Claritin D (Loratadine and Pseudoephedrine) - Uses, Dose, Brands

Claritin D contains Loratadine and Pseudoephedrine. Loratadine is an antiallergic drug (antihistamine). Pseudoephedrine is a decongestant and sympathomimetic.

Loratadine and Pseudoephedrine (Claritin D) Uses:

  • Cold and allergic symptoms:

    • It is used to temporarily relieve sinusitis, hay fever, allergic rhinitis, runny nose, itching, throat irritation, watery eyes, and other allergy symptoms of the upper respiratory tract. It is also indicated for the temporary treatment of nasal and sinus congestion.

Loratadine and Pseudoephedrine (Claritin D) Dose in Adults:

Loratadine and Pseudoephedrine (Claritin D) Dose in the treatment of Cold and allergic symptoms:

  • Loratadine 5 mg/ pseudoephedrine 120 mg per tablet:

    • Two tablets per day, taken every 12 hours.
    • Two pills per day is the maximum dosage.
  • Loratadine 10 mg/ pseudoephedrine 240 mg per tablet:

    • once day, one tablet
    • One tablet per day is the maximum dose.

Loratadine and Pseudoephedrine (Claritin D) Dose in Children:

Loratadine and Pseudoephedrine (Claritin D) Dose in the treatment of Seasonal allergic rhinitis and as a nasal decongestant: 

  • Children ≥12 years and Adolescents:

    • 12-hour formulation (loratadine 5 mg and pseudoephedrine 120 mg):

      • One tablet twice daily, administered orally every 12 hours.
    • 24-hour formulation (loratadine 10 mg and pseudoephedrine 240 mg):

      • One tablet once a day.

Dose in Pregnancy & lactation


Dose in Kidney Disease:

  • It should be used with caution in patients with kidney disease.
  • However, Dosage adjustments have not been provided in the manufacturer's labeling.

Dose in Liver disease:

  • It should be used with caution in patients with liver disease.
  • However, Dosage adjustments have not been provided in the manufacturer's labeling.

Side effects of Claritin D:

See side effects of loratadine. See side effects of Pseudoephedrine.


Contraindications to Loratadine and Pseudoephedrine (Claritin D):

  • Allergy to pseudoephedrine, loratadine or any other component of the formulation
  • MAOI therapy can be completed within the first 14 days.
  • Patients suffering from severe hypertension or coronary disease

Warnings and precautions

  • Cardiovascular disease

    • Patients with hypertension, angina, ischemic heart disease, or other cardiovascular conditions should not use it.
  • Diabetes:

    • Patients with diabetes mellitus should not take the drug.
  • Hepatic impairment

    • Patients suffering from liver disease should be cautious when taking the drug.
  • Glaucoma/increased intraocular pressure

    • Patients with glaucoma and those with elevated intraocular pressure should use it with caution.
  • Prostatic hyperplasia/urinary block:

    • Patients suffering from genitourinary obstruction or prostatic hyperplasia must be cautious when taking the drug.
  • Renal impairment

    • Patients with impaired kidney function should not use it.
  • Thyroid dysfunction:

    • Hyperthyroid patients should be cautious about taking the drug.

Loratadine and pseudoephedrine: Drug Interaction

Risk Factor C (Monitor therapy)

Acetylcholinesterase Inhibitors

May diminish the therapeutic effect of Anticholinergic Agents. Anticholinergic Agents may diminish the therapeutic effect of Acetylcholinesterase Inhibitors.

Alcohol (Ethyl)

Alcohol's CNS depressing effect may be amplified by CNS depressants (Ethyl).

Alizapride

CNS depressants may have an enhanced CNS depressant impact.

Alkalinizing Agents

May raise the serum level of beta- and alpha-agonists (IndirectActing).

Alpha1-Blockers

May lessen the vasoconstriction caused by alpha/beta agonists. The vasodilation caused by Alpha1-Blocker may also be resisted by Alpha-/Beta-Agonists.

Amantadine

May strengthen an anticholinergic agent's anticholinergic action.

