Allergic rhinitis or conjunctivitis: Oral: 10 mg once daily or 5 mg twice daily.
OTC labeling (patient-guided therapy for symptoms of hay fever or other upper respiratory allergies): Oral: 10 mg once daily or 5 mg twice daily; maximum dose: 10 mg/day.
Urticaria, new onset and chronic spontaneous:
New onset: Oral: Initial: 10 mg once daily. If symptom control is inadequate, may immediately increase to 10 mg twice daily (Asero 2021).
Chronic spontaneous: Oral: Initial: 10 mg once daily. If symptom control is inadequate after 1 to 4 weeks, may increase to 10 mg twice daily. Although current guidelines state that antihistamine doses may be increased up to 4 times the standard dose (eg, to 20 mg twice daily), there is limited evidence for greater efficacy with this dose of loratadine, and other antihistamines are preferred. Periodically reevaluate necessity for continued treatment (EAACI [Zuberbier 2018]; Khan 2021).
The renal dosing recommendations are based upon the best available evidence and clinical expertise. Senior Editorial Team: Bruce Mueller, PharmD, FCCP, FASN, FNKF; Jason Roberts, PhD, BPharm (Hons), B App Sc, FSHP, FISAC; Michael Heung, MD, MS.
Note: Renally adjusted dose recommendations are based on a usual dose of 10 mg/day.
Altered kidney function:
Oral:
CrCl ≥30 mL/minute: No dosage adjustment necessary (Matzke 1990; manufacturer's labeling).
CrCl <30 mL/minute: 10 mg every 48 hours (Matzke 1990; expert opinion; manufacturer's labeling).
Hemodialysis, intermittent (thrice weekly): Not dialyzable (Matzke 1990): Oral: 10 mg every 48 hours (Matzke 1990; expert opinion).
Peritoneal dialysis: Unlikely to be significantly dialyzable (large Vd, highly protein bound): Oral: 10 mg every 48 hours (expert opinion).
CRRT:
Note: Drug clearance is dependent on the effluent flow rate, filter type, and method of renal replacement. Recommendations are based on high-flux dialyzers and effluent flow rates of 20 to 25 mL/kg/hour (or ~1,500 to 3,000 mL/hour) unless otherwise noted.
Oral: 10 mg every 48 hours (expert opinion).
PIRRT (eg, sustained, low-efficiency diafiltration):
Note: Drug clearance is dependent on the effluent flow rate, filter type, and method of renal replacement.
Oral: 10 mg every 48 hours (expert opinion).
No dosage adjustment provided in manufacturer’s labeling; however, hepatic impairment increases systemic exposure to loratadine.
(For additional information see "Loratadine: Pediatric drug information")
Allergic symptoms/hay fever:
General dosing:
Children ≥2 to <6 years: Oral: 5 mg once daily.
Children ≥6 years and Adolescents: 5 mg twice daily or 10 mg once daily.
Product-specific dosing:
Children ≥2 to <6 years: Oral: Oral liquid or chewable tablet: 5 mg once daily.
Children ≥6 years and Adolescents: Oral:
Oral liquid, capsule, tablet, or chewable tablet: 10 mg once daily.
Dispersible tablet: 5 mg twice daily or 10 mg once daily.
Urticaria, chronic spontaneous (idiopathic): Limited data available (Kliegman 2020; Pozzo-Magaña 2017): Note: Considered first-line therapy for management of chronic urticaria; if response inadequate after 2 to 4 weeks of therapy or symptoms intolerable, consider increasing the dose of loratadine (as age and weight permits) as second-line treatment rather than changing therapy (Zuberbier 2018).
Children ≥2 to <6 years: Oral: 5 mg once daily.
Children ≥6 years and Adolescents: Oral: 10 mg once daily.
There are no dosage adjustments provided in manufacturer's labeling, however, the following recommendations have been recommended (Aronoff 2007):
Children ≥2 years and Adolescents: No dosage adjustment necessary for any degree of renal impairment.
There are no dosage adjustments provided in manufacturer's labeling.
