• Keep this leaflet. You may need to read it again.
• If you have any further questions, ask your doctor or pharmacist.
• This medicine has been prescribed for you only. Do not pass it on to others. It may harm them, even if their symptoms are the same as yours.
• If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. See section 4.

The name of your medicine is Alfresed 30mg/5ml Syrup, but it will be referred to as Alfresed throughout this leaflet.

1. What Alfresed is and what it is used for
2. What you need to know before you take Alfresed
3. How to take Alfresed
4. Possible side effects
5. How to store Alfresed
6. Contents of the pack and other information

• To treat itching (pruritus) or an itchy, lumpy rash (urticaria)
• As a sedative for children aged between 2 and 7 years. This is a medicine given to reduce awareness or make the child feel relaxed and at ease before an operation.

• are allergic (hypersensitive) to:
  • alimemazine tartrate or any of the other ingredients of this medicine (listed in section 6)
  • any other similar medicines (phenothiazines) such as chlorpromazine.
  The signs of an allergic reaction include: a rash, swallowing or breathing problems, swelling of your lips, face, throat or tongue
• have liver or kidney problems
• have epilepsy
• have Parkinson’s disease
• have thyroid problems (hypothyroidism)
• have a tumour on the adrenal gland (called phaeochromocytoma)
• have myasthenia gravis (a form of muscle weakness)
• have an enlarged prostate gland
• have increased pressure in the eye (called narrow angle glaucoma).

Alfresed should not be used in children under 2 years of age. Alfresed syrup of a lower strength (7.5mg/5ml) should be used in children to treat itching (pruritus) and urticaria, as it is easier to measure the dose required.

Do not take this medicine if any of the above applies to you. If you are not sure, talk to your doctor or pharmacist before taking Alfresed.

Talk to your doctor or pharmacist before taking Alfresed if:

• the person taking the medicine is under 2 years of age
• you are diabetic. This medicine contains sucrose, a type of sugar
• you have heart problems
• you are elderly and are dehydrated or have been told you have a low blood volume
• you are elderly and have had constipation for some time
• you are an elderly male and have problems when passing water (urine)
• you are elderly and it is very hot or cold. Your body may find it harder to control its temperature when taking this medicine.

If you are not sure if any of the above apply to you, talk to your doctor or pharmacist before taking Alfresed.

Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines. This includes medicines you can buy without prescription, including herbal medicines. This is because Alfresed can affect the way some medicines work. Also some medicines can affect the way Alfresed works.

In particular, tell your doctor or pharmacist if you are taking any of the following:

• Medicines to help you sleep or lower your anxiety
• Lithium - used to treat some types of mental illness
• Amfetamine - used for Attention Deficit Hyperactivity Disorder (ADHD)
• Phenobarbital - used for epilepsy
• Adrenaline - used for life threatening allergic reactions
• Medicines for Parkinson’s disease such as levodopa
• Medicines for depression
• Medicines for severe pain (such as codeine or morphine)
• Medicines for diabetes. Your doctor may need to change the dose of your medicine
• Medicines for high blood pressure such as doxazosin, terazosin, guanethidine, clonidine
• Medicines for indigestion and heartburn (antacids)
• Anticholinergic medicines - includes some medicines used for irritable bowel syndrome, asthma or incontinence.

Do not drink alcohol or take any medicines containing alcohol while you are taking Alfresed. This is because alcohol can increase the chances of you getting side effects. It can also cause serious breathing difficulties.

If you are pregnant, think you may be pregnant or planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine.

You should not take Alfresed if you are breastfeeding.

This is because small amounts may pass into mothers’ milk. This can be harmful to your baby.

If you are breast-feeding or planning to breast-feed, talk to your doctor or pharmacist before taking any medicine.

You may feel drowsy or sleepy while taking this medicine. If this happens, do not drive or use any tools or machines.

Sucrose: If you have been told by your doctor that you have an intolerance to some sugars, contact your doctor before taking this medicine. Furthermore, sucrose may be harmful to the teeth if this medicine is taken for long-term use e.g. for two weeks or more.

Methyl parahydroxybenzoate (E218), which may cause allergic reactions (possibly delayed).

Sodium sulfite anhydrous (E221) and sodium metabisulfite (E223): These may rarely cause severe hypersensitivity reactions and difficulty breathing, wheezing and tightness in the chest (bronchospasm).

This medicine contains less than 1 mmol sodium (23 mg) per 5ml, that is to say essentially ‘sodium-free’.

The recommended dose is:

For itching or an itchy lumpy rash

Adults:

• 10mg (approx. 1.7ml of syrup) two or three times each day
• Your doctor may increase your dose depending on your illness.

Older people:

• 10mg (approx. 1.7ml of syrup) once or twice each day.

