Page 80 WHO - Guidelines on the pharmacological treatment of persisting pain in children with medical illness

Dose in opioid-naive patients
Intravenous:
• neonate, infant or child – 10 mcg/kg; if no response, give subsequent dose of 100 mcg/kg A1 A1
(resuscitation doses); review diagnosis if respiratory function does not improve; further doses may
be required if respiratory function deteriorates.

Continuous IV infusion using an infusion pump:
• neonate, infant or child – 5–20 mcg/kg/hr, adjusted according to response.
A2
Renal impairment: excretion of some opiods and/or their active metabolites (codeine,
dextropropoxyphene, dihydrocodeine, morphine, pethidine, oxycodone) is delayed in impairment so
these opioids will accumulate; extended treatment with naloxone infusion may be required to reverse
opioid effect.

Hepatic impairment: no dose adjustment necessary.

Adverse effects: A3
• common – nausea, vomiting, sweating;
• uncommon – tachycardia, ventricular arrhythmias;
• rare – cardiac arrest.

Interactions with other medicines: there are no known interactions where it is advised to avoid
concomitant use.
A4
Notes:
• Naloxone hydrochloride may be administered in the same doses as for intravenous injection by
subcutaneous injection, but only if the intravenous route is not feasible (slower onset of action).
• For continuous intravenous infusion, dilute to a concentration of 4 mcg/ml with glucose 5% or
sodium chloride 0.9%.
• For intravenous bolus, administer over 30 seconds as undiluted preparation.
• The intravenous dose may be repeated every 2–3 minutes until response. A5
• After initial response, the intravenous dose may need to be repeated every 20–60 minutes due to the
short duration of action.
• Do not administer naloxone to neonates of mothers who have been taking methadone or heroin.

References:
Berde C et al. Analgesics for the treatment of pain in children. New England Journal of Medicine, 2002, 347:1542.
Hill SR, Kouimtzi M, Stuart MC, eds. WHO model formulary. Geneva, World Health Organization, 2008. A6
Hodding JH, Kraus DM, Taketomo CK. Pediatric dosage handbook, 16th ed. Hudson, OH, Lexicomp, 2009.
Paediatric Formulary Committee. British national formulary for children 2009. London, BMJ Group RBS Publishing,
2009.
Rossi S, ed. Australian medicines handbook. Adelaide, Australian Medicines Handbook Pty Ltd., 2009.

A7

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