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INTRODUCTION

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levocetirizine (lee-vo-se-teer-i-zeen)

Xyzal

Classification

Therapeutic: antihistamines

Pharmacologic: piperazines

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Indications
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Management of seasonal/perennial allergic rhinitis. Management of chronic idiopathic urticaria.

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Action
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Antagonizes the effects of histamine at H1 receptor sites; does not bind to or inactivate histamine.

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Therapeutic Effects: Decreased symptoms of histamine excess (rhinitis, itching).

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Adverse Reactions/Side Effects
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CNS: drowsiness, fatigue, weakness. GI: dry mouth.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • 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 (See Appendix E), especially in older adults or patients with excessive drowsiness, weakness, or fatigue.

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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 following oral administration.

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Distribution: Unknown.

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Metabolism and Excretion: Excreted mostly unchanged by the kidneys (85%).

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Half-life: 8 hr.

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TIME/ACTION PROFILE

ROUTE ONSET PEAK DURATION
PO rapid 0.9 hr 24 hr

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Contraindications/Precautions
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Contraindicated in: Hypersensitivity to levocetirizine or cetirizine; Severe renal impairment (CCr <10 mL/min); Pedi: Pediatric patients with impaired renal function; Lactation: Lactation.

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Use Cautiously in: Geri: Consider age-related ↓ in renal function and concurrent disease states; OB: Use in pregnancy only if clearly needed; Pedi: Children <6 yr (safety not established).

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Interactions
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Drug-Drug: ↑ blood levels of ritonavir. ↑ CNS depression may occur with alcohol, opioid analgesics, or sedative hypnotics.

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Route/Dosage
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PO (Adults and Children ≥12 yr): 5 mg once daily in the evening; some patients may respond to 2.5 mg once daily.

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PO (Children 6–11 yr): 2.5 mg once daily in the evening.

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Renal Impairment
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PO (Adults and Children ≥12 yr): CCr 50–80 mL/min—2.5 mg once daily; CCr 30–50 mL/min—2.5 mg every other day; CCr 10–30 mL/min—2.5 mg twice weekly (q 3–4 days).

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