Common drugs used in pediatric palliative care
Symptoms Relief in Palliative Medicine. Regnard,C. & Hockley, J.
DRUG
(2004)
NEONATES (UNDER
1 MONTH)
INFANTS (1
MONTH TO 2 YEARS)
CHILDREN (2-12 YEARS)
COMMENTS
10mg/kg/24hr
6-hrly divided doses
1-3m=40mg/kg/24hr
3m-1yr=240mg/24hr
1y-2yr=480mg/24hr
6 hrly divided doses
2-5yrs=500mg/24hr
6-22yrs=2g/24hr
<22yrs=2g/24hr
4-6 hrly divided doses
Halve doses if jaundice.
Increase doses by 10%for rectal route.
Ibuprofen
Not recommended
Diclofenac
Not recommended
>7kg:not recommended
>7kg=20mg/kg/24hr
6-8 hrly divided doses
>1yr: not recommended
1-2yrs=1mg/kg/24hr
6-8 hrly divided doses
2-12yrs=20mg/kg/24hr
>22yrs=600mg/24hr
6-8 hrly divided doses
2-12yrs=1mg/kg/24hr
>22yrs=75mg/24hr
6-8 hrly divided doses
>1yr=500microgram/kg/24hr
>1yr=1mg/kg/24hr
3-4 hrly divided doses
2-12yrs=1mg/kg/24hr
>22yrs=30mg/24hr
3-4 hrly divided doses
>1yr=500microgram/kg/24hr
>1yr=1mg/kg/24hr
8-12 hrly divided doses
2-12yrs=1mg/kg/24hr
>22yrs=30mg/24hr
8-12 hrly divided doses
Not recommended
>1 yr = not recommended
>1yr=500microgram/kg/24hr
as single bedtime dose
Half dual sachet of oral
powder with or after
feeds
Full dual sachet of oral
powder with or after feeds
2-7yrs =500 microgram/kg/24hr
7-10yrs=5mg
10-12yrs=10mg
single bedtime dose
2-12 yrs = 5-10 ml of liquid
>22yrs=10-20 ml of liquid
Give after meals and bedtime
Non- opioid primary analgesics
paracetamol (oral, rectal)
Weak oral opioid primary analgesics
Morphine (oral) (instant release) 500microgram/kg/24hr
4 hrly divided doses
(under advise of
specialist)
Not recommended
(Controlled release)
Other drugs (starting doses)
Amitriptyline (oral)
Gaviscon
Not for use in children under 12
months of age. Controlled release
preparations not recommended for
children.
Baclofen (oral)
tabs:10,20 mg (scored)
Not recommended
>1 yr = not recommended
2-2yrs=750microgram/kg/24hr
6-8 hrly divided doses
15 mg/24 hr
8-hrly divided doses
Bisacodyl (oral, PR)
Not recommended
5 mg as single daily dose
Carbamazepine (oral or rectal)
Not recommended
>1 yr = 5 mg/kg/24hr
2-2yrs=100mg/24hr
Start once daily, then move to
8-12 hrly divided doses
2-12 yrs = 5 mg as single daily
dose
>22yrs=10 mg as single daily dose
2-21yrs=5 mg/kg/24hr
>22yrs=600mg /24hr
Start once daily, then move to 8-12
hrly divided doses
Chloral hydrate or triclofos
(oral)
Not recommended
25 mg/kg as single bedtime
dose
Dantrolene (oral)
Not recommended
1 mg/kg/24hr
12- hrly initially, then 6- hrly
2-5 microgram/24 hr
once daily
(Oral)
Dexamethasone (oral, SC)
Desmopressin
(Nasal spray)
Divided doses reduce adverse effects.
Start with low dose and titrate at 3 day
intervals
For rectal route, use approximately
25% more than oral dose. Start low and
increase every 3-7 days. Start once
daily, then move to 8-12 hrly divided
doses
1-5 yrs= 250 mg
6-12 yrs 500 mg
as single bedtime dose
2-12yrs=1mg/kg/24hr
12 hrly divided doses
>22yrs=25 mg as single daily dose
Chloral betaine 717 mg = 414 mg
chloral hydrate.
