خواص دارویی و گیاهی
(cetirizine)
Cetirizine belongs to the class of medications called second-generation antihistamines, specifically the class known as histamine receptor antagonists. For adults and children 2 years of age and older, it is used for the relief of symptoms associated with seasonal allergies including sneezing; itchy nose and throat; stuffy and runny nose; and tearing, red, or itchy eyes. It is also used for the relief of symptoms associated with allergic skin conditions (e.g., chronic idiopathic urticaria) such as itchy skin and hives. For adults and children over the age of 12 years, it is also used for the relief of symptoms associated with year-round allergies and hives.
Cetirizine works by blocking the actions of one of the body’s natural chemicals known as histamine. Histamine is responsible for many of the symptoms caused by allergies.
Cetirizine usually starts to relieve allergy symptoms within 20 minutes and lasts for 24 hours.
This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.
apo cetirizine high
Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.
Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.
What you think is a temporary inconvenience could get in the way of your daily life. Don’t ignore the red flags.
Sponsored
10 mg
Each white, ovoid, film-coated tablet, scored and engraved “10 mg” on one side and “APO” on the other, contains 10 mg of cetirizine HCl. Nonmedicinal ingredients: carnauba wax, cornstarch, hydroxypropyl methylcellulose, lactose, magnesium stearate, microcrystalline cellulose, polydextrose, polyethylene glycol, and titanium dioxide.
20 mg
Each white-to-off-white, film-coated, rectangle-shaped, biconvex, tablet engraved “20” score “MG” on one side, and “APO” on the other side, contains 20 mg of cetirizine hydrochloride. Nonmedicinal ingredients: carnauba wax, cornstarch, hydroxypropyl methylcellulose, lactose monohydrate, magnesium stearate, microcrystalline cellulose, polydextrose, polyethylene glycol, and titanium dioxide.
If you frequently use over-the-counter drops and are still experiencing bothersome dry eye symptoms, it could be dry eye disease.
The recommended dose for adults and children 12 years of age and older is 5 mg to 10 mg once daily taken by mouth depending on the severity of the symptoms and circumstances of the person taking the medication. If 10 mg once daily is not enough to control your allergy symptoms, talk to your doctor.
For adults 65 years of age and over, the recommended dose is 5 mg once daily.
For children 6 to 12 years of age, the recommended dose is 10 mg once daily or 5 mg in the morning and in the evening.
For children 2 to 6 years of age, the recommended dose is 5 mg (one teaspoon) given once daily, or 2.5 mg (one-half teaspoon) of syrup in the morning and evening.
Use an oral syringe to measure each dose of the liquid, as it gives a more accurate measurement than household teaspoons.
All forms of cetirizine may be taken with or without food.
Seniors, and people with kidney or liver problems, may need lower doses of this medication.
Children should not use this medication for more than 14 days at a time unless recommended by a doctor.
Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.
It is important to take this medication exactly as suggested by your doctor or pharmacist. If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.
Store this medication at room temperature, protect it from moisture, and keep it out of the reach of children.
Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.
Do not take this medication if you:
Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.
The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.
The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.
Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.
Although most of the side effects listed below don’t happen very often, they could lead to serious problems if you do not seek medical attention.
Check with your doctor as soon as possible if any of the following side effects occur:
Stop taking the medication and seek immediate medical attention if any of the following occur:
Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.
Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.
Drowsiness/reduced alertness: Studies have shown that cetirizine does not cause drowsiness under normal circumstances. A small percentage of people taking this medication have experienced a degree of drowsiness. Do not drive or operate machinery if you become drowsy while taking this medication.
Reduced kidney function: If you have reduced kidney function, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Reduced liver function: If you have reduced liver function, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.
Breast-feeding: It is not known if cetirizine passes into breast milk. If you are a breast-feeding mother and are taking this medication, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.
Children: The safety and effectiveness of using this medication for seasonal allergies and allergic skin conditions have not been established for children less than 2 years of age. The safety and effectiveness of using this medication for year-round allergies have not been established for children 12 years of age and under.
apo cetirizine high
Seniors: Seniors may be more sensitive to the effects of cetirizine. Therefore, a lower starting dose may be recommended by your doctor or pharmacist.
There may be an interaction between cetirizine and any of the following:
If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:
An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.
Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.
All material copyright MediResource Inc. 1996 – 2019. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/drug/getdrug/Apo-Cetirizine
Sponsored
(cetirizine)
Cetirizine belongs to the class of medications called second-generation antihistamines, specifically the class known as histamine receptor antagonists. For adults and children 2 years of age and older, it is used for the relief of symptoms associated with seasonal allergies including sneezing; itchy nose and throat; stuffy and runny nose; and tearing, red, or itchy eyes. It is also used for the relief of symptoms associated with allergic skin conditions (e.g., chronic idiopathic urticaria) such as itchy skin and hives. For adults and children over the age of 12 years, it is also used for the relief of symptoms associated with year-round allergies and hives.
Cetirizine works by blocking the actions of one of the body’s natural chemicals known as histamine. Histamine is responsible for many of the symptoms caused by allergies.
Cetirizine usually starts to relieve allergy symptoms within 20 minutes and lasts for 24 hours.
This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.
apo cetirizine high
Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.
Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.
What you think is a temporary inconvenience could get in the way of your daily life. Don’t ignore the red flags.
Sponsored
10 mg
Each white, ovoid, film-coated tablet, scored and engraved “10 mg” on one side and “APO” on the other, contains 10 mg of cetirizine HCl. Nonmedicinal ingredients: carnauba wax, cornstarch, hydroxypropyl methylcellulose, lactose, magnesium stearate, microcrystalline cellulose, polydextrose, polyethylene glycol, and titanium dioxide.
20 mg
Each white-to-off-white, film-coated, rectangle-shaped, biconvex, tablet engraved “20” score “MG” on one side, and “APO” on the other side, contains 20 mg of cetirizine hydrochloride. Nonmedicinal ingredients: carnauba wax, cornstarch, hydroxypropyl methylcellulose, lactose monohydrate, magnesium stearate, microcrystalline cellulose, polydextrose, polyethylene glycol, and titanium dioxide.
If you frequently use over-the-counter drops and are still experiencing bothersome dry eye symptoms, it could be dry eye disease.
The recommended dose for adults and children 12 years of age and older is 5 mg to 10 mg once daily taken by mouth depending on the severity of the symptoms and circumstances of the person taking the medication. If 10 mg once daily is not enough to control your allergy symptoms, talk to your doctor.
