prescription Q

[emelianenko]

Hi

I have a query with a prescription I came across in a dispensing class. It is a FP10 prescription for a 5 yr old child. The item prescribed is diclofenac sodium at a dose of 4mg/kg/daily divided doses and dispersible tablets 50mg are requested. I checked the weight of a 5 yr old in childrens BNF and it states 18kg. The guidelines in the BNF are 0.3-1mg/kg TDS. Now I know I would have to get the dose changed and going by 1mg/kg that comes to 18mg daily divides doses (6mg tds). Now in the BNF it states that solid dosage forms containing more than 25mg are not licensed for use in children and it states that a 10mg formulation is also available from specials manufacture. Im struggling a bit with regards to what solution I would present to the prescriber, if any, with regards to the preparation to dispense. And If I was to use the 50mg dispersible preparation, how would one direct the patient on use??? Advice would be much appreciated.

Thanks.

[Pharmanaut]

Specials really add dramatically to the cost of treatment.
If you are advising a prescriber, what is the child's condition - are there any other routes of admin?
Might not be suitable, but worth adding to your discussion.

Here's a clue if you are having problems.
http://tinyurl.com/y7vc39x

[Nik]

What exactly is the condition for which diclofenac is needed ? If for mild/mod inflammation could you not consider ibuprofen ?

[emelianenko]

Hi

Thanks for the replies.

I dont have the exact specifics on exact indications. I just have the script from a dispensing class. Say I did make supply and had the dose changed to 6mg tds (1mg/kg @ 18kg) ... would I advise the patient to disperse one tablet in i.e. 10mL of water and administer 1.2mL for each dose?

I am assuming it is indicated for pain/inflammation

[Nik]

Have you already had the dispensing class or is this a separate exercise ? If diclofenac was just for mild pain/inflammation then would you not consider ibuprofen instead ? Diclofenac 50mg tabs not licensed for use in children, suppositories not for under 6 and 10mg as specials - cannot see how they would make a dispensing exercise which would lead to unlicensed/special prescribing.

[bobbin]

I have a query with a prescription I came across in a dispensing class. It is a FP10 prescription for a 5 yr old child. The item prescribed is diclofenac sodium at a dose of 4mg/kg/daily divided doses and dispersible tablets 50mg are requested. I checked the weight of a 5 yr old in childrens BNF and it states 18kg. The guidelines in the BNF are 0.3-1mg/kg TDS. Now I know I would have to get the dose changed and going by 1mg/kg that comes to 18mg daily divides doses (6mg tds). Now in the BNF it states that solid dosage forms containing more than 25mg are not licensed for use in children and it states that a 10mg formulation is also available from specials manufacture. Im struggling a bit with regards to what solution I would present to the prescriber, if any, with regards to the preparation to dispense. And If I was to use the 50mg dispersible preparation, how would one direct the patient on use??? Advice would be much appreciated.

Diclofenac isn't much used in children except for juvenile arthritis.

If the child was 18kg and was being treated with 1mg/kg tds, the dose would be 18mg tds (not 6mg tds).

For arthritis, the BNF-C recommends a dose of 1.5-2.5mg/kg twice a day. This is equivalent to 3-5mg/kg per day in divided dose. The BNF-C also notes that the same total dose can be given in three divided doses as an alternative.

Your question states that 4mg/kg/day was prescribed, which is within the range of 3-5mg/kg/day used to relieve the symptoms of juvenile arthritis. Assuming a weight of 18kg, the total daily dose would be 4 x 18 = 72mg/day. This would have to be rounded off to 75mg/day in order to facilitate administration. The dose would therefore be 25mg three times a day.

If the child was able to swallow tablets, diclofenac sodium 25mg e/c tablets could be prescribed (and are licensed for use in children). The 25mg tablets are quite small and many children can swallow them.

Although the 50mg dispersible tablets are not licensed for use in children, some children cannot swallow tablets and so the dispersible tablets could be used 'off label'. In general, doctors are not particularly interested in licensing. This is something that pharmacists seem to spend more time worrying about! Diclofenac suppositories have the advantage of being licensed for use in juvenile arthritis, although I imagine that the dispersible tablets would generally be preferable. Unfortunately, since diclofenac dispersible tablets are not marketed in a 25mg strength, the parent would have to dissolve a 50mg tablet in water and give half. The 10mg dispersible tablets are an unlicensed 'special'; they aren't often used.

[emelianenko]

Thanks for the detailed reply bobbin. Much appreciated.