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Sucrose: Pediatric drug information

Sucrose: Pediatric drug information
(For additional information see "Sucrose: Drug information")

For abbreviations, symbols, and age group definitions used in Lexicomp (show table)
Brand Names: US
  • Sweet-Ease [OTC];
  • TootSweet [OTC]
Therapeutic Category
  • Analgesic, Nonopioid
Dosing: Neonatal

Analgesia (mild), minor procedures: Limited data available, optimal dose not established: Oral: 0.1 to 0.2 mL of 24% solution placed on the tongue or buccal surface (via oral syringe or pacifier) 2 minutes prior to procedure; various regimens reported (Stevens 2016; Stevens 2018). Some regimens suggest that lower doses (0.1 mL) may be repeated after 2 minutes for longer procedures; doses should be limited to <10 doses/day (Johnston 2002; Johnston 2007). Some experts have recommended doses in pre-term infants of 0.1 to 0.4 mL and in term infants of 2 mL (Anand 2001). Some studies have found that sucrose used in combination with non-nutritive sucking is more effective than sucrose alone when administered to full-term neonates prior to heel lance (Thakkar 2016).

Age-directed dosing (LeFrak 2006): Oral: Dip pacifier in sucrose solution and allow infant to suck or administer via an oral syringe directly onto tongue; administer 1 to 2 minutes prior to procedure; for direct administration onto tongue, begin with 1 drop and assess tolerance; use minimum volume needed for pain relief up to the following maximum dose:

GA 27 to 31 weeks: 0.5 mL/procedure

GA 32 to 36 weeks: 1 mL/procedure

GA ≥37 weeks: 2 mL/procedure

Note: Repeat doses may be administered if needed.

Weight-directed dosing (Krishnan 2013): Note: Administer dose 2 minutes prior to procedure; do not use more than 3 doses per procedure. Oral:

<1 kg: 0.1 mL/dose

1 to 2 kg: 0.1 to 0.2 mL/dose

>2 kg: 0.1 to 0.5 mL/dose

Dosing: Pediatric

Analgesia (mild)/Comfort: Oral:

Manufacturer's labeling: Infants: 0.2 to 0.5 mL of 24% sucrose solution placed on the tongue or buccal surface or dip pacifier in sucrose solution and allow infant to suck

Immunization: Limited data available; optimal dose not established: Infants: Usual dose: 2 mL of 24% solution administered 1 to 2 minutes prior to vaccine administration; effective range: 1 to 2 mL of 12% to 75% solution (Kassab 2012)

Minor ED painful procedures (eg, heel sticks, venipuncture, IV line insertion, arterial puncture, insertion of a Foley catheter, and lumbar puncture): Limited data available: Infants ≤6 months: 2 mL of 25% sucrose no more than 2 minutes before the start of the painful procedure; may be administered as 1 mL in each cheek or allow infant to suck solution from pacifier (AAP [Fein 2012])

Dosing: Kidney Impairment: Pediatric

There are no dosage adjustments in the manufacturer's labeling.

Dosing: Hepatic Impairment: Pediatric

There are no dosage adjustments in the manufacturer's labeling.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution, oral:

Sweet-Ease® Preserved: 24% (15 mL)

TootSweet™: 24% (0.5 mL, 1 mL, 2 mL, 12 mL)

Solution, oral [preservative free]:

Sweet-Ease Natural®: 24% (15 mL)

Generic Equivalent Available: US

No

Administration: Pediatric

For oral use only. May be administered directly onto baby's tongue or buccal surface or via a pacifier dipped into solution. Dispose of product after use.

Volume of drops differs between dropper (cup) and vial:

Sweet-ease vial: 5 to 8 drops equivalent to 0.2 to 0.5 mL

Sweet-ease cup: Dropper: 1 to 2 drops equivalent to 0.2 to 0.5 mL. Pacifier dip: 1 dip equivalent to 0.1 mL.

Storage/Stability

Store at 4°C to 32°C (40°F to 90°F). Unused portion should be discarded.

Use

To calm or soothe in times of distress (OTC product: Approved in infants); has also been used for short-term analgesia in neonates during minor procedures (eg, heel stick, immunization, venipuncture, OG or NG tube insertion, IM or SubQ injection, bladder catheterization) and adjunctive analgesia for more complex procedures (eg, circumcision, eye exam for retinopathy of prematurity); provide short-term analgesia in infants during immunization administration and select minor procedures in the ED

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

Frequency not defined.

Cardiovascular: Bradycardia (self-limiting)

Hematologic & oncologic: Oxygen desaturation (premature neonates; spontaneous resolution)

Respiratory: Apnea (brief apnea in premature neonates; spontaneous resolution)

Warnings/Precautions

Disease-related concerns:

• Gastrointestinal disorders: Patients should have a functioning gastrointestinal tract; avoid use in patients with gastrointestinal tract abnormalities (eg, esophageal atresia or tracheal esophageal fistula); while necrotizing enterocolitis (NEC) has not been reported with sucrose administration, risk:benefit assessment should be considered in patients at high risk for NEC.

Special populations:

• Neonates: Efficacy in unstable or extremely low birth weight, premature neonates has not been established (LeFrak 2006).

