Claritin dosing for children under 2 years of age?

[RxBlueDevils]

I have seen a lot of prescriptions for kids under 2 years old (sometimes 4 or 5 months old) for Claritin. I have looked in Lexi-Comp and there is no dosage for children under the age of 2. Does anyone know what the dosage is?

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[WVUPharm2007]

I've seen 1.25mg for infants closer to 12 mo, but there is no official recommended dose.

The rest of them have dosing recommendations from the manufacturer for 6 month olds and up...

 

[StringTheorist]

You know, we just had a script like this 2 weeks ago for a 9 month old. The pharmacist (Im a grad intern right now) stated that she would NOT fill the script as the safety and efficacy for children <2 yoa had not been established. If the doc wanted it to be filled, she had to provide the pharmacist a faxed copy of a study/recommendation that would support its use. The doc said "I do it all the time." The pharmacist said "that doesn't make it right, I'm not filling it." Boy were they Pissed.

 

[CUpharmD2013]

You know, we just had a script like this 2 weeks ago for a 9 month old. The pharmacist (Im a grad intern right now) stated that she would NOT fill the script as the safety and efficacy for children <2 yoa had not been established. If the doc wanted it to be filled, she had to provide the pharmacist a faxed copy of a study/recommendation that would support its use. The doc said "I do it all the time." The pharmacist said "that doesn't make it right, I'm not filling it." Boy were they Pissed.

On a somewhat related note, I've seen a lot of parents coming in and asking for benadryl for their child under 2. While I always tell them that it's not recommended for children under 2, I always get: "but my doctor said it was ok."

 

[Thoughtfulsinner]

I bet that pharmacist is proud of herself in denying that infant a harmless medication after consulting with an MD.

 

[Actinomycin]

I see a lot of scripts for Amoxicillin that are over the typically recommended 90mg/kg max. What is a safe limit for Amox?

 

[TonyRx]

I bet that pharmacist is proud of herself in denying that infant a harmless medication after consulting with an MD.

If the safety and efficacy of Loratadine isn't well established for <2yoa, how are we certain that it is a harmless medication in this scenario?

 

[Old Timer]

You know, we just had a script like this 2 weeks ago for a 9 month old. The pharmacist (Im a grad intern right now) stated that she would NOT fill the script as the safety and efficacy for children <2 yoa had not been established. If the doc wanted it to be filled, she had to provide the pharmacist a faxed copy of a study/recommendation that would support its use. The doc said "I do it all the time." The pharmacist said "that doesn't make it right, I'm not filling it." Boy were they Pissed.

The pharmacist is an @sshole. So an infant with hives or severe allergies gets no treatment? Once you consult with the physician, unless you have data to back up the fact the medication is not safe, you have to dispense. The prescriber still has the authority to order the medication. Unless there is some compelling reason, you should dispense. Drugs are used off label all of the time

Also note, you cannot count on the packages of OTC products to have complete dosing information. They only have dosage recommendations for approved indications. I guess this ***** @sshole would never tell a person with poison ivy to get Benadryl, since it's not approved for OTC use for contact dermatitis. What a complete douche bag.

 

[pharaday]

The pharmacist is an @sshole. So an infant with hives or severe allergies gets no treatment? Once you consult with the physician, unless you have data to back up the fact the medication is not safe, you have to dispense. The prescriber still has the authority to order the medication. Unless there is some compelling reason, you should dispense. Drugs are used off label all of the time

I completely agree!