Refer to adult dosing.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Capsule, Oral:
Claritin: 10 mg [contains fd&c blue #1 (brilliant blue)]
GoodSense Allergy Relief: 10 mg [contains fd&c blue #1 (brilliant blue)]
Generic: 10 mg
Solution, Oral:
Childrens Loratadine: 5 mg/5 mL (120 mL) [alcohol free, dye free, sugar free; contains propylene glycol, sodium benzoate; grape flavor]
Loratadine Childrens: 5 mg/5 mL (120 mL [DSC]) [alcohol free, dye free, sugar free; contains polyethylene glycol (macrogol), propylene glycol, sodium benzoate]
Syrup, Oral:
Childrens Loratadine: 5 mg/5 mL (120 mL) [fruit flavor]
Childrens Loratadine: 5 mg/5 mL (120 mL) [alcohol free, dye free; contains propylene glycol, sodium benzoate, sodium metabisulfite; grape flavor]
Claritin Allergy Childrens: 5 mg/5 mL (240 mL) [alcohol free, dye free, sugar free; contains edetate (edta) disodium, propylene glycol, sodium benzoate, sorbitol]
Loratadine Childrens: 5 mg/5 mL (120 mL) [alcohol free, dye free, gluten free, sugar free; contains edetate (edta) disodium, propylene glycol, sodium benzoate; grape flavor]
Loratadine Childrens: 5 mg/5 mL (120 mL, 240 mL) [alcohol free, dye free, sugar free; contains edetate (edta) disodium dihydrate, propylene glycol, sodium benzoate; grape flavor]
Loratadine Childrens: 5 mg/5 mL (10 mL [DSC]) [alcohol free, dye free, sugar free; contains propylene glycol, sodium benzoate; grape flavor]
Loratadine Childrens: 5 mg/5 mL (120 mL) [sugar free; contains polyethylene glycol (macrogol), propylene glycol, sodium benzoate, sodium metabisulfite; grape flavor]
Generic: 5 mg/5 mL (120 mL)
Tablet, Oral:
Allergy: 10 mg [DSC]
Allergy Non-Drowsy: 10 mg [DSC]
Allergy Relief: 10 mg
Allergy Relief: 10 mg [contains corn starch]
Allergy Relief: 10 mg [gluten free]
Allergy Relief (Loratadine): 10 mg
Allergy Relief (Loratadine): 10 mg [contains corn starch]
Allergy Relief Loratadine: 10 mg [DSC]
Claritin: 10 mg
Loradamed: 10 mg
Generic: 10 mg
Tablet Chewable, Oral:
Claritin: 5 mg [contains aspartame, fd&c blue #2 (indigo carm) aluminum lake; grape flavor]
Claritin Childrens: 5 mg [contains aspartame, carmine; bubble-gum flavor]
Loratadine Childrens: 5 mg [contains aspartame; bubble-gum flavor]
Loratadine Childrens: 5 mg [dye free; contains aspartame; bubble-gum flavor]
Tablet Disintegrating, Oral:
Alavert: 10 mg [contains aspartame]
Alavert: 10 mg [DSC] [contains aspartame; citrus flavor]
Claritin Reditabs: 5 mg, 10 mg
Triaminic Allerchews: 10 mg
Generic: 10 mg
Yes
May be administered without regard to meals.
Dispersible tablet: Place in mouth and allow to dissolve. Swallow with or without water.
Oral: Administer without regard to meals.
Rapidly disintegrating tablet: Place rapidly disintegrating tablet on the tongue; tablet disintegration occurs rapidly; may administer with or without water.
Allergic rhinitis or conjunctivitis: Relief of nasal and non-nasal symptoms of seasonal allergies.
OTC labeling: Patient-guided therapy for symptoms of hay fever or other upper respiratory allergies.
Urticaria, new onset and chronic spontaneous: Treatment of itching due to hives (urticaria).
Claritin may be confused with Clarispray, clarithromycin
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Adverse reactions reported in adults and pediatric patients unless otherwise indicated.