Children over 2 years of age:

• Alfresed syrup of a lower strength (7.5mg/5ml) should be used.

As a sedative

Children aged between 2 and 7 years:

• Your child’s doctor will decide the amount to give
• The maximum dose is 2mg (approx. 0.3ml of syrup) per kg of bodyweight
• Alfresed is given 1-2 hours before the operation.

Alfresed can make your skin more sensitive to sunlight. Keep out of direct sunlight while taking this medicine.

• Take this medicine by mouth
• Avoid the syrup touching any part of your skin. This can cause skin redness, swelling and itching (contact skin sensitisation)
• If you feel the effect of your medicine is too weak or too strong, do not change the dose yourself, but ask your doctor
• Do not take more than the recommended dose
• Use the measuring syringe provided in the pack to deliver the required dose.

Instructions for the use of syringe:

1. Open the bottle: press the cap and turn it anticlockwise (figure 1). Separate the adaptor from the syringe (figure 2).

2. Insert the adaptor into the bottle neck (figure 3). Ensure it is properly fixed. Take the syringe and put it in the adaptor opening (figure 4).

3. Turn the bottle upside down. Fill the syringe with a small amount of syrup by pulling the piston down (figure 5A), then push the piston upwards in order to remove any possible bubble (figure 5B). Pull the piston down to the graduation mark corresponding to the quantity in millilitres (ml) prescribed by your doctor (figure 5C).

4. Turn the bottle the right way up (figure 6A). Remove the syringe from the adaptor (figure 6B).

5. Empty the contents of the syringe into the patient’s mouth by pushing the piston to the bottom of the syringe (figure 7). Leave the syringe adaptor in place after first use. Close the bottle with the plastic screw cap. Wash the syringe with water (figure 8).

If you take more Alfresed than you should, tell a doctor or go to a hospital casualty department straight away. Take the medicine pack with you. This is so the doctor knows what you have taken. Also do this if a child under 2 years of age swallows some of this medicine.

The following effects may happen: feeling drowsy, loss of consciousness, increased or rapid heartbeat, changes in heart beat, uneven heart beats and feeling very cold. You may also feel dizzy, light headed or faint (due to low blood pressure) and you may notice that you cannot control your movements (for example of the eyes, neck, arms and legs).

If you forget a dose, take it as soon as you remember it. However, if it is nearly time for the next dose, skip the missed dose. Do not take a double dose to make up for a forgotten dose.

• An allergic reaction. The signs may include: a rash, swallowing or breathing problems, swelling of your lips, face, throat or tongue
• Liver problems that may cause the eyes or skin to go yellow (jaundice)
• High temperature, sweating, stiff muscles, fast heartbeat, fast breathing and feel confused, drowsy or agitated.
  These could be signs of a serious side effect called ‘neuroleptic malignant syndrome’
• Very fast, uneven or forceful heartbeat (palpitations).
  You may also have breathing problems such as wheezing, shortness of breath, tightness in the chest and chest pain
• Convulsions/fits and movements that you cannot control, mainly of the tongue, mouth, jaw, arms and legs
• You may get infections more easily than normal such as fever, severe chills, sore throat or mouth ulcers. These could be signs of a blood problem.

• Breathing more slowly or less deeply than normal
• Feeling restless and not being able to keep still (akathisia)
• Changes in skin or eye colour
• Problems with your eyesight
• Rigid or stiff muscles, trembling or shaking or difficulty moving
• Feeling dizzy, light-headed or faint when you stand or sit up quickly (due to low blood pressure)
• Unexpected excitement or hyperactivity.

• Dry mouth
• Stuffy nose
• Difficulty sleeping (insomnia)
• Feeling agitated
• Being more sensitive to the sun than usual
• Unusual production of breast milk in men and women
• Breast enlargement in men
• Loss of menstrual periods
• Difficulty in getting or maintaining an erection or in ejaculating (impotence)
• Skin redness, swelling and itching (contact skin sensitisation)
• Skin rashes.

If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the Yellow Card Scheme Website at: www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store. By reporting side effects you can help provide more information on the safety of this medicine.

The active substance is alimemazine tartrate.

Each 5ml of syrup contains 30mg alimemazine tartrate.

The other ingredients are sucrose, citric acid monohydrate, sodium citrate, methyl parahydroxybenzoate (E218), sodium sulfite anhydrous (E221), sodium metabisulfite (E223), ascorbic acid, caramel flavour, apricot flavour and purified water.

Alfresed is a clear, colourless to pale yellow syrupy liquid with caramel odour supplied in an amber glass bottle of 100ml, with a tamper evident, child resistant white plastic cap and a 5ml oral syringe with 0.1ml graduation and a syringe adaptor.