 

[lorain]

The pharmacist is an @sshole. So an infant with hives or severe allergies gets no treatment? Once you consult with the physician, unless you have data to back up the fact the medication is not safe, you have to dispense. The prescriber still has the authority to order the medication. Unless there is some compelling reason, you should dispense. Drugs are used off label all of the time

Also note, you cannot count on the packages of OTC products to have complete dosing information. They only have dosage recommendations for approved indications. I guess this ***** @sshole would never tell a person with poison ivy to get Benadryl, since it's not approved for OTC use for contact dermatitis. What a complete douche bag.

i totally agree (aside from the colorfull adjectives used)

 

[ancienbon]

The pharmacist is an @sshole. So an infant with hives or severe allergies gets no treatment? Once you consult with the physician, unless you have data to back up the fact the medication is not safe, you have to dispense. The prescriber still has the authority to order the medication. Unless there is some compelling reason, you should dispense. Drugs are used off label all of the time

Also note, you cannot count on the packages of OTC products to have complete dosing information. They only have dosage recommendations for approved indications. I guess this ***** @sshole would never tell a person with poison ivy to get Benadryl, since it's not approved for OTC use for contact dermatitis. What a complete douche bag.

I could not agree with you more. Most of the otc products will say that if the patient is under a certain age , the doctor has to recommend it . So as long as the doctor says it is ok, we pharmacists have to dispense it.
It is hard to believe that pharmacist would dispense the medication once the doctor says it is ok. That pharmacist has to know most of the time precribers do not go by the package insert or otc labels.

 

[rxlea]

I see off label uses come through all the time on various things. For something like claritin, I can't imagine denying that to a patient. Even if you think it's "harmful" or whatever, what's more harmful? Child continuing with hive and no tx or some side effects of claritin?

 

[StringTheorist]

as a new grad, i would be scared of doing soemthing that i felt uncomfortable with and that would jeopordize my newly minted license. therefore, i can see where my pharmacist was coming from. but i did feel bad for the patient and even worse being the one to tell the doctor that we were refusing to fill the script.

 

[Old Timer]

as a new grad, i would be scared of doing soemthing that i felt uncomfortable with and that would jeopordize my newly minted license. therefore, i can see where my pharmacist was coming from. but i did feel bad for the patient and even worse being the one to tell the doctor that we were refusing to fill the script.

You have to practice evidence based medicine. If you have no proof of harm or suspect there will be harm you must dispense. You treat patients, not guidelines. I who gives a crap is you are uncomfortable. When you make a declarative statement, you need proof, not the doctor.

When I refuse to fill 100 Pyridium, 1 tid. I can call the doctor & say arganulocytosis. What can you say in this case? NOTHING!!! I once got a script for MS-Contin 100 mg 18 tabs q 12h. When I called the oncologist to see if this was assisted suicide, he told be the patient was a heroin addict with pancreatic cancer with bone mets and 15mg of Morphine wasn't going to do it for him. Since it was a regular doc from the local cancer hospital I filled it

 

[meister]

Don't worry loratadine is a placebo drug anyway.

 

[Caverject]

Take ur Lexi program and look up peds dose...if zytec is okay to give I would say claritin is too

 

[Ackj]

What sorts of liabilities do we have in these scenarios? Say we contacted the doctor, and doc says "go ahead and fill it." Does consulting them free us from liability if something goes wrong? I suppose we still do have the ultimate ability to stop the dispensing, but if the doc orders it, are we to just go along with it?

 

[Old Timer]

What sorts of liabilities do we have in these scenarios? Say we contacted the doctor, and doc says "go ahead and fill it." Does consulting them free us from liability if something goes wrong? I suppose we still do have the ultimate ability to stop the dispensing, but if the doc orders it, are we to just go along with it?

You can be sued for anything. You would only have liability if you dispensed something that is KNOWN to be harmful.

 

[spacecowgirl]

I have seen this discussion on Pharmacists Letter and some folks were saying that providing dosing recs on OTCs is "practicing medicine" and should never be done. I have been giving dosing recs for kids <2 for years and never thought twice about it.

Thoughts?

 

[Thoughtfulsinner]

I have seen this discussion on Pharmacists Letter and some folks were saying that providing dosing recs on OTCs is "practicing medicine" and should never be done. I have been giving dosing recs for kids <2 for years and never thought twice about it.

Thoughts?

There is a reason why it says "ask a doctor" on the label. It doesn't say "ask a nurse, or pharmacist" for that matter.