>10%: Nervous system: Headache (adolescents and adults: 12%)
1% to 10%:
Cardiovascular: Chest pain (<2%), flushing (<2%), hypertension (<2%), hypotension (<2%), palpitations (<2%), supraventricular tachycardia (<2%), syncope (<2%), tachycardia (<2%)
Dermatologic: Dermatitis (<2%), diaphoresis (<2%), dry hair (<2%), pruritus (<2%), skin photosensitivity (<2%), skin rash (children: 2% to 3%), xeroderma (<2%)
Endocrine & metabolic: Decreased libido (<2%), heavy menstrual bleeding (<2%), increased thirst (<2%), weight gain (<2%)
Gastrointestinal: Abdominal pain (children: 2%), altered salivation (<2%), anorexia (<2%), constipation (<2%), diarrhea (children: 2% to 3%), dysgeusia (<2%), dyspepsia (<2%), flatulence (<2%), gastritis (<2%), hiccups (<2%), increased appetite (<2%), loose stools (<2%), nausea (<2%), stomatitis (children: 2% to 3%), vomiting (<2%), xerostomia (adolescents and adults: 3%)
Genitourinary: Altered micturition (<2%), dysmenorrhea (<2%), impotence (<2%), mastalgia (<2%), urinary incontinence (<2%), urinary retention (<2%), urine discoloration (<2%), vaginitis (<2%)
Hematologic & oncologic: Purpuric disease (<2%)
Hypersensitivity: Angioedema (<2%)
Infection: Viral infection (children: 2% to 3%)
Nervous system: Agitation (<2%), amnesia (<2%), anxiety (<2%), confusion (<2%), depression (<2%), dizziness (<2%), drowsiness (adolescents and adults: 8%), fatigue (2% to 4%), hypertonia (<2%), hypoesthesia (<2%), insomnia (<2%), irritability (<2%), lack of concentration (<2%), malaise (children: 2%), migraine (<2%), nervousness (children: 4%), nightmares (<2%), paresthesia (<2%), rigors (<2%), vertigo (<2%), voice disorder (children: 2%)
Neuromuscular & skeletal: Arthralgia (<2%), asthenia (<2%), back pain (<2%), hyperkinetic muscle activity (children: 3%), lower limb cramp (<2%), myalgia (<2%), tremor (<2%)
Ophthalmic: Blepharospasm (<2%), blurred vision (<2%), conjunctivitis (children: 2%), eye pain (<2%)
Otic: Otalgia (children: 2% to 3%), tinnitus (<2%)
Respiratory: Bronchitis (<2%), bronchospasm (<2%), cough (<2%), dry nose (<2%), dyspnea (<2%), epistaxis (children: 2% to 3%), flu-like symptoms (children: 2% to 3%), hemoptysis (<2%), laryngitis (<2%), pharyngitis (children: 2% to 3%), upper respiratory tract infection (children: 2%), wheezing (children: 4%)
Miscellaneous: Fever (<2%)
Postmarketing:
Cardiovascular: Peripheral edema
Dermatologic: Alopecia, erythema multiforme
Genitourinary: Breast hypertrophy
Hematologic & oncologic: Thrombocytopenia
Hepatic: Abnormal liver function, hepatic necrosis, hepatitis, jaundice
Hypersensitivity: Anaphylaxis
Nervous system: Seizure
Hypersensitivity to loratadine or any component of the formulation
Disease-related concerns:
• Hepatic impairment: Hepatic impairment increases systemic exposure. Use with caution.
• Renal impairment: Use with caution in patients with renal impairment.
Concurrent drug therapy issues:
• Sedatives: Effects may be potentiated when used with other sedative drugs or ethanol.
