Telfast D (Fexofenadine and pseudoephedrine) - Uses, Dose, Brands

Fexofenadine and pseudoephedrine (Telfast D) are available as a single combination pill. It is used in the treatment of allergic symptoms primarily allergic rhinitis by acting as a decongestant and antihistamine.

Fexofenadine and pseudoephedrine Uses:

  • Seasonal allergic rhinitis:

    • It is approved for the treatment of allergic rhinitis symptoms in people 12 years of age and older, including flu-like symptoms, sneezing, rhinitis, itching, red and watery eyes, nasal congestion, and an itchy throat.

Fexofenadine and pseudoephedrine (Telfast D) Dose in Adults

Fexofenadine and pseudoephedrine (Telfast D) Dose in the treatment of Seasonal allergic rhinitis: Oral:

  • Fexofenadine 60 mg/pseudoephedrine 120 mg 12 Hour:
    • One tablet two times a day.
  • Fexofenadine 180 mg/pseudoephedrine 240 mg 24 Hour:
    • One tablet once a day.

Dose in Children:

Refer to adult dosing.

Pregnancy Risk Factor C

  • Animal reproduction studies have shown adverse drug reactions and fetal outcomes.
  • Talk to individual agents.

Use of pseudoephedrine and fexofenadine during breastfeeding

  • Breast milk contains pseudoephedrine. It is unknown if breastmilk contains fexofenadine.
  • Check with individual agents. The manufacturer suggests that breastfeeding mothers use the drug with caution.

Dose in Kidney Disease:

  • Fexofenadine 60 mg/pseudoephedrine 120 mg 12 Hour:

    • CrCl ≥80 mL/minute:
      • Adjustment in the dose is not necessary.
    • CrCl <80 mL/minute:
      • Initial: One tablet once a day.
  • Fexofenadine 180 mg/pseudoephedrine 240 mg 24 Hour:

    • Avoid its use.

Dose in Liver disease:

In the manufacturer’s labeling, dose adjustments have not been provided.

Side effects of Fexofenadine and pseudoephedrine (Telfast D):

See individual agents (fexofenadine and pseudoephedrine)

Contraindications to Fexofenadine and pseudoephedrine (Telfast D):

  • Allergy to pseudoephedrine, fexofenadine and other drugs that stimulate your sympathetic system, or any other drug of similar structure or any component of this formulation
  • Glaucoma with narrow angles
  • Urinary retention
  • Use within 14 days or concomitantly with MAO inhibitor treatment
  • Coronary heart disease and severe uncontrolled hypertension

Warnings and precautions

  • Cardiovascular disease

    • It is not recommended for severe hypertension or coronary artery disease.
    • Patients with heart disease, including those with moderate to severe hypertension and those with ischemic heart diseases, should be cautious.
  • Diabetes:

    • Diabetes mellitus patients should be cautious when using the drug.
  • Increased intraocular pressure

    • Patients with glaucoma or elevated intraocular pressure should be cautious.
  • Prostatic hyperplasia/urinary block:

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

    • Patients with impaired renal function should be cautious when taking the drug.
  • Seizure disorder:

    • It can stimulate the central nervous system. Patients with epilepsy or seizure disorders should be cautious when using the drug.
  • Thyroid dysfunction:

    • Patients suffering from thyroid dysfunction should be cautious about taking the drug.

Fexofenadine 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

May enhance the hypertensive effect of Sympathomimetics. AtoMOXetine may enhance the tachycardic effect of Sympathomimetics.

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 increase the serum concentration of Alpha-/Beta-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.

Eltrombopag

May increase the serum concentration of OATP1B1/1B3 (SLCO1B1/1B3) Substrates.

Erdafitinib

P-glycoprotein/ABCB1 Substrates serum levels can rise.

Erythromycin (Systemic)

Fexofenadine serum concentration can rise

Esketamine

CNS depressants may have an enhanced CNS depressant impact.

Gastrointestinal Agents (Prokinetic)

The therapeutic benefit of gastrointestinal agents may be diminished by anticholinergic agents (Prokinetic).

Gemfibrozil

May raise the level of OATP1B1/1B3 (SLCO1B1/1B3) Substrates in the serum.Agents indicated as exceptions should be examined in separate drug interaction monographs.

Glucagon

Anticholinergic drugs may make glucagon's harmful or toxic effects worse. Particularly, there may be a higher chance of unfavourable gastrointestinal consequences.

Grapefruit Juice

Fexofenadine's serum concentration can drop.

Guanethidine

Could make sympathomimetics more arrhythmogenic. Guanethidine might make sympathomimetic drugs more hypertensive.

HydrOXYzine

CNS depressants may have an enhanced CNS depressant impact.

Itopride

Itopride's therapeutic impact may be diminished by anticholinergic drugs.

Itraconazole

Fexofenadine serum concentration can rise.

Kava Kava

CNS depressants' harmful or toxic effects could be increased.

Ketoconazole (Systemic)

Fexofenadine serum concentration can rise.

Lofexidine

CNS depressants may have an enhanced CNS depressant impact. Management: Separate drug interaction monographs go into further detail about the medications indicated as exceptions to this book.

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

CNS depressants may have an enhanced CNS depressant impact.

Mirabegron

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

Mirtazapine

The CNS depressing action of mirtazapine may be enhanced by CNS depressants.

Nabilone

CNS depressants may have an enhanced CNS depressant impact.

