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.
- Tablets 10mg (£0.77)
- Oral solution 5mg/5ml (£1.52 = 200ml)
- Adult and child over 12 years, 10mg once daily;
- Child, 2–6 years 2.5mg twice daily, 6–12 years 5mg twice daily
- Tablets 4mg (£3.04 = 4mg six hourly)
- Liquid 2mg/5ml (£2.62 = 150ml)
- Injection 10mg/ml (£4.50 = 1ml amp)
- 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
- Tablets 10mg (£0.81)
- Syrup 5mg/5ml (£1.89 = 100ml)
- Adult and child over 12 years 10mg once daily;
- Child 2–12 years, body-weight under 30 kg, 5mg once daily; body-weight over 30 kg, 10mg once daily
- Tablets 10mg, 25mg (£0.62 = 28 x 25mg)
- MHRA Drug Safety Update (April 2015):
- do not prescribe hydroxyzine to people with a prolonged QT interval or who have risk factors for QT interval prolongation
- avoid use in the elderly - they are more susceptible than younger patients to the side effects of hydroxyzine
- consider the risks of QT interval prolongation and Torsade de Pointes before prescribing to patients taking medicines that lower heart rate or potassium levels
- the maximum daily dose is now
- 100mg for adults
- 50mg for the elderly (if use cannot be avoided)
- 2mg per kg body weight for children up to 40kg in weight
- prescribe the lowest effective dose for as short a time as possible
- Tablets 10mg, 25mg (£4.65 = 56 x 25mg)
- Insomnia: 25-50mg at night
- Nausea and vomiting in pregnancy and Hyperemesis Gravidarum: Initially 25mg at night; can be increased to 25mg morning and evening
- Promethazine may be a useful alternative to benzodiazepines and other hypnotics for night time sedation, also where possible benzodiazepine dependence is a major concern. However, residual sedation may occur the following day and its sedative effects may diminish after a few days of continued treatment.
- For the treatment of chronic idiopathic urticaria in patients not adequately treated with cetirizine.
- Chronic idiopathic urticaria, adult and child over 12 years, 180mg once daily
- Fexofenadine 180mg is only included in the formulary for chronic idiopathic urticaria.
- The 120mg tablets are not included in the formulary
3. Respiratory >
3.4 Antihistamines, hyposensitisation, and allergic emergencies >
- First line
- Second line