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Position Statement on Alimemazine

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Position Statement on Alimemazine Position Statement on Alimemazine Waltham Forest CCG does NOT recommend the prescribing of ALIMEMAZINE The Do’s and Don’ts of prescribing sedating anti-histamines Do’s Review all patients currently prescribed alimemazine and stop where clinically appropriate or change to either chlorphenamine or hydroxyzine. There is no strong evidence to support that one antihistamine is more effective than the other. Prescribe chlorphenamine as the first line choice of sedating antihistamine for the treatment of urticaria as its long-term safety has been well established, Commence all new patients requiring a sedating antihistamine on either chlorphenamine or hydroxyzine (1). Dont’s Do not prescribe hydroxyzine to people with a prolonged QT interval or risk factors for QT interval prolongation. The MHRA recommends that the maximum adult daily dose of hydroxyzine is 100mg (3). Do not use sedating antihistamines long term unless clinically indicated Rationale There is no published literature available to state that alimemazine is superior in efficacy to other antihistamines. NICE recommend chlorphenamine or hydroxyzine if a sedating antihistamine is required for urticaria. 1 The cost of alimemazine (both capsules and liquid) has increased significantly over the last 6 months.3 Costs Promethazine 25mg tablet Hydroxyzine 25mg tablet Chlorphenamine 4mg tablet Alimemazine 10mg tablet £0.00 £0.20 £0.40 £0.60 £0.80 £1.00 £1.20 £1.40 £1.60 Cost per tablet (£) Figure 1: Alimemazine product and price comparison (2) References 1. NICE CKS Urticaria http://cks.nice.org.uk/urticaria Last revised December 2011. Date accessed 01/03/2016. 2. Dm+D Browser. Last accessed 3/10/2017. https://apps.nhsbsa.nhs.uk/DMDBrowser/DMDBrowser.do#product 3. MHRA Drug Safety Update (2015) Hydroxyzine (Atarax, Ucerax): risk of QT interval prolongation and Torsade de Pointes. Date accessed 01/10/2017. https://www.gov.uk/drug-safety-update/hydroxyzine-atarax-ucerax-risk-of-qt- interval-prolongation-and-torsade-de-pointes Date produced: 31st March 2017 Date of review: March 2018 Date: Approved: Oct 2017 Author: Kay Saini Version 1 Waltham Forest CCG Position Statement: Alimemazine .
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