Nitroglycerin

Nitroglycerin absorption may be decreased by anticholinergic agents.

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.

Pitolisant

Pitolisant's therapeutic effects may be lessened by antihistamines.

Pramipexole

The sedative effects of pramipexole might be enhanced by CNS depressants.

Ramosetron

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

Ranolazine

P-glycoprotein/ABCB1 Substrates serum levels can rise.

RifAMPin

Fexofenadine's serum concentration can drop. Fexofenadine's serum levels may rise in response to RifAMPin.

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 enhance the hypertensive effect of Solriamfetol.

Spironolactone

May diminish the vasoconstricting effect of Alpha-/Beta-Agonists.

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.

Teriflunomide

May raise the level of OATP1B1/1B3 (SLCO1B1/1B3) Substrates in the serum.

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).

Verapamil

Fexofenadine serum concentration can rise.

Risk Factor D (Consider therapy modification)

Antacids

Fexofenadine's serum concentration can drop. Administration of fexofenadine and antacids containing aluminium or magnesium should be separated. Calcium carbonate, magnesium, and sodium bicarbonate are exceptions.

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 patches (Butrans brand) at 5 mcg/hr in adults when used with other 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)

May enhance the hypertensive effect of Sympathomimetics. Management: Consider alternatives to use of this combination when possible. Monitor closely for substantially increased blood pressure or heart rate and for any evidence of myocardial ischemia with concurrent use.

Droperidol

May enhance the CNS depressant effect of CNS Depressants. Management: Consider dose reductions of droperidol or of other CNS agents (eg, opioids, barbiturates) with concomitant use. Exceptions to this monograph are discussed in further detail in separate drug interaction monographs.

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.

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.

Tolvaptan

May increase the serum concentration of OATP1B1/1B3 (SLCO1B1/1B3) Substrates.

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

Anticholinergic Agents may enhance the constipating effect of Eluxadoline.

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)

The anticholinergic effect of glycopyrrolate may be enhanced by anticholinergic agents (Oral Inhalation).

Glycopyrronium (Topical)

May strengthen an anticholinergic agent's anticholinergic action.

Iobenguane Radiopharmaceutical Products

Iobenguane radiopharmaceutical products' therapeutic effects may be lessened by alpha-/beta-agonists (indirect-acting). Treatment: Before administering iobenguane, stop taking any medications that could impede or interfere with catecholamine transport or uptake for at least five biological half-lives. After each dose of iobenguane, wait at least 7 days before administering these medications.

Ipratropium (Oral Inhalation)

May enhance the anticholinergic effect of Anticholinergic Agents.

Levosulpiride

Anticholinergic Agents may diminish the therapeutic effect of Levosulpiride.

Monoamine Oxidase Inhibitors

Might make alpha-/beta-agonists' hypertensive effects more pronounced (Indirect-Acting). Although this is the expected mode of action for linezolid, management guidelines are different from those for other monoamine oxidase inhibitors. Details can be found in linezolid-specific monographs. Exceptions: Tedizolid; 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.

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:

  • Monitor the response to therapy, heart rate, and blood pressure.
  • Closed monitoring may be required in patients with angina and ischemic heart disease.

How to administer Fexofenadine and pseudoephedrine?

Administer the tablets on an empty stomach as a whole without crushing or chewing them. Avoid taking the drug with food

Mechanism of action of Fexofenadine and pseudoephedrine (Telfast D):

Fexofenadine

  • It affects the digestive system, blood vessels, and respiratory system's H1 receptors.

Pseudoephedrine:

  • It acts directly on alpha-adrenergic receptors, causing vasoconstriction in the nasal and respiratory mucosa.
  • It also causes dilation of the bronchial smooth muscle beta-adrenergic receptors.

Talk to individual agents.

International Brand Names of Fexofenadine and pseudoephedrine:

  • Allegra-D 12 Hour
  • Allegra-D 24 Hour
  • Allegra-D
  • Alcreas D
  • Alerfedine D
  • Alexia D
  • Alexia-D
  • Allegra D
  • Allegra-D
  • Allexofedrin D
  • Altiva-D
  • Dellegra
  • Dinafex Plus
  • Fenofex
  • Fexet-d
  • Fexo-d
  • Fexofed
  • Restaler D
  • Rinolast D
  • Sardin Plus
  • Telfast D
  • Telfast Decongestant
  • Telfast Plus
  • Telfast-D
  • Telfex-d
  • Vantydin

Fexofenadine and pseudoephedrine Brand Names in Pakistan:

Fexofenadine and pseudoephedrine Tablets 60 mg in Pakistan

Aloc D Bosch Pharmaceuticals (Pvt) Ltd.
Axodine-D Gray`S Pharmaceuticals
Fastec-D Panacea Pharmaceuticals
Fenoxin Cf Jawa Pharmaceuticals(Pvt) Ltd.
Fexet D Getz Pharma Pakistan (Pvt) Ltd.
Fexo-D Hilton Pharma (Pvt) Limited
Fexofin Bio Labs (Pvt) Ltd.
Fexofin D Bio Labs (Pvt) Ltd.
Fexota Plus Orta Labs. (Pvt) Ltd.
Genfix-D Genix Pharma (Pvt) Ltd
Regofast D Regent Laboratories Ltd.
Sizzle D Wilshire Laboratories (Pvt) Ltd.
Telfast-D Sanofi Aventis (Pakistan) Ltd.
Telfex-D Polyfine Chempharma (Pvt) Ltd.