Amlodipine in children with AML and BMT

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Hello! I am trying to write my care plan on my pediatric patient who had a bone marrow transplant, and I am really having a hard time with one of the drugs the patient is on. I asked the nurse and I did not really receive an explanation. Then, I went to Davis Drug guide and there is not a pediatric dose for amlodipine... so I am having a hard time! We have to put the purpose specific to that patient... and it was my first and only experience in oncology ever. So I am not familiar with the way any of these drugs work. If you know or can direct me in the right direction, I will be forever thankful! There are several drugs that I am having difficulty with and I really want to do well on this care plan.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

Humm...... there is more to this story. What else did this child have? Did they have HTN? There is a risk of developing HTN/pulmonary HTN post transplant, host versus graft(GvHD) and certain of the anti-rejection drugs and steroids can cause hypertension.

While many drugs are not "approved" by the FDA they are given when the benefit will out weight the risk. I have a couple of references....one is for medscape...you have to register with an account but it is FREE.

A small number of publications are available describing the use of amlodipine in infants and children.[4- 10]In 1998, Pfammatter and colleagues studied the effects of amlodipine in 28 children between 3 and 19 years of age.[4]Fifteen patients had underlying renal disease, eight had post-renal transplant hypertension, three had essential hypertension, one child had Prune-belly syndrome, and one had a coarctation of the abdominal aorta. The children were treated with standard adult doses of 5 to 10 mg once daily, producing a weight-based dose of 0.19-0.3 mg/kg/day. Amlodipine was withdrawn in five patients because of edema and flushing. In the remaining patients, amlodipine produced a significant reduction in blood pressure during the 12 week observation period, with an average decrease in systolic blood pressure of 21 mm Hg and diastolic blood pressure of 12 mm Hg. Heart rate and body weight were unchanged. The authors concluded that amlodipine was effective in the treatment of hypertension in their sample population.
http://www.medscape.com/viewarticle/460500_2

and Bone marrow transplant - Risks - NHS Choices

In particularly serious cases of GvHD, lung or liver function can be affected which can be very serious.

GvHD can be treated using immunosuppressants, usually in conjunction with corticosteroids (see below).

Immunosuppressants stop the transplanted tissue releasing antibodies that would otherwise attack the rest of your body. However, they will also affect the rest of your immune system, placing you at a higher risk of infection.

Corticosteroids are a type of medication containing powerful hormones. They can help suppress (control) the exaggerated immune response that leads to GvHD. However, corticosteroids can cause a number of side effects including:

  • high blood sugar levels
  • increased appetite
  • mood changes
  • vomiting
  • diarrhoea
  • itchiness
  • hypertension (high blood pressure)

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Specializes in Pedi.

Hypertension is a very common complication post-stem cell transplant. I have many patients who are on amlodipine because of it. Your drug book may not be the best place to look for pediatric doses as many drugs are not officially approved/indicated for children but are used in them all the time. There should be an online formulary at the hospital with the appropriate pediatric dosing.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

I knew you'd come along!!!! Thanks Kel!!!

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Hypertension is a very common complication post-stem cell transplant. I have many patients who are on amlodipine because of it. Your drug book may not be the best place to look for pediatric doses as many drugs are not officially approved/indicated for children but are used in them all the time. There should be an online formulary at the hospital with the appropriate pediatric dosing.
Do you know why? or is it one of those complex things that surmount to "it just is"
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Specializes in Pedi.
Do you know why? or is it one of those complex things that surmount to "it just is"

Honestly I don't. I think part of it is the meds they have to take- cyclosporine together with the steroids. They also tend to have problems with their magnesium levels and I see kids at home on IVF with mag in addition to mag supplements up to 4 times a day. Those are probably the two complications I regularly see kids at home with following transplant. The other big complications (like GVHD) tend to keep them in the hospital.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

Thank you!!!!

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Thank you so much for your responses! I really appreciate it.

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