 

[Thoughtfulsinner]

I have seen this discussion on Pharmacists Letter and some folks were saying that providing dosing recs on OTCs is "practicing medicine" and should never be done. I have been giving dosing recs for kids <2 for years and never thought twice about it.

Thoughts?

There is a reason why it says "ask a doctor" on the label. It doesn't say "ask a nurse, or pharmacist" for that matter.

 

[Old Timer]

I have seen this discussion on Pharmacists Letter and some folks were saying that providing dosing recs on OTCs is "practicing medicine" and should never be done. I have been giving dosing recs for kids <2 for years and never thought twice about it.

Thoughts?

You are NOT practicing medicine w/o a license. There is a difference between self medicating and following a doctors orders....

 

[pharmschooler]

There is a reason why it says "ask a doctor" on the label. It doesn't say "ask a nurse, or pharmacist" for that matter.

While that might be true, aren't you the same person who posted about wearing diapers to work?

Anybody who wears diapers for a non-medical or age-related reason is a bit suspect in my book.

 

[Jabberwocky12]

While that might be true, aren't you the same person who posted about wearing diapers to work?

Anybody who wears diapers for a non-medical or age-related reason is a bit suspect in my book.

Isn't that a straw man bolstered by a personal attack diversion?

I swear we talked about that in public speaking and debate class....

 

[pharmschooler]

Isn't that a straw man bolstered by a personal attack diversion?

I swear we talked about that in public speaking and debate class....

Quite possibly. Good job on remembering your logic.

Frankly, I think this whole argument is pretty silly, but so is wearing diapers when they aren't necessary. I take what hwks09 writes with a grain of salt because I can't take anybody seriously who chooses to wear diapers just because. It makes me question their judgment on other, larger issues.

Sorry for getting sassy. I keep seeing things on this board written by the same few over-the-top reactionary people and it makes it hard to take seriously...

 

[Jabberwocky12]

I can agree with that. Part of the problem is that the same people opinionated on one issue are usually opinionated on another. Even worse is if you disagree with them on enough issues, then eventually people will automatically side against them even if they shouldn't.

 

[owlegrad]

I have seen this discussion on Pharmacists Letter and some folks were saying that providing dosing recs on OTCs is "practicing medicine" and should never be done. I have been giving dosing recs for kids <2 for years and never thought twice about it.

Thoughts?

I am curious how you provide dosing advice. I don't mean that I think it is wrong, only that I want to know what your method is for choosing a dose. If the product says "not recommended for children less than 2", how do you decide what to tell the parent? I think I would be really nervous to try and give advice in that situation, other than to see a pediatrician.

 

[All4MyDaughter]

I am curious how you provide dosing advice. I don't mean that I think it is wrong, only that I want to know what your method is for choosing a dose. If the product says "not recommended for children less than 2", how do you decide what to tell the parent? I think I would be really nervous to try and give advice in that situation, other than to see a pediatrician.

Lexi has dosing recommendations for most common drugs. I learned the weight based recs in the pediatric part of therapeutics.

 

[spacecowgirl]

There is a reason why it says "ask a doctor" on the label. It doesn't say "ask a nurse, or pharmacist" for that matter.

Were you not hugged enough as a child? Every post of yours is like this. Should the patient call the on-call doc on a Sunday night for a dose of diphenhydramine? Go to the ED? What is your suggestion?

 

[Thoughtfulsinner]

Were you not hugged enough as a child? Every post of yours is like this. Should the patient call the on-call doc on a Sunday night for a dose of diphenhydramine? Go to the ED? What is your suggestion?

If it's not an emergency they can wait until the morning to call the pediatrician. If it is an emergency they can either have their pediatrician paged or go to the ER.

 

[Ackj]

If it's just some parent who wants to give something to their kid: "Ask your pediatrician"

If it's a parent who says "My pediatrician said to use this" then I'll give my advice, since it seems like the pediatrician says the drug is fair game.