Amezinium

Antihistamines may intensify Amezinium's stimulant effects.

Amphetamines

May lessen antihistamines' sedative effects.

Anticholinergic Agents

Other anticholinergic agents' negative or hazardous effects might be amplified.

AtoMOXetine

Could make sympathomimetics' hypertensive effects stronger. The tachycardic impact of sympathomimetics may be increased by atoMOXetine.

Betahistine

Antihistamines may diminish the therapeutic effect of Betahistine.

Botulinum Toxin-Containing Products

May enhance the anticholinergic effect of Anticholinergic Agents.

Brexanolone

CNS Depressants may enhance the CNS depressant effect of Brexanolone.

Brimonidine (Topical)

May enhance the CNS depressant effect of CNS Depressants.

Bromopride

May enhance the CNS depressant effect of CNS Depressants.

Cannabidiol

May enhance the CNS depressant effect of CNS Depressants.

Cannabis

May enhance the CNS depressant effect of CNS Depressants.

Carbonic Anhydrase Inhibitors

May raise the serum level of beta- and alpha-agonists (Indirect-Acting).

Chloral Betaine

May worsen anticholinergic agents' harmful or hazardous effects.

Chloroprocaine

Alpha-/Beta-Agonists' hypertensive effects might be amplified.

Chlorphenesin Carbamate

May enhance the adverse/toxic effect of CNS Depressants.

CNS Depressants

May enhance the adverse/toxic effect of other CNS Depressants.

Dimethindene (Topical)

May enhance the CNS depressant effect of CNS Depressants.

Doxofylline

Sympathomimetics may enhance the adverse/toxic effect of Doxofylline.

Doxylamine

May enhance the CNS depressant effect of CNS Depressants. Management: The manufacturer of Diclegis (doxylamine/pyridoxine), intended for use in pregnancy, specifically states that use with other CNS depressants is not recommended.

Dronabinol

May enhance the CNS depressant effect of CNS Depressants.

Erdafitinib

May increase the serum concentration of P-glycoprotein/ABCB1 Substrates.

Esketamine

CNS depressants may have an enhanced CNS depressant impact.

Gastrointestinal Agents (Prokinetic)

Anticholinergic Agents may diminish the therapeutic effect of Gastrointestinal Agents (Prokinetic).

Glucagon

Anticholinergic Agents may enhance the adverse/toxic effect of Glucagon. Specifically, the risk of gastrointestinal adverse effects may be increased.

Guanethidine

May enhance the arrhythmogenic effect of Sympathomimetics. Guanethidine may enhance the hypertensive effect of Sympathomimetics.

HydrOXYzine

May enhance the CNS depressant effect of CNS Depressants.

Itopride

Anticholinergic Agents may diminish the therapeutic effect of Itopride.

Kava Kava

May enhance the adverse/toxic effect of CNS Depressants.

Lofexidine

May enhance the CNS depressant effect of CNS Depressants. Management: Drugs listed as exceptions to this monograph are discussed in further detail in separate drug interaction monographs.

Lumacaftor

May lower the level of P-glycoprotein/ABCB1 Substrates in the serum. The serum concentration of P-glycoprotein/ABCB1 Substrates may rise when using lumacaftor.

Magnesium Sulfate

CNS depressants may have an enhanced CNS depressant impact.

MetyroSINE

The sedative effects of metyroSINE may be strengthened by CNS depressants.

Mianserin

May strengthen an anticholinergic agent's anticholinergic action.

Minocycline (Systemic)

CNS depressants may have an enhanced CNS depressant impact.

Mirabegron

Anticholinergic drugs may make Mirabegron's harmful or hazardous effects worse.

Nabilone

CNS depressants may have an enhanced CNS depressant impact.

Nitroglycerin

Nitroglycerin absorption may be decreased by anticholinergic agents. Anticholinergic medications specifically have the potential to impede or prevent the absorption of nitroglycerin by reducing the breakdown of sublingual nitroglycerin pills.

