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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:
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
Cetirizine
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Desloratadine
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Diphenhydramine
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Fexofenadine
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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:
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
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:
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
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: ~$0.99 CAD / 10mg tab (ON)
Coverage: ON (ODB)
Age Group: ages ≥2
Pregnancy: Avoid (not enough data)
Contraindications: Hypersensitivity, QT prolongation or history of Torsades
Common SEs: Drowsiness 3-9%[D], 2-5%[P]; headache 1-6%[D], 2-5%[P]; tiredness 1%[D], 1%[P]; QT-prolongation 1%[D], <1%[P]; dizziness 1%[D], 1%[P]; nausea 0-2%[D], 1-2%[P]
Severe SEs: All very rare (<1%): Torsades (only 1 event), liver enzyme elevation
Monograph Links:
Pearls
No data for hepatic or renal insufficiency
Take with or without food (avoid grapefruit)
Going more than OD is technically off-label
Template (med)
Brand Names: brandnameA, brandnameB
Routes: Xmg tab; Xmg/ml liq
MoA: Insert MoA
Half-life: ~X hours
Time to peak action: Optional
Doses:
- diseaseA: Zmg OD (ages 3-11)
- diseaseA: Zmg OD (ages ≥12; CrCl < 30)
- diseaseB: Zmg BID (ages ≥18; >25kg)
Cost: ~$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
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