For adults 65 years of age and over, the recommended dose is 5 mg once daily.
For children 6 to 12 years of age, the recommended dose is 10 mg once daily or 5 mg in the morning and in the evening.
For children 2 to 6 years of age, the recommended dose is 5 mg (one teaspoon) given once daily, or 2.5 mg (one-half teaspoon) of syrup in the morning and evening.
Use an oral syringe to measure each dose of the liquid, as it gives a more accurate measurement than household teaspoons.
All forms of cetirizine may be taken with or without food.
Seniors, and people with kidney or liver problems, may need lower doses of this medication.
Children should not use this medication for more than 14 days at a time unless recommended by a doctor.
Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.
It is important to take this medication exactly as suggested by your doctor or pharmacist. If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.
Store this medication at room temperature, protect it from moisture, and keep it out of the reach of children.
Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.
Do not take this medication if you:
Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.
The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.
The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.
Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.
Although most of the side effects listed below don’t happen very often, they could lead to serious problems if you do not seek medical attention.
Check with your doctor as soon as possible if any of the following side effects occur:
Stop taking the medication and seek immediate medical attention if any of the following occur:
Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.
Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.
Drowsiness/reduced alertness: Studies have shown that cetirizine does not cause drowsiness under normal circumstances. A small percentage of people taking this medication have experienced a degree of drowsiness. Do not drive or operate machinery if you become drowsy while taking this medication.
Reduced kidney function: If you have reduced kidney function, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Reduced liver function: If you have reduced liver function, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.
Breast-feeding: It is not known if cetirizine passes into breast milk. If you are a breast-feeding mother and are taking this medication, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.
Children: The safety and effectiveness of using this medication for seasonal allergies and allergic skin conditions have not been established for children less than 2 years of age. The safety and effectiveness of using this medication for year-round allergies have not been established for children 12 years of age and under.
apo cetirizine high
Seniors: Seniors may be more sensitive to the effects of cetirizine. Therefore, a lower starting dose may be recommended by your doctor or pharmacist.
There may be an interaction between cetirizine and any of the following:
If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:
An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.
Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.
All material copyright MediResource Inc. 1996 – 2019. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/drug/getdrug/Apo-Cetirizine
Sponsored
(cetirizine)
Cetirizine belongs to the class of medications called second-generation antihistamines, specifically the class known as histamine receptor antagonists. For adults and children 2 years of age and older, it is used for the relief of symptoms associated with seasonal allergies including sneezing; itchy nose and throat; stuffy and runny nose; and tearing, red, or itchy eyes. It is also used for the relief of symptoms associated with allergic skin conditions (e.g., chronic idiopathic urticaria) such as itchy skin and hives. For adults and children over the age of 12 years, it is also used for the relief of symptoms associated with year-round allergies and hives.
Cetirizine works by blocking the actions of one of the body’s natural chemicals known as histamine. Histamine is responsible for many of the symptoms caused by allergies.
Cetirizine usually starts to relieve allergy symptoms within 20 minutes and lasts for 24 hours.
This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.
apo cetirizine high
Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.
Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.
What you think is a temporary inconvenience could get in the way of your daily life. Don’t ignore the red flags.
Sponsored
10 mg
Each white, ovoid, film-coated tablet, scored and engraved “10 mg” on one side and “APO” on the other, contains 10 mg of cetirizine HCl. Nonmedicinal ingredients: carnauba wax, cornstarch, hydroxypropyl methylcellulose, lactose, magnesium stearate, microcrystalline cellulose, polydextrose, polyethylene glycol, and titanium dioxide.
20 mg
Each white-to-off-white, film-coated, rectangle-shaped, biconvex, tablet engraved “20” score “MG” on one side, and “APO” on the other side, contains 20 mg of cetirizine hydrochloride. Nonmedicinal ingredients: carnauba wax, cornstarch, hydroxypropyl methylcellulose, lactose monohydrate, magnesium stearate, microcrystalline cellulose, polydextrose, polyethylene glycol, and titanium dioxide.
If you frequently use over-the-counter drops and are still experiencing bothersome dry eye symptoms, it could be dry eye disease.
The recommended dose for adults and children 12 years of age and older is 5 mg to 10 mg once daily taken by mouth depending on the severity of the symptoms and circumstances of the person taking the medication. If 10 mg once daily is not enough to control your allergy symptoms, talk to your doctor.
For adults 65 years of age and over, the recommended dose is 5 mg once daily.
For children 6 to 12 years of age, the recommended dose is 10 mg once daily or 5 mg in the morning and in the evening.
For children 2 to 6 years of age, the recommended dose is 5 mg (one teaspoon) given once daily, or 2.5 mg (one-half teaspoon) of syrup in the morning and evening.
Use an oral syringe to measure each dose of the liquid, as it gives a more accurate measurement than household teaspoons.
All forms of cetirizine may be taken with or without food.
Seniors, and people with kidney or liver problems, may need lower doses of this medication.
Children should not use this medication for more than 14 days at a time unless recommended by a doctor.
Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.
It is important to take this medication exactly as suggested by your doctor or pharmacist. If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.
Store this medication at room temperature, protect it from moisture, and keep it out of the reach of children.
Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.
Do not take this medication if you:
Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.
The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.
The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.
Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.
Although most of the side effects listed below don’t happen very often, they could lead to serious problems if you do not seek medical attention.
Check with your doctor as soon as possible if any of the following side effects occur:
Stop taking the medication and seek immediate medical attention if any of the following occur:
Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.
Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.
Drowsiness/reduced alertness: Studies have shown that cetirizine does not cause drowsiness under normal circumstances. A small percentage of people taking this medication have experienced a degree of drowsiness. Do not drive or operate machinery if you become drowsy while taking this medication.
Reduced kidney function: If you have reduced kidney function, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Reduced liver function: If you have reduced liver function, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.
Breast-feeding: It is not known if cetirizine passes into breast milk. If you are a breast-feeding mother and are taking this medication, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.
Children: The safety and effectiveness of using this medication for seasonal allergies and allergic skin conditions have not been established for children less than 2 years of age. The safety and effectiveness of using this medication for year-round allergies have not been established for children 12 years of age and under.
apo cetirizine high
Seniors: Seniors may be more sensitive to the effects of cetirizine. Therefore, a lower starting dose may be recommended by your doctor or pharmacist.
There may be an interaction between cetirizine and any of the following:
If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:
An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.
Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.
