Non-Sedating Antihistamine

Aka: Non-Sedating Antihistamine, Second Generation Antihistamine, Loratadine, Claritin, Cetirizine, Zyrtec, Fexofenadine, Allegra

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II. Indications

  1. Allergic Rhinitis

III. Pathophysiology

  1. Second Generation Antihistamine

IV. Preparations: Advantages and Disadvantages

  1. Fexofenadine (Allegra)
    1. Least sedating, even in higher doses
  2. Loratadine (Claritin)
    1. Sedating at higher doses
    2. Less potent than Allegra and Zyrtec
  3. Cetirizine (Zyrtec) and Levocetirizine (Xyzal)
    1. May be sedating even at normally recommended doses (Hydroxyzine analog); reported by 10% of patients
    2. More rapid onset than other Non-Sedating Antihistamines (1 hour instead of 3 hours)
      1. Only significant if Antihistamine is taken as needed (instead of daily)

V. Preparations: Oral by Age Restrictions

  1. Age 6 months and older
    1. Cetirizine (Zyrtec, Pregnancy category B)
    2. Desloratadine (Clarinex, Pregnancy category C)
    3. Fexofenadine (Allegra, Pregnancy category C)
  2. Age 2 years and older
    1. Loratadine (Claritin, Pregnancy category B)
  3. Age 12 years and older
    1. Levocetirizine (Xyzal, Pregnancy category B)

VI. Preparations: Oral

  1. Fexofenadine (Allegra, OTC, Tabs 30-60-180 mg, Dissolving 30 mg, Suspension 30 mg/5ml)
    1. Adult Dose (ages 12 and over): 60 mg orally twice daily or 180 mg orally daily
    2. Child Dose (ages 6-11 years): 30 mg orally twice daily
    3. Low sedation and highly effective
  2. Loratadine (Claritin, OTC, tabs 10 mg, Dissolving 5-10 mg, Syrup 1mg/ml)
    1. Adult Dose (ages 6 and over): 10 mg orally daily
    2. Child Dose (ages 2-5 years): 5 mg orally daily
  3. Cetirizine (Zyrtec, OTC, Tabs or Chewables 5-10 mg, Syrup 5 mg/5 ml)
    1. Adult Dose (includes ages 6-11): 5 or 10 mg orally daily
    2. Child Dose (ages 2-5 years): 2.5 mg orally daily to twice daily
    3. Infant Dose (ages 6 months to 2 years): 2.5 mg orally daily
  4. Levocetirizine (Xyzal, OTC, Scored Tabs 5 mg, solution 2.5 mg/5ml)
    1. Active isomer of Cetirizine (Zyrtec)
    2. Adult Dose (ages 12 and over): 5 mg orally daily
    3. Child Dose (ages 6-11 years): 2.5 mg orally daily
  5. Desloratadine (Clarinex, prescription only, tabs 5 mg, Dissolving 2.5-5 mg, Syrup 0.5 mg/ml)
    1. Adult Dose (ages 12 and over): 5 orally daily
    2. Child Dose (ages 6-11 years): 2.5 mg orally daily to twice daily
    3. Preschool Dose (ages 12 months to 5 years): 1.25 mg orally daily
    4. Infant Dose (ages 6-12 months): 1 mg orally daily

VII. Preparations: Nasal

  1. Azelastine (Astelin) 1-2 sprays per nostril twice daily (ages 5 and over)
  2. Olopatadine (Patanol) 2 sprays per nostril twice daily (ages 12 and over)

VIII. Safety: Pregnancy and Lactation

  1. Contraindicated in Lactation
  2. Pregnancy Class B agents (other agents are Category C)
    1. Cetirizine (Zyrtec)
    2. Loratadine (Claritin)
    3. Levocetirizine (Xyzal)
  3. Pregnancy Class C agents
    1. Fexofenadine (Allegra)
      1. Appears as safe in pregnancy as other Non-Sedating Antihistamines that are category B (Cetirizine, Loratadine)
      2. Andersson (2020) JAMA Pediatr 174(8): e201316 [PubMed]

IX. Drug Interactions

  1. Historical Only: Astemizole (Hismanal) and Terfenadine (Seldane)
    1. Prolong QT Interval
    2. Contraindicated with Erythromycin, Ketoconazole
    3. Resulted in fatal Arrhythmias in multiple cases
  2. Fexofenadine
    1. Absorption decreased by orange juice, Grapefruit juice, apple juice (separate by at least 4 hours)

X. References

  1. Howarth (1999) J Allergy Clin Immunol 104:927 [PubMed]
  2. Walsh (2001) Drugs 61:207 [PubMed]
  3. (2001) Med Lett Drugs Ther 43(1103):35

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Related Studies

Cost: Medications

loratadine (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
LORATADINE 10 MG ODT Generic OTC $0.36 each
LORATADINE 10 MG TABLET Generic OTC $0.06 each
LORATADINE 5 MG/5 ML SOLUTION Generic OTC $0.04 per ml
LORATADINE 5 MG/5 ML SYRUP Generic OTC $0.04 per ml
LORATADINE ALLERGY 5 MG/5 ML Generic OTC $0.04 per ml
LORATADINE-D 12 HOUR TABLET Generic OTC $0.76 each
LORATADINE-D 24HR TABLET Generic OTC $0.57 each
cetirizine (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
CETIRIZINE HCL 1 MG/ML SOLN Generic $0.02 per ml
CETIRIZINE HCL 1 MG/ML SYRUP Generic $0.02 per ml
CETIRIZINE HCL 10 MG CHEW TAB Generic OTC $1.79 each
CETIRIZINE HCL 10 MG TABLET Generic OTC $0.07 each
CETIRIZINE HCL 5 MG CHEW TAB Generic OTC $1.93 each
CETIRIZINE HCL 5 MG TABLET Generic OTC $0.05 each
CETIRIZINE-PSE ER 5-120 MG TAB Generic OTC $0.62 each
fexofenadine (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
FEXOFENADINE HCL 180 MG TABLET Generic OTC $0.26 each
FEXOFENADINE HCL 60 MG TABLET Generic OTC $0.17 each
FEXOFENADINE-PSE ER 60-120 TAB Generic OTC $0.51 each
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information. GoodRx is another tool for finding lower drug prices.

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