Dosage form specific issues:
• Benzyl alcohol and derivatives: Some dosage forms may contain sodium benzoate/benzoic acid; benzoic acid (benzoate) is a metabolite of benzyl alcohol; large amounts of benzyl alcohol (≥99 mg/kg/day) have been associated with a potentially fatal toxicity (“gasping syndrome”) in neonates; the “gasping syndrome” consists of metabolic acidosis, respiratory distress, gasping respirations, CNS dysfunction (including convulsions, intracranial hemorrhage), hypotension, and cardiovascular collapse (AAP ["Inactive" 1997]; CDC, 1982); some data suggests that benzoate displaces bilirubin from protein binding sites (Ahlfors, 2001); avoid or use dosage forms containing benzyl alcohol derivative with caution in neonates. See manufacturer’s labeling.
• Phenylalanine: Some products may contain phenylalanine.
Safety and efficacy for the use of cough and cold products in pediatric patients <4 years of age is limited; the AAP warns against the use of these products for respiratory illnesses in young children. Serious adverse effects including death have been reported. Many of these products contain multiple active ingredients, increasing the risk of accidental overdose when used with other products. The FDA does not recommend OTC uses for these products in pediatric patients <2 years of age and recommends to use with caution in pediatric patients ≥2 years of age. Health care providers are reminded to ask caregivers about the use of OTC cough and cold products in order to avoid exposure to multiple medications containing the same ingredient (AAP 2018; CDC 2007; FDA 2017; FDA 2018).
Substrate of CYP2D6 (minor), CYP3A4 (minor), P-glycoprotein/ABCB1 (minor); Note: Assignment of Major/Minor substrate status based on clinically relevant drug interaction potential
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
Acetylcholinesterase Inhibitors: May diminish the therapeutic effect of Anticholinergic Agents. Anticholinergic Agents may diminish the therapeutic effect of Acetylcholinesterase Inhibitors. Risk C: Monitor therapy
Aclidinium: May enhance the anticholinergic effect of Anticholinergic Agents. Risk X: Avoid combination
Alcohol (Ethyl): CNS Depressants may enhance the CNS depressant effect of Alcohol (Ethyl). Risk C: Monitor therapy
Alizapride: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy
Amantadine: May enhance the anticholinergic effect of Anticholinergic Agents. Risk C: Monitor therapy
Amezinium: Antihistamines may enhance the stimulatory effect of Amezinium. Risk C: Monitor therapy
Amiodarone: May increase the serum concentration of Loratadine. Management: Due to reported QT interval prolongation and Torsades de Pointes with this combination, consider an alternative to loratadine when possible. If concomitant use cannot be avoided, monitor QT interval and for signs of dyshythmias (eg, syncope). Risk D: Consider therapy modification
Anticholinergic Agents: May enhance the adverse/toxic effect of other Anticholinergic Agents. Risk C: Monitor therapy
Azelastine (Nasal): May enhance the CNS depressant effect of CNS Depressants. Risk X: Avoid combination
Benzylpenicilloyl Polylysine: Antihistamines may diminish the diagnostic effect of Benzylpenicilloyl Polylysine. Management: Suspend systemic H1 antagonists for benzylpenicilloyl-polylysine skin testing and delay testing until systemic antihistaminic effects have dissipated. A histamine skin test may be used to assess persistent antihistaminic effects. Risk D: Consider therapy modification
Betahistine: May diminish the therapeutic effect of Antihistamines. Antihistamines may diminish the therapeutic effect of Betahistine. Risk C: Monitor therapy
Blonanserin: CNS Depressants may enhance the CNS depressant effect of Blonanserin. Management: Use caution if coadministering blonanserin and CNS depressants; dose reduction of the other CNS depressant may be required. Strong CNS depressants should not be coadministered with blonanserin. Risk D: Consider therapy modification
Botulinum Toxin-Containing Products: May enhance the anticholinergic effect of Anticholinergic Agents. Risk C: Monitor therapy
Brexanolone: CNS Depressants may enhance the CNS depressant effect of Brexanolone. Risk C: Monitor therapy
Brimonidine (Topical): May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy
Bromopride: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy
