 minutes as necessary;
CHILD body-weight under 15 kg, [unlicensed] 150 micrograms
repeated after 10–15 minutes as necessary
EpiPen
c
(ALK-Abello
´
) A
1
EpiPen
c
Auto-injector 0.3 mg
(delivering a single
dose of adrenaline 300 micrograms),
adrenaline
1 mg/mL (1 in 1000),
net price 2-mL auto-injector
device = £28.77
Excipients
include sulphites
Note
1.7 mL of
the solution remains in the auto-injector device
after use
Dose
by intramuscular injection,
ADULT and CHILD body-weight
over 30 kg, 300 micrograms repeated after 5–15 minutes as
necessary
Epipen
c
Jr Auto-injector 0.15 mg
(delivering a single
dose of adrenaline 150 micrograms),
adrenaline
500 micrograms/mL (1 in 2000), net price 2-mL auto-
injector device = £28.77
Excipients
include sulphites
Note
1.7 mL of
the solution remains in the auto-injector device
after use
Dose
by intramuscular injection,
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 5–15 minutes as necessary;
CHILD body-weight
under 15 kg, [unlicensed] 150 micrograms repeated after 5–15
minutes as necessary
Angioedema
Angioedema
is dangerous if
laryngeal
oedema
is pre-
sent.
In this circumstance adrenaline (epinephrine)
injection and oxygen should be given as
described
under Anaphylaxis (see p.
197); antihistamines and cor-
ticosteroids should also be given.
Tracheal
intubation
may be necessary.
Hereditary angioedema
The administration of
C1-
esterase inhibitor, an endogenous complement blocker
derived from human plasma, (in fresh frozen plasma or
in partially purified form) can terminate acute attacks of
hereditary angioedema
,
but
is not
practical
for long-
term prophylaxis;
it
can also be used for
short-term
prophylaxis before surgery or dental
procedures [unli-
censed indication].
Icatibant is licensed for the treat-
ment
of
acute attacks
of
hereditary angioedema in
adults with C1-esterase inhibitor deficiency.
Tranexamic acid (section 2.11)
and danazol
(section
6.7.2)
[unlicensed indication]
are used for
short-term
and long-term prophylaxis of
hereditary angioedema.
Short-term prophylaxis with tranexamic acid or danazol
is started several
days before planned procedures (e.g.
dental
work)
and continued for
2–5 days afterwards.
Danazol
should be avoided in children because of
its
androgenic effects.
C1-ESTERASE INHIBITOR
Indications
acute attacks of hereditary angioedema;
prophylaxis prior to surgery or major dental proce-
dures [unlicensed]
Cautions
vaccination against hepatitis A,
p.
754 and
hepatitis B,
p.
755 may be required
Pregnancy
manufacturer advises avoid unless essen-
tial
Breast-feeding
manufacturer advises use only if
potential benefit outweighs risk—no information
available
Side-effects
rarely
injection-site reactions,
hyper-
sensitivity reactions (including anaphylaxis)
Dose
. By slow intravenous injection or intravenous infusion,
ADULT
and
CHILD
20 units/kg
Berinert
c
(CSL Behring) T A
Injection
,
powder for reconstitution C1-esterase
inhibitor,
net price 500-unit vial = £550.00
Electrolytes
Na
+
2.1 mmol/10 mL vial
ICATIBANT
Indications
acute attacks of hereditary angioedema in
patients with C1-esterase inhibitor deficiency
Cautions
ischaemic heart disease,
stroke
Pregnancy
manufacturer advises use only if potential
benefit outweighs risk—toxicity in
animal
studies
Breast-feeding
manufacturer advises avoid for 12
hours after administration
Side-effects
dizziness,
headache,
injection-site reac-
tions,
rash,
pruritus,
erythema
Dose
. By subcutaneous injection,
ADULT
over 18 years,
30 mg as a single dose,
repeated after 6 hours if
necessary; a third dose may be given after a further 6
hours (max.
3 doses in 24 hours)
Firazyr
c
(Shire HGT) T A
Injection
,
icatibant (as acetate) 10 mg/mL,
net price
3-mL prefilled syringe = £1395.00
3.5
Respiratory stimulants
and pulmonary
surfactants
3.5.1 Respiratory stimulants
3.5.2 Pulmonary surfactants
3.5.1
Respiratory stimulants
Respiratory stimulants (analeptic drugs) have a limited
place in the treatment of ventilatory failure in patients
with chronic obstructive pulmonary disease.
They are
effective only when given by intravenous injection or
infusion and have a short duration of action.
Their use
has largely been replaced by ventilatory support includ-
1.
A restriction does
not
apply to adrenaline injection
1 mg/mL where
administration
is
for
saving
life
in
emergency
BNF 61
3.5 Respiratory stimulants and pulmonary surfactants
199
3
Respiratory system