BNF for Children 2011-2012

BNFC 2011–2012 13.3 Topical antipruritics 557Drapolene c (Chefaro UK)Cream, benzalkonium chloride 0.01%, cetrimide 0.2%in a basis containing white soft paraffin, cetyl alcoholand wool fat, net price 100 g = £1.54, 200 g = £2.50,350 g = £3.75Excipients include cetyl alcohol, chlorocresol, wool fatMedicaid c (LPC)Cream, cetrimide 0.5% in a basis containing lightliquid paraffin, white soft paraffin, cetostearyl alcohol,glyceryl monostearate, net price 50 g = £1.69Excipients include cetostearyl alcohol, fragrance, hydroxybenzoates(parabens), wool fatMetanium c (Thornton & Ross)Ointment, titanium dioxide 20%, titanium peroxide5%, titanium salicylate 3% in a basis containingdimeticone, light liquid paraffin, white soft paraffin,and benzoin tincture, net price 30 g = £2.01Excipients none as listed in section 13.1.3Morhulin c (Actavis)Ointment, cod-liver oil 11.4%, zinc oxide 38%, in abasis containing liquid paraffin and yellow soft paraffin,net price 50 g = £1.91Excipients include wool fat derivativeSiopel c (Derma UK)Barrier cream, dimeticone ‘1000’ 10%, cetrimide0.3%, arachis (peanut) oil, net price 50 g = £2.15Excipients include butylated hydroxytoluene, cetostearyl alcohol,hydroxybenzoates (parabens)Sprilon c (Ayrton Saunders)Spray application, dimeticone 1.04%, zinc oxide12.5%, in a basis containing wool alcohols, cetostearylalcohol, dextran, white soft paraffin, liquid paraffin,propellants, net price 115-g pressurised aerosol unit =£3.54Excipients include cetostearyl alcohol, hydroxybenzoates (parabens),wool fatNote FlammableSudocrem c (Forest)Cream, benzyl alcohol 0.39%, benzyl benzoate 1.01%,benzyl cinnamate 0.15%, hydrous wool fat (hypoallergeniclanolin) 4%, zinc oxide 15.25%, net price 60 g= £1.25, 125 g = £1.84, 250 g = £3.09, 400 g = £4.34Excipients include beeswax (synthetic), propylene glycol, butylatedhydroxyanisole, fragranceVasogen c (Forest)Barrier cream, dimeticone 20%, calamine 1.5%, zincoxide 7.5%, net price 100 g = £2.72Excipients include hydroxybenzoates (parabens), wool fat13.3 Topical antipruriticsPruritus may be caused by systemic disease (such asobstructive jaundice, endocrine disease, chronic renaldisease, iron deficiency, and certain malignant diseases),skin disease (such as eczema, psoriasis, urticaria, andscabies), drug hypersensitivity, or as a side-effect ofopioid analgesics. Where possible, the underlyingcause should be treated. For the treatment of pruritusin palliative care, see Prescribing in Palliative Care,p. 19. Pruritus caused by cholestasis generally requiresa bile acid sequestrant (section 1.9.2).An emollient (section 13.2.1) may be of value where thepruritus is associated with dry skin. Preparations containingcalamine or crotamiton are sometimes usedbut are of uncertain value.A topical preparation containing doxepin 5% is licensedfor the relief of pruritus in eczema in children over 12years; it can cause drowsiness and there may be a risk ofsensitisation.Topical antihistamines and local anaesthetics (section15.2) are only marginally effective and occasionallycause sensitisation. For insect stings and insect bites, ashort course of a topical corticosteroid is appropriate.Short-term treatment with a sedating antihistamine(section 3.4.1) may help in insect stings and in intractablepruritus where sedation is desirable. Calaminepreparations are of little value for the treatment of insectstings or bites.In pruritus ani, the underlying cause such as faecalsoiling, eczema, psoriasis, or helminth infection shouldbe treated; for preparations used to relieve pruritus ani,see section 1.7.CALAMINE UIndication and dosePruritus but see notes aboveCalamine (Non-proprietary) UAqueous cream, calamine 4%, zinc oxide 3%, liquidparaffin 20%, self-emulsifying glyceryl monostearate5%, cetomacrogol emulsifying wax 5%, phenoxyethanol0.5%, freshly boiled and cooled purifiedwater 62.5%, net price 100 mL = 84pLotion (= cutaneous suspension), calamine 15%, zincoxide 5%, glycerol 5%, bentonite 3%, sodium citrate0.5%, liquefied phenol 0.5%, in freshly boiled andcooled purified water, net price 200 mL = 63pOily lotion (BP 1980), calamine 5%, arachis (peanut)oil 50%, oleic acid 0.5%, wool fat 1%, in calciumhydroxide solution, net price 200 mL = £1.57CROTAMITONCautions avoid use near eyes and broken skin; use ondoctor’s advice for children under 3 yearsContra-indications acute exudative dermatosesIndication and dosePruritus (including pruritus after scabies—section13.10.4) see notes aboveApply 2–3 times daily (for pruritus after scabies inchildren under 3 years apply once daily only)Eurax c (Novartis Consumer Health)Cream, crotamiton 10%, net price 30 g = £2.38, 100 g= £4.15Excipients include beeswax, fragrance, hydroxybenzoates (parabens),stearyl alcoholLotion, crotamiton 10%, net price 100 mL = £3.14Excipients include cetyl alcohol, fragrance, propylene glycol, sorbicacid, stearyl alcoholDOXEPIN HYDROCHLORIDECautions susceptibility to angle-closure glaucoma;urinary retention; mania; cardiac arrhythmias; severeheart disease; avoid application to large areas; interactions:Appendix 1 (antidepressants, tricyclic)Skilled tasks Drowsiness may affect performance of skilledtasks (e.g. driving); effects of alcohol enhancedHepatic impairment manufacturer advises caution insevere liver disease13 Skin