Loratadine, pseudoephedrine sulfate.
Each tablet contains loratadine 10 mg in the coating and pseudoephedrine sulfate 240 mg in the core. The loratadine component is released immediately, whereas the pseudoephedrine component is released slowly from the core allowing for once daily administration.
It also contains the following excipients: Hydroxypropyl methylcellulose, ethylcellulose, calcium hydrogen phosphate, polyvidone, silicon dioxide, magnesium stearate, hydroxypropyl methylcellulose, polyethylene glycol, white color dispersion and macrogol 400.
Pharmacotherapeutic Group: Long-acting, nonsedating antihistamine/decongestant.
Pharmacology: Loratadine is a potent long-acting tricyclic antihistamine with selective peripheral H1-receptor antagonistic activity.
Pseudoephedrine sulfate, 1 of the naturally occurring alkaloids of Ephedra and an orally administered vasoconstrictor, produces a gradual but sustained decongestant effect facilitating shrinkage of congested mucosa in upper respiratory areas. The mucous membrane of the respiratory tract is decongested through the action on the sympathetic nerves.
The combination of loratadine and pseudoephedrine sulfate controls histamine-mediated symptoms and relieves the nasal congestion associated with allergic rhinitis and the common cold.
Pharmacodynamics: Loratadine: During studies of its effects on the central nervous system (CNS), loratadine has exhibited no depressant activity and no acute anticholinergic activity.
Loratadine has exhibited a very low affinity for membrane receptors from the cerebral cortex and does not readily penetrate into the CNS. Whole body autoradiographic studies in rats and monkeys, radiolabeled tissue distribution studies in mice and rats, and in vivo radioligand studies in mice have shown that neither loratadine nor its metabolites readily cross the blood-brain barrier.
Radioligand-binding studies with guinea pig pulmonary and brain H1-receptors indicate that there was preferential binding to peripheral versus CNS H1-receptors.
The sedation profile of loratadine, 10 mg daily, is comparable to that of placebo and, during long-term treatment, there were no clinically significant changes in vital signs, laboratory test values, physical examinations or electrocardiograms (ECGs). In studies with loratadine tablets at doses 2-4 times higher than the recommended dose of 10 mg, a dose-related increase in the incidence of somnolence was observed.
Loratadine has no significant H2-receptor activity, does not inhibit norepinephrine uptake and has practically no influence on cardiovascular function or on intrinsic cardiac pacemaker activity. In a study in which loratadine tablets were administered at 4 times the clinical dose for 90 days, no clinically significant increase in the QTc was seen in ECGs.
Pseudoephedrine: Pseudoephedrine acts directly on both α- and to a lesser degree, β-adrenergic receptors. It is believed that α-adrenergic effects result from the inhibition of the production of cyclic adenosine-3',5'-monophosphate (AMP) by inhibition of the enzyme adenyl cyclase, whereas β-adrenergic effects result from stimulation of adenyl cyclase activity. Like ephedrine, pseudoephedrine also has an indirect effect by releasing norepinephrine from its storage sites.
Pseudoephedrine acts directly in α-adrenergic receptors in the mucosa of respiratory tract producing vasoconstriction which results in shrinkage of swollen nasal mucous membranes, reduction of tissue hyperemia, edema and nasal congestion, and in an increase in nasal airway patency. Drainage of sinus secretions is increased and obstructed eustachian hostia may be opened.
Pseudoephedrine may relax bronchial smooth muscle by stimulation of β2-adrenergic receptors; however, substantial bronchodilation has not been demonstrated consistently following oral administration of the drug.
Oral administration of usual doses of pseudoephedrine to normotensive patients usually produces negligible effect on blood pressure. Pseudoephedrine may increase the irritability of the heart muscle and may alter the rhythmic function of the ventricles, especially in large doses or after administration to patients eg, those with cardiac disease who are hypersensitive to the myocardial effects of sympathomimetic drugs. Tachycardia, palpitation and/or multifocal premature ventricular contractions may occur.