P-glycoprotein/ABCB1 Inducers

May lower the level of Pglycoprotein/ABCB1 Substrates in the serum. P-glycoprotein inducers may also further restrict the distribution of p-glycoprotein substrates to particular cells, tissues, and organs that have high levels of p-glycoprotein (e.g., brain, T-lymphocytes, testes, etc.).

P-glycoprotein/ABCB1 Inhibitors

Pglycoprotein/ABCB1 Substrates serum levels can rise. Additionally, p-glycoprotein inhibitors may improve the distribution of pglycoprotein substrates to particular cells, tissues, and organs where high levels of p-glycoprotein are present (e.g., brain, T-lymphocytes, testes, etc.).

Piribedil

Piribedil's CNS depressing effects may be enhanced by other CNS depressants.

Pramipexole

CNS Depressants may enhance the sedative effect of Pramipexole.

Ramosetron

Anticholinergic Agents may enhance the constipating effect of Ramosetron.

Ranolazine

May increase the serum concentration of P-glycoprotein/ABCB1 Substrates.

ROPINIRole

CNS Depressants may enhance the sedative effect of ROPINIRole.

Rotigotine

CNS Depressants may enhance the sedative effect of Rotigotine.

Rufinamide

May enhance the adverse/toxic effect of CNS Depressants. Specifically, sleepiness and dizziness may be enhanced.

Selective Serotonin Reuptake Inhibitors

CNS Depressants may enhance the adverse/toxic effect of Selective Serotonin Reuptake Inhibitors. Specifically, the risk of psychomotor impairment may be enhanced.

Solriamfetol

Sympathomimetics may intensify Solriamfetol's hypertensive effects.

Spironolactone

May lessen the vasoconstrictor effects of alpha/beta antagonists

Sympathomimetics

Could intensify the hazardous or harmful effects of other sympathomimetics.

Tedizolid

Could make sympathomimetics' hypertensive effects stronger. The tachycardic impact of sympathomimetics may be increased by tedizolid.

Tetrahydrocannabinol

May enhance the CNS depressant effect of CNS Depressants.

Tetrahydrocannabinol and Cannabidiol

May enhance the CNS depressant effect of CNS Depressants.

Thiazide and Thiazide-Like Diuretics

Anticholinergic Agents may increase the serum concentration of Thiazide and Thiazide-Like Diuretics.

Topiramate

Anticholinergic Agents may enhance the adverse/toxic effect of Topiramate.

Trimeprazine

May enhance the CNS depressant effect of CNS Depressants.

Urinary Acidifying Agents

May decrease the serum concentration of Alpha-/Beta-Agonists (Indirect-Acting).

Risk Factor D (Consider therapy modification)

Amiodarone

May raise the level of loratadine in the serum. Management: When possible, look into alternatives to loratadine due to reported QT interval prolongation and Torsades de Pointes with this combination.

Benzylpenicilloyl Polylysine

Antihistamines may reduce Benzylpenicilloyl Polylysine's ability to diagnose. Management: Delay testing until systemic antihistaminic effects have subsided and discontinue systemic H1 antagonists for benzylpenicilloyl-polylysine skin testing. To determine whether permanent antihistaminic effects exist, a histamine skin test may be utilised.

Benzylpenicilloyl Polylysine

Alpha-/Beta-Agonists may lessen the Benzylpenicilloyl Polylysine's ability to diagnose. Management: To evaluate a patient's capacity to mount a wheal and flare response, consider using a histamine skin test as a positive control.

Blonanserin

CNS Depressants may enhance the CNS depressant effect of Blonanserin.

Buprenorphine

CNS Depressants may enhance the CNS depressant effect of Buprenorphine. Management: Consider reduced doses of other CNS depressants, and avoiding such drugs in patients at high risk of buprenorphine overuse/self-injection. Initiate buprenorphine at lower doses in patients already receiving CNS depressants.

Chlormethiazole

May enhance the CNS depressant effect of CNS Depressants. Management: Monitor closely for evidence of excessive CNS depression. The chlormethiazole labeling states that an appropriately reduced dose should be used if such a combination must be used.

