Options for liquid antihistamines for children and toddlers
Children's health,  Health

Liquid antihistamines for children and toddlers

There are plenty of choices when it comes to the management of hayfever symptoms and allergic skin reactions in children and toddlers. Most antihistamines available for an adult population exist in liquid form. In this post, I will review liquid antihistamines for kids, which are available in the UK, focusing on:

  • Restrictions on the availability of liquid antihistamines (pharmacy-only products vs. general sale products)
  • Age restrictions for each liquid antihistamine
  • Dosage for treatment of hayfever
  • Common-side effects, particularly review of drowsiness

Note:

Pharmacy-only medicines (P) can only be sold in pharmacies, including online chemists.

General sale list products (GSL) can be sold in any retail outlets such as supermarkets.

The following liquid antihistamines for kids will be reviewed:

  • Cetirizine
  • Loratadine
  • Chlorphenamine
  • Promethazine
  • Diphenhydramine

Antihistamines for children: caution on the use 

As with other medicines, precautions should be taken before the use. Check for product information, special warning, and interactions with other medications where necessary.

In this post, you can learn about the common side effects of liquid antihistamines. Please read product information leaflet to learn more about possible, less common side effects.   

Antihistamines for kids discussed in this post are broadly divided into first and second-generation antihistamines. Newer, second-generation antihistamines are less likely to cause drowsiness, although there is small risk of experiencing drowsiness, with minimal sedation.

1. Cetirizine liquid antihistamine

Cetirizine is one of the most popular ‘second-generation’ antihistamines available for the management of hayfever symptoms.

What is cetirizine liquid used for?

Cetirizine liquid is indicated for:

  • Management of hayfever symptoms and year-round allergies, for example, to pets or dust such as the runny nose, watery eyes, sneezing.  
  • Cetirizine liquid can also be used for symptoms of urticaria (hives) and skin rashes.

Cetirizine liquid: availability and age restrictions 

Cetirizine liquid can be purchased from many supermarkets or pharmacies. All liquid preparations of cetirizine are the same in terms of their strength and usually sold as 5mg/5ml or 1mg/1ml (same strength). The main difference in the availability of cetirizine liquid comes from licensed restrictions on age. Generally, cetirizine liquid available for self-selection by customers (GSL) is licensed for children 6 years and above. In contrast, cetirizine liquid available from a pharmacy (P) is licensed for children from 2 years of age.

The table below lists some common cetirizine liquid products available in the UK and their age restrictions:

Name of the productAge restrictionsAvailability

Sizes

Benadryl Allergy Children’s 1mg/ml Oral Solution

2 years and aboveP

75ml, 100ml or 200ml

Benadryl Allergy Children’s 6+ 1mg/ml Oral Solution

6 years and aboveGSL

70ml

Piriteze Allergy 1mg/ml Syrup

6 years and aboveGSL

70ml

Zirtek Allergy Relief for Children 1 mg/mL oral solution

Zirtek Allergy Solution 1mg/ml oral solution

6 years and aboveGSL

60ml and 70ml

Various brands:

Tesco Family Allergy Relief Syrup

Sainsbury’s Family Hayfever and Allergy Relief Liquid

ASDA 6 Year + Allergy Relief Liquid

Boots Hayfever and allergy relief Syrup

6 years and aboveGSL

70ml

In addition to the above brands, pharmacies may stock dispensing packs of generic cetirizine liquid, available usually in the size of 200ml bottles and licensed as P products. Dispensing packs of liquid cetirizine are the best value for money for a given volume of the medicine. Not all pharmacies may sell dispensing packs of cetirizine liquid; however, it is worth asking a pharmacy team about it.

Cetirizine liquid: recommended doses for kids

  • Children age 2 – 6 years: 2.5 mg twice a day (2.5ml twice a day)
  • Children age 6 – 12 years: 5mg twice a day (5ml twice a day)
  • Children and adults over 12 years of age: 10mg once daily (10ml once daily)

Cetirizine liquid: common side effects

Cetirizine is classified as a non-drowsy antihistamine; however, listed common side effects may include drowsiness and tiredness. Other common side effects:

  • Headache or dizziness
  • Restlessness
  • Tiredness and feeling sleepy
  • Dry mouth
  • Upset stomach (abdominal pain, diarrhoea)
  • Nausea
  • Runny nose

Please refer to the product information leaflet for more details on other less common side effects associated with cetirizine.

2. Loratadine liquid antihistamine

Loratadine liquid antihistamine for kids

What is loratadine liquid used for?

Loratadine is another antihistamine which has the same licensed indications as cetirizine:

  • Reliving the symptoms of hayfever including runny nose, sneezing, itchy, red and watery eyes
  • Management of skin allergies, including skin rashes and urticaria (hives).

Loratadine liquid: availability and age restrictions

Loratadine liquid (loratadine 5mg/5ml oral solution)  is available as pharmacy only product (P) and over the counter product sold in supermarkets for example (GSL). The Same age restrictions apply for both P and GSL products.
Customers who want to buy loratadine liquid (dispensing pack), may need to ask a pharmacy team to get it from the dispensary, which may be cheaper than branded products displayed on the shelf.  

Loratadine liquid: recommended doses for kids

Children age 2-12 years of age:

  • Bodyweight more than 30kg: 10ml (10mg) once daily.
  • Bodyweight 30kg or less: 5ml (5mg) once daily.

