ALLEGRY (Antihistamine)

ALLERGY 

Antihistamines

1. Azelastine (Astelin, Optivar) 
2. Cetirizine (Zyrtec, Zyrtec-D) 
3. Chlorpheniramine (Chlor-Trimeton)
4. Clemastine fumarate (Tavist)
5. Cyproheptadine (Periactin)
6. Desloratadine (Clarinex) 
7. Diphenhydramine (Benadryl)
8. Fexofenadine (Allegra, Allegra-D, generic)
9. Hydroxyzine (Atarax, Vistaril)
10. Levocetirizine (Xyzal)
11. Loratadine (Alavert, Claritin)
12. Cromolyn sodium (Intal, NasalCrom, Opticrom)
13. Montelukast (Singulair, generic)
14. Phenylephrine, oral (Sudafed, others [OTC]

*Acts:- Actions

*W/P: Warnings And Precautions:

*CI:- Contraindicated

*Disp:- Dispensed

*SE:- Side Effects

*OTC:- Over the counter 

*BOO:-  Bladder Outlet Obstruction

*MAO/MAOI: monoamine oxidase/ inhibitor 

*EtOH: ethanol

*BPH: benign prostatic hyperplasia

*ESRD: end-stage renal disease

Azelastine (Astelin, Optivar)

Uses: *Allergic rhinitis (rhinorrhea, sneezing, nasal pruritus), vasomotor rhinitis; allergic conjunctivitis* Acts: Histamine H1-receptor antagonist Dose: Adults & Peds > 12 y. Nasal: 1–2 sprays/ nostril bid Ophth: 1 gtt in each affected eye bid Peds 5–11 y. 1 spray/nostril 1× d Warnings And Precautions: [C, ?/−] Contraindicated: Component sensitivity Dispensed: Nasal 137 mcg/spray; ophthalmic soln 0.05% SE: Somnolence, bitter taste, HA, colds Sx (rhinitis, cough)

Cetirizine (Zyrtec, Zyrtec-D)

Uses: *Allergic rhinitis & other allergic Sxs including urticaria* Acts: Nonsedating antihistamine; Zyrtec D contains a decongestant Dose: Adults & Children > 6 y: 5–10 mg/d; Zyrtec D 5/120 mg PO bid whole Peds 6–11 mo. 2.5 mg daily. 12 mo–5 y: 2.5 mg daily-bid; ↓ to QD in renal/hepatic impair W/P: [C, ?/−] w/ HTN, BPH, rare CNS stimulation, DM, heart Dz CI: Allergy to cetirizine, hydroxyzine Disp: Tabs 5, 10 mg; chew tabs 5, 10 mg; syrup 5 mg/5 mL; Zyrtec D: Tabs 5/120 mg (cetirizine/pseudoephedrine) SE: HA, drowsiness, xerostomia Notes: Can cause sedation; swallow ER tabs whole

Chlorpheniramine (Chlor-Trimeton)

OTC meds w/ chlorpheniramine should not be used in peds < 2 y Uses: *Allergic rhinitis*, common cold Acts: Antihistamine Dose: Adults. 4 mg PO q4–6h or 8–12 mg PO bid of SR 24 mg/d max Peds. 0.35 mg/kg/24 h PO ÷ q4–6h or 0.2 mg/kg/24 h SR W/P: [C, ?/−] BOO; NAG; hepatic Insuff CI: Allergy Disp: Tabs 4 mg; SR tabs 12 mg SE: Anticholinergic SE & sedation common, postural ↓ BP, QT changes, extrapyramidal Rxns, photosensitivity Notes: Do not cut/crush/chew ER forms; deaths in pts < 2 y associated w/ cough and cold meds

Clemastine fumarate (Tavist)

[OTC]  Uses: *Allergic rhinitis & Sxs of urticaria*  Acts: Antihistamine  Dose: Adults & Peds > 12 y. 1.34 mg bid–2.68 mg tid; max 8.04 mg/d, 6–12 y: 0.67–1.34 mg bid (max 4.02/d), < 6 y: 0.335–0.67 mg/d ÷ into 2–3 doses (max 1.34 mg/d),  W/P: [B, M]  BOO; Do not take w/  MAOI CI: NAG Disp: Tabs 1.34, 2.68 mg; syrup 0.67 mg/5 mL  SE: Drowsiness, dyscoordination, epigastric distress, urinary retention  Notes: Avoid EtOH