 

[VCU07]

If it's just some parent who wants to give something to their kid: "Ask your pediatrician"

If it's a parent who says "My pediatrician said to use this" then I'll give my advice, since it seems like the pediatrician says the drug is fair game.

Like OldTimer said, practice evidence based medicine. Would you rather have the parent take their kid to the doctor, pay a copay, wait a long ass time, take off from work, etc...if a pharmacist is equally, if not more knowledgeable about drug use and capable of giving his/her recommendation. I mean, "ask your pediatrician?" What do you think the parent is thinking when they specifically sought your advice? I agree that some circumstances require physician intervention, but most things in community practice can be handled by a well trained pharmacist.

 

[Jabberwocky12]

I'm also of the opinion that if a pharmacist only followed published guidelines by the T then a technician could do it, or pharmacists really could be replaced by robots. A pharmacist is there to make clinical decisions with the information provided and use practical judgement in different settings.

Hell, as a technician in many of my books to be certified they talk about 3 different equations to dose children for meds including age, weight, and etc. depending on necessary accuracy. I don't see why a pharmacist couldn't tell someone to take a smaller dose of children's tylenol for younger patients if absolutely necessary.

I get that practicing medicine is an issue since pharmacists don't have all of the medical records that a doctor has and maybe the child has certain issues that the parent doesn't know to mention. But still, a pharmacist has enough judgement to know if the situation is too complex or not after a few questions. I have pharmacists all the time saying to patients "I don't know enough about the situation, you need to talk to your doctor."

Even if the pharmacist says "Talk to your doctor in the morning since he has all of your child's records but it sounds reasonable for tonight to give your child (this dose) for some relief" the patient is able to care for their child for a short duration.

 

[Socrates25]

There is a reason why it says "ask a doctor" on the label. It doesn't say "ask a nurse, or pharmacist" for that matter.

Nowadays its more likely to say "ask your healthcare provider"

Now who is my healthcare "provider"? Is it the nurse? Is it the phlebotomist? Is it the lab tech? Arent they all healthcare "providers?"

 

[dingerx]

I have seen this discussion on Pharmacists Letter and some folks were saying that providing dosing recs on OTCs is "practicing medicine" and should never be done. I have been giving dosing recs for kids <2 for years and never thought twice about it.

Thoughts?

That's because you are actually practicing intelligently. You must be residency trained or smarter than the bunch. "Practicing medicine" is NOT defined by giving a dose recommendation. It would be diagnosing a more complex disease state. I have worked adult med and peds and have given numerous recommendations where there isn't literature, but I make the disclaimer to the MD that this is an educated thought (not guess) based on what I know and what I think would be the best for the patient. Keep doing what you're doing- helping patients!

 

[dingerx]

I can't wait until some of you @ssholes have children of your own and something bad happens. I don't work as a pharmacist anymore, but I'd love to say to you at 10 PM on a Friday night "call your pediatrician on Monday morning." Screw all of you that have that mentality!

 

[Ackj]

Like OldTimer said, practice evidence based medicine. Would you rather have the parent take their kid to the doctor, pay a copay, wait a long ass time, take off from work, etc...if a pharmacist is equally, if not more knowledgeable about drug use and capable of giving his/her recommendation. I mean, "ask your pediatrician?" What do you think the parent is thinking when they specifically sought your advice? I agree that some circumstances require physician intervention, but most things in community practice can be handled by a well trained pharmacist.

I don't know about you, but I haven't done a peds residency, and I don't feel comfortable coming up with doses of any random otc med for a 3 week infant. Many pharmacists I work with feel the same way.

If you are comfortable enough with your knowledge, by all means, go ahead and make recommendations.

 

[dingerx]

I don't know about you, but I haven't done a peds residency, and I don't feel comfortable coming up with doses of any random otc med for a 3 week infant. Many pharmacists I work with feel the same way.

If you are comfortable enough with your knowledge, by all means, go ahead and make recommendations.

