Paracetamol  BFP

Tablet

Suspension

Rectal

10-15 mg/kg 6 hourly

Max dose

1000 mg / dose

75 mg/kg / day

( up to 4000 mg / day )

1000 mg QDS

No age limit

Ibuprofen

Tablet / Capsule

Syrup

5-10 mg/kg 6-8 hourly

Max dose

400 mg / dose

40 mg/kg / day

( up to 2400 mg / day )

200-400 mg TDS to 4 hourly

6 months and above

Diclofenac

Tablet

SR Tablet

IM

Rectal

0.5-1 mg/kg 8-12 hourly

Max dose

3 mg/kg / day

50-100 mg BD-TDS

SR Tablet

75 mg = 2 tabs OD

100 mg = 1 tab OD

IM

75 mg OD-BD

Max dose

100 mg / dose

200 mg / day

1 year and above

Naproxen

Tablet

Suspension

Juvenile RA

10 mg/kg/day, divided BD

More than 50 kg = adult dose

275-550 mg BD-QDS

Max dose

825 mg / dose

1375 mg / day

Juvenile RA

5 years and above

Others

16 years and above

Mefenamic acid

Tablet / Capsule

Suspension

-

250-500 mg TDS-QDS

Max dose

500 mg / dose

1500 mg / day

14 years and above

Celecoxib

Capsule

-

100-200 mg OD-BD

Max dose

400 mg / day

18 years and above

Etoricoxib

Tablet

-

OA

60 mg / day

RA / AS

90 mg / day

Others

120 mg / day

16 years and above

Tramadol

Tablet / Capsule

IM / IV

-

50-100 mg TDS

Max dose

400 mg / day

12 years and above

18 years and above for post-operative pain following tonsillectomy / adenoidectomy

Cetirizine

Tablet

Syrup

6 months to <1 year

2.5 mg OD

1 to <2 years

2.5 mg OD - BD

2 to 5 years

2.5 mg BD / 5 mg OD

6 years and above

5 mg BD

-

10 mg OD

Max: 10 mg BD

6 months and above

Levocetirizine

Tablet

6 years and above

5 mg OD

-

5 mg OD

Max: 5 mg BD

6 years and above

Loratadine

Tablet

Syrup

-

-

-

10 mg OD

Max: 10 mg BD

2 years and above

Desloratadine

Tablet

Syrup

1 to <6 years

1.25 mg (2.5 ml) OD

6 to <12 years

2.5 mg (5 ml) OD

12 years and above

Follow adult dosing

-

5 mg OD

1 year and above

Fexofenadine

Tablet

Suspension

6 months to <2 years

15 mg (2.5 ml) BD

2 to <12 years

30 mg (5 ml) BD

12 years and above

Follow adult dosing

-

120 - 180 mg OD

6 months and above

Chlorpheniramine

Tablet

Syrup

IM/ IV / SC

1 to <2 years

1 mg (1.25 ml) BD

2 to <6 years

1 mg (1.25 ml) TDS

6 to <12 years

2 mg (2.5 ml) TDS

12 years and above

Follow adult dosing

-

Usual: 4 mg TDS

Max: 24 mg / day

1 year and above

Racecadotril (Hidrasec)

Granules

Less than 9 kg

10 mg TDS

9 kg to < 13 kg

20 mg TDS

13 kg to 27 kg

30 mg TDS

More than 27 kg

60 mg TDS

( 1.5 mg/kg TDS )

The duration of treatment in the clinical trials with children was 5 days.

-

No trials in infants < 3 months old

Smecta

Powder

1 satchet BD-TDS

1 satchet TDS

2 years and above  

Ondansetron

Tablet

IM / IV

IM / IV (1 month and above)

0.15 - 0.3 mg/kg ONCE

Oral (6 months and above)

8-15 kg = 2 mg ONCE

15-30 kg = 4 mg ONCE

>30 kg = 6-8 mg ONCE

Max dose

16 mg / dose

4-8 mg ONCE

Repeat 4-8 mg 4-8 hourly as needed

1 month and above

Domperidone

Tablet

Suspension

Rectal

< 12 years OR < 35 kg

Oral = 0.25 mg/kg TDS

Rectal = 0.75 mg/kg BD

≥ 12 years AND ≥ 35 kg

Oral = 10 mg TDS

Rectal = 30 mg BD

10 mg TDS

1 month and above

Contraindicated:  

Raised QTc

Significant electrolyte disturbances

Underlying cardiac disease

Caution:

> 60 years

Augmentin

Tablet

Suspension

4:1 formulation

20 - 40 mg/kg/day divided TDS

Max dose = 1500 mg / day

7:1 formulation

25 - 45 mg/kg/day divided BD

Max dose = 1750 mg / day

500 mg BD to TDS

or

875 mg BD

Dose according to amoxicillin content

Formulations generally fall into ratios of 2:1, 4:1, or 7:1 (of amoxicillin to clavulanate)

Ceftriaxone

IM / IV

Neonates (up to 14 days)

20-50 mg/kg OD

Up to 12 years

20-80 mg/kg OD

≥50 kg = adult dosing

Gonorrhoea

<45 kg OR < 12 years

25-50 mg/kg ONCE

(max 250 mg IM)

≥45 kg AND ≥ 12 years

Follow adult dosing

Usual

1 - 2 g OD

Gonorrhoea  

500 mg ONCE

(+ anti-chlamydial treatment)

Dilution (IM)

500 mg = 2 ml of lignocaine 1%

1 g = 3.5 ml of lignocaine 1%

Dilution (IV injection)

500 mg = 5 ml of water

1 g = 10 ml of water

Dilution (IV infusion)

2 g = 40 ml of calcium-free infusion solution

Clarithromycin

IR Tablet

MR Tablet

Suspension

IV

1 month to 12 years

7.5 mg/kg/dose BD

( Max: 500 mg BD )

13 years and up

Follow adult dosing

IR tablet

250 - 500 mg BD

MR tablet

1 - 2 tab(s) OD

1 month and above

Drug interactions

Ergotamines (ergot toxicity)

Lovastatin, simvastatin (myopathy)

Colchicine (colchicine toxicity)

Azithromycin

Tablet

Suspension

IV

≤ 45 kg

10 mg/kg/day OD

( Max: 1500 mg total )

> 45 kg

Follow adult dosing

500 mg OD x 3 days

or

500 mg OD x 1 day then 250 mg OD x 4 days

No age limit

Association with infantile hypertrophic pyloric stenosis up to 7 weeks

Caution

QT prolongation

Myasthenia Gravis flare

Doxycycline

Capsule

Malaria prophylaxis  

2.2 mg/kg OD

( Max: 100 mg OD )

Start 2 days before travel

Continue for 4 weeks after return

Malaria prophylaxis  

100 mg OD

Start 2 days before travel

Continue for 4 weeks after return

Acne

100 mg OD

Min 6 weeks for effect

Limit to 3-4 months

8 years and above

ADR

GI upset

Esophagitis

Photosensitivity

Ciprofloxacin

Tablet

Eye / Ear

IV

10 - 15 mg/kg/dose BD

( Max: 500 mg BD )

250 - 500 mg BD

Avoid in children (? age)

Risk of arthropathy

Caution

Tendinitis / tendon rupture

AAA / risk of AAA (Marfan, Ehlers-Danlos)

QT prolongation

Reduce seizure threshold

Valacyclovir

Tablet

Varicella

20 mg/kg/dose (max 1000 mg) TDS x 5 days

Children who need treatment

> 12 years old

Secondary cases in household contacts

Chronic cutaneous or pulmonary disease

On oral or inhaled steroids

Varicella

1000 mg TDS x 1 week

Zoster

1000 mg TDS x 1 week

Ramsay Hunt

1000 mg TDS x 7-10 days

+ prednisolone 1 mg/kg x 5 days, no taper

Bell's palsy

For severe cases (HB grade IV or higher) = 1000 mg TDS x 1week

Genital herpes

First episode = 1000 mg BD x 7-10 days

Recurrence = 500 mg BD x 3 days OR 1000 mg OD x 5 days

Oral herpes

First episode = 1000 mg BD x 7-10 days

Recurrence = 2000 mg BD x 1 day

Start within 72 hours of onset

Oseltamivir

Capsule

Influenza treatment

Less than 1 year old:

3 mg/kg/dose BD

1 year and above:

Less than 15 kg = 30 mg BD

15 to 22 kg = 45 mg BD

23 to 39 kg = 60 mg BD

40 kg and above = 75 mg BD

Influenza prophylaxis

Same dose, just OD instead of BD

Not recommended for < 3 months old

Influenza treatment

75 mg BD x 5 days

Influenza prophylaxis

75 mg OM

Duration of prophylaxis

Used as adjunct to influenza vaccination

Taken throughout duration of exposure

Continue for 1 week after last exposure

Minimum duration of treatment is 2 weeks (time taken for antibody development after vaccination)

