Over dose of HU

My son is thalassemic intermedia(e-beta), 4 yrs, 14 kgs. He has been taking HU for last 6 months. Initially  the dose was 500mg alt days.  For last two months,  his doctor has increased the dose to 500mg daily , which is a overdose. Can the dose be reduced to 500mg alt days as before?  Another point- Since he is too young, is it OK to give the HU my mixing the powder with little water? Please help...

The normal dose for hydroxyurea in thalassemics is 15-20 mg/kg. For a child of 14 kg, a daily dose of less than 300 mg would be appropriate. I have never seen any study that showed doses of more than 20 mg/kg per day had any additional value. I do not agree with giving such a high dose to a child that age with thalassemia.

You can mix the drug with water but do not allow the powder to come into contact with skin and wash any spoons or container used thoroughly after use.

Formulation
Hydroxyurea is available as 500mg capsules and liquid. Liquid is often most suitable
for children under the age of seven years, although it has a short-shelf life, and can be
difficult to obtain from local hospitals for shared-care patients. It is possible to
arrange for local hospitals or pharmacies to dispense the drug, and this should be
discussed with the pharmacy here.
It is possible to open hydroxyurea capsules and give the powder to the child with a
small amount of water or juice. This works well for some parents but it should be
explained that hydroxyurea is a form of chemotherapy and should not come into
contact with skin or anybody other than the patient; this will mean washing the spoon
very carefully and wiping up any spills immediately.
Because the capsules only come as 500mg, it is sometimes difficult to give the exact
calculated dose or increment; in general it is satisfactory to give alternating day doses
such as 500mg alternating with 1g, although this should be explained carefully to the
carers and child.

Thanks a lot for your valuable suggestions. We  will give  him 500mg alt days and discuss with doctor. Thanks a lot...

Thank you Andy once again. Since he has been on overdose for two months, is it OK to stop HU for some days, say around 15 days or so? His activity  is OK. Thanks  and Regards...

The half life of hydroxyurea is only 3-4 hours. There would be no value to stopping the drug entirely. I would suggest start alternating doses.

Thanks a  lot for the suggestion.