All material copyright MediResource Inc. 1996 – 2019. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/drug/getdrug/Apo-Cetirizine
Sponsored
(cetirizine)
Cetirizine belongs to the class of medications called second-generation antihistamines, specifically the class known as histamine receptor antagonists. For adults and children 2 years of age and older, it is used for the relief of symptoms associated with seasonal allergies including sneezing; itchy nose and throat; stuffy and runny nose; and tearing, red, or itchy eyes. It is also used for the relief of symptoms associated with allergic skin conditions (e.g., chronic idiopathic urticaria) such as itchy skin and hives. For adults and children over the age of 12 years, it is also used for the relief of symptoms associated with year-round allergies and hives.
Cetirizine works by blocking the actions of one of the body’s natural chemicals known as histamine. Histamine is responsible for many of the symptoms caused by allergies.
Cetirizine usually starts to relieve allergy symptoms within 20 minutes and lasts for 24 hours.
This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.
apo cetirizine high
Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.
Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.
What you think is a temporary inconvenience could get in the way of your daily life. Don’t ignore the red flags.
Sponsored
10 mg
Each white, ovoid, film-coated tablet, scored and engraved “10 mg” on one side and “APO” on the other, contains 10 mg of cetirizine HCl. Nonmedicinal ingredients: carnauba wax, cornstarch, hydroxypropyl methylcellulose, lactose, magnesium stearate, microcrystalline cellulose, polydextrose, polyethylene glycol, and titanium dioxide.
20 mg
Each white-to-off-white, film-coated, rectangle-shaped, biconvex, tablet engraved “20” score “MG” on one side, and “APO” on the other side, contains 20 mg of cetirizine hydrochloride. Nonmedicinal ingredients: carnauba wax, cornstarch, hydroxypropyl methylcellulose, lactose monohydrate, magnesium stearate, microcrystalline cellulose, polydextrose, polyethylene glycol, and titanium dioxide.
If you frequently use over-the-counter drops and are still experiencing bothersome dry eye symptoms, it could be dry eye disease.
The recommended dose for adults and children 12 years of age and older is 5 mg to 10 mg once daily taken by mouth depending on the severity of the symptoms and circumstances of the person taking the medication. If 10 mg once daily is not enough to control your allergy symptoms, talk to your doctor.
For adults 65 years of age and over, the recommended dose is 5 mg once daily.
For children 6 to 12 years of age, the recommended dose is 10 mg once daily or 5 mg in the morning and in the evening.
For children 2 to 6 years of age, the recommended dose is 5 mg (one teaspoon) given once daily, or 2.5 mg (one-half teaspoon) of syrup in the morning and evening.
Use an oral syringe to measure each dose of the liquid, as it gives a more accurate measurement than household teaspoons.
All forms of cetirizine may be taken with or without food.
Seniors, and people with kidney or liver problems, may need lower doses of this medication.
Children should not use this medication for more than 14 days at a time unless recommended by a doctor.
Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.
It is important to take this medication exactly as suggested by your doctor or pharmacist. If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.
Store this medication at room temperature, protect it from moisture, and keep it out of the reach of children.
Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.
Do not take this medication if you:
Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.
The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.
The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.
Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.
Although most of the side effects listed below don’t happen very often, they could lead to serious problems if you do not seek medical attention.
Check with your doctor as soon as possible if any of the following side effects occur:
Stop taking the medication and seek immediate medical attention if any of the following occur:
Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.
Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.
Drowsiness/reduced alertness: Studies have shown that cetirizine does not cause drowsiness under normal circumstances. A small percentage of people taking this medication have experienced a degree of drowsiness. Do not drive or operate machinery if you become drowsy while taking this medication.
Reduced kidney function: If you have reduced kidney function, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Reduced liver function: If you have reduced liver function, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.
Breast-feeding: It is not known if cetirizine passes into breast milk. If you are a breast-feeding mother and are taking this medication, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.
Children: The safety and effectiveness of using this medication for seasonal allergies and allergic skin conditions have not been established for children less than 2 years of age. The safety and effectiveness of using this medication for year-round allergies have not been established for children 12 years of age and under.
apo cetirizine high
Seniors: Seniors may be more sensitive to the effects of cetirizine. Therefore, a lower starting dose may be recommended by your doctor or pharmacist.
There may be an interaction between cetirizine and any of the following:
If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:
An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.
Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.
All material copyright MediResource Inc. 1996 – 2019. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/drug/getdrug/Apo-Cetirizine
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Cetirizine is an allergy medication that you can buy over-the-counter at a pharmacy. That is, you don’t need a prescription. The medication comes in capsules, tablets, and a syrup. You typically take it just once per day, and it begins to work quickly. It’s inexpensive, too — usually less than $1 per day for brand-name versions (Zyrtec, Aller-Tec, and Alleroff), and even less for generic products.
Generally, cetirizine is a safe and effective drug, but you should be aware of certain warnings and precautions when taking this drug. Learn how this drug works, what it’s used for, and how to take it safely.
If you have year-round symptoms, or seasonal allergies like hay fever, your doctor may recommend cetirizine. Cetirizine may help relieve these allergy symptoms, but it doesn’t prevent them.
When you come in contact with allergens, your body produces a chemical called histamine. Histamine causes most of the symptoms related to allergic reactions. Cetirizine is an antihistamine. It blocks the effects of histamine.
Cetirizine helps relieve mild to moderate allergy symptoms, such as:
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These reactions can happen after you touch or inhale allergens such as plant pollen, mold, or pet dander. Allergies usually affect your nose, sinuses, throat, and other areas of your upper respiratory system.
Cetirizine also helps relieve hives. They are itchy, raised rashes on the skin. Hives often occur with food or medication allergies.
Adults and children 2 years and older can take the syrup, which is fruit flavored. Adults and children 6 years and older and take the capsules and tablets.
The usual dosage for adults younger than 65 and children who are 6 years and older is one 10-milligram (mg) dose per day. You shouldn’t take more than 10 mg in 24 hours. Your doctor may recommend a 5-mg dose once or twice per day if your allergies are mild.
Talk to your doctor about dosage for people who:
Cetirizine is a newer, second-generation antihistamine. Unlike first-generation antihistamines, cetirizine is less likely to cause side effects such as dangerous drowsiness, dry mouth, blurred vision, and overheating.
That said, Cetirizine can cause adverse effects, such as:
Tell your doctor about any unexpected side effects that you have while taking cetirizine. Also, discuss any ongoing or bothersome side effects. These effects are usually not emergencies.