Benefit is greatest if started within 48 hours

Itraconazole

Capsule

Solution

-

Tinea / pityriasis versicolor

200 mg OD x 7 days

Dermatomycosis

Regular skin = 200 mg OD x 7 days OR 100 mg OD x 15 days

Highly keratinised skin (e.g. palms, soles) = 200 mg OD x 7 days OR 100 mg OD x 30 days

Onychomycosis

Continuous treatment = 200 mg OD x 3 months

Pulsed treatment = 200 mg BD x 1 weeks THEN Break x 3 weeks

Fingernails = 2 pulses, Toenails = 3 pulses

Vulvovaginal candidiasis

200 mg BD x 1 day OR 200 mg OD x 3 days

-

Nystatin

Suspension

Vaginal tablet

Premature infants

1 ml QDS

Infants

2 ml QDS

(1 ml to each side of mouth)

1 year and above

Follow adult dose

Oropharyngeal candidiasis

5 ml QDS

Vulvovaginal candidiasis

1 vaginal tablet ON

No age limit

Infants

Paint onto recesses of mouth mucosa

Children / adults

Swish in mouth for few minutes, then swallow

Duration of treatment

1-2 weeks

Budesonide / Formoterol (Symbicort)

Rapihaler (MDI)

Turbuhaler (DPI)

6 to 11 years

Maintenance

80/2.25 = 2 puffs BD

160/4.5 = not recommended

SMART / PRN Reliever

Not recommended

12 years and above

Follow adult dose

Maintenance

80/2.25 = 2-4 puffs BD

(can step up to max 8 puffs BD)

160/4.5 = 2 puffs BD

(can step up to max 4 puffs BD)

SMART

80/2.25 = 2-4 puffs BD + 2 puffs PRN

(max 24 puffs per day)

160/4.5 = 1-2 puffs BD + 1 puff PRN

(max 12 puffs per day)

PRN Reliever

80/2.25 = 2 puffs PRN

(max 24 puffs per day)

160/4.5 = 1 puffs PRN

(max 12 puffs per day)

Maintenance therapy

6 years and above

PRN Reliever

12 years and above

Maintenance + Reliever (SMART)

12 years and above

Fluticasone propionate / Salmeterol (Seretide)

Evohaler (MDI)

Accuhaler (DPI)

4 to 11 years

50/25 = 2 puffs BD

100/50 = 1 puff BD

Other strengths = not recommended

12 years and above

Follow adult dose

Evohaler = 2 puffs BD

(can step up to ___)

Accuhaler = 1 puff BD

(can step up to ___)

4 years and above

Fluticasone furoate / Vilanterol (Relvar)

Ellipta (DPI)

12 years and above

Follow adult dose

Asthma

Either strength = 1 puff BD

COPD

100/25 = 1 puff BD

200/25 = not recommended

12 years and above

Fluticasone furoate (Avamys)

Nasal spray

2 to 11 years

Start: 1 spray to each nostril OD

Max: 2 sprays to each nostril OD

12 years and above

Start: 2 sprays to each nostril OD

Maintenance: 1 spray to each nostril OD

2 years and above

Mometasone furoate (Nasonex)

Nasal spray

2 to 11 years

1 spray to each nostril OD

12 years and above

Start: 2 sprays to each nostril OD

Max: 4 sprays to each nostril OD

Maintenance: 1 spray to each nostril OD

AR

2 years and above

Acute rhinosinusitis

12 years and above

Nasal polyposis

18 years and above

Fluticasone propionate / Azelastine hydrochloride (Dymista)

Nasal spray

6 years and above

Follow adult dose

1 spray to each nostril BD

6 years and above

Mometasone furoate / Olopatadine hydrochloride (Ryaltris)

Nasal spray

12 years and above

Follow adult dose

2 sprays to each nostril BD

12 years and above

Captopril

Tablet

-

Initial: 6.25 - 25 mg BD - TDS

Max: 50 mg TDS

-

Enalapril

Tablet

-

Initial: 2.5 - 10 mg OD - BD

Max: 20 mg BD

-

Lisinopril

Tablet

-

Initial: 2.5 - 10 mg OD

Max: 40 mg OD

6 years and above

Perindopril arginine

Tablet

-

Initial: 2.5 - 5 mg OD

Max: 10 mg OD

18 years and above

Perindopril erbumine

Tablet

-

Initial: 4 mg OD

Max: 8 - 16 mg OD

18 years and above

Max for CrCl 30-80: 8 mg OD

Candesartan

Tablet

-

4 - 32 mg OD

18 years and above

Irbesartan

Tablet

-

75 - 300 mg OD

Losartan

Tablet

-

25 - 100 mg OD

Olmesartan

Tablet

-

20 - 40 mg OD

Telmisartan

Tablet

-

20 - 160 mg OD

18 years and above

Valsartan

Tablet

-

Hypertension

80 - 320 mg OD

Heart failure

40 - 160 mg BD

Post-MI

20 - 160 mg BD

18 years and above

Amlodipine

Tablet

-

2.5 - 10 mg OD

Nifedipine LA

Tablet

-

20 - 160 mg OD

(ACG Max: 120 mg OD)

