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.