Even though cetirizine doesn’t usually cause drowsiness, some people respond differently when taking it, especially in the first few doses. Be cautious, and don’t drive your car or use machinery until you know for sure how your body will respond to cetirizine.
Don’t use cetirizine if you have ever had an allergic reaction to it or to any of the ingredients in it. Also, steer clear of cetirizine if you are allergic to any antihistamine that contains hydroxyzine.
Talk to your doctor before you take cetirizine if you are pregnant or planning to become pregnant. Taking cetirizine is generally not recommended during pregnancy. It’s also not recommended if you breastfeed your child. This is because the drug passes into breast milk.
If you have liver or kidney disease, ask your doctor about taking cetirizine. If your doctor feels it is safe for you to take, they may recommend taking less than the typical dosage.
Cetirizine does interact with other substances. For example, avoid consuming alcoholic drinks while you take cetirizine. Doing so may be dangerous. Mixing cetirizine with alcohol can cause drowsiness or make you less alert.
If you take any type of tranquilizer, sedative, or sleep aid, make sure to ask your doctor before you use cetirizine. Mixing cetirizine with drugs that depress your central nervous system can amplify sedation. It can further impair your mental and nervous system functions.
There is a possibility of a drug interaction between cetirizine and theophylline. Theophylline (Theo-24, Theolair) is a drug that some people with asthma and other lung problems take. However, the interaction is most likely dose-related. It has only been reported with daily theophylline doses of 400 mg or more. In these cases, it took longer for cetirizine to leave the body. Talk to your doctor if you take theophylline and are considering cetirizine.
Cetirizine-D and brand-name versions, such as Zyrtec-D, are combination drugs. The “D” stands for decongestant. These drugs contain both cetirizine and the decongestant pseudoephedrine.
Your doctor may tell you that cetirizine-D is not for you if you have any of these conditions:
Cetirizine is an over-the-counter drug that can relieve mild to moderate allergy symptoms. Like any drug, especially over-the-counter medication, you should understand all of the considerations before you start taking it.
Talk to your doctor about any questions you have about your symptoms and any other conditions you may have. Your doctor may recommend a different antihistamine or a combination drug of cetirizine and another product. It may require a prescription.
Here are a few questions you might ask your doctor about cetirizine:
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Cetirizine, sold under the brand name Zyrtec among others, is a second generation antihistamine used to treat hay fever, dermatitis, and urticaria.[5] It is taken by mouth.[6] Effects generally begin within an hour and last for about a day.[6] The degree of benefit is similar to other antihistamines such as diphenhydramine.[6]
Common side effects include sleepiness, dry mouth, headache, and abdominal pain.[6] The degree of sleepiness that occurs is generally less than with first generation antihistamines.[5] Serious side effects may include aggression and angioedema.[5] Use in pregnancy appears safe, but use during breastfeeding is not recommended.[7] The medication works by blocking histamine H1 receptors, mostly outside the brain.[6]
It was patented in 1981 and came into medical use in 1987.[8] It is available as a generic medication.[5] A month’s supply in the United Kingdom costs the NHS about £0.70 as of 2019.[5] In the United States the wholesale cost of this amount is about US$2.50.[9] In 2016 it was the 74th most prescribed medication in the United States, with more than 10 million prescriptions.[10]
Cetirizine’s primary indication is for hay fever and other allergies. Because the symptoms of itching and redness in these conditions are caused by histamine acting on the H1 receptor, blocking those receptors temporarily relieves those symptoms.
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Cetirizine is also commonly prescribed to treat acute and (in particular cases) chronic urticaria, more efficiently than any other second-generation antihistamine[citation needed].
Cetirizine is available over-the-counter in the US in the form of 5 and 10 mg tablets. A 20 mg strength is available by prescription only.[1]
In the UK up to 30 tablets of 10mg are on the general sales list (of pharmaceuticals) and can be purchased without a prescription and without pharmacist supervision.
Commonly reported side effects of cetirizine include headache (16%), dry mouth (5.7%), drowsiness (5–20%), and fatigue (5.6%), while more serious but rare side effects include cardiac failure, tachycardia, and edema.[11]
Discontinuing cetirizine after prolonged use (typically, use beyond six months) may result in generalized itching.[12][13][14]
Cetirizine acts as a highly selective antagonist of the histamine H1 receptor.[1] The Ki values for the H1 receptor are approximately 6 nM for cetirizine, 3 nM for levocetirizine, and 100 nM for dextrocetirizine, indicating that the levorotatory enantiomer is the main active form.[1] Cetirizine has 600-fold or greater selectivity for the H1 receptor over a wide variety of other sites, including muscarinic acetylcholine, serotonin, dopamine, and α-adrenergic receptors, among many others.[1] The drug shows 20,000-fold or greater selectivity for the H1 receptor over the five muscarinic acetylcholine receptors, and hence does not exhibit anticholinergic effects.[15][16] It shows negligible inhibition of the hERG channel (IC50 > 30 µM)[17] and no cardiotoxicity has been observed with cetirizine at doses of up to 60 mg/day, six times the normal recommended dose[1] and the highest dose of cetirizine that has been studied in healthy subjects.[18]
Cetirizine crosses the blood–brain barrier only slightly, and for this reason, it produces minimal sedation compared to many other antihistamines.[19] A positron emission tomography (PET) study found that brain occupancy of the H1 receptor was 12.6% for 10 mg cetirizine, 25.2% for 20 mg cetirizine, and 67.6% for 30 mg hydroxyzine.[20] (A 10 mg dose of cetirizine equals about a 30 mg dose of hydroxyzine in terms of peripheral antihistamine effect.)[21] PET studies with antihistamines have found that brain H1 receptor occupancy of more than 50% is associated with a high prevalence of somnolence and cognitive decline, whereas brain H1 receptor occupancy of less than 20% is considered to be non-sedative.[22] In accordance, H1 receptor occupancy correlated well with subjective sleepiness for 30 mg hydroxyzine but there was no correlation for 10 or 20 mg cetirizine.[20] As such, brain penetration and brain H1 receptor occupancy by cetirizine are dose-dependent, and in accordance, while cetirizine at doses of 5 to 10 mg have been reported to be non-sedating or mildly sedating, a higher dose of 20 mg has been found to induce significant drowsiness in other studies.[20]
