loratadine

Therapeutic Classification: allergy, cold and cough remedies

Pharmacologic Classification: antihistamines

Indications ⬆ ⬇

REMS

Seasonal allergies.
Chronic idiopathic urticaria.
Hives.

Action ⬆ ⬇

Blocks peripheral effects of histamine released during allergic reactions.

Therapeutic effects:

Decreased symptoms of allergic reactions (nasal stuffiness; red, swollen eyes, itching).

Pharmacokinetics ⬆ ⬇

Absorption: Rapidly absorbed after oral administration (80%).

Distribution: Unknown.

Protein Binding: Loratadine: 97%; descarboethoxyloratadine: 73–77%.

Metabolism/Excretion: Rapidly and extensively metabolized during first pass through the liver. Much is converted to descarboethoxyloratadine, an active metabolite.

Half-Life: Loratadine: 8.4 hr; descarboethoxyloratadine: 28 hr.

Time/Action Profile ⬆ ⬇

(antihistaminic effects)

ROUTE	ONSET	PEAK	DURATION
PO	1–3 hr	8–12 hr	>24 hr

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity.

Use Cautiously in:

Hepatic impairment or CCr <30 mL/min (↓ dose to 10 mg every other day);
Pedi: Children 2 yr (safety and effectiveness not established). Syrup contains sodium benzoate; avoid use in neonates;
Geri: risk of adverse reactions in older adults.

Adv. Reactions/Side Effects ⬆ ⬇

Derm: photosensitivity, rash

EENT: blurred vision

GI: dry mouth, GI upset

Metab: weight gain

Neuro: confusion, drowsiness (rare), paradoxical excitation

Interactions ⬆ ⬇

Drug-drug:

The following interactions may occur, but are less likely to occur with loratadine than with more sedating antihistamines.
MAO inhibitors may intensify and prolong effects of antihistamines.
↑CNS depression may occur with other CNS depressants, including alcohol, antidepressants, opioid analgesics, and sedative/hypnotics.
Amiodarone may ↑ loratadine levels and ↑ risk of QTc interval prolongation

Drug-Natural Products:

Kava-kava, valerian, or chamomile can ↑ CNS depression.

Route/Dosage ⬆ ⬇

PO (Adults and Children ≥6 yr): 10 mg once daily.
PO (Children ≥2–5 yr): 5 mg once daily.

Renal Impairment

PO (Adults ): CCr <30 mL/min: 10 mg every other day.

Hepatic Impairment

PO (Adults ): 10 mg every other day.

Availability ⬆ ⬇

(Generic available)

Tablets: 10 mg^OTC
Capsules: 10 mg^OTC
Chewable tabletscool-mint-flavor, grape-flavor, bubblegum-flavor: 5 mg^OTC; 10 mg^OTC
Orally disintegrating tabletsmint: 5 mg^OTC; 10 mg^OTC
Oral solutiongrape-flavor, fruit-flavor: 5 mg/5 mL^OTC
In combination with: pseudoephedrine (Claritin-D)OTC. See Appendix [not included in this PDA edition].

Assessment ⬆ ⬇

Assess allergy symptoms (rhinitis, conjunctivitis, hives) before and periodically during therapy.
Assess lung sounds and character of bronchial secretions. Maintain fluid intake of 1500–2000 mL/day to decrease viscosity of secretions.

Lab Test Considerations:

May cause false-negative result on allergy skin testing.

Implementation ⬆ ⬇

PO: Administer once daily.
- For rapidly disintegrating tablets (Alavert, Claritin Reditabs): place on tongue. Tablet disintegrates rapidly. May be taken with or without water.

Patient/Family Teaching ⬆ ⬇

Instruct patient to take medication as directed.
May cause dizziness or drowsiness. Caution patient to avoid driving or other activities requiring alertness until response to medication is known.
Caution patient to use sunscreen and protective clothing to prevent photosensitivity reactions.
Advise patient to avoid taking alcohol or other CNS depressants concurrently with this drug.
Advise patient that good oral hygiene, frequent rinsing of mouth with water, and sugarless gum or candy may minimize dry mouth. Patient should notify dentist if dry mouth persists >2 wk.
Instruct patient to contact health care professional immediately if dizziness, fainting, or fast or irregular heartbeat occurs or if symptoms persist.
Rep: Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected, or if breastfeeding.

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Pronunciation ⬇

Classifications ⬆ ⬇