Cyproheptadine (Periactin)

Uses *Allergic Rxns; itching*  Acts: Phenothiazine antihistamine; serotonin antagonist  Dose: Adults. 4–20 mg PO ÷ q8h; max 0.5 mg/kg/d. Peds 2–6 y. 2 mg bid-tid (max 12 mg/24 h). 7–14 y: 4 mg bid-tid; ↓ in hepatic impair  W/P: [B, ?] Elderly, CV Dz, asthma, thyroid Dz,  BPH CI: Neonates or < 2 y; NAG; BOO; acute asthma;  GI Obst; MAOI Disp: Tabs 4 mg; syrup 2 mg/5 mL  SE: Anticholinergic, drowsiness  Notes: May stimulate appetite

Desloratadine (Clarinex)

Uses: *Seasonal & perennial allergic rhinitis; chronic idiopathic urticaria*  Acts: Active metabolite of Claritin, H1-antihistamine blocks inflammatory mediators  Dose: Adults & Peds > 12 y. 5 mg PO daily; 5 mg PO q other day w/ hepatic/renal impair  W/P: [C, ?/−] RediTabs contain phenylalanine  Disp: Tabs 5 mg; RediTabs (rapid dissolving) 2.5, 5 mg, syrup 0.5 mg/mL  SE: Allergy, anaphylaxis, somnolence, HA, dizziness, fatigue, pharyngitis, xerostomia, N, dyspepsia, myalgia

Diphenhydramine (Benadryl)

[OTC]   Uses: *Rx & prevent allergic Rxns, motion sickness, potentiate narcotics, sedation, cough suppression, & Rx of extrapyramidal Rxns*  Acts: Antihistamine, antiemetic  Dose: Adults. 25–50 mg PO, IV, or IM tid-qid. Peds > 2 y. 5 mg/kg/24 h PO or IM ÷ q6h (max 300 mg/d); ↑ dosing interval w/ mod–severe renal Insuff  W/P: [B, −] Elderly, NAG, BPH, w/  MAOI CI: acute asthma Disp: Tabs & caps 25, 50 mg; chew tabs 12.5 mg; elixir 12.5 mg/ 5 mL; syrup 12.5 mg/5 mL; liq 12.5 mg/5 mL; Inj 50 mg/mL, cream, gel, liq 2%  SE: Anticholinergic (xerostomia, urinary retention, sedation)

Fexofenadine (Allegra, Allegra-D, generic)

Uses: *Allergic rhinitis; chronic idiopathic urticaria*  Acts: Selective antihistamine, antagonizes H1-receptors; Allegra-D contains w/ pseudoephedrine  Dose: Adults & Peds > 12 y. 60 mg PO bid or 180 mg/d; 12-h ER form bid, 24-h ER form QD. Peds 2–11 y. 30 mg PO bid; ↓ in renal impair  W/P: [C, +] w/ Nevirapine  CI: Component sensitivity  Disp: Tabs 30, 60, 180 mg; susp 6 mg/mL; Allegra-D 12-h ER tab (60 mg fexofenadine/120 mg pseudoephedrine), Allegra-D 24-h ER (180 mg fexofenadine/240 mg pseudoephedrine)  SE: Drowsiness (rare), HA, ischemic colitis

Hydroxyzine (Atarax, Vistaril, Generic)

Uses: *Anxiety, sedation, itching*  Acts: Antihistamine, antianxiety  Dose: Adults. Anxiety/sedation: 50–100 mg PO or IM qid or PRN (max 600 mg/d). Itching: 25–50 mg PO or IM tid-qid. Peds. 0.5–1.0 mg/kg/24 h PO or IM q6h; ↓ w/ hepatic impair  W/P: [C, +/−] ↑ Effects w/ CNS depressants, anticholinergics,  EtOH CI: Component sensitivity Disp: Tabs 10, 25, 50 mg; caps 25, 50 mg; syrup 10 mg/5 mL; susp 25 mg/5 mL; Inj 25, 50 mg/mL  SE: Drowsiness, anticholinergic effects Notes: Used to potentiate narcotic effects; not for IV/SQ (thrombosis & digital gangrene possible)

Levocetirizine (Xyzal)