Cetirizine has been shown to inhibit eosinophil chemotaxis and LTB4 release.[23] At a dosage of 20 mg, Boone et al. found that it inhibited the expression of VCAM-1 in patients with atopic dermatitis.[23]
Cetirizine is rapidly and extensively absorbed upon oral administration in tablet or syrup form.[1] The oral bioavailability of cetirizine is at least 70% and of levocetirizine is at least 85%.[3] The Tmax of cetirizine is approximately 1.0 hour regardless of formulation and its onset of action has been reported to be as early as 20 minutes.[2] The pharmacokinetics of cetirizine have been found to increase linearly with dose across a range of 5 to 60 mg.[1] Its Cmax following a single dose has been found to be 257 ng/mL for 10 mg and 580 ng/mL for 20 mg.[2] Food has no effect on the bioavailability of cetirizine but has been found to delay the Tmax by 1.7 hours (i.e., to approximately 2.7 hours) and to decrease the Cmax by 23%.[1][2][24] Similar findings were reported for levocetirizine, which had its Tmax delayed by 1.25 hours and its Cmax decreased by about 36% when administered with a high-fat meal.[24] Steady-state levels of cetirizine occur within 3 days and there is no accumulation of the drug with chronic administration.[2] Following once-daily administration of 10 mg cetirizine for 10 days, the mean Cmax was 311 ng/mL.[25]
The mean plasma protein binding of cetirizine has been found to be 93 to 96% across a range of 25 to 1,000 ng/mL independent of concentration.[2] Plasma protein binding of 88 to 96% has also been reported across multiple studies.[3] The drug is bound to albumin with high affinity, while α1-acid glycoprotein and lipoproteins contribute much less to total plasma protein binding.[3] The unbound or free fraction of levocetirizine has been reported to be 8%.[3] The true volume of distribution of cetirizine is unknown but is estimated to be 0.3 to 0.45 L/kg.[1][3] Cetirizine poorly and slowly crosses the blood–brain barrier, which is due mainly to its chemical properties but also to a minor extent to its activity as a P-glycoprotein substrate.[3]
Cetirizine does not undergo extensive metabolism.[1] It is notably not metabolized by the cytochrome P450 system.[26] Because of this, it does not interact significantly with drugs that inhibit or induce cytochrome P450 enzymes such as theophylline, erythromycin, clarithromycin, cimetidine, or alcohol.[1] While cetirizine does not undergo extensive metabolism or metabolism by the cytochrome P450 enzyme, it does undergo some metabolism by other means, the metabolic pathways of which include oxidation and conjugation.[1][2] Plasma radioactivity attributed to unchanged cetirizine is more than 90% at 2 hours, 80% at 10 hours, and 70% at 24 hours, indicating limited and slow metabolism.[2] The enzymes responsible for transformation of cetirizine have not been identified.[1]
Cetirizine is eliminated approximately 70 to 85% in the urine and 10 to 13% in the feces.[1] About 50 or 60% of cetirizine eliminated in the urine is unchanged.[1][2] It is eliminated in the urine via an active transport mechanism.[2] The elimination half-life of cetirizine ranges from 6.5 to 10 hours in healthy adults, with a mean across studies of approximately 8.3 hours.[1][2] Its duration of action is at least 24 hours.[2] The elimination half-life of cetirizine is increased in the elderly (to 12 hours), in hepatic impairment (to 14 hours), and in renal impairment (to 20 hours).[2]
Cetirizine contains L- and D-stereoisomers. Chemically, levocetirizine is the active L-enantiomer of cetirizine. The drug is a member of the diphenylmethylpiperazine group of antihistamines. Analogues include cyclizine and hydroxyzine.
The 1-[(4-chlorophenylmethyl]-piperazine is alkylated with methyl (2-chloroethoxy)-acetate in the presence of sodium carbonate and xylene solvent to produce the Sn2 substitution product in 28% yield. Saponification of the acetate ester is done by refluxing with potassium hydroxide in absolute ethanol to afford a 56% yield of the potassium salt intermediate. This is then hydrolyzed with aqueous HCl and extracted to give an 81% yield of the carboxylic acid product.
Cetirizine is marketed under the brand names Alatrol, Alerid, Alzene, Cetirin, Cetzine, Cezin, Cetgel, Histazine, Humex, Letizen, Reactine, Razene, Rigix, Triz, Zetop, Zirtec, Zirtek, Zodac, Zyllergy, Zynor, Zyrlek, and Zyrtec among others.
Formerly prescription-only in many countries, cetirizine is now available without prescription in most countries. In some countries it is available over-the-counter only in packages containing seven or ten 10 mg doses.
Like many other antihistamine medications, cetirizine is commonly prescribed in combination with pseudoephedrine, a decongestant. These combinations are often marketed using the same brand name as the cetirizine with a “-D” suffix (Zyrtec-D, Virlix-D, etc.)
UK Edition. Click here for US version.
(Cetirizine hydrochloride)
Read all of this leaflet carefully because it contains important information for you.
This medicine is available without prescription. However, you still need to use Cetirizine 10 mg
Tablets carefully to get the best results from it.
In this leaflet:
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Cetirizine hydrochloride is the active ingredient
of Cetirizine 10 mg Tablets.
Cetirizine 10 mg Tablets is an antiallergic
medication.
In adults and children aged 6 year and above,
Cetirizine 10 mg Tablets are indicated
Do not take Cetirizine 10 mg Tablets
You should not take Cetirizine 10 mg Tablets:
Take special care with Cetirizine 10 mg Tablets
If you have kidney problems, please ask your
doctor for advice; if necessary, you may have to
take a lower dose. The new dose will be
determined by your doctor.
If you are an epileptic patient or a patient at risk
of convulsions, you should ask your doctor for
advice.
Taking other medicines
Please tell your doctor or pharmacist if you are
taking or have recently taken any other medicines,
including medicines obtained without a
prescription.
Due to the profile of cetirizine, no interactions with
other drugs are expected.
Taking Cetirizine 10 mg Tablets with food and
drink
Food does not noticeably affect the absorption of
cetirizine.
No interactions having a noticeable impact have
been observed between alcohol (at the blood
level of 0.5 per millilitre corresponding to one
glass of wine) and cetirizine used at the normal
doses. However, as it is the case with all
antihistamines, it is recommended to avoid
consumption of alcohol while taking this medicine.
Pregnancy and breast-feeding
Ask your doctor for advice before taking any
medicine.
As with other drugs, use of Cetirizine 10 mg
Tablets should be avoided by pregnant women.
