3.4.1 Antihistamines

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 (£0.77)
  • Oral solutionSF 5mg in 5ml (£1.52 = 200ml)

Indications

  • Allergic rhinitis
  • Urticaria

Dose

  • Adult and child over 12 years, 10mg once daily
  • Child, 2–6 years 2.5mg twice daily, 6–12 years 5mg twice daily
Chlorphenamine
  • Tablets 4mg (£3.04 = 4mg six hourly)
  • Liquid 2mg/5ml (£2.62 = 150ml)
  • Injection 10mg/ml (£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)
  • Oral solution 5mg in 5ml (£1.89 = 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 (£0.62 = 28 x 25mg)

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
  • Tablets 10mg, 25mg (£4.65 = 56 x 25mg)
  • ElixirSF 5mg in 5ml (£2.85 = 100ml)
  • Injection 25mg in 1ml

Indication

Fexofenadine
  • Tablets 180mg (£2.73)

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

 

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