Uses: *Perennial/seasonal allergic rhinitis, chronic urticaria*  Acts: Antihistamine  Dose: Adults. 5 mg QD Peds. 6 mo–5 y: 1.25 mg once daily 6–11 y 2.5 mg QD W/P: [B, ?/–] ↓ Adult dose w/ renal impair, CrCl 50–80 mL/min 2.5 mg daily, 30–50 mL/min 2.5 mg q other day, 10–30 mL/min 2.5 mg 2×/wk  CI: Peds 6–11 y, w/ renal impair, adults w/ ESRD  Disp: Tab 5 mg, soln 0.5 mL/mL (150 mL)  SE: CNS depression, drowsiness, fatigue, xerostomia  Notes: Take in an evening

Loratadine (Claritin, Alavert)

Uses: *Allergic rhinitis, chronic idiopathic urticaria*  Acts: Nonsedating antihistamine  Dose: Adults. 10 mg/d PO. Peds 2–5 y. 5 mg PO daily. > 6 y: Adult dose; on empty stomach; ↓ in hepatic Insuff; q other day dose w/ Cr Cl < 30 mL/min  W/P: [B, +/−]  CI: Component allergy  Disp: Tabs 10 mg (OTC); rapidly disintegrating RediTabs 10 mg; chew tabs 5 mg; syrup 1 mg/ mL  SE: HA, somnolence, xerostomia, hyperkinesis in peds

Cromolyn Sodium (NasalCrom, Opticrom, Others)

Uses: *Adjunct to the Rx of asthma; prevent exercise-induced asthma; allergic rhinitis; ophthal allergic manifestations*; food allergy, systemic mastocytosis, IBD Acts: Antiasthmatic; mast cell stabilizer Dose: Adults & Children > 12 y. Inh: 20 mg (as a powder in caps) inhaled qid PO: 200 mg qid 15–20 min ac, up to 400 mg qid. Nasal instillation: Spray once in each nostril 2–6×/d. Ophthal: 1–2 gtt in each eye 4–6 × d. Peds. Inh: 2 puffs qid of a metered-dose inhaler. PO: Infants < 2 y: (not OK) 20 mg/ kg/d in 4 ÷ doses. 2–12 y: 100 mg QID ac W/P: Renal/hepatic impair CI: Acute asthmatic attacks Disp: PO conc 100 mg/5 mL; soln for nebulizer 20 mg/2 mL; nasal soln 40 mg/mL; ophthal soln 4% SE: Unpleasant taste, hoarseness, coughing Notes: No benefit in acute Rx; 2–4 wk for maximal effect in perennial allergic disorders

Montelukast (Singulair, Generic)

Uses: *Prevent/chronic Rx asthma  ≥ 12 mo; seasonal allergic rhinitis ≥ 2 y; perennial allergic rhinitis ≥ 6 mo; prevent exercise-induced bronchoconstriction (EIB) ≥ 15 y; prophylaxis & Rx of chronic asthma, seasonal allergic rhinitis* Acts: Leukotriene receptor antagonist Dose: Asthma: Adults & Peds > 15 y. 10 mg/d PO in p.m. 6–23 mo: 4-mg pack granules QD. 2–5 y: 4 mg/d PO q p.m. 6–14 y: 5 mg/d PO q p.m. W/P: [B, M] CI: Component allergy Disp: Tabs 10 mg; chew tabs 4, 5 mg; granules 4 mg/pack SE: HA, dizziness, fatigue, rash, GI upset, Churg-Strauss syndrome, flu, cough, neuro-psych events (agitation, restlessness, suicidal ideation) Notes: Not for acute asthma; use w/in 15 min of opening package

Phenylephrine, Oral (Sudafed, Others [OTC])

BOX: Not for use in peds < 2 y Uses: *Nasal congestion*  Acts: α-Adrenergic agonist Dose: Adults. 10–20 mg PO q4h PRN, max 60 mg/d. Peds. 4–5 y: 2.5 mg q4h max 6 doses/d; > 6–12: 5 mg q4h, max 30 mg/d ≥ 12: adult dosing W/P: [C, +/−] HTN, acute pancreatitis, hep, coronary Dz, NAG, hyperthyroidism CI: MAOI w/in 14 d, NAG, severe ↑ BP or CAD, urinary retention Disp: Liq 7.5 mg/5 mL; drops: 1.25/0.8 mL, 2.5 mg/5 mL; tabs 5, 10 mg; chew tabs 10 mg; tabs once daily 10 mg; strips: 1.25, 2.5, 10 mg; many combo OTC products SE: Arrhythmias, HTN, HA,