Allegra

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fexofenadine hydrochloride

Allegra, Allegra ODT, Telfast (UK)

Pharmacologic class: Peripherally selective piperidine, selective histamine1-receptor antagonist

Therapeutic class: Antihistamine (nonsedating type), second-generation

Pregnancy risk category C

Action

Blocks effects of histamine at peripheral histamine1-receptor sites, decreasing allergy signs and symptoms

Availability

Capsules: 60 mg

Oral suspension: 30 mg/5 ml (6 mg/ml)

Tablets: 30 mg, 60 mg, 180 mg

Tablets (orally disintegrating): 30 mg

Indications and dosages

Seasonal allergic rhinitis; chronic idiopathic urticaria

Adults and children age 12 and older: 60 mg P.O. b.i.d. or 180 mg once daily (conventional tablets)

Children ages 6 to 11: 30 mg P.O. b.i.d. (conventional tablets or ODT tablets)

Seasonal allergic rhinitis

Children ages 2 to 11: 30 mg P.O. b.i.d. (oral suspension and ODT)

Chronic idiopathic urticaria

Children ages 6 months to less than 2 years: 15 mg P.O. b.i.d.(oral suspension and ODT)

Dosage adjustment

• Renal impairment

Contraindications

• Hypersensitivity to drug, terfenadine, or their components

Precautions

Use cautiously in:
• renal impairment
• concurrent ketoconazole or erythromycin therapy
• elderly patients
• pregnant or breastfeeding patients.

Administration

• Give capsules and conventional tablets with water; don't give with apple, orange, or grapefruit juice.
• Don't remove orally disintegrating tablets from original blister package until time of administration.
• Administer orally disintegrating tablets on an empty stomach; allow tablets to disintegrate on the tongue and then have patient swallow tablets with or without water.
• Don't break or use partial orally disintegrating tablets
• Know that orally disintegrating tablets contain phenylalanine.
• Don't give antacids within 2 hours of fexofenadine.

Adverse reactions

CNS: drowsiness, fatigue, headache

EENT: otitis media

GI: nausea, dyspepsia

Metabolic: dysmenorrhea

Respiratory: upper respiratory tract infection

Other: viral infection

Interactions

Drug-drug.Antacids containing aluminum and magnesium: decreased absorption and efficacy of fexofenadine

Drug-diagnostic tests.Skin allergy tests: false-negative results

Drug-food.Apple, orange, and grapefruit juice: decreased absorption and efficacy of fexofenadine

Patient monitoring

• Monitor renal function.
• Watch for signs and symptoms of viral infection.

Patient teaching

• Instruct patient to take conventional tablets with water, and not with apple, orange, or grapefruit juice.
• Instruct patient not to remove orally disintegrating tablets from original blister package until time of administration.
• Instruct patient to take orally disintegrating tablets on an empty stomach at least 1 hour before or 2 hours after a meal, to allow tablet to disintegrate on the tongue, and then to swallow with or without water. Advise patient not to chew tablets.
• Tell patient not to break or use partial orally disintegrating tablets.
• Tell patient to stop taking drug 4 days before diagnostic skin tests, to avoid interference with test results.
• Advise patient to report signs or symptoms of viral infection, especially upper respiratory tract infection.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.
• Advise female patient to inform prescriber if she is pregnant or breastfeeding.
• As appropriate, review all other significant adverse reactions and interactions, especially those related to the drugs, tests, and foods mentioned above.

fexofenadine

(fex-oh-fen-a-deen) ,

Allegra

(trade name)

Classification

Therapeutic: allergy cold cough remedies
Pregnancy Category: C

Indications

Relief of symptoms of seasonal allergic rhinitis.Management of chronic idiopathic urticaria.

Action

Antagonizes the effects of histamine at peripheral histamine–1 (H1) receptors, including pruritus and urticaria.
Also has a drying effect on the nasal mucosa.

Therapeutic effects

Decreased sneezing, rhinorrhea, itchy eyes, nose, and throat associated with seasonal allergies.
Decreased urticaria.

Pharmacokinetics

Absorption: Rapidly absorbed after oral administration.
Distribution: Unknown.
Metabolism and Excretion: 80% excreted in urine, 11% excreted in feces.
Half-life: 14.4 hr (↑ in renal impairment).

Time/action profile (antihistaminic effect)

ROUTEONSETPEAKDURATION
POwithin 1 hr2–3 hr12–24 hr

Contraindications/Precautions

Contraindicated in: Hypersensitivity.
Use Cautiously in: Impaired renal function (↑ dosing interval recommended); Obstetric: use only if maternal benefit outweighs potential risk to fetus; Lactation: Usually compatible with breast feeding (AAP).

Adverse Reactions/Side Effects

Central nervous system

  • drowsiness
  • fatigue

Gastrointestinal

  • dyspepsia

Endocrinologic

  • dysmenorrhea

Interactions

Drug-Drug interaction

Magnesium and aluminum-containing antacids ↓ absorption and may decrease effectiveness.Apple, orange, and grapefruit juice ↓ absorption and may decrease effectiveness.

Route/Dosage

Oral (Adults and Children ≥12 yr) 60 mg twice daily, or 180 mg once daily.
Oral (Children 2–11 yr) 30 mg twice daily.
Oral (Children 6 mo–2 yr) 15 mg twice daily.

Renal Impairment

Oral (Adults) 60 mg once daily as a starting dose.
Oral (Children 6–11 yr) 30 mg once daily as a starting dose.

Availability (generic available)

Tablets: 30 mgOTC, 60 mgOTC, 120 mgOTC, 180 mgOTC
Orally disintegrating tablets: 30 mgOTC
Suspensionberry flavor: 30 mg/5 mLOTC
In combination with: pseudoephedrine (Allegra-D). See combination drugs.

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: Will cause false-negative reactions on allergy skin tests; discontinue 3 days before testing.

Potential Nursing Diagnoses

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

Implementation

  • Do not confuse Allegra with Viagra.
  • Oral: Administer with food or milk to decrease GI irritation. Capsules and tablets should be taken with water or milk, not juice.

Patient/Family Teaching

  • Instruct patient to take medication as directed. Take missed doses as soon as remembered unless almost time for next dose.
  • Inform patient that drug may cause drowsiness, although it is less likely to occur than with other antihistamines. Avoid driving or other activities requiring alertness until response to drug is known.
  • Instruct patient to contact health care professional if symptoms persist.

Evaluation/Desired Outcomes

  • Decrease in allergic symptoms.
  • Decrease in urticaria.

Allegra

(ə-lĕg′rə)
A trademark for the drug fexofenadine hydrochloride.
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