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Qxd 5/1/07 11:42 Page 15 Prescribing in Children Prescribing in Children 3 Simon Keady Definitions of age groups Neonate: birth to 1 month. Infant: 1 month to 2 years. Child: 2–12 years. Adolescent: 12–18 years. General principles of prescribing When it comes to prescribing, children are not ‘little adults’. • Some adult drugs are banned in children. • Drug doses often don’t just ‘scale down’ by weight. • Many products contain excipients that are risky for kids, eg, alcohol (phenobarbitone, ranitidine, senna), propylene glycol (pyridoxine injection) and dyes.
You must therefore consult a reference source (such as the BNF or your pharmacist) if in any doubt. Polypharmacy Older patients often have multiple diseases and need multiple drugs. This increases the risk of drug–drug and drug–food interactions and the development of adverse drug reactions. Polypharmacy can also affect compliance and increase the risk of errors. qxd 5/1/07 11:42 Page 21 Prescribing in Older Patients Risk–benefit Older patients should not be denied treatment due to their age – but do consider the risk–benefit analysis.
For nighttime sedation, give a larger dose (eg, double the daytime dose) at bedtime and the ward will enjoy a quieter night! Take care when prescribing for a patient who is intoxicated or sedated. If you opt for controlled withdrawal, Table 7 gives a suggested oral reducing regimen (titrate according to the patient’s response). Prescribe 20 mg PRN on top of this. Doses can be reduced if necessary (eg, in older patients). qxd 5/1/07 11:42 Page 45 Alcohol Dependence and the DTs Table 7. Chlordiazepoxide dosing regimen for the prevention of DTs.