Pseudoephedrine may cause mild CNS stimulation, especially in patients who are sensitive to the effects of sympathomimetic drugs.
Pharmacokinetics: Loratadine: After oral administration, loratadine is rapidly and well absorbed and undergoes an extensive first-pass metabolism. In normal subjects, plasma distribution half-lives (t½) of loratadine and its active metabolite are approximately 1 hrs and 2 hrs, respectively. Initial data in normal subjects demonstrated a mean elimination t½ of 12.4 hrs for loratadine and 19.6 hrs for the active metabolite.
Subsequent data in normal adult subjects demonstrated mean elimination t½ of 8.4 hrs (range 3-20 hrs) for loratadine and 28 hrs (range 8.8-92 hrs) for the major active metabolite. In nearly all patients, exposure [area under the curve (AUC)] to the metabolite was greater than exposure to the parent compound.
Loratadine is highly bound (97-99%) and its active metabolite moderately bound (73-76%) to plasma proteins. The bioavailability parameters of loratadine and of the active metabolite are dose proportional.
Approximately 40% of the dose is excreted in the urine and 42% in the feces over a 10-day period and that, mainly in the form of conjugated metabolites.
Approximately 27% of the dose is eliminated in the urine during the first 24 hrs. Traces of unchanged loratadine and of its active metabolite were found in the urine.
The pharmacokinetic profile of loratadine and its metabolites is comparable in healthy adult volunteers and in healthy geriatric volunteers.
In patients with chronic renal impairment, both the AUCs and peak plasma levels (Cmax) increased for loratadine and its metabolite as compared to the AUCs and Cmax of patients with normal renal function. The mean elimination t½ of loratadine and its metabolite were not significantly different from that observed in normal subjects. Hemodialysis does not have an effect on the pharmacokinetics of loratadine or its active metabolite in subjects with chronic renal impairment.
In patients with chronic alcoholic liver disease, the AUC and Cmax of loratadine were double while the pharmacokinetic profile of the active metabolite was not significantly changed from that in patients with normal liver function. The elimination t½ of loratadine and its metabolite were 24 hrs and 37 hrs, respectively, and increased with increasing severity of liver disease.
Loratadine and its active metabolite are excreted in the breast milk of lactating women. Forty-eight (48) hrs after dosing, only 0.029% of the loratadine dose is detected in the milk as unchanged loratadine and its active metabolite.
Pseudoephedrine: Absorption: After oral administration of pseudoephedrine HCl 60 mg as tablets or oral solution, nasal decongestion occurs within 30 min and persists for 4-6 hrs. Nasal decongestion may persist for 8 hrs following oral administration of 60 mg and up to 12 hrs following 120 mg of the drug in extended-release preparations.
Distribution: Although specific information is lacking, pseudoephedrine is presumed to cross the placenta and to enter cerebrospinal fluid (CSF). Pseudoephedrine may also be distributed in milk.
Elimination: Pseudoephedrine is incompletely metabolized in the liver by N-demethylation to an inactive metabolite. Pseudoephedrine and its metabolite are excreted in urine; 55-75% of a dose is excreted unchanged. The rate of urinary excretion of pseudoephedrine is accelerated when urine is acidified to a pH of about 5 by prior administration of ammonium chloride. When the urine is alkalinized to a pH of about 8 by prior administration of sodium bicarbonate, some of the drug is reabsorbed in the kidney tubule and the rate of urinary excretion is slowed.
Clarityn-D 24Hour Extended Release is indicated for relief of symptoms associated with allergic rhinitis and the common cold including nasal congestion, sneezing, rhinorrhea, pruritus and lacrimation.
Clarityn-D 24Hour Extended Release is recommended when both the antihistaminic properties of loratadine and the decongestant effect of pseudoephedrine sulfate are desired.
Adults and Children ≥12 years: 1 tab once daily.
