levocetirizine


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levocetirizine


levocetirizine dihydrochloride

Xyzal

Pharmacologic class: Histamine1 (H1)-receptor antagonist

Therapeutic class: Antihistamine

Pregnancy risk category B

Action

Exerts principal antihistaminic effects via selective inhibition of H1 receptors

Availability

Oral solution: 2.5 mg/5 ml (0.5 mg/ml)

Tablets: 5 mg

Indications and dosages

Symptoms of allergic rhinitis (seasonal and perennial); uncomplicated skin manifestations of chronic idiopathic urticaria

Adults and children ages 12 and older: 5 mg P.O. daily in evening

Children ages 6 to 11: 2.5 mg P.O. daily in evening; don't exceed recommended dosage.

Dosage adjustment

• Renal impairment.

• Hepatic impairment

Contraindications

• Hypersensitivity to drug, its components, or cetirizine

• End-stage renal disease

• Hemodialysis

• Renal impairment (children ages 6 to 11)

Precautions

Use cautiously in:

• renal impairment

• pregnant patients

• elderly patients

• breastfeeding patients (use not recommended)

• children younger than age 6 (safety and efficacy not established).

Administration

• Give with or without food.

Adverse reactions

CNS: somnolence, fatigue, asthenia

EENT: epistaxis (children), nasopharyngitis, pharyngitis

GI: dry mouth

Respiratory: cough (children)

Other: pyrexia (children)

Interactions

Drug-drug. Ritonavir: increased levocetirizine blood level and half-life, decreased clearance

Drug-behaviors. Alcohol use: increased risk of impaired CNS function

Patient monitoring

• Stay alert for excessive CNS depression.

• Closely monitor renal function tests in patients with renal impairment.

Patient teaching

• Tell patient drug can be taken with or without food.

• Instruct patient to avoid alcohol and other depressants, such as sleeping pills, unless prescriber approves.

• Caution patient to avoid hazardous activities until drug's effects on concentration and alertness are known.

• Advise female patient to notify prescriber if she is pregnant or intends to become pregnant.

• Tell breastfeeding patient to discontinue breastfeeding during therapy.

• As appropriate, review all other significant adverse reactions and interactions, especially those related to the drugs and behaviors mentioned above.

levocetirizine

(lee-vo-se-teer-i-zeen) ,

Xyzal

(trade name)

Classification

Therapeutic: antihistamines
Pharmacologic: piperazines
Pregnancy Category: B

Indications

Management of seasonal/perennial allergic rhinitis.Management of chronic idiopathic urticaria.

Action

Antagonizes the effects of histamine at H1 receptor sites; does not bind to or inactivate histamine.

Therapeutic effects

Decreased symptoms of histamine excess (rhinitis, itching).

Pharmacokinetics

Absorption: Well absorbed following oral administration.
Distribution: Unknown.
Metabolism and Excretion: Excreted mostly unchanged by the kidneys (85%).
Half-life: 8 hr.

Time/action profile

ROUTEONSETPEAKDURATION
POrapid0.9 hr24 hr

Contraindications/Precautions

Contraindicated in: Hypersensitivity to levocetirizine or cetirizine; Severe renal impairment (CCr <10 mL/min); Pediatric: Pediatric patients with impaired renal function; Lactation: Lactation.
Use Cautiously in: Geriatric: Consider age related ↓ in renal function and concurrent disease states; Obstetric: Use only if clearly needed; Pediatric: Children <6 mo (safety not established).

Adverse Reactions/Side Effects

Central nervous system

  • drowsiness
  • fatigue
  • weakness

Gastrointestinal

  • dry mouth

Genitourinary

  • urinary retention

Interactions

Drug-Drug interaction

↑ levels of ritonavir.↑ CNS depression may occur with alcohol, opioid analgesics, or sedative hypnotics.

Route/Dosage

Oral (Adults and Children ≥12 yr) 5 mg once daily in the evening; some patients may respond to 2.5 mg once daily.

Renal Impairment

Oral (Children 6–11 yr) 2.5 mg once daily in the evening.
Oral (Children 6 mo–5 yr) 1.25 mg (oral solution) once daily in the evening.

Renal Impairment

(Adults and Children ≥12 yr) CCr 50–80 mL/min—2.5 mg once daily; CCr 30–50 mL/min—2.5 mg every other day; CCr 10–30 mL/min—2.5 mg twice weekly (every 3–4 days).

Availability (generic available)

Tablets : 5 mg
Oral solution: 2.5 mg/5 mL

Nursing implications

Nursing 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 in allergy skin testing.
    • May cause transient ↑ in serum bilirubin and transaminases.

Potential Nursing Diagnoses

Ineffective airway clearance (Indications)
Risk for injury (Adverse Reactions)

Implementation

  • Oral: Administer once daily in the evening without regard to food. Solution is clear and colorless; administer undiluted.

Patient/Family Teaching

  • Instruct patient to take medication as directed. Do not increase doses; may cause increased drowsiness.
  • May cause drowsiness. Caution patient to avoid driving or other activities requiring alertness until response to medication is known.
  • 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.

Evaluation/Desired Outcomes

  • Decrease in allergic symptoms.
  • Resolution of uncomplicated skin manifestations of chronic idiopathic urticaria.
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Kundawala, Development and characterization of pharmacokinetic parameters of fast-dissolving films containing levocetirizine, Sci.
Besides, the Group has launched a number of new products during the reporting period, including Celecoxib Capsule, Etoricoxib Tablet, Valsartan Tablet, Irbesartan Tablet, and Levocetirizine Tablet.
These include generic names cetirizine, levocetirizine, chlorpheniramine, diphenhydramine, ketotifen and brompheniramine among others.
The basic principles of drug selection, for the purpose of AR therapy, are based on the optimal ratio of efficacy and safety of use, on this basis, systemic AR treatment is usually limited to oral administration of antihistamines, mainly selective antiallergic action (fexofenadine, desloratadine, levocetirizine), which are effective eliminate the main nasal symptoms of AR--sneezing, pruritus, rhinorrhea (22).
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Reddy's Laboratories Launches Levocetirizine Dihydrochloride Tablets USP, 5 mg in the US
(234.) These are Xyzal (levocetirizine dihydrochloride), DaTscan
Finally, medical treatment involving an intranasal steroid (mometasone furoate nasal spray, 4 sprays, once a day), along with an oral antihistamine (levocetirizine 5 mg qd) was given for continued management of AR.