18 years and above

Atenolol

Tablet

-

Initial: 25 mg OD - BD

Max: 100 mg / day

-

Bisoprolol

Tablet

-

Initial: 2.5 - 5 mg OD

Max: 10 mg OD (ACG: 20 mg OD)

-

Carvedilol

Tablet

-

Initial: 12.5 mg for first 2 days, then 25 mg OD

Max: 50 mg OD (PI: 50 mg BD)

18 years and above

Labetalol

Tablet

IV

-

Initial: 100 mg BD

Max: 800 - 2400 mg / day in divided doses

-

Metoprolol tartrate

Tablet

-

Initial: 50 mg BD

Max: 400 mg / day in divided doses

-

Nebivolol

Tablet

-

Initial: 2.5 - 5 mg OD

Max: 40 mg OD (PI: 10 mg OD)

18 years and above

Propranolol

Tablet

-

Initial: 80 mg / day in 1-4 divided doses

Max: 160 mg / day

-

Hydrochlorothiazide

Tablet

-

Initial: 12.5 - 25 mg OD

Max: 50 - 100 mg OD

-

Indapamide

IR Tablet

SR Tablet

-

IR tablet

Initial: 1.25 mg OD

Max: 2.5 mg OD

SR tablet

Single dose: 1.5 mg OD

Doses above maximum does not appreciably reduce BP, but causes more diuretic ADR

Frusemide

Tablet

IV / (IM)

Oral

2 mg / kg

Max: 40 mg / day

IV

1 mg / kg

Max: 20 mg / day

Oral

Initial: 20 - 40 mg OD

Max: 160 mg / day, divided BD

IV

1 mg / kg

Max: 20 mg / day

-

Phentermine (Duromine)

Capsule

-

Initial: 30 mg OM

Maintenance: 15 - 30 mg OM

Use for up to 6-12 months (MOH CPG 2016)

ADR

Insomnia, restlessness, tremors

Dry mouth, nausea, constipation

Can raise BP and HR

Contraindications

Poorly controlled hypertension

Atherosclerotic diseases (IHD, CVA)

Valvular heart disease / arrhythmiaa

Psychiatric illness or history of drug abuse

Concomitant MAO inhibitors (stop for at least 14 days)

Orlistat (Xenical)

Capsule

-

120 mg with each main meal, up to TDS

(Omit if meal contains no fat)

Use for up to 4 years (MOH CPG 2016)

ADR

Flatulence, bloating

Steatorrhea

Abdominal pain

Contraindications

Chronic malabsorption syndromes

Cholestasis

Liraglutide (Saxenda)

SC (pre-filled pen)

-

Start: 0.6 mg OD

Increase by 0.6 mg OD each week

Maintenance: 3.0 mg OD

Use for up to 4 years (MOH CPG 2016)

18 years and above

ADR

Acute pancreatitis

Cholelithiasis, cholecystitis

Suicidal behaviour, ideation

Semaglutide (Wegovy)

SC (pre-filled pen)

-

Start: 0.25 mg once a WEEK

Increase to next dose step every 4 weeks

Maintenance: 2.4 mg once a WEEK

Day of week can be changed -- minimum 3 days (72 hours) between each dose

Use for up to 4 years (MOH CPG 2016)

12 years and above

ADR

Acute pancreatitis

Cholelithiasis, cholecystitis

Acetazolamide

Tablet

-

Altitude sickness

125 mg BD (prevention)

250 mg BD (treatment)

Start 2 days (48 hours) before beginning ascent

Continue throughout ascent

Take for 2 days after reaching highest altitude

Contraindications

Adrenal disease

Hyponatremia

Hypokalemia

eGFR < 10

Ulipristal (Ella)

Tablet

-

1 tablet STAT

Effectiveness

Up to 5 days (120 hours)

~ 95%

Reduced effectiveness if used concurrently with OCP

Start OCP on 6th day after taking ulipristal

Levonorgestrel
(Postinor 2)

Tablet

-

1 tablet STAT, then 1 tablet 12 hours later

Effectiveness

Up to 3 days (72 hours)

~ 80%

No interaction with OCP