Adults and children 12 years and above:

  • 10ml (10mg) once daily

Loratadine liquid common side effects

Loratadine is classified as a non-drowsy antihistamine; however, sedation may still occur; sedation if generally minimal (BNF, 2020).

Other side effects may include:

  • headache
  • nervousness
  • tiredness
  • increased appetite
  • difficulty sleeping

3. Liquid antihistamines: Chlorphenamine liquid

Piriton liquid antihistamine for babies

Chlorphenamine, the 1st generation of antihistamine, is mostly known as a liquid form under the brand name of Pirion syrup. The main difference between chlorphenamine and other newer antihistamines, such as cetirizine and loratadine is the sedating properties associated with their use. Chlorphenamine syrup is marketed as

What is chlorphenamine liquid used for?

The main indications for chlorphenamine liquid are the management of:

  • hayfever symptoms
  • allergic rashes
  • reactions to food or medicines
  • reactions to insect bites

Chlorphenamine liquid: availability and age restrictions

Chlorphenamine can be purchased as a branded product known as Piriton syrup (2mg/5ml) or in its generic form as chlorphenamine oral solution (2mg/5ml).

Chlorphenamine is licensed as pharmacy-only medication, which means it can only be purchased in chemists, including online pharmacies.  

Chlorphenamine syrup is licensed for adults and children from 1 year of age.

Chlorphenamine liquid: recommended doses for kids

  • Children over 12 years of age:
  • 5ml doses every four-six hours. Maximum of six doses in 24 hours if required.
  • Children 6-12 years
  • 5ml dose every four-six hours. Maximum of six doses in 24 hours if required.
  • Children 2-5 years:
  • 2.5ml dose every four to six hours up to a maximum of six doses in 24 hours as required.
  • Children 1 -2 years:
  • 2.5ml dose twice a day up. Maximum of two doses in 24 hours if needed.

Chlorphenamine liquid: common side effects

Common side effects associated with the use of chlorphenamine include:

  • Sedation and drowsiness
  • Dizziness
  • Headache
  • Blurred vision
  • Nausea
  • Dry mouth
  • Fatigue

4. Promethazine liquid

Phenergan liquid antihistamine

Promethazine is another first-generation antihistamine sold under the brand name of Phenergan Elixir / Oral Solution.

What is promethazine liquid used for?

As with previously discussed liquid antihistamines Phenergan Elixir is licensed in the management of:

  • Allergic conditions such as hayfever
  • Rashes, for example, hives or nettle rash
  • Nausea (antiemetic effect)
  • Short term management of insomnia

Promethazine liquid: availability and age restrictions

Phenergan Elixir is licensed as P medication. Not all conventional pharmacies may stock Phenergan Elixir; additionally, it is usually kept in the dispensary, away from the public view. Some pharmacies may be able to order Phenergan oral solution on an individual basis. Phenergan Elixir can be purchased online from registered chemists.

Phenergan Elixir can be used in children from 2 years of age.

Promethazine liquid: recommended doses for children

The dosage of Phenergan Elixir depends on the intended use. The dose is different when used as an antihistamine, as an antiemetic (to stop nausea) and when used as a sedative on a short term basis. Please refer to detailed dosing instructions to the product information leaflet for Phenergan Elixir.

Promethazine liquid: common side effects

The main side effect associated with the use of promethazine liquid is sedation. Other side effects that may be experienced by children taking Phenergan Elixir may include (frequency not known):

  • Drowsiness
  • Dizziness
  • Headaches
  • Tiredness
  • Nightmares
  • Blurred vision 
  • Dry mouth 

Please refer to the product information leaflet for more information about possible side effects and special warning related to Phenergan Elixir. 

5. Diphenhydramine liquid

Diphenhydramine is the first-generation antihistamine, which became available in a liquid formulation recently. Diphenhydramine is sold under a brand name of Nytol Liquid Caramel Flavour 10mg/5ml Oral Solution. As with other first-generation antihistamines, diphenhydramine is classified as a sedative antihistamine.

What is diphenhydramine liquid used for?

Nytol Liquid is licensed only as a sleep aid.

Diphenhydramine liquid: availability and age restrictions

Nytol Liquid is a pharmacy-only medication licensed for adults and children from 16 years of age.

Diphenhydramine liquid: dose

The recommended dose for children over 16 years of age and adults is:

10 to 25ml to be taken at bedtime, limited to one dose per night.             

Diphenhydramine liquid: common side effects

Common side effects listed for Nytol liquid include:

  • Sedation (feeling sleepy)
  • Drowsiness, dizziness
  • Dry mouth
  • Fatigue

Conclusion

Liquid antihistamines are effective medicines in the management of hayfever symptoms.

Additionally, children’s hayfever symptoms can be managed with antihistamine eye drops, such as sodium cromoglicate eye drops.

Other alternatives include prescribed drugs such as fexofenadine and steroid nasal sprays.

Congestion in babies and children associated with colds can be managed with different over the counter products.

References:

NICE 2020.Loratadine. Available at: https://bnf.nice.org.uk/drug/loratadine.html#sideEffects Accessed on 14/04/2020

I am a community pharmacist working in UK. I blog about drugs, health and pharmacy.

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