Other warnings/precautions:

• Appropriate use: Avoid use in patients at risk for aspiration; sucrose should not be used for patients requiring ongoing analgesia.

Warnings: Additional Pediatric Considerations

Use with caution in patients who are intubated to avoid gagging and choking; avoid use in paralyzed patients (LeFrak 2006).

Concerns have been raised regarding repeated use of sucrose in patients <31 weeks postconceptual age and neurodevelopmental and physical outcomes. In a randomized, double-blind, placebo-controlled trial, 103 neonates were randomized to sucrose (n=53) or sterile water at the beginning of minor procedures, repeat doses were given every 2 minutes for 3 doses or if longer than 15 minutes, 3 more doses were allowed. Patients receiving a higher number of sucrose doses had lower scores on motor development and vigor, and alertness and orientation components of the Neurobehavioral Assessment of the Preterm Infant (NAPI) at 36 weeks postconceptual age, lower motor development and vigor at 40 weeks postconceptual age, and higher Neuro-Biological Risk Score (NBRS) at 2 weeks postnatal age (Johnston 2002). The authors conducted a secondary analysis of the raw data and suggested neonates receiving >10 doses of sucrose over a 24-hour period are at a higher risk of poorer neurodevelopmental outcomes (Johnston 2007).

Monitoring Parameters

Pain relief (including heart rate and respiratory rate)

Mechanism of Action

Exact mechanism is not known; it has been proposed that sucrose induces endogenous opioid release.

Pharmacokinetics (Adult data unless noted)

Onset: Maximum effect: 2 minutes (Blass 1991)

Duration: 3 to 5 minutes (Blass 1991)

  1. Anand KJ, International Evidence-Based Group for Neonatal Pain. Consensus statement for the prevention and management of pain in the newborn. Arch Pediatr Adolesc Med. 2001;155(2):173-180. [PubMed 11177093]
  2. Blass EM and Hoffmeyer LB, "Sucrose as an Analgesic for Newborn Infants," Pediatrics, 1991, 87(2):215-8. [PubMed 1987534]
  3. Fein JA, Zempsky WT, Cravero JP, Committee on Pediatric Emergency Medicine and Section on Anesthesiology and Pain Medicine, American Academy of Pediatrics. Relief of pain and anxiety in pediatric patients in emergency medical systems. Pediatrics. 2012;130(5):e1391-1405. [PubMed 23109683]
  4. Harrison D, Stevens B, Bueno M, et al, "Efficacy of Sweet Solutions for Analgesia in Infants Between 1 and 12 Months of Age: A Systematic Review," Arch Dis Child, 2010, 95(6):406-13. [PubMed 20463370]
  5. Johnston CC, Filion F, Snider L, et al. How much sucrose is too much sucrose? Pediatrics. 2007;119(1):226. [PubMed 17200300]
  6. Johnston CC, Filion F, Snider L, et al. Routine sucrose analgesia during the first week of life in neonates younger than 31 weeks' postconceptional age. Pediatrics. 2002;110(3):523-528. [PubMed 12205254]
  7. Johnston CC, Stremler R, Horton L, et al, "Effect of Repeated Doses of Sucrose During Heel Stick Procedure in Preterm Neonates," Biol Neonate, 1999, 75(3):160-6. [PubMed 9925903]
  8. Kassab M, Foster JP, Foureur M, Fowler C. Sweet-tasting solutions for needle-related procedural pain in infants one month to one year of age. Cochrane Database Syst Rev. 2012;12:CD008411. [PubMed 23235662]
  9. Krishnan L. Pain relief in neonates. J Neonatal Surg. 2013;2(2):19. [PubMed 26023439]
  10. Lefrak L, Burch K, Caravantes R, et al. Sucrose analgesia: identifying potentially better practices. Pediatrics. 2006;118 Suppl 2:S197-202. [PubMed 17079623]
  11. Reis EC, Roth EK, Syphan JL, et al, "Effective Pain Reduction for Multiple Immunization Injections in Young Infants," Arch Pediatr Adolesc Med, 2003, 157(11):1115-20. [PubMed 14609903]
  12. Shah V, Taddio A, Rieder MJ, et al, "Effectiveness and Tolerability of Pharmacologic and Combined Interventions for Reducing Injection Pain During Routine Childhood Immunizations: Systematic Review and Meta-Analyses," Clin Ther, 2009, 31(Suppl 2):104-51. [PubMed 19781433]
  13. Stevens B, Yamada J, and Ohlsson A, "Sucrose for Analgesia in Newborn Infants Undergoing Painful Procedures," Cochrane Database Syst Rev, 2010, (1):CD001069. [PubMed 20091512]
  14. Stevens B, Yamada J, Campbell-Yeo M, et al. The minimally effective dose of sucrose for procedural pain relief in neonates: a randomized controlled trial. BMC Pediatr. 2018;18(1):85. [PubMed 29475433]
  15. Thakkar P, Arora K, Goyal K, et al. To evaluate and compare the efficacy of combined sucrose and non-nutritive sucking for analgesia in newborns undergoing minor painful procedure: a randomized controlled trial. J Perinatol. 2016;36(1):67-70. [PubMed 26583940]
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