Accidental use of the drug by a pregnant woman
should not produce any harmful effects on the
foetus. Nevertheless, the administration of the
medicine should be discontinued.
You should not take Cetirizine 10 mg Tablets
during breast-feeding because cetirizine passes
into breast milk.
Driving and using machines
Clinical studies have produced no evidence of
impaired attention, alertness and driving
capabilities after taking Cetirizine 10 mg Tablets
at the recommended dose.
If you intend to drive, operate machinery, or
perform other tasks that need your full attention,
you should not exceed the recommended dose
and you should closely observe your response
to the drug.If you are a sensitive patient, you may
find that the simultaneous use of alcohol or other
nervous depressant agents may additionally affect
your attention and ability to react.
Important information about some of the
ingredients of Cetirizine 10 mg Tablets
Cetirizine 10 mg Tablets contain lactose; if you
have been told by your doctor that you have an
intolerance to some sugars, please contact your
doctor before taking this medicinal product.
Allergy skin test
If you are going to have an allergy skin test stop
taking Cetirizine 10 mg Tablets for three days
before the test.
How and when should you take Cetirizine 10
mg Tablets?
These guidelines apply unless your doctor has
given you different instructions on how to use
Cetirizine 10 mg Tablets.
Please follow these instructions, otherwise Cetirizine
10 mg Tablets may not be fully effective.
Tablets need to be swallowed with a glass of
liquid.
Adults and adolescents above 12 years old:
10 mg once daily as one tablet.
Children between 6 and 12 years old:
5 mg twice daily as half a tablet.
Patients with kidney problems:
Patients with moderate renal impairment are
recommended to take 5 mg once daily as a half
tablet.
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If you feel that the effect of Cetirizine 10 mg
Tablets is too weak or too strong, please consult
your doctor.
If you take more Cetirizine 10 mg Tablets than
you should
If you think you have taken an overdose of
Cetirizine 10 mg Tablets, please inform your doctor.
Your doctor will then decide what measures, if any,
should be taken.
After an overdose, the side effects described
below may occur with increased intensity. Adverse
effects such as confusion, diarrhoea, dizziness,
tiredness, headache, ailing, dilating (widening)
of the pupil, itching, restlessness, sedation,
somnolence, stupor, abnormal rapid heart rate,
tremors and urinary retention have been reported.
If you forget to take Cetirizine 10 mg Tablets
If you forget to take a tablet, take it as soon as
you remember, but wait at least 24 hours before
taking the next tablet. Do not take a double dose
to make up for a forgotten dose.
If you stop taking Cetirizine 10 mg Tablets
If you have any further questions on the use of
this product, ask your doctor or pharmacist.
Like all medicines, Cetirizine 10 mg Tablets can
cause side effects, although not everybody gets
them.
The following side effects have been reported in
post marketing experience. The frequencies are
defined as such: (common: 1 patient out of 100
to less than 1 out of 10, uncommon: 1 out of
1,000 to less than 1 out of 100, rare: 1 out of
10,000 to less than 1 out of 1,000, very rare: less
than 1 out of 10,000, not known: cannot be
estimated from the available data).
If you develop one of the side effects
described above, please inform your doctor.
At the first signs of an allergic
(hypersensitivity) reaction, stop taking
Cetirizine 10 mg Tablets and contact your
doctor immediately. Symptoms of an allergic
(hypersensitivity) reaction include difficulty
breathing, swelling of the face, neck, tongue
or throat. Your doctor will then assess the
severity and decide on any further measures
that may be necessary.
If you think you have any side effects not
mentioned in this leaflet, please inform your
doctor or pharmacist.
Keep out of the reach and sight of children.
Do not use Cetirizine 10 mg Tablets after the
expiry date which is stated on the box and blister.
This medicine does not require any special
storage conditions.
What Cetirizine 10 mg Tablets contain
What Cetirizine 10 mg Tablets look like and
contents of the pack
White, capsule shaped film-coated tablets with
a score on one side.
There are 7, 10 or 30 tablets in a pack.
Not all pack sizes may be marketed.
Marketing Authorization Holder and
Manufacturer:
Dexcel®-Pharma Ltd., 7 Sopwith Way, Drayton
Fields, Daventry, Northamptonshire, NN11 8PB,
UK.
This leaflet was last revised in May 2012.
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.
Medical Disclaimer
Use these dosage charts for infants and children under 12 years old:
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This medication contains an antihistamine. Typically, it is used for itching or for allergic rhinitis. It may also be used to treat urticaria. Its effects can be felt within 1 hour.
This medication is typically used only once a day. However, your doctor or pharmacist may have suggested a different schedule that is more appropriate for you. Generally, it is used only as needed.
Important: Follow the instructions on the label. Do not use more of this product, or more often, than prescribed. This medication may be taken with or without food.
Consuming alcohol may intensify the effect of this product. It is therefore advisable to avoid consuming alcohol or alcohol-containing products while taking this medication.
In addition to its desired action, this medication may cause some side effects, notably:
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Each person may react differently to a treatment. If you think this medication may be causing side effects (including those described here, or others), talk to your doctor or pharmacist. He or she can help you to determine whether or not the medication is the source of the problem.
As with most medications, this product should be stored at room temperature. Store it in a secure location where it will not be exposed to excessive heat, moisture or direct sunlight. Keep it out of reach of young children. Make sure that any leftover portion is disposed of safely.
It is important to tell the health professionals you consult:
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1Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
2Masih Daneshvari Hospital, Darabad, Tehran, Iran
2Masih Daneshvari Hospital, Darabad, Tehran, Iran
3Pediatric Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
1Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
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There are limited numbers of articles, studying combined use of antihistamines. In this study, we compare single therapy of Apo-Cetirizine with a new regimen of intermittent sequential therapy with cetirizine, loratadine and chlorpheniramine in treatment of seasonal allergic rhinitis. This randomized clinical trial was performed between April and September at the peak prevalence of seasonal allergic rhinitis. Fifty-four eligible patients diagnosed clinically to have seasonal allergic rhinitis were randomized in two groups: 24 cases in single therapy arm, received Apo-Cetirizine 10 mg tablet daily and in other arm, 30 patients received sequential regimen of cetirizine 10 mg tablet, loratadine 10 mg tablet and chlorpheniramine 4 mg tablet, one tablet each day. Major Symptom Complex Score (MSCS) and Total Symptom Complex Score (TSCS) of patients were recorded before treatment and after 30 days of treatment in two groups. The average post-treatment MSCS and TSCS in combination therapy group showed better improvement than single therapy group but difference was not statistically significant (p value = 0.053 and p value = 0.104 respectively). Combination therapy regimen was better in improvement of nasal congestion (p value = 0.006). There were no significant difference between two groups in efficacy, side effects and patient’s satisfaction. Combination therapy would be effective on a wide spectrum of symptoms with lower price and theoretically offers lower chance of tolerance and re-appearance of complaints.
