Pediatric emergency medicine trisk 2621 2621
Bạn đang xem bản rút gọn của tài liệu. Xem và tải ngay bản đầy đủ của tài liệu tại đây (100.28 KB, 1 trang )
Management. A number of agents are available for the treatment of acute
migraine ( Table 97.4 ). For many children, mild oral analgesics such as
acetaminophen or ibuprofen combined with bed rest may provide sufficient relief
and should be considered the first-line agents of choice.
TABLE 97.4
AGENTS FOR ACUTE TREATMENT OF MIGRAINE
Drug
Analgesics
Acetaminophen
Ibuprofen
Ketorolac (Toradol)
Antiemetics
Metoclopramide (Reglan)
Prochlorperazine (Compazine)
Promethazine (Phenergan)
Specific antimigraine agents
Dihydroergotamine
Sumatriptan (Imitrex)
Usual dose
10–15 mg/kg/dose PO or PR q4h
5–10 mg/kg/dose PO q6h
30 mg initial dose, then 0.5 mg/kg (max 30
mg) IV or IM, or 10 mg/dose PO, q4–6h
0.5–2 mg/kg/dose PO or IV q4–6h
0.1 mg/kg/dose PO, IM, or IV q6h
0.25–1.0 mg/kg/dose PO, PR, IV, or IM q4–6h
0.5–1.0 mg/dose IV or IM; may repeat after 1
hr
6 mg SC or 100 mg PO
PO, orally; PR, per rectum; IV, intravenously; IM, intramuscularly; SC, subcutaneously.
Sumatriptan succinate (Imitrex) is a serotonergic agent available for oral,
intranasal, or subcutaneous administration. Administered alone or in combination
with naproxen, its effectiveness in relieving symptoms of acute migraine has been
demonstrated in clinical trials in children and adults, but it has not been approved
by the U.S. Food and Drug Administration for use in younger children. The dose
for children 12 years and older is 6 mg subcutaneously or 100 mg orally. The
intranasal sumatriptan dose is 20 mg for children >40 kg and 10 mg for children
weighing 20 to 39 kg. Sumatriptan is generally well tolerated. Side effects include
irritation at the injection site, flushing, tachycardia, disorientation, and chest
tightness that last for several minutes after parenteral administration. In one trial,
adverse effects were more common in younger children. A reasonable approach is