I haven't done a peds residency, either. I do know how to dose most of the OTC meds that would be used in infants or peds. This is the problem with pharmacy school today. You apparently need a residency to be a pharmacist now. I do agree with you. If you aren't comfortable giving a recommendation then don't. But at least call around to see if you can find somebody with the answer (like maybe a children's hospital).

 

[spacecowgirl]

I don't know about you, but I haven't done a peds residency, and I don't feel comfortable coming up with doses of any random otc med for a 3 week infant. Many pharmacists I work with feel the same way.

If you are comfortable enough with your knowledge, by all means, go ahead and make recommendations.

I'm not talking about "any random OTC". I'm talking about things that are safe (as safe as any drug can be considered) and effective in children <2 yrs.

I haven't done a peds residency, either. I do know how to dose most of the OTC meds that would be used in infants or peds. This is the problem with pharmacy school today. You apparently need a residency to be a pharmacist now. I do agree with you. If you aren't comfortable giving a recommendation then don't. But at least call around to see if you can find somebody with the answer (like maybe a children's hospital).

I know, right? I understand CYA, but I don't think referring somone to an ER for a diphenhydramine dose is a very appropriate use of healthcare dollars.

 

[dingerx]

I'm not talking about "any random OTC". I'm talking about things that are safe (as safe as any drug can be considered) and effective in children <2 yrs.



I know, right? I understand CYA, but I don't think referring somone to an ER for a diphenhydramine dose is a very appropriate use of healthcare dollars.

Exactly. I'm pretty conservative from a political view and it makes me so angry that Medicaid people go to the ER as a primary care visit. This is the same thing. Take working people's money and screw it away over something simple. And it's the attitude. If you don't know that's fine. God knows I don't know everything and I don't profess that I do, but at least try to help. I don't get why pharmacists won't do that. I'd suspect they are new grads or students because I don't think that peds gets taught heavily in school anymore. But the whole scenario sends me on a tirade. People want the salary, but not the responsibility. AHHHH!

Again, thanks for thinking about things from a logical standpoint. I think there will always be jobs for pharmacists like that.

 

[pharmschooler]

Exactly. I'm pretty conservative from a political view and it makes me so angry that Medicaid people go to the ER as a primary care visit. This is the same thing. Take working people's money and screw it away over something simple. And it's the attitude. If you don't know that's fine. God knows I don't know everything and I don't profess that I do, but at least try to help. I don't get why pharmacists won't do that. I'd suspect they are new grads or students because I don't think that peds gets taught heavily in school anymore. But the whole scenario sends me on a tirade. People want the salary, but not the responsibility. AHHHH!

Again, thanks for thinking about things from a logical standpoint. I think there will always be jobs for pharmacists like that.

I think people from any point on the political spectrum could easily agree with your issue with Medicaid folks using the ER for primary care...it's inefficient and costly for everyone. Liberals and conservatives alike should agree on that issue.

People who won't take on the responsibility they signed up for make me upset, too. Enough of the "that's above my payscale" mentality...especially when it isn't actually above your payscale.

 

[Old Timer]

But the whole scenario sends me on a tirade. People want the salary, but not the responsibility. AHHHH!

Because they are:

 

[MountainPharmD]

If it's a parent who says "My pediatrician said to use this" then I'll give my advice, since it seems like the pediatrician says the drug is fair game.

What irritates me about this is the open ended statement "my pediatrician said to use this." So we just give the pediatrician a free pass? We want to argue semantics and minutia on the pharmacy side what about the pediatrician?

My thoughts? If the pediatrician said to use it then they should have also specified the dosage. Perhaps basing that dose on the patients last weight or if that was to long ago then age? Or maybe use the patients chart, history and current medications all of which the pharmacist does not have to get that dosage. I guess if you want to be the hero when dealing with the random customer who walks by and holds something up and shouts over the three other people in line "My kids pediatrician said to use this for my two month old is that okay?" you go right ahead.