Allergic rhinitis is a common disease involving many people in Iran and other countries. The reported prevalence is 10–30 % [1–4]. The disease impairs the quality of life [5, 6] and is associated with recurrent sinusitis, otitis media and recurrent respiratory infections. Allergic rhinitis results in high direct (physician’ visit and drug cost) and indirect (absence from work) costs [7, 8].
Rhinitis is defined based on the presence of two or more of these nasal symptoms: sneezing, rhinorrhea (anterior or posterior), nasal congestion and itching [9]. Allergic rhinitis is one of rhinitis syndromes characterized by a combination of these symptoms especially sneezing and itching of eyes, nose and palate [10]. IgE molecule has a prominent role in pathogenesis of allergic rhinitis. IgE adheres to especial receptors on the surface of mast cells and basophils. Connection of allergen molecule and IgE on the surface of these cells results in degranulation and release of multiple mediators [11]. Histamine is one of these mediators that causes acute symptoms of allergy. Histamine induces mucosal secretion, vascular dilation, increased vascular permeability, tissue edema, itching and sneezing. In some patients, delayed symptoms present 2–6 h after allergen exposure and acute symptoms [12].
Treatment of allergic rhinitis consists of allergen avoidance and medical therapy. Intranasal corticosteroids, systemic or intranasal antihistamines, mast cell stabilizers and drugs active on leukotrienes are in use in the treatment of allergic rhinitis [13].
Evaluation of efficacy of new drugs in the treatment of allergic rhinitis may be performed in two different settings: in a naturalistic environment similar to normal life and condition of patient or in a completely controlled or artificial condition [14].
Oral antihistamines frequently are used as OTC, therefore it is important the physician should be sure the patient receives correct drug in enough dose with minimal side effects.
Antihistamines have been used as single therapy or in combination with intranasal corticosteroids or other oral agents such as decongestants or montelukast in treatment of allergic rhinitis [15–17]. There are a few reports in literature about combined use of antihistamines with each other or especially sequential use of different antihistamines [18]. In this study we evaluate efficacy, side effects and satisfaction of patients and costs of two different antihistamines regimens in treatment of allergic rhinitis. We compare single therapy of antihistamines and a new combined therapy regimen of different antihistamines. We think this new regimen may have lower rates of drug tolerance, unwanted effects and lower cost.
This study was performed as a randomized clinical trial and investigator blinded. We evaluated outpatients referred to otolaryngology clinic of National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of medical sciences, Tehran, Iran that complained of nasal symptoms from April 2008 to September 2008 at the peak of the prevalence of seasonal allergic rhinitis. We selected cases of allergic rhinitis based on history and physical examination. Patients were between 16 and 60 years of age and had rhinitis history compatible with seasonal allergic rhinitis at least for 2 years. Presence of two or more of these symptoms at least for 3 weeks was mandatory for diagnosis of allergic rhinitis: sneezing, rhinorrhea, nasal congestion and itching of nose and eyes. Patients at least should have one of two symptoms of sneezing or itching. Exclusion criteria were: present smoking, any significant anatomical abnormality on physical examination as nasal septal deviation obstructing more than 50 % of cross sectional area, polyp, purulent discharge, history of recurrent epistaxis, history of sinonasal surgery during past 3 months, respiratory infection in past 4 weeks, treatment by intranasal or systemic corticosteroids in past 8 weeks, antihistamines in past 4 weeks, anti-inflammatory drugs in past 2 weeks, systemic or topical decongestants during recent 2 weeks and severe comorbidity such as heart, kidney or liver disease. Breast-feeding, pregnancy or uncertain contraception was additional exclusion criteria in women.
Written informed consent was obtained from eligible patients or parents. Based on a computer generated randomized codes, patients were divided in two groups. In one group, patients received Apo-Cetirizine tablet of APOTEX Company, Canada, 10 mg daily for 30 days. Patients of other group treated with our protocol of a sequential intermittent regimen of Cetirizine-ABIDI 10 mg tablet, Loratadine OSVAH 10 mg tablet and Chlorpheniramine PURSINA 4 mg tablet, one tablet each day, in this order. Dosage of chlorpheniramine that we used in this study was less than its usual dose.
Our study was done in a naturalistic environment. Before treatment, Major Symptom Complex Score (MSCS) and Total Symptom Complex Score (TSCS) of patients were recorded. These parameters were recorded again after treatment. MSCS, a predetermined composite variable, was defined as a sum of the scores of six symptoms: runny nose (average of left and right), sniffles, itchy nose (average of left and right), nose blows, sneezes and watery eyes. The TSCS was composed of the MSC symptoms plus four additional symptoms (itchy eyes/ears, itchy throat, cough and post-nasal drip). Symptoms were rated on a scale ranging from 0 (none = no symptoms whatsoever) to 5 (very severe symptoms = very bothersome and disabling) [19].
Clinician blind to therapeutic regimen performed evaluation of symptoms of patients before and after treatment. Side effects were recorded separately.
We recommended patients to come back in the case of severe or intolerable drug side effects. In this clinical trial, we treated patients with drugs commonly used in allergic rhinitis control, so there was no ethical challenge in performing this study.
Data analyzed by SPSS version 15. Quantitative variables were compared by T test and qualitative variables by χ2 test and p < 0.05 considered significant.
Fifty-four patients had clinical criteria of allergic rhinitis to include in this study. They were 29 male and 25 female. Randomly 24 patients treated in single therapy group of Apo-Cetirizine with mean age of 32.4 ± 9.7 years and 30 patients treated in combined therapy group that their mean age was 36.3 ± 12. There was no significant difference between two groups in gender, age and education level (Tables 1, ,22).