Bromperidol: May enhance the CNS depressant effect of CNS Depressants. Risk X: Avoid combination
Buprenorphine: CNS Depressants may enhance the CNS depressant effect of Buprenorphine. Management: Consider reduced doses of other CNS depressants, and avoiding such drugs in patients at high risk of buprenorphine overuse/self-injection. Initiate buprenorphine at lower doses in patients already receiving CNS depressants. Risk D: Consider therapy modification
Cannabinoid-Containing Products: Anticholinergic Agents may enhance the tachycardic effect of Cannabinoid-Containing Products. Risk C: Monitor therapy
Cannabinoid-Containing Products: CNS Depressants may enhance the CNS depressant effect of Cannabinoid-Containing Products. Risk C: Monitor therapy
Chloral Betaine: May enhance the adverse/toxic effect of Anticholinergic Agents. Risk C: Monitor therapy
Chlormethiazole: May enhance the CNS depressant effect of CNS Depressants. Management: Monitor closely for evidence of excessive CNS depression. The chlormethiazole labeling states that an appropriately reduced dose should be used if such a combination must be used. Risk D: Consider therapy modification
Chlorphenesin Carbamate: May enhance the adverse/toxic effect of CNS Depressants. Risk C: Monitor therapy
Cimetropium: Anticholinergic Agents may enhance the anticholinergic effect of Cimetropium. Risk X: Avoid combination
CloZAPine: Anticholinergic Agents may enhance the constipating effect of CloZAPine. Management: Consider alternatives to this combination whenever possible. If combined, monitor closely for signs and symptoms of gastrointestinal hypomotility and consider prophylactic laxative treatment. Risk D: Consider therapy modification
CNS Depressants: May enhance the adverse/toxic effect of other CNS Depressants. Risk C: Monitor therapy
Daridorexant: May enhance the CNS depressant effect of CNS Depressants. Management: Dose reduction of daridorexant and/or any other CNS depressant may be necessary. Use of daridorexant with alcohol is not recommended, and the use of daridorexant with any other drug to treat insomnia is not recommended. Risk D: Consider therapy modification
DexmedeTOMIDine: CNS Depressants may enhance the CNS depressant effect of DexmedeTOMIDine. Management: Monitor for increased CNS depression during coadministration of dexmedetomidine and CNS depressants, and consider dose reductions of either agent to avoid excessive CNS depression. Risk D: Consider therapy modification
Difelikefalin: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy
Dimethindene (Topical): May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy
Doxylamine: May enhance the CNS depressant effect of CNS Depressants. Management: The manufacturer of Diclegis (doxylamine/pyridoxine), intended for use in pregnancy, specifically states that use with other CNS depressants is not recommended. Risk C: Monitor therapy
Droperidol: May enhance the CNS depressant effect of CNS Depressants. Management: Consider dose reductions of droperidol or of other CNS agents (eg, opioids, barbiturates) with concomitant use. Risk D: Consider therapy modification
Eluxadoline: Anticholinergic Agents may enhance the constipating effect of Eluxadoline. Risk X: Avoid combination
Esketamine: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy
Flunarizine: CNS Depressants may enhance the CNS depressant effect of Flunarizine. Risk X: Avoid combination
Flunitrazepam: CNS Depressants may enhance the CNS depressant effect of Flunitrazepam. Management: Reduce the dose of CNS depressants when combined with flunitrazepam and monitor patients for evidence of CNS depression (eg, sedation, respiratory depression). Use non-CNS depressant alternatives when available. Risk D: Consider therapy modification
Gastrointestinal Agents (Prokinetic): Anticholinergic Agents may diminish the therapeutic effect of Gastrointestinal Agents (Prokinetic). Risk C: Monitor therapy
Glucagon: Anticholinergic Agents may enhance the adverse/toxic effect of Glucagon. Specifically, the risk of gastrointestinal adverse effects may be increased. Risk C: Monitor therapy
Glycopyrrolate (Oral Inhalation): Anticholinergic Agents may enhance the anticholinergic effect of Glycopyrrolate (Oral Inhalation). Risk X: Avoid combination
Glycopyrronium (Topical): May enhance the anticholinergic effect of Anticholinergic Agents. Risk X: Avoid combination
