NHS England (NHSE) has published new prescribing guidance for various common conditions for which over the counter (OTC) items should not be routinely prescribed in primary care (quick reference guide). These conditions include mild to moderate hay fever/seasonal allergic rhinitis.

Many of these products are cheap to buy and are readily available OTC along with advice from pharmacies. Some self-care medicines are available from shops and supermarkets. Please click here for further information, exceptions, and a patient leaflet.

Cetirizine

• Tablets 10mg (£0.72 = 30 tablets)
• Oral solution sugar free 5mg in 5ml (£17.16 = 200ml)

Indications

• Allergic rhinitis
• Urticaria

Dose

• Adult and child over 12 years: 10mg once daily
• Child, 6–12 years: 5mg twice daily
• Child, 2–6 years: 2.5mg twice daily

Chlorphenamine

• Tablets 4mg (£5.56 = 4mg six hourly)
• Oral solution 2mg in 5ml (£3.34 = 150ml)
• Solution for injection 10mg in 1ml (£4.50 = 1ml ampoule)

Indications

• Allergic rhinitis
• Itching skin (pruritus)
• Emergency treatment of anaphylactic reactions

Dose

• Oral, 4mg every 4–6 hours, maximum 24mg daily (elderly maximum 12mg daily);
• Oral, child 1–2 years 1mg twice daily; 2–6 years 1mg every 4–6 hours, maximum 6mg daily; 6–12 years 2mg every 4–6 hours, maximum 12mg daily
• I/M or I/V over 1 minute, 10mg, repeated if required up to maximum 4 doses in 24 hours; child under 6 months 250 micrograms/kg (maximum 2.5mg); 6 months–6 years 2.5mg; 6–12 years 5mg; these doses may be repeated if required up to maximum 4 doses in 24 hours

Loratadine

• Tablets 10mg (£0.81 = 30 tablets)
• Oral solution 5mg in 5ml (£3.13 = 100ml)

Indications

• Allergic rhinitis
• Urticaria

Dose

• Adult and child over 12 years 10mg once daily
• Child, 2–12 years, body-weight under 30kg, 5mg once daily; body-weight over 30kg, 10mg once daily

Hydroxyzine

• Tablets 10mg, 25mg (£1.14 = 25mg x 28 tablets)

Indication

• Itching skin (pruritus)

Dose

• Initially 25mg at night increased if necessary to 25mg 3–4 times daily
• Child 1–6 years initially 5–15mg at night increased if necessary to 50mg daily in 3–4 divided doses; 6–12 years initially 15–25mg at night increased if necessary to 50–100mg daily in 3–4 divided doses

Notes

1. MHRA Drug Safety Update (April 2015):
   1. do not prescribe hydroxyzine to people with a prolonged QT interval or who have risk factors for QT interval prolongation
   2. avoid use in the elderly - they are more susceptible than younger patients to the side effects of hydroxyzine
   3. consider the risks of QT interval prolongation and Torsade de Pointes before prescribing to patients taking medicines that lower heart rate or potassium levels
   4. the maximum daily dose is now
      1. 100mg for adults
      2. 50mg for the elderly (if use cannot be avoided)
      3. 2mg per kg body weight for children up to 40kg in weight
   5. prescribe the lowest effective dose for as short a time as possible.

Promethazine hydrochloride

• Tablets 10mg (£13.29 = 56 tablets)
• Tablets 25mg (click here for preferred brand)
• Oral solution sugar free 5mg in 5ml (£3.28 = 100ml)
• Injection 25mg in 1ml

Indication

• Insomnia (short term use)
  • 25-50mg at night
• Nausea and vomiting in pregnancy and hyperemesis gravidarum (first line)
  • Initially 25mg at night; can be increased to 25mg morning and evening

Notes

1. Where a preferred brand is recommended for a particular presentation, prescribing by brand helps ensure cost-efficient use of local NHS resources (see preferred brand link above)

Fexofenadine

• Tablets 180mg (£1.78 = 30 tablets)

Indication

• For the treatment of chronic idiopathic urticaria in patients not adequately treated with cetirizine

Dose

• Chronic idiopathic urticaria, adult and child over 12 years, 180mg once daily

Notes

1. Fexofenadine 180mg is only included in the formulary for chronic idiopathic urticaria.
2. The 120mg tablets are not included in the formulary.