Excipients

Where possible use sugar –free preparations, particularly for long term medication. The BNF-C states which branded preparations are sugar free. Rarely some liquid preparations have a high level of alcohol (e.g. some preparations of phenobarbital elixir), which is unsuitable for children. Benzyl alcohol, which is a preservative used in some injectable products should be avoided in neonates as it has been associated with a fatal syndrome (gasping syndrome) in pre-term neonates. Information on these excipients are also indicated in the BNF-C

Unlicensed medicine use

Many medicines are only licensed for use in adults, as the manufacturer will have only investigated their safety and efficacy in adults, either due to commercial reasons or difficulty in recruiting children into clinical trials. Almost three quarters of medicine use on neonatal wards, and about one quarter of medicines on paediatric wards are prescribed outside of their licence (DoH, 2004). Prescribing unlicensed medicines or medicines outside of their licence increases your professional responsibility and potential liability. You should ensure that such prescribing is done on an informed basis, and that a suitable licensed alternative is not available. See chapter 2 for more information about unlicensed medicine use.

Choosing an antihistamine

A 5 year old child requires an antihistamine for travel sickness. Using the BNF-C to guide you, what are the most appropriate choices?