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Rx

Beclomethasone dipropionate (inhaler)

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Rx

Bilastine

Brand Names: Blexten

Routes: 10/20mg tab, 2.5mg/ml liq (uncommon)

MoA: 2nd gen H1 receptor antagonist

Half-life: ~15 hours

Time to peak action: ~1h, rapid absorption

Doses:

  • CSU, AR: 20mg PO OD to QID (ages ≥12)
  • CSU, AR: 10mg PO OD to QID (ages 4-11)

Cost: ~$1.1 CAD / 20mg tab (ON)

Coverage: ON (ODB)

Age Group: ages ≥4

Pregnancy: Avoid (not enough data)

Contraindications: Hypersensitivity, QT prolongation or history of torsades

Common SEs: QT prolongation (at 100mg ODx4, max mean increase 6ms); drowsiness/headache ~4%[D], ~3%[P]; abdo pain 3%[D], 3%[P]

Severe SEs: Torsades (extremely rare; only 1 case reported in monograph post-market reactions)

Monograph Links:

Abbr.
CSU-chronic spontaneous urticaria; AR-allergic rhinitis

Pearls

  • Theoretically does not cross BBB; less sedating than other AHs

  • No renal adjustments needed; minimal data with hepatic impairment but not expected to cause issues

  • Going beyond OD is technically off-label

  • Take without food or juice otherwise absorption impaired

Rx

Budesonide (inhaler)

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Cetirizine

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Abbr.
CSU-chronic spontaneous urticaria; AR-allergic rhinitis

Pearls

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Rx

Ciclesonide (inhaler)

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Rx

Desloratadine

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Abbr.
CSU-chronic spontaneous urticaria; AR-allergic rhinitis

Pearls

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Rx

Diphenhydramine

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Fexofenadine

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Abbr.
CSU-chronic spontaneous urticaria; AR-allergic rhinitis

Pearls

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Rx

Fluticasone furoate (inhaler)

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Fluticasone propionate (inhaler)

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OTC

Loratadine

Brand Names: Claritin, Alavert

Routes: 10mg tab (generic), 5mg tab, 1mg/ml liq

MoA: 2nd gen H1 receptor antagonist

Half-life: 7.8-11 hours (half life of active metabolite descarboethoxyloratadine is 17-24h)

Time to peak action: Rapid onset, ~1-2h

Doses:

  • CSU, AR: 10mg OD to QID (ages ≥6)
  • CSU, AR: 5mg OD to QID (ages 2-6)
  • CSU, AR: 5mg OD or 10mg q48h (>30kg; if severe liver impairment)
  • CSU, AR: 5mg q48h (≤30kg; if severe liver impairment)

Cost: ~$0.6 CAD / 10mg tab (ON)

Coverage: ON (ODB)

Age Group: ages ≥2

Pregnancy: Safe as per ACOG and firstexposure

Contraindications: Hypersensitivity

Common SEs: Fatigue 4%[D], 4%[P]; headache 8%[D], 6%[D]; drowsiness 8%[D], 6%[P]

Severe SEs: Extremely rare and all post-market: anaphylaxis, hepatic dysfunction, palpitations

Monograph Links:

Abbr.
CSU-chronic spontaneous urticaria; AR-allergic rhinitis

Pearls

  • No QTc prolongation in humans noted in monographs or UpToDate. 'Prolongation of QRS-interval was observed in monkeys at a dose 200 times the proposed clinical dose'

  • Mostly hepatically cleared. No renal adjustment required

Rx

Mometasone furoate (INCS)

Brand Names: Nasonex, Sinuva

Routes: nasal spray (50mcg)

MoA: Steroid, topical

Half-life: ~5.8 hours

Time to peak action: While monograph says ~12 hours, maximal effect requires 2-4 weeks of use

Doses:

  • AR: 1-4 sprays (50mcg per spray) EN OD (ages ≥12)
  • AR: 1 spray (50mcg per spray) EN OD (ages 3-11)
  • CRS: 1-2 sprays (50mcg per spray) EN BID (ages ≥12)

Coverage: ON (ODB)

Age Group: ages ≥3

Pregnancy: Maybe OK, but no adequate or well-controlled studies in pregnant or nursing women

Contraindications: Hypersensitivity, acute bacterial sinus infection without antibiotics

Common SEs: For adults: headache 8%[D], 6%[P]; epistaxis 8%[D], 5%[P], pharyngitis 4%[D], 3%[P]. For 3-11, all comparable to placebo

Severe SEs: All very rare (<1%): liver enzyme elevation

Monograph Links:

Abbr.
AR-allergic rhinitis; CRS-chronic rhinosinusitis; AI-adrenal insufficiency

Pearls

  • 2nd-gen INCS, minimal systemic absorption (0.5%), no evidence of AI in PII and PIII studies

  • For AR, classically useful for 'wet' nasal congestion

  • High operator error; see here for how to use

  • OTC in the US; Rx in Canada

Rx

Mometasone furoate (inhaler)

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Rx

Rupatadine

Brand Names: Rupall, Rupafin, Rupita

Routes: 10 mg tab, 1mg/ml liq

MoA: 2nd gen H1 receptor antagonist, platelet activating factor antagonist

Half-life: ~6 hours, but some metabolites (ie. desloratadine) remain longer; effects last ~24h

Time to peak action: Rapid absorption; max blood concentration in 1 hr

Doses:

  • CSU, AR: 10mg tab OD to QID (ages ≥12)
  • CSU, AR: 2.5mg liq OD to QID, (10-25kg, ages 2-11)
  • CSU, AR: 5mg liq OD to QID, (>25kg, ages 2-11)

Cost: ~$0.99 CAD / 10mg tab (ON)

Coverage: ON (ODB)

Age Group: ages ≥2

Pregnancy: Avoid (not enough data)

Contraindications: Hypersensitivity, QT prolongation or history of Torsades

Common SEs: Drowsiness 3-9%[D], 2-5%[P]; headache 1-6%[D], 2-5%[P]; tiredness 1%[D], 1%[P]; QT-prolongation 1%[D], <1%[P]; dizziness 1%[D], 1%[P]; nausea 0-2%[D], 1-2%[P]

Severe SEs: All very rare (<1%): Torsades (only 1 event), liver enzyme elevation

Monograph Links:

Pearls

  • No data for hepatic or renal insufficiency

  • Take with or without food (avoid grapefruit)

  • Going more than OD is technically off-label

Rx

Salbutamol

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OTC

Template (med)

Brand Names: brandnameA, brandnameB

Routes: Xmg tab; Xmg/ml liq

MoA: Insert MoA

Half-life: ~X hours

Time to peak action: Optional

Doses:

  • diseaseA: Zmg OD (ages 3-11)
  • diseaseA: Zmg OD (ages ≥12; CrCl < 30)
  • diseaseB: Zmg BID (ages ≥18; >25kg)

Cost: ~$X CAD / Ymg tab (ON); ~$X CAD / Ymg tab (BC)

Coverage: ON (enter details); BC (enter details)

Age Group: insert age group

Pregnancy: insert information, can link to data/links if need be

Contraindications: insert

Common SEs: insert

Severe SEs: insert

Monograph Links:

Pearls

  • Insert pearl here