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INTRODUCTION

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desloratadine (des-lor-at-a-deen)

Clarinex

Classification

Therapeutic: allergy, cold, and cough remedies, antihistamines

Pharmacologic: piperidines

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Indications
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Symptoms of allergic rhinitis (seasonal and perennial). Chronic idiopathic urticaria.

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Action
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Blocks peripheral effects of histamine released during allergic reactions. Therapeutic Effects: Decreased symptoms of allergic reactions (nasal stuffiness, red swollen eyes). Decreased pruritus, reduction in number and size of hives in chronic idiopathic urticaria.

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Adverse Reactions/Side Effects
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CNS: drowsiness (rare). EENT: pharyngitis. GI: dry mouth. Misc: ALLERGIC REACTIONS, INCLUDING ANAPHYLAXIS.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Monitor signs of allergic reactions and anaphylaxis, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician immediately if these reactions occur.

  • Monitor symptoms of seasonal allergies (sneezing, rhinitis, itching eyes, cough) or chronic idiopathic urticaria (rash, hives, itching) to help document benefits of this drug in treating these disorders.

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Interventions
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  • Guard against falls and trauma (hip fractures, head injury, and so forth). Implement fall- prevention strategies, especially in older adults or if balance is impaired (See Appendix E).

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Patient/Client-Related Instruction
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  • Advise patient about the risk of daytime drowsiness and decreased attention and mental focus. Although the risk of drowsiness is considerably lower with this drug compared to traditional antihistamines, patients should use care if driving or in other activities that require quick reactions and strong concentration.

  • Advise patient to avoid alcohol and other CNS depressants because of the increased risk of sedation and adverse effects.

  • Instruct patient to report other troublesome side effects, including dry mouth or upper respiratory tract irritation.

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Pharmacokinetics
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Absorption: Well absorbed; absorption for orally disintegrating tablets and oral tablets is identical.

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Distribution: Enters breast milk.

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Metabolism and Excretion: Extensively metabolized to 3-hydroxydesloratadine, an active metabolite; small percentage of patients may be slow metabolizers.

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Half-life: 27 hr.

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TIME/ACTION PROFILE (antihistaminic effects)

ROUTE ONSET PEAK DURATION
PO unknown 3 hr 24 hr

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Contraindications/Precautions
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Contraindicated in: Hypersensitivity; OB: Lactation.

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Use Cautiously in: Patients with hepatic or renal impairment (↓ dose to 5 mg every other day); Geri: Dosing for the elderly should consider ↓ hepatic, renal, or cardiac function, concomitant diseases, other drug therapy, and ↑ risk of adverse reactions; Pedi: Children <6 mo (safety not established).

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Interactions
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Drug-Drug: The following interactions may occur, but are less likely to occur with desloratadine than with more sedating antihistamines. MAO inhibitors may ↑ and prolong effects of antihistamines. ↑ CNS depression may occur with other CNS depressants, including alcohol, ...

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