Cocaine (Topical)

Could make sympathomimetics' hypertensive effects stronger. Management: Whenever possible, look at alternatives to using this combo. When used concurrently, keep a close eye out for noticeably elevated blood pressure or heart rate as well as any signs of myocardial ischemia.

Droperidol

CNS depressants may have an enhanced CNS depressant impact. Consider lowering the dosage of droperidol or other CNS drugs (such as opioids or barbiturates) when they are used concurrently. In separate drug interaction monographs, exceptions to this monograph are covered in more detail.

Flunitrazepam

CNS Depressants may enhance the CNS depressant effect of Flunitrazepam.

Hyaluronidase

Antihistamines may diminish the therapeutic effect of Hyaluronidase. Management: Patients receiving antihistamines (particularly at larger doses) may not experience the desired clinical response to standard doses of hyaluronidase. Larger doses of hyaluronidase may be required.

HYDROcodone

CNS Depressants may enhance the CNS depressant effect of HYDROcodone. Management: Avoid concomitant use of hydrocodone and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug.

Lemborexant

May enhance the CNS depressant effect of CNS Depressants. Management: Dosage adjustments of lemborexant and of concomitant CNS depressants may be necessary when administered together because of potentially additive CNS depressant effects. Close monitoring for CNS depressant effects is necessary.

Linezolid

May enhance the hypertensive effect of Sympathomimetics. Management: Reduce initial doses of sympathomimetic agents, and closely monitor for enhanced pressor response, in patients receiving linezolid. Specific dose adjustment recommendations are not presently available.

Methotrimeprazine

CNS Depressants may enhance the CNS depressant effect of Methotrimeprazine. Methotrimeprazine may enhance the CNS depressant effect of CNS Depressants. Management: Reduce adult dose of CNS depressant agents by 50% with initiation of concomitant methotrimeprazine therapy. Further CNS depressant dosage adjustments should be initiated only after clinically effective methotrimeprazine dose is established.

Opioid Agonists

CNS Depressants may enhance the CNS depressant effect of Opioid Agonists. Management: Avoid concomitant use of opioid agonists and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug.

OxyCODONE

CNS Depressants may enhance the CNS depressant effect of OxyCODONE. Management: Avoid concomitant use of oxycodone and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug.

Perampanel

May enhance the CNS depressant effect of CNS Depressants. Management: Patients taking perampanel with any other drug that has CNS depressant activities should avoid complex and high-risk activities, particularly those such as driving that require alertness and coordination, until they have experience using the combination.

Pramlintide

May enhance the anticholinergic effect of Anticholinergic Agents. These effects are specific to the GI tract.

Secretin

Anticholinergic Agents may diminish the therapeutic effect of Secretin. Management: Avoid concomitant use of anticholinergic agents and secretin. Discontinue anticholinergic agents at least 5 half-lives prior to administration of secretin.

Serotonin/Norepinephrine Reuptake Inhibitors

Alpha-/Beta-Agonists' tachycardic impact may be boosted. The vasopressor impact of alpha/beta agonists may be enhanced by serotonin/norepinephrine reuptake inhibitors.

Sodium Oxybate

May enhance the CNS depressant effect of CNS Depressants. Management: Consider alternatives to combined use. When combined use is needed, consider minimizing doses of one or more drugs. Use of sodium oxybate with alcohol or sedative hypnotics is contraindicated.

Suvorexant

CNS Depressants may enhance the CNS depressant effect of Suvorexant. Management: Dose reduction of suvorexant and/or any other CNS depressant may be necessary. Use of suvorexant with alcohol is not recommended, and the use of suvorexant with any other drug to treat insomnia is not recommended.

Tapentadol

May enhance the CNS depressant effect of CNS Depressants. Management: Avoid concomitant use of tapentadol and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug.

Tricyclic Antidepressants

May enhance the vasopressor effect of Alpha-/Beta-Agonists. Management: Avoid, if possible, the use of alpha-/beta-agonists in patients receiving tricyclic antidepressants. If combined, monitor for evidence of increased pressor effects and consider reductions in initial dosages of the alpha-/beta-agonist.