Hyaluronidase: Antihistamines may diminish the therapeutic effect of Hyaluronidase. Risk C: Monitor therapy
HydrOXYzine: May enhance the CNS depressant effect of CNS Depressants. Management: Consider a decrease in the CNS depressant dose, as appropriate, when used together with hydroxyzine. Increase monitoring of signs/symptoms of CNS depression in any patient receiving hydroxyzine together with another CNS depressant. Risk D: Consider therapy modification
Ipratropium (Oral Inhalation): May enhance the anticholinergic effect of Anticholinergic Agents. Risk X: Avoid combination
Itopride: Anticholinergic Agents may diminish the therapeutic effect of Itopride. Risk C: Monitor therapy
Kava Kava: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy
Ketoconazole (Systemic): May increase the serum concentration of Loratadine. Risk C: Monitor therapy
Kratom: May enhance the CNS depressant effect of CNS Depressants. Risk X: Avoid combination
Lemborexant: May enhance the CNS depressant effect of CNS Depressants. Management: Dosage adjustments of lemborexant and of concomitant CNS depressants may be necessary when administered together because of potentially additive CNS depressant effects. Close monitoring for CNS depressant effects is necessary. Risk D: Consider therapy modification
Levosulpiride: Anticholinergic Agents may diminish the therapeutic effect of Levosulpiride. Risk X: Avoid combination
Lisuride: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy
Lofexidine: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy
Magnesium Sulfate: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy
Methotrimeprazine: CNS Depressants may enhance the CNS depressant effect of Methotrimeprazine. Methotrimeprazine may enhance the CNS depressant effect of CNS Depressants. Management: Reduce the usual dose of CNS depressants by 50% if starting methotrimeprazine until the dose of methotrimeprazine is stable. Monitor patient closely for evidence of CNS depression. Risk D: Consider therapy modification
Metoclopramide: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy
MetyroSINE: CNS Depressants may enhance the sedative effect of MetyroSINE. Risk C: Monitor therapy
Mianserin: May enhance the anticholinergic effect of Anticholinergic Agents. Risk C: Monitor therapy
Minocycline (Systemic): May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy
Mirabegron: Anticholinergic Agents may enhance the adverse/toxic effect of Mirabegron. Risk C: Monitor therapy
Nitroglycerin: Anticholinergic Agents may decrease the absorption of Nitroglycerin. Specifically, anticholinergic agents may decrease the dissolution of sublingual nitroglycerin tablets, possibly impairing or slowing nitroglycerin absorption. Risk C: Monitor therapy
Olopatadine (Nasal): May enhance the CNS depressant effect of CNS Depressants. Risk X: Avoid combination
Opioid Agonists: CNS Depressants may enhance the CNS depressant effect of Opioid Agonists. Management: Avoid concomitant use of opioid agonists and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. Risk D: Consider therapy modification
Orphenadrine: CNS Depressants may enhance the CNS depressant effect of Orphenadrine. Risk X: Avoid combination
Oxatomide: May enhance the anticholinergic effect of Anticholinergic Agents. Risk X: Avoid combination
Oxomemazine: May enhance the CNS depressant effect of CNS Depressants. Risk X: Avoid combination
Oxybate Salt Products: CNS Depressants may enhance the CNS depressant effect of Oxybate Salt Products. Management: Consider alternatives to this combination when possible. If combined, dose reduction or discontinuation of one or more CNS depressants (including the oxybate salt product) should be considered. Interrupt oxybate salt treatment during short-term opioid use Risk D: Consider therapy modification
OxyCODONE: CNS Depressants may enhance the CNS depressant effect of OxyCODONE. Management: Avoid concomitant use of oxycodone and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. Risk D: Consider therapy modification
Paraldehyde: CNS Depressants may enhance the CNS depressant effect of Paraldehyde. Risk X: Avoid combination
Perampanel: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy
Piribedil: CNS Depressants may enhance the CNS depressant effect of Piribedil. Risk C: Monitor therapy