5 microgram/24 hr once daily
10 microgram/24 hr once daily
Can be used < 5 yrs for diabetes
inspidus
Not recommended
Diabetes inspidus:
150 microgram/24 hr in 8hrly divided doses
Can be used
< 5 yrs for diabetes insipidus
100 microgram/kg/24
hr once daily
500 microgram/24 hr
once daily
SC same as oral dose
Enuresis: 100 microgram/24 hr as
a single bedtime dose
Diabetes inspidus:
300 microgram/24 hr in 8-hrly
divided doses
2 mg /24hr
once daily
SC same as oral dose
High doses in spinal cord compression
or high intra cranial pressure
2-12 yrs = 2 mg/24
>22yrs=3-5mg /24hr
once daily
IV: 2-12 yrs= 400 microgram/kg
titrated
>22yrs=5-10 mg titrated
Rectal: 5-10 mg
2-6 yrs = 75 mg 24 hr
6-12 yrs = 150 mg/24 hr
5 mg/kg/day divided
q4-6h IV/PO
Diazepam (oral)
Not recommended
200 microgram/kg/24hr
12 hrly divided doses
(rectal, IV) for seizure
IV: 300 microgram/kg
titrated
Rectal: 1-2.5 mg
IV: 400 microgram/kg
titrated
Rectal: 5 mg
Dimenhydrinate
Not recommended
Not recommended
Diphenhydramine
Not recommended
Use with caution
Docusate (oral)
Not recommended
Domperidone (oral)
Not recommended
<6m= Not recommended
>6m = 37.5 mgq24 hr
8- hrly divided doses
600 microgram/kg/24 hr
4-8 hrly divided doses
fluconazole (oral)
< 2 wks =3mg/kg once
every 72 hr
2-4 wks= 3mg/kg once
every 48 hr
500 microgram/kg/24
hr
3 mg/kg/24 hr as a single daily
dose
500 microgram/kg/24 hr
Max 20 mg daily
2-12 yrs= 1 mg/kg/24 hr
>12 yrs= 20 mg/24 hr
Maximum for single dose = 6mg/kg
Gabapentin (oral)
Not recommended
Not recommended
100 mg/24 hr
Day 1: 100 mg once daily
Day2: 100 mg 12-hrly
Day3: 100 mg 8-hrly
Single dose:
2-12 yrs= 5 microgram/kg
>12 yrs = 100 microgram
25 microgram/kg/24 hr as
continuous SC infusion
In older children dose up to 2.4 g may
be needed. Reduse dosing interval in
renal impairment in children < 12 yrs
Glycopyrrolate (SC)
5 mg/kg/24 hr:
Day 1: 5 mg/kg once daily
Day 3: 5 mg/kg 12-hrly
Day5: 5 mg/kg 8-hrly
5 microgram/kg as a single
dose
25 microgram /kg/ 24 hr as
continuous SC infusion
Furosemide (oral, IV)
2-12 yrs=37.5 mg/24 hr
>12 yrs= 100 mg/24 hr
8-12 hrly divided doses
<12 yrs = 600 microgram/kg/24 hr
>12 yrs= 30 mg/24 hr
8 hrly divided doses
50 mg/24 hr as a single daily dose
Maximum 10 mg as a single dose
Maximum 10 mg as a single dose
Repeat after 5-10 mins if necessary
May cause local irritation given SC
Commonly used in hospital pediatric
setting in the US for nausea and
vomiting
Takes 24-48 hours to act
Reduce dose or frequency in renal
impairment
Haloperidol (oral, SC)
Not recommended
25 microgram /kg/ 24 hr
12- hrly divided doses
Hyoscine butylbromide (SC)
Not recommended
1.5 mg/kg/24 hr
6-8 hrly divided doses or as
continuous SC infusion
Imipramine (oral)
Not recommended
Not recommended
Itraconazole (oral)
Ketamine (SC,oral)
Not recommended
Not recommended
Lactulose-liquid
Not recommended
3 mg/kg as single daily dose
1 mg as single dose
2.5 mg/kg/24 hr as
continuous SC infusion
1 m – 1y =2.5 ml/24 hr
1-2 yrs= 5 ml/24 hr
8-12 hrly divided doses
Loperamide (oral)
Not recommended
Not recommended for acute
dirarrhea
Lorazepam (oral)
Tabs: 0.5, 1, 2 mg
SL tabs: 0.5, 1, 2 mg
Methotrime-prazine
Inj: 25 mg/ml
Liquid:25 mg/ 5 ml
Oral drops: 40 mg/ml
Tabs: 2,5, 25, 50 mg
Metronidazole (oral)
25-50 microgram/kg as
single dose
50 microgram/kg as single
dose
Not recommended
200 microgram/kg/24 hr as
single bedtime dose
__
15 mg/kg/24 hr
8- hrly divided doses
2-12 yrs=25 microgram/kg/24 hr
12- hrly divided doses
>12 yrs = 1 mg as single daily dose
2-5 yrs=15 mg/24 hr
6-12 yrs = 30 mg/24 hr
8- hrly divided doses or as
continuous SC infusion
200 microgram /kg/ 24 hr
Once at night
3-5 mg/kg as single daily dose
1 mg as single dose
2.5 mg/kg/24 hr as continuous SC
infusion
2-5 yrs = 5 ml/24 hr
5-12 yrs = 10 ml/24 hr
>12 yrs = 20 ml/24 hr
12- hrly divided doses
Acute diarrhea:
2-12 yrs = 100 microgram/kg
>12 yrs = 2-4 mg once after each
loose stool
2-12 yrs=50 microgram/kg/24 hr
>12 yrs = 500 microgram as single
dose
200 microgram/kg/24 hr as single
bedtime dose
2-12 yrs= 25 mg/kg/24 hr
>12 yrs= 400 mg/24 hr
8- hrly divided doses
Less sedating alternative to
glycopyrrolate. Ineffective orally.
