Drugs List

Therapeutic Indications

Uses

Allergic reaction - responsive to antihistamines
For the symptomatic relief of itch associated with chickenpox

Contraindications

Neonates under 1 month
Within 2 weeks of discontinuing MAOIs

Precautions and Warnings

Children under 18 years
Elderly
Asthma
Benign prostatic hyperplasia
Breastfeeding
Bronchiectasis
Bronchitis
Cardiovascular disorder
Epileptic disorder
Galactosaemia
Glaucoma
Glucose-galactose malabsorption syndrome
Hepatic impairment
Hereditary fructose intolerance
Lactose intolerance
Pregnancy
Pyloroduodenal obstruction
Raised intra-ocular pressure
Renal impairment
Severe hypertension
Thyrotoxicosis
Urinary retention

Advise ability to drive/operate machinery may be affected by side effects
Not all available brands are licensed for use in children under 6 years
Not all formulations are licensed for all uses
Oral solution with maltitol unsuitable in hereditary fructose intolerance
Some formulations contain lactose
Some formulations contain sucrose
Reduce dose in elderly
Should not be taken with other cough or cold medicine
Advise patient to avoid alcohol during treatment
Alcohol may enhance side effects

Pregnancy and Lactation

Pregnancy

Use chlorphenamine with caution in pregnancy.

The manufacturers note that the safety of chlorphenamine in pregnancy has not been established. Use during the third trimester may result in reactions in the newborn or premature neonates.

Briggs notes the use of chlorphenamine in pregnancy as having a low risk of harm to the foetus but an association between exposure during the last 2 weeks of pregnancy to antihistamines in general and retrolental fibroplasia in premature infants has been reported.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Use chlorphenamine with caution in breastfeeding.

The manufacturers note that small amounts of antihistamines may be excreted in breast milk and may inhibit lactation.

Medications and Mothers' Milk note that although no data is available on chlorphenamine and its excretion into breast milk, it has not been reported to produce side effects. Sedation is the only likely side effect.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Abdominal pain
Anaphylactic reaction
Angioedema
Anorexia
Antimuscarinic effects
Arrhythmias
Blood dyscrasias
Blurred vision
Chest tightness
Confusion
Convulsions
Depression
Diarrhoea
Dizziness
Drowsiness
Dry mouth
Dyspepsia
Excitement (paradoxical)
Exfoliative dermatitis
Extrapyramidal effects
Gastro-intestinal disturbances
Haemolytic anaemia
Hair loss
Headache
Hepatic impairment
Hepatitis
Hypersensitivity reactions
Hypotension
Impaired concentration
Inco-ordination
Irritability
Jaundice
Lassitude
Muscle weakness
Myalgia
Nausea
Nightmares
Palpitations
Paraesthesia
Photosensitivity
Rash
Sedation
Sleep disturbances
Sweating
Tachycardia
Thickening of bronchial secretions
Tinnitus
Tremor
Twitching
Urinary retention
Urticaria
Vomiting

Presentation

Oral formulations containing chlorphenamine maleate.

Drugs List

Therapeutic Indications

Uses

Allergic reaction - responsive to antihistamines
For the symptomatic relief of itch associated with chickenpox

Dosage

Adults

Elderly

Children

Contraindications

Neonates under 1 month
Within 2 weeks of discontinuing MAOIs

Precautions and Warnings

Children under 18 years
Elderly
Asthma
Benign prostatic hyperplasia
Breastfeeding
Bronchiectasis
Bronchitis
Cardiovascular disorder
Epileptic disorder
Galactosaemia
Glaucoma
Glucose-galactose malabsorption syndrome
Hepatic impairment
Hereditary fructose intolerance
Lactose intolerance
Pregnancy
Pyloroduodenal obstruction
Raised intra-ocular pressure
Renal impairment
Severe hypertension
Thyrotoxicosis
Urinary retention

Advise ability to drive/operate machinery may be affected by side effects
Not all available brands are licensed for use in children under 6 years
Not all formulations are licensed for all uses
Oral solution with maltitol unsuitable in hereditary fructose intolerance
Some formulations contain lactose
Some formulations contain sucrose
Reduce dose in elderly
Should not be taken with other cough or cold medicine
Advise patient to avoid alcohol during treatment
Alcohol may enhance side effects

Pregnancy and Lactation

Pregnancy

Use chlorphenamine with caution in pregnancy.

The manufacturers note that the safety of chlorphenamine in pregnancy has not been established. Use during the third trimester may result in reactions in the newborn or premature neonates.

Briggs notes the use of chlorphenamine in pregnancy as having a low risk of harm to the foetus but an association between exposure during the last 2 weeks of pregnancy to antihistamines in general and retrolental fibroplasia in premature infants has been reported.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Use chlorphenamine with caution in breastfeeding.

The manufacturers note that small amounts of antihistamines may be excreted in breast milk and may inhibit lactation.

Medications and Mothers' Milk note that although no data is available on chlorphenamine and its excretion into breast milk, it has not been reported to produce side effects. Sedation is the only likely side effect.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Abdominal pain
Anaphylactic reaction
Angioedema
Anorexia
Antimuscarinic effects
Arrhythmias
Blood dyscrasias
Blurred vision
Chest tightness
Confusion
Convulsions
Depression
Diarrhoea
Dizziness
Drowsiness
Dry mouth
Dyspepsia
Excitement (paradoxical)
Exfoliative dermatitis
Extrapyramidal effects
Gastro-intestinal disturbances
Haemolytic anaemia
Hair loss
Headache
Hepatic impairment
Hepatitis
Hypersensitivity reactions
Hypotension
Impaired concentration
Inco-ordination
Irritability
Jaundice
Lassitude
Muscle weakness
Myalgia
Nausea
Nightmares
Palpitations
Paraesthesia
Photosensitivity
Rash
Sedation
Sleep disturbances
Sweating
Tachycardia
Thickening of bronchial secretions
Tinnitus
Tremor
Twitching
Urinary retention
Urticaria
Vomiting

Overdosage

It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

The following number will direct the caller to the relevant local centre (0844) 892 0111

Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Further Information

Last Full Review Date: May 2018

Reference Sources

Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 10th edition (2015) ed. Briggs, G., Freeman, R. Wolters Kluwer Health, Philadelphia.

Medications and Mothers' Milk, Sixteenth Edition (2014) Hale, T and Rowe, H, Hale Publishing, Plano, Texas.

Summary of Product Characteristics: Allerief 2mg/5ml oral solution. Crescent Pharma Limited. Revised March 2018.

Summary of Product Characteristics: Allerief 4mg tablets. Crescent Pharma Limited. Revised December 2017.

Summary of Product Characteristics: Hayleve. Chelonia Healthcare Limited. Revised August 2016.

Summary of Product Characteristics: Piriton Allergy Tablets. GlaxoSmithKline Consumer Healthcare (UK) Trading Limited. Revised April 2016.

Summary of Product Characteristics: Piriton Tablets. GlaxoSmithKline Consumer Healthcare (UK) Trading Limited. Revised April 2016.

Summary of Product Characteristics: Piriton Syrup. GlaxoSmithKline Consumer Healthcare (UK) Trading Limited. Revised March 2016.

NICE Evidence Services Available at: www.nice.org.uk Last accessed: 08 May 2018