Pitolisant: Antihistamines may diminish the therapeutic effect of Pitolisant. Risk X: Avoid combination
Potassium Chloride: Anticholinergic Agents may enhance the ulcerogenic effect of Potassium Chloride. Management: Patients on drugs with substantial anticholinergic effects should avoid using any solid oral dosage form of potassium chloride. Risk X: Avoid combination
Potassium Citrate: Anticholinergic Agents may enhance the ulcerogenic effect of Potassium Citrate. Risk X: Avoid combination
Pramipexole: CNS Depressants may enhance the sedative effect of Pramipexole. Risk C: Monitor therapy
Pramlintide: May enhance the anticholinergic effect of Anticholinergic Agents. These effects are specific to the GI tract. Risk X: Avoid combination
Procarbazine: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy
Ramosetron: Anticholinergic Agents may enhance the constipating effect of Ramosetron. Risk C: Monitor therapy
Revefenacin: Anticholinergic Agents may enhance the anticholinergic effect of Revefenacin. Risk X: Avoid combination
Ropeginterferon Alfa-2b: CNS Depressants may enhance the adverse/toxic effect of Ropeginterferon Alfa-2b. Specifically, the risk of neuropsychiatric adverse effects may be increased. Management: Avoid coadministration of ropeginterferon alfa-2b and other CNS depressants. If this combination cannot be avoided, monitor patients for neuropsychiatric adverse effects (eg, depression, suicidal ideation, aggression, mania). Risk D: Consider therapy modification
ROPINIRole: CNS Depressants may enhance the sedative effect of ROPINIRole. Risk C: Monitor therapy
Rotigotine: CNS Depressants may enhance the sedative effect of Rotigotine. Risk C: Monitor therapy
Rufinamide: May enhance the adverse/toxic effect of CNS Depressants. Specifically, sleepiness and dizziness may be enhanced. Risk C: Monitor therapy
Secretin: Anticholinergic Agents may diminish the therapeutic effect of Secretin. Management: Avoid concomitant use of anticholinergic agents and secretin. Discontinue anticholinergic agents at least 5 half-lives prior to administration of secretin. Risk D: Consider therapy modification
Suvorexant: CNS Depressants may enhance the CNS depressant effect of Suvorexant. Management: Dose reduction of suvorexant and/or any other CNS depressant may be necessary. Use of suvorexant with alcohol is not recommended, and the use of suvorexant with any other drug to treat insomnia is not recommended. Risk D: Consider therapy modification
Thalidomide: CNS Depressants may enhance the CNS depressant effect of Thalidomide. Risk X: Avoid combination
Thiazide and Thiazide-Like Diuretics: Anticholinergic Agents may increase the serum concentration of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor therapy
Tiotropium: Anticholinergic Agents may enhance the anticholinergic effect of Tiotropium. Risk X: Avoid combination
Topiramate: Anticholinergic Agents may enhance the adverse/toxic effect of Topiramate. Risk C: Monitor therapy
Trimeprazine: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy
Umeclidinium: May enhance the anticholinergic effect of Anticholinergic Agents. Risk X: Avoid combination
Valerian: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy
Zolpidem: CNS Depressants may enhance the CNS depressant effect of Zolpidem. Management: Reduce the Intermezzo brand sublingual zolpidem adult dose to 1.75 mg for men who are also receiving other CNS depressants. No such dose change is recommended for women. Avoid use with other CNS depressants at bedtime; avoid use with alcohol. Risk D: Consider therapy modification
Food increases bioavailability and delays peak. Management: Administer without regard to meals.
Guidelines for the use of antihistamines in the treatment of allergic rhinitis or urticaria in pregnancy are generally the same as in nonpregnant females. Loratadine may be used when a second generation antihistamine is needed. The lowest effective dose should be used (BSACI [Powell 2015]; BSACI [Scadding 2017]; Zuberbier 2018).
Loratadine and its active metabolite, desloratadine, are present in breast milk.
The relative infant dose (RID) of loratadine plus desloratadine has been calculated to be 1.1% when compared to a maternal dose of 40 mg/day of loratadine (Hilbert 1988).
In general, breastfeeding is considered acceptable when the RID is <10% (Anderson 2016; Ito 2000).
