Loratadine

INTRODUCTION

Indications

Relief of symptoms of seasonal allergies. Management of chronic idiopathic urticaria. Management of hives.

Action

Blocks peripheral effects of histamine released during allergic reactions. Therapeutic Effects: Decreased symptoms of allergic reactions (nasal stuffiness; red, swollen eyes; itching).

Adverse Reactions/Side Effects

CNS: confusion, drowsiness (rare), paradoxical excitation. EENT: blurred vision. GI: dry mouth, GI upset. Derm: photosensitivity, rash. Metab: weight gain.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• 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.

• Monitor signs of increased excitation, including restlessness, agitation, and hyperactivity. Severe or problematic excitation may require a change in dose or drug.

• Periodically assess body weight and other anthropometric measures (body mass index, body composition). Report a rapid or unexplained weight gain or increased body fat.

Interventions

• 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).

• Causes photosensitivity; use care if administering UV treatments. Advise patient to avoid direct sunlight and use sunscreens and protective clothing. Also report any rashes and other skin reactions.

Patient/Client-Related Instruction

• Advise patient about the risk of daytime drowsiness, confusion, 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 severe or prolonged dry mouth, skin rash, or GI upset.

Pharmacokinetics

Absorption: Rapidly absorbed after oral administration (80%).

Distribution: Unknown.

Protein Binding: Loratadine—97%; descarboethoxyloratadine—73–77%.

Metabolism and Excretion: Rapidly and extensively metabolized during first pass through the liver. Much is converted to descarboethoxyloratadine, an active metabolite.

Half-life: Loratadine—7.8–11 hr; descarboethoxylo-ratadine—20 hr.

Contraindications/Precautions

Contraindicated in: Hypersensitivity; OB: Lactation.

Use Cautiously in: Patients with hepatic impairment or CCr ...