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Drugs, Supplies and Delivery

Desloratadine

Desloratadine is a safe, non-sedating antihistamine for allergic rhinitis and urticaria, with minimal drug interactions. Its once-daily dosing and tolerability make it ideal for long-term use. Adherence to BNF guidelines ensures efficacy, particularly in pediatric and sensitive populations

Desloratadine is a second-generation antihistamine and the primary active metabolite of loratadine. It selectively antagonizes peripheral H₁ histamine receptors, blocking histamine-induced allergic responses. Key features include:

  1. Peripheral Selectivity: Minimal penetration of the blood-brain barrier, reducing sedation (Lippincott).
  2. Anti-inflammatory Effects: Inhibits histamine-mediated vasodilation, bronchoconstriction, and pruritus.
  3. Long Duration: Provides 24-hour relief with once-daily dosing due to prolonged receptor binding.

Desloratadine is approved for:

  1. Allergic Rhinitis:
    • Seasonal (hay fever) and perennial allergic rhinitis (≥12 years).
  2. Chronic Idiopathic Urticaria:
    • Reduces itching and hives (≥1 year).
  3. Off-Label Uses:
    • Allergic conjunctivitis (adjunct therapy).

Adults and Adolescents (≥12 years):

  • Oral: 5 mg once daily.

Children:

  • 6–11 years: 2.5 mg once daily (syrup or tablet).
  • 1–5 years: 1.25 mg once daily (syrup).

Special Populations:

  • Renal/Hepatic Impairment: No dose adjustment required (BNF).
  • Elderly: No specific recommendations; standard dosing applies.

Administration Tips:

  • Take with or without food.
  • Avoid grapefruit juice (theoretical interaction via CYP3A4 inhibition).
  • Common (≥1%): Headache, dry mouth, fatigue.
  • Rare (<1%):
    • Dizziness, nausea, diarrhea.
    • Hypersensitivity reactions (angioedema, rash).
    • Tachycardia (isolated reports).
  1. Contraindications:
    • Hypersensitivity to desloratadine, loratadine, or components.
  2. Pregnancy/Lactation:
    • BNF Category: Use only if benefits outweigh risks (limited human data).
    • Excreted in breast milk; avoid during lactation.
  3. Hepatic/Renal Monitoring:
    • Safe in mild-to-moderate impairment; monitor in severe cases.

Desloratadine has low interaction potential due to minimal hepatic metabolism (primarily CYP3A4/2D6). Notable considerations:

  • CYP3A4 Inhibitors (e.g., ketoconazole, erythromycin): May increase desloratadine levels (monitor for side effects).
  • CNS Depressants: No significant additive sedation (Lange).
  • Alcohol: No interaction reported, but avoid excess.
  • Generic: Desloratadine.
  • Brand Names:
    • US: Clarinex®, Aerius®.
    • UK: Neoclarityn®.

Others: Azomyr® (Europe), Deslor® (India

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