Gender distribution between two treatment groups
There was no difference between groups in gender
Age distribution between two treatment groups
Age distribution was similar in two treatment groups, without significant difference between them
The most common symptoms in single therapy group were: PND (21 cases, 87 %), sneezing (21 cases, 87 %), rhinorrhea (20 cases, 83 %) and aural itching (19 cases, 79 %). The most common symptoms in combination therapy group were: PND (26 cases, 92 %), nasal obstruction (24 cases, 85 %), sneezing (22 cases, 78 %).
The average pre-treatment MSCS was 9 ± 4.1 in single therapy group and 8.5 ± 4.1 in combination therapy group. Difference between two groups was not significant (p value = 0.71).
The average pre-treatment TSCS was 30 ± 12.9 in single therapy group with Apo-Cetirizine and 27.7 ± 15.4 in combination therapy group without significant difference between two (p value = 0.501).
The average post-treatment MSCS was 5.08 ± 4.2 in single therapy group. The difference between pre- and post-treatment average of MSCS in this group was significant (p value = 0.036). The average post-treatment MSCS in combination group was 3.21 ± 2.45, showing significant difference with pre-treatment average (p value = 0.001) (Fig. 1).
MSCS before and after treatment in two groups. MSCS in both groups decreased significantly after treatment
The average TSCS after treatment in single and combination therapy groups was 16.75 ± 12.2 and 11.82 ± 9.25 respectively. Difference with pre-treatment values was significant in both groups (p value = 0.03 and p value = 0.019 respectively) (Fig. 2).
TSCS before and after treatment in two groups. TSCS in both groups decreased significantly after treatment
The average post-treatment MSCS in combination therapy group showed better improvement than single therapy group but this difference was not statistically significant (p value = 0.053).
More improvement of the average post-treatment TSCS was seen in combination therapy group but there was not statistically significant difference between two regimens (p value = 0.104).
Fatigue was the most common side effect of treatment in combination therapy group, we saw in 23 cases or 82.1 % of patients. In single therapy group, 17 cases or 70.8 % of patients complained of this problem. Difference between two groups was insignificant (p value = 0.67). There was also no significant difference between two treatment groups in prevalence of dryness of mouth, dryness of nose and sleepiness (Fig. 3).
Side effects of treatment in two groups. There was no significant difference between groups in frequency of important side effects
In single and combination therapy groups, 13 patients (54.2 %) and 22 patients (78.6 %) respectively were satisfied by their treatment and difference between two regimens was not significant.
Currently prevalence of allergic rhinitis is increasing [20, 21]. Choosing correct treatment with minimal side effects still is a challenge for physicians. Besides intranasal corticosteroids, second generation antihistamines have an outstanding role in treatment of allergic rhinitis [22]. They are more effective and have fewer side effects in comparison with first generation antihistamines. Physicians should consider two points in prescribing antihistamines. First, symptoms are not completely similar in all of patients and occurrence and severity of a certain symptom may be different among patients. Second, spectrum of therapeutic and also unwanted effects of antihistamines are different and the physician has a critical role in choosing drug because no H1 receptor antagonist has important advantage over another [17, 22].
Because of lack of an ideal antihistamine drug covering all symptoms of allergic rhinitis with acceptable side effects, researchers have used these agents in combination with other family of drugs. Combination of these drugs with oral decongestants is an example. Nasal congestion is not completely relieved by most antihistamines so decongestants are suitable candidates for combination therapy [17]. There is also suggestion for combined use of first and second-generation antihistamines for better control of diurnal and nocturnal symptoms [17, 18, 23].
After search of PubMed and MEDLINE databases, we did not find any study similar to our trial of sequential intermittent treatment with first and second-generation antihistamines. We supposed that this regimen would be effective on a wide spectrum of symptoms with lower chance of tolerance, side effects, re-appearance of complaints and lower price. In contrast to usual dose of chlorpheniramine, we prescribed it once a day and sleepiness was not more common in combined therapy group. Because of chronic nature of the disease and dependence of symptoms to drug, patients have to use medications for long times, so economic burden and price of treatment especially in developing countries should be considered. Though tolerance to antihistamines has not been proved, but it may be possible especially in long-term use of these drugs [24]. We think this strategy can lower the chance of probable drug tolerance.
In our study there was no significant difference in efficacy, side effects and patient’s satisfaction between single therapy group with Apo-Cetirizine and sequential intermittent combination of cetirizine, loratadine and chlorpheniramine. Price of 1-month course of single Apo-Cetirizine treatment and combination therapy is 60,000 and 8,000 Rials respectively. This difference will be prominent in long-term period. If we imagine a 10 % prevalence of allergic rhinitis in IRAN, nearly 7,000,000 of population may need treatment. On the other hand, constant access to imported drugs may be a problem especially in some areas.
In most studies, antihistamines have had variable effects on nasal congestion and many of them cannot relieve this symptom [17]. In this study, there was no significant difference in nasal congestion prevalence between two arms of therapy before treatment. This was 24 (85 %) in combination group and 18 (75 %) in single therapy group. After 1-month therapy, 15 patients in each group or 53 % of combination treatment and 62.5 % in single therapy still complained of nasal congestion. There was significant difference between groups in nasal congestion (p value = 0.006). So combination therapy was more effective in treating nasal congestion.
apo cetirizine high
Different response of various symptoms of allergic rhinitis to treatment is another interesting issue. In combination treatment group, sneezing and aural fullness showed the best and the worst improvement respectively. In single therapy group, sneezing and aural itching were more responsive and epiphora and itching of eyes were poor responsive to treatment. So we can conclude every antihistamine regimen is more effective on certain types of symptoms and exclusive recommendation of one drug as the best choice in every case is not correct.
In previous studies, various side effects of antihistamines have been indicated. But nasal dryness, which may have physiological implications, has been forgotten. In this study, 64.3 % of combination therapy group and 62.5 % of patients of single therapy group showed nasal dryness after treatment. There was no significant difference between two groups. This necessitates more research to resolve the problem.
It may seem impractical to use this regimen by patients, but if other studies confirm our results, this problem can be resolved by modification in package of drug to help the patient to receive correct antihistamine in correct day.
Results of our study showed no significant difference between two treatment groups, but because of novelty of combining different types of antihistamines in allergic rhinitis, more studies with more definite diagnostic criteria are required. Though this study with its small sample size, gives a promising prospect in treating seasonal allergic rhinitis with antihistamines.
Authors declare no conflict of interest.
Ali Safavi Naini, Phone: +9821-27122610, Email: moc.liamg@0002ivafasila.
Jahangir Ghorbani, Phone: +9821-27122610, Email: moc.liamg@inabrohgjj.
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