Zolpidem

CNS Depressants may enhance the CNS depressant effect of Zolpidem. Management: Reduce the Intermezzo brand sublingual zolpidem adult dose to 1.75 mg for men who are also receiving other CNS depressants. No such dose change is recommended for women. Avoid use with other CNS depressants at bedtime; avoid use with alcohol.

Risk Factor X (Avoid combination)

Aclidinium

May enhance the anticholinergic effect of Anticholinergic Agents.

Azelastine (Nasal)

CNS Depressants may enhance the CNS depressant effect of Azelastine (Nasal).

Bromperidol

May enhance the CNS depressant effect of CNS Depressants.

Cimetropium

Anticholinergic Agents may enhance the anticholinergic effect of Cimetropium.

Eluxadoline

Eluxadoline's constipating effects may be enhanced by anticholinergic drugs.

Ergot Derivatives

Alpha-/Beta-Agonists' hypertensive effects might be amplified. Alpha-/Beta-Agonists' vasoconstrictive effects may be strengthened by ergot derivatives. Exceptions: Mesylates of ergoloid; nicergoline.

Glycopyrrolate (Oral Inhalation)

Anticholinergic Agents may enhance the anticholinergic effect of Glycopyrrolate (Oral Inhalation).

Glycopyrronium (Topical)

May enhance the anticholinergic effect of Anticholinergic Agents.

Iobenguane Radiopharmaceutical Products

Alpha-/Beta-Agonists (Indirect-Acting) may diminish the therapeutic effect of Iobenguane Radiopharmaceutical Products. Management: Discontinue all drugs that may inhibit or interfere with catecholamine transport or uptake for at least 5 biological half-lives before iobenguane administration. Do not administer these drugs until at least 7 days after each iobenguane dose.

Ipratropium (Oral Inhalation)

May enhance the anticholinergic effect of Anticholinergic Agents.

Lasmiditan

May increase the serum concentration of P-glycoprotein/ABCB1 Substrates.

Levosulpiride

Levosulpiride's therapeutic impact may be diminished by anticholinergic medications.

Monoamine Oxidase Inhibitors

Might make alpha-/beta-agonists' hypertensive effects more pronounced (Indirect-Acting). While linezolid is expected to interact via this mechanism, management recommendations differ from other monoamine oxidase inhibitors. Refer to linezolid specific monographs for details. Exceptions: Linezolid.

Orphenadrine

CNS Depressants may enhance the CNS depressant effect of Orphenadrine.

Oxatomide

May enhance the anticholinergic effect of Anticholinergic Agents.

Oxomemazine

May enhance the CNS depressant effect of CNS Depressants.

Paraldehyde

CNS Depressants may enhance the CNS depressant effect of Paraldehyde.

Pitolisant

Antihistamines may diminish the therapeutic effect of Pitolisant.

Potassium Chloride

Anticholinergic Agents may enhance the ulcerogenic effect of Potassium Chloride. Management: Patients on drugs with substantial anticholinergic effects should avoid using any solid oral dosage form of potassium chloride.

Potassium Citrate

Anticholinergic Agents may enhance the ulcerogenic effect of Potassium Citrate.

Revefenacin

Anticholinergic Agents may enhance the anticholinergic effect of Revefenacin.

Thalidomide

CNS Depressants may enhance the CNS depressant effect of Thalidomide.

Tiotropium

Anticholinergic Agents may enhance the anticholinergic effect of Tiotropium.

Umeclidinium

May enhance the anticholinergic effect of Anticholinergic Agents.

 

Monitoring parameters:

None mentioned.


How to administer Loratadine and Pseudoephedrine (Claritin D)?

It is administered orally. The tablets should not be divided, chewed, crushed, or dissolved.


Mechanism of action of Loratadine and Pseudoephedrine (Claritin D):

Claritin D includes Loratadine (and Pseudoephedrine)

Loratadine MOA and Pharmacology

loratadine has specific peripheral histamine H-1 receptor antagonistic effects.

