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Tablet Press Extra The prescribing newsletter for GPs, nurses and pharmacists in NHS Nene CCG and NHS Corby CCG Hay Fever Treatment Update March 2018

ORAL ANTI-INFLAMMATORY EYE DROPS

Most of the commonly used antihistamines e.g. Like other preparations, many eye drops for , , & ocular symptoms of hay fever are available OTC at are available “Over The Counter” (OTC) and are less than the charge for a prescription. Sodium inexpensive. If it is appropriate to prescribe an oral cromoglicate 2% eye drops are now £6.71 for 13.5mL tablet then loratadine & cetirizine when prescribed generically. If a prescription is TABLETS are the CCG formulary choices. needed it is more cost-effective if prescribed as ® Drug Usual Adult Cost / Notes Pollenase 2% eye drops (£2.40 for 10mL). Dose 30 days They should be prescribed as a QDS dose. Loratadine* 10mg OD 65p Rx GENERIC Nedocromil has the advantage of ‘BD’ dosing and is £2.86 for 5mL. Cetirizine TABS* 10mg OD 73p Rx GENERIC

NASAL PREPARATIONS 5mg OD £1.00 Rx GENERIC Generically prescribed Mometasone is the 120mg OD £1.53 Rx GENERIC formulary choice of nasal spray and has the Chlorphenamine* 4mg QDS £3.04 Rx GENERIC advantage of OD dosing. 10-20mg £3.17- * Rx GENERIC Beclometasone nasal spray (200 dose) is also cost- BD-TDS £9.51 effective and should be prescribed generically (£2.51), Double Red ® 5mg OD £4.37 rather than as the Beconase brand (£2.63). m/r ® 10mg OD £6.92 Double Red Please ensure the script specifies “200 dose” rather (Mizollen ) than 180 dose or “OP” to avoid the “Hayfever” OTC 1mg BD to £6.05- Double Red (Tavegil®) 6mg OD £18.15 version being dispensed. This is nearly three times the cost of the 200 dose pack prescribed generically. ® £7.53- (Zaditen ) 1-2mg BD Double Red £15.06 Drug Adult Dose to Approx Notes Loratadine oral each nostril cost / 28 lyophilisates * days 10mg OD £9.72 Double Red 2-4 puffs OD (Clarityn Rapide Mometasone £0.66 - £1.65 / OP Allergy®) reducing to (GENERIC) £2.64 (140 doses) Bilastine (Ilaxten®) 20mg OD £15.09 Double Red 1 puff OD * Beclometasone 2 puffs BD See note above ® 4mg TDS £17.97 Double Red £1.41- (Periactin ) reducing to ‘200’ £2.51 50mcg* £2.81 Acrivastine* (GENERIC) 1 puff BD ‘180’ £7.11 (Benadryl ® Allergy 8mg TDS £20.44 Double Red Budesonide 2 puffs OM £2.23 - £4.77 / OP Relief) 64mcg reducing to 1 £4.45 (120 doses) (Rhinocort Aqua) puff OD LIQUID PREPARATIONS Fluticasone 2 puffs OD £3.01- £6.44 / OP furoate reducing to 1 If a liquid is needed for young children, cetirizine oral ® £6.01 (120 doses) (Avamys ) puff OD solution (first choice) and loratadine syrup are Ipratropium 2 puffs BD - £8.14- £6.54 / OP options. Both are licensed for use in children from 2 (Rinatec®) TDS £12.21 (180 doses) years upwards. (Note: more expensive than tablets).

Drug Dose range Cost / Notes 2 puffs OD Triamcinolone £3.45 - £7.39 / OP 200mL * reducing to 1 for children ® £6.90 (120 doses) According to age/wt (Nasacort ) puff OD Cetirizine* 2 puffs OD – 2.5 – 5mg BD £1.12 Rx GENERIC £4.11 - £11.01 / OP 5mg / 5mL Fluticasone* BD reducing ® £16.44 (150 doses) Loratadine* (Flixonase ) to 1 puff OD 5 -10mg OD £2.90 Rx GENERIC 5mg / 5mL Fluticasone propionate with £14.80 / OP 1 spray BD £13.81 Levocetirizine (120 doses) ® 1.25mg BD – ® (Xyzal ) £6.00 Double Red (Dymista ) 5mg OD 2.5mg / 5mL

Desloratadine ® 1.25 – 2.5mg CORTICOSTEROIDS (Neoclarityn ) £13.53 Double Red OD 2.5mg / 5mL Consider short-term course of oral steroids in patients

with severe symptoms or in extenuating (*) = OTC versions available, but often as different brand circumstances e.g examinations. names and/or smaller pack sizes. See BNF for more details Depot Triamcinolone use is NOT recommended.

(Prices are based on Feb 18 Drug Tariff and C&D).

Disclaimer: Information in this newsletter is believed to be accurate and true. NHS Nene CCG and NHS Corby CCG employees accept no liability for loss of any nature, to persons, organisations or institutions that may arise as a result of any errors or omissions. 0160 4 651360