You want some evidence based medicine? Okay here ya go......
http://www.fda.gov/downloads/forconsumers/consumerupdates/ucm048524.pdf

http://sciencebasedpharmacy.wordpress.com/2009/05/19/cough-and-cold-products-for-children/

To sum it up for ya.

•FDA issued a nationwide Public Health Advisory in January 2008 recommending that these products not be used in children under the age of 2 because of the risk of serious and potentially life-threatening side effects.

In fact the FDA has recommended that most over the counter cough and cold products not be used in anyone under the age of six because adverse side effects far out number any positive benefits. There is a ****ing reason the labeling does not have dosing info on it. Again, be the hero if you want and do your own thing. I prefer to use the evidence out there and stand by the following statement. If your pediatrician told you to use that in your two month old then you need to call your pediatrician and get the exact dose.

 

[MountainPharmD]

I'm not talking about "any random OTC". I'm talking about things that are safe (as safe as any drug can be considered) and effective in children <2 yrs.

How many OTC drugs do you know of that have been studied and proven to be safe and effective in children <2 years old? Please see my above link to the FDA advisory commitees recommendations from 2008 if you have any questions.

 

[VCU07]

How many OTC drugs do you know of that have been studied and proven to be safe and effective in children <2 years old? Please see my above link to the FDA advisory commitees recommendations from 2008 if you have any questions.

So a parent pleads with you to help dose benadryl for what looks like an allergic reaction in their 16mo old. What would you say? We know benadry is effective for this scenario. Do you send them to the ER to pay out the ass for something that could have been treated by you. I'm and EM pharmacist and see this scenario way too often. Most of our patients are uninsured and end up not paying a penny. This increases healthcare costs period. The FDA advisory is great guidance, but guess what? We treat these patients with Benadryl in the ED and send them on their way.

 

[All4MyDaughter]

Just use clinical judgment. Three week old baby? They need to call their pediatrician. Older baby, more clear cut symptoms? Make a recommendation. Recently I had a 14 month old with influenza B who was having trouble sleeping d/t congestion and cough. I asked the parents how much the baby weighed and calculated a conservative weight based dose for diphenhydramine. Followed up with the parents the next day. They said he slept much better and did fine.

One of the issues with OTC cough and cold products in very young children was that parents couldn't safely dose them and didn't understand the differences between formulations. Not knowing how much to give, not realizing that some products are more concentrated than others, etc. This is one way that pharmacists can make a difference by educating patients. Isn't this what we went to school for?

 

[dingerx]

How many OTC drugs do you know of that have been studied and proven to be safe and effective in children <2 years old? Please see my above link to the FDA advisory commitees recommendations from 2008 if you have any questions.

Hey buddy... you just picked the wrong side of the argument. I'm in regulatory and can tell you look up GRAS at the FDA website. Furthermore, the cough and cold products you refer to are based on apap and pse containing products. Nice try, though.

 

[WVUPharm2007]

...but is recommending a dosage of an antihistamine in a patient that is contraindicated in the OTC labeling considered practicing medicine?

There is a ton of **** I'm well trained in and perfectly capable of doing, but I don't because its illegal...this issue...is kinda a gray area...

 

[MountainPharmD]

Hey buddy... you just picked the wrong side of the argument. I'm in regulatory and can tell you look up GRAS at the FDA website. Furthermore, the cough and cold products you refer to are based on apap and pse containing products. Nice try, though.

You have failed to convince me I have picked the wrong side of the argument. Are you trying to tell me you work in "regulatory" what ever that means and information easily searched and available on the FDAs website is false? Here is another link for you to read.

http://www.uspharmacist.com/content/c/14137/

 

[Thoughtfulsinner]

You have failed to convince me I have picked the wrong side of the argument. Are you trying to tell me you work in "regulatory" what ever that means and information easily searched and available on the FDAs website is false? Here is another link for you to read.

http://www.uspharmacist.com/content/c/14137/

Lol. He works in "regulatory?" His post makes no sense.