Notice:Children aged 2-12 years have a similar pharmacokinetic profile to adults.

The onset of action:

  • 1-3 hours.

Peak effect:

  • 8-12 hours.

Duration of action:

  • More than 24 hours.

Absorption:

  • It is rapidly absorbed;
  • Food increases total bioavailability (AUC) by 40% to 48%.

Distribution:

  • A tricyclic antihistamine with a long half-life,
  • no appreciable entry into CNS.

Protein binding:

  • 97% to 99% (loratadine),
  • 73% to 76% (metabolite).

Metabolism:

  • It is extensively metabolized in the liver via CYP2D6 and 3A4 to an active metabolite (des-carboethoxy loratadine).

Half-life elimination:

  • 8.4 hours (range: 3 to 20 hours) (loratadine),
  • 28 hours (range: 8.8 to 92 hours) (metabolite).
  • hepatic impairment:
    • 24 hours (loratadine),
    • 37 hours (metabolite).

Time to peak serum concentration:

  • Loratadine: 1.3 hours,
  • 2.3 hours (metabolite).

Excretion:

  • Urine (40%) and feces (40%) as metabolites.

    Pseudoephedrine MOA and Pharmacology:

It binds predominantly to H-1 receptors in the peripheral nervous system.

The onset of action:

  • Decongestant: Oral: 30 minutes

Peak effect:

  • Decongestant: Oral: ~1-2 hours

Duration:

  • Immediate release tablet: 3-8 hours

Absorption:

  • Rapid

Metabolism:

  • It is metabolized via n-demethylation to convert into its active form nor-pseudoephedrine
  • Hepatic (<1%).

Half-life elimination:

  • Variable according to urine pH and flow rate;
    • alkaline urine decreases renal elimination of pseudoephedrine.
  • Children: ~3 hours (urine pH ~6.5)
  • Adults: 9-16 hours (pH 8); 3-6 hours (pH 5)

Time to peak:

  • Children (immediate-release) ~2 hours
  • Adults (immediate-release): 1-3 hours (dose-dependent)

Excretion:

  • Urine (43% to 96% as unchanged drug, 1% to 6% as active norpseudoephedrine);
  • The excretion depends on urine pH and flow rate;
    • alkaline urine decreases renal elimination of pseudoephedrine.

International Brand Names of Loratadine and pseudoephedrine:

  • Alavert Allergy and Sinus
  • Allergy Relief-D
  • Claritin-D 12 Hour Allergy & Congestion
  • Claritin-D 24 Hour Allergy & Congestion
  • Loratadine-D 12 Hour
  • Loratadine-D 24 Hour
  • Chlor-Tripolon ND
  • Claritin Extra
  • Claritin Liberator
  • Airet
  • Aldisa-SR
  • Alergicol LP
  • Allerpid
  • Bonalerg - D
  • Carinox
  • Clariflu
  • Clarifriol
  • Clarinase
  • Clarinase 24 Hour Extended Release
  • Clarinase 24 Hour Relief
  • Clarinase Repetabs
  • ClaritineD
  • Clarityn-D 12 hour Repetabs
  • Clarityn-D 24 hour Repetabs
  • Clarityne
  • Clarityne D Repetabs
  • Clarityne Plus
  • Clarityne-D
  • Coderin ER
  • Cronase
  • De-Cold
  • Defonase
  • Dimegan D
  • Gralddep
  • Larotin D
  • Lertamine D
  • Lertamine Repetabs
  • Lodin Plus
  • Lorfast-D
  • Lorimox
  • Lorinase
  • Minlife-P
  • Narine
  • Rhilor D
  • Rhinos SR
  • Sensibit
  • Sudo PLUS
  • Theraflu
  • Tricel-D
  • Zoratadine-P

Loratadine and pseudoephedrine Brand Names in Pakistan:

Loratadine and pseudoephedrine Tablets 5 mg

Rhilor D Pharmatec Pakistan (Pvt) Ltd.

 

Loratadine and pseudoephedrine Tablets SR 5 mg

Clarinase Repetabs ICI Pakistan Ltd.