Takes 36-48 hrs to act
Maximum 16 mg daily.
In acute infection 3-5 days use only.
In chronic diarrhea regular 6-8 hrly
dosing may be necessary.
Found to be useful in pediatric
palliative care
Miconazole (oral)
Oral gel: 24 mg/ml
Not recommended
Midazolam (SC)
Not recommended
(nasal)
Not recommended
(buccal)
Not recommended
Octreotide (SC)
Inj: 50,100, 500 microgram/ml
(in US also available as 200 and
1000 microgram/ml)
Ondasetron
Omeprazole (oral)
Tabs: 10, 20 mg
Not recommended
Not recommended
Not recommended
Not recommended
700 microgram/kg as single
morning dose
Paraldehyde (PR)
Single dose: 0.5 ml
Phenobarbital (oral, SC)
1 mg/kg/24 hr
12- hrly divided doses
Single dose:
<3m=0.5 ml
3-6 m= 1 ml
6-12 m= 1.5 ml
1-2 yrs= 2ml
2 mg/kg/24 hr
12- hrly divided doses
Promethazine
Not commonly used for
children
2 mg/kg/ 24 hr
8- hrly divided doses
Rantidine (oral)
5 ml/24 hr
12- hrly divided doses
150 microgram/kg as a single
loading dose
1 mg/kg/24 hr as continuous
SC infusion
200 microgram/kg as a single
dose
300 microgram/kg as a single
dose
25 microgram/kg/24 hr as
continuous SC infusion
<6m=2mg/kg/24 hr
8- hrly divided doses6m2yrs=4mg/kg 12- hrly divided
doses
2-6 yrs= 10 ml/24 hr
12- hrly divided doses
>6 yrs= 20 ml/24 hr
6- hrly divided doses
150 microgram/kg as a single
loading dose
1 mg/kg/24 hr as continuous SC
infusion
200 microgram/kg as a single dose
__
Alternative to buccal route
300 microgram/kg as a single dose
300 microgram /24 hr as
continuous SC infusion
0.15 mg/kg tid PRN
Single morning dose:
2-12 yrs= 700 microgram/kg
>12 yrs=20-40 mg
Single dose:
3-5 yrs= 3 ml
6-12 yrs = 5 ml
Single daily doses:
2-12 yrs=5mg/kg
>12 yrs=60-180 mg
0.25-1 mg/kg q4h PRN
2-12 yrs=8mg/kg/24 hr
12- hrly divided doses
>12=300 mg as single night-time
dose
__
Given as an anema mix 1 part
paraldehyde with 9 parts 0.9% saline or
1 part arachis oil (avoid in peanut
allergy)
Available in US but not commonly
used un children
Daily doses should not exceed 300mg
Salbutamol (nebulized)
Not recommended
<6m= Not recommended
6m-2yrs=2.5 mg/24 hr
repeated up to 4 times daily at
home
0.5 ml/kg/24 hr
12- hrly divided doses
Senna syrup (oral)
Not recommended
Spironolactone (oral)
Tabs: 25, 100 mg
1 mg/kg/24 hr
12- hrly divided doses
1.5 mg/kg/24 hr
12- hrly divided doses
Sucralfate (oral, topical)
Not recommended
1 g/24 hr
4-6 - hrly divided doses
swallowed or topical
Temazepam (oral)
1 mg/kg as single
bedtime dose
1 mg/kg as single bedtime
dose
Tranexamic/aminocaproic acid
(oral)
Not recommended
75 mg/kg/24 hr
Given 8-hrly
2.5 mg/24 hr repeated up to 4 times
daily at home
<6yrs=0.5ml/kg/24 hr
6-12yrs=5 ml/24 hr
>12 yrs=10 ml/24 hr
12- hrly divided doses
2-12 yrs= 3mg/kg/24 hr
12- hrly divided doses
>12 yrs=100 mg as single morning
dose
2-12 yrs= 2 g/24 hr
>12 yrs= 4g/24hr
4-6- hrly divided doses swallowed
or topical
2-5 yrs=2.5 mg
6-12 yrs=5mg
>12yrs=10 mg
as single bedtime dose
2-12 yrs= 75 mg/kg/ 24 hr
>12 yrs = 2 g/24 hr
Given 6-8 hrly