page215
KETOTIFEN
Indications
allergic rhinitis
Cautions
see notes above
Contra-indications
see notes above
Hepatic impairment
see notes above
Pregnancy
see notes above
Breast-feeding
see notes above
Side-effects
see notes above;
also excitation,
irrit-
ability,
nervousness;
less commonly
cystitis;
rarely
weight gain;
very rarely
Stevens-Johnson syndrome
Dose
. 1 mg twice daily with food increased if necessary to
2 mg twice daily; initial treatment in readily sedated
patients 0.5–1 mg at night;
CHILD
3 years and over,
1 mg twice daily
Zaditen
c
(Swedish Orphan) A
Tablets
,
scored,
ketotifen (as hydrogen fumarate)
1 mg,
net price 60-tab pack = £7.53.
Label:
2,
21
Elixir
,
ketotifen (as hydrogen fumarate),
1 mg/5 mL,
net price 300 mL (strawberry-flavoured) = £8.91.
Label:
2,
21
PROMETHAZINE HYDROCHLORIDE
Indications
symptomatic relief of allergy such as hay
fever and urticaria;
emergency treatment of anaphy-
lactic reactions;
sedation (section 4.1.1);
nausea and
vomiting (section 4.6)
Cautions
see notes above; avoid extravasation with
intravenous injection;
severe coronary artery disease
Contra-indications
see notes above
Hepatic impairment
see notes above
Renal impairment
use with caution
Pregnancy
see notes above
Breast-feeding
see notes above
Side-effects
see notes above;
also restlessness; intra-
muscular injection may be painful
Dose
. By mouth, 10–20 mg 2–3 times daily;
CHILD
2–5 years
5–15 mg daily in 1–2 divided doses,
5–10 years 10–
25 mg daily in 1–2 divided doses
. By deep intramuscular injection,
25–50 mg; max.
100 mg;
CHILD
5–10 years 6.25–12.5 mg
. By slow intravenous injection in emergencies,
25–
50 mg as a solution containing 2.5 mg/mL in water for
injections;
max.
100 mg
Promethazine
(Non-proprietary) A
1
Injection
,
promethazine hydrochloride 25 mg/mL,
net price 1-mL amp = 68p,
2-mL amp = £1.20
1.
A restriction does not apply where administration is for
saving life in emergency
Phenergan
c
(Sanofi-Aventis)
Tablets
,
both blue,
f/c,
promethazine hydrochloride
10 mg,
net price 56-tab pack = £2.85;
25 mg,
56-tab
pack = £4.34.
Label:
2
Dental prescribing on NHS
May be prescribed as Promethazine
Hydrochloride Tablets 10 mg or 25 mg
Elixir
,
golden,
promethazine hydrochloride 5 mg/
5 mL,
net price 100 mL = £2.67.
Label:
2
Dental prescribing on NHS
May be prescribed as Promethazine
Hydrochloride Oral Solution 5 mg/5 mL
Injection
A
1
,
promethazine hydrochloride 25 mg/
mL,
net price 1-mL amp = 67p
1.
A restriction does not apply where administration is for
saving life in emergency
3.4.2
Allergen Immunotherapy
Immunotherapy
using
allergen
vaccines
containing
house dust mite, animal dander (cat or dog), or extracts
of grass and tree pollen can reduce symptoms of asthma
and allergic rhinoconjunctivitis.
A vaccine containing
extracts of wasp and bee venom is used to reduce the
risk of
severe anaphylaxis and systemic reactions in
individuals with hypersensitivity to wasp and bee stings.
An oral preparation of grass pollen extract (
Grazax
c
) is
also
licensed for
grass
pollen-induced rhinitis
and
conjuctivitis.
Those requiring immunotherapy must be
referred to a hospital
specialist for accurate diagnosis,
assessment,
and treatment.
In view of concerns about the safety of desensitising
vaccines,
it is recommended that they are used by
specialists and only for the following indications:
.
seasonal
allergic hay fever (caused by pollen)
that has not responded to anti-allergic drugs;
.
hypersensitivity to wasp and bee venoms.
Desensitising vaccines should generally be avoided
or used with particular care in patients with asthma.
Desensitising vaccines should be avoided in pregnant
women,
in children under five years old,
and in those
taking beta-blockers (adrenaline may be ineffective in
case of
a hypersensitivity reaction),
or ACE inhibitors
(risk of severe anaphylactoid reactions).
Hypersensitivity reactions
to immunotherapy (espe-
cially to wasp and bee venom extracts)
can be life-
threatening;
bronchospasm usually develops within 1
hour
and anaphylaxis within 30 minutes of
injection.
Therefore,
cardiopulmonary
resuscitation
must
be
immediately available and patients need to be moni-
tored for at least 1 hour after injection.
If symptoms or
signs of
hypersensitivity develop (e.g.
rash,
urticaria,
bronchospasm, faintness), even when mild, the patient
should be observed until these have resolved comple-
tely.
The first
dose of
oral
grass pollen extract
(
Grazax
c
)
should be taken under
medical
supervision and the
patient should be monitored for 20–30 minutes.
For
details
of
the management
of
anaphylaxis,
see
section 3.4.3.
Each set of
allergen extracts usually contains vials for
the administration of
graded amounts of
allergen to
patients
undergoing
hyposensitisation.
Maintenance
sets containing vials at
the highest
strength are also
available.
Product
literature
must
be
consulted for
details of allergens,
vial strengths,
and administration.
BEE AND WASP ALLERGEN
EXTRACTS
Indications
hypersensitivity to wasp or bee venom
(see notes above)
Cautions
see notes above and consult product litera-
ture
Contra-indications
see notes above and consult pro-
duct literature
Pregnancy
avoid
Side-effects
consult product literature
Dose
. By subcutaneous injection, consult product literature
BNF 61
3.4.2 Allergen Immunotherapy
195
3
Respiratory system