The RID was calculated by the authors of a study following maternal administration of a single oral dose of loratadine 40 mg to six breastfeeding women between 1 and 12 months' postpartum. The estimated daily infant dose of loratadine equivalents via breast milk was calculated to be 29.1 mcg/day in a theoretical 4 kg infant. The half-life of loratadine in breast milk was reported to be 10.7 hours in one woman (Hilbert 1988).
Drowsiness and irritability have been reported in breastfed infants exposed to antihistamines (Ito 1993). In general, second generation antihistamines (eg, loratadine) are less sedating as compared to their first generation counterparts. If a breastfed infant is exposed to a second generation antihistamine via breast milk, they should be monitored for irritability, jitteriness, or drowsiness (Butler 2014).
When treatment with an antihistamine is needed for the treatment of rhinitis and urticaria in breastfeeding women, a second generation antihistamine, such as loratadine, is preferred (BSACI [Powell 2015]; BSACI [Scadding 2017]; Butler 2014; Zuberbier 2018).
Antihistamines may decrease maternal serum prolactin concentrations when administered prior to the establishment of lactation (Messinis 1985).
May be taken without regard to meals. Some products may contain phenylalanine and/or sodium.
Long-acting tricyclic antihistamine with selective peripheral histamine H1-receptor antagonistic properties
Note: The pharmacokinetic profile of children 2 to 12 years is similar to that of adults (Claritin prescribing information 2000)
Onset of action: 1-3 hours (Claritin prescribing information 2000)
Peak effect: 8-12 hours (Claritin prescribing information 2000)
Duration: >24 hours (Claritin prescribing information 2000)
Absorption: Rapid; food increases total bioavailability (AUC) by 40% to 48% (Claritin prescribing information 2000)
Distribution: Vd: 119 L/kg (Haria 1994); binds preferentially to peripheral nervous system H1 receptors; no appreciable entry into CNS (Claritin prescribing information 2000)
Protein binding: 97% to 99% (loratadine), 73% to 76% (metabolite) (Haria 1994)
Metabolism: Extensively hepatic via CYP2D6 and 3A4 to active metabolite (descarboethoxyloratadine) (Claritin prescribing information 2000)
Half-life elimination: 8.4 hours (range: 3 to 20 hours) (loratadine), 28 hours (range: 8.8 to 92 hours) (metabolite) (Claritin prescribing information 2000); hepatic impairment: 24 hours (loratadine), 37 hours (metabolite) (Claritin prescribing information 2000)
Time to peak, serum: Loratadine: 1.3 hours (loratadine), 2.3 hours (metabolite) (Claritin prescribing information 2000)
Excretion: Urine (40%) and feces (40%) as metabolites
Altered kidney function: With CrCl <30 mL/minute, AUC and Cmax are increased approximately 73% for loratadine and 120% for its metabolite.
Hepatic function impairment: AUC and Cmax doubled for loratadine
Older adult: AUC and Cmax are increased approximately 50%, and t½ ranged from 6.7 to 37 hours
Capsules (Claritin Oral)
10 mg (per each): $1.10
Capsules (Loratadine Oral)
10 mg (per each): $1.76
Chewable (Claritin Childrens Oral)
5 mg (per each): $0.80
Chewable (Claritin Oral)
5 mg (per each): $1.08
Syrup (Claritin Allergy Childrens Oral)
5 mg/5 mL (per mL): $0.07
Syrup (Loratadine Oral)
5 mg/5 mL (per mL): $0.05 - $0.07
Tablet, orally-disintegrating (Claritin Reditabs Oral)
5 mg (per each): $0.92
10 mg (per each): $1.06
Tablet, orally-disintegrating (Loratadine Oral)
10 mg (per each): $1.82
Tablet, orally-disintegrating (Triaminic Allerchews Oral)
10 mg (per each): $0.64
Tablets (Claritin Oral)
10 mg (per each): $0.75
Tablets (Loratadine Oral)
10 mg (per each): $0.04 - $0.86
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