Clarityn-D 24Hour Extended Release may be taken without regard to mealtime.
Patients who have a history of difficulty in swallowing tablets or have known upper gastrointestinal narrowing or abnormal oesophageal peristalsis should not use Clarityn-D 24Hour Extended Release (see Precautions & Adverse Reactions).
To date, overdosage has not been reported with Clarityn-D 24Hour Extended Release. In the event of overdosage, general symptomatic and supportive treatment should be started immediately and maintained for as long as necessary.
Manifestations: These may vary from central nervous system depression (sedation, apnea, diminished mental alertness, cyanosis, coma, cardiovascular collapse) to stimulation (insomnia, hallucinations, tremors or convulsions) to death. Other signs and symptoms may be euphoria, excitement, tachycardia, palpitations, thirst, perspiration, nausea, dizziness, tinnitus, ataxia, blurred vision and hypertension or hypotension. Stimulation is particularly likely in children, as are atropine-like signs and symptoms (dry mouth; fixed, dilated pupils; flushing; hyperthermia and gastrointestinal symptoms).
In large doses, sympathomimetics may give rise to giddiness, headache, nausea, vomiting, sweating, thirst, tachycardia, precordial pain, palpitations, difficulty in micturition, muscular weakness, tenseness, anxiety, restlessness and insomnia. Some patients present a toxic psychosis with delusions and hallucinations. Some may develop cardiac arrhythmias, circulatory collapse, convulsions, coma and respiratory failure.
The oral LK50 values for loratadine and pseudoephedrine sulfate in combination product were approximately 600 mg/kg in mice and 2000 mg/kg in rats. Cynomolgus monkeys tolerated single doses of up to 240 mg/kg.
Treatment: The patient should be induced to vomit, even if emesis has occurred spontaneously. Pharmacologically-induced vomiting by the administration of ipecac syrup is a preferred method. However, vomiting should not be induced in patients with impaired consciousness. The action of ipecac is facilitated by physical activity and by the administration of 240-360 mL of water. If emesis does not occur within 15 min, the dose of ipecac should be repeated. Precautions against aspiration must be taken, especially in children.
Following emesis, adsorption of any drug remaining in the stomach may be attempted by the administration of activated charcoal as a slurry with water. If vomiting is unsuccessful or contraindicated, gastric lavage should be performed. Physiologic saline solution is the lavage solution of choice, particularly in children. In adults, tap water can be used; however, as much as possible, the amount administered should be removed before the next instillation. Saline cathartics draw water into the bowel by osmosis and therefore may be valuable for their action in rapid dilution of bowel content. Loratadine is not removed by hemodialysis; it is not known if loratadine is removed by peritoneal dialysis. After emergency treatment, the patient should continue to be medically monitored.
Treatment of the signs and symptoms of overdosage is symptomatic and supportive. Stimulants (analeptic agents) should not be used. Vasopressors may be used to treat hypotension. Short-acting barbiturates, diazepam or paraldehyde may be administered to control seizures. Hyperpyrexia, especially in children, may require treatment with tepid water sponge baths or hypothermic blanket. Apnea is treated with ventilatory support.
Hypersensitivity or idiosyncrasy to loratadine, pseudoephedrine sulfate or to any of the components of Clarityn-D 24Hour Extended Release or to adrenergic agents; patients receiving monoamine oxidase inhibitor (MAOI) therapy or within 2 weeks of discontinuing such treatment; patients with narrow-angle glaucoma, urinary retention, severe hypertension, severe coronary artery disease and hyperthyroidism.
Sympathomimetic agents should be used with caution in patients with glaucoma, prostatic hypertrophy or bladder neck obstruction, cardiovascular disease, increased intraocular pressure or diabetes mellitus.
Sympathomimetics should be used with caution in patients receiving digitalis.
Sympathomimetics may cause central nervous system (CNS) stimulation, excitability, convulsions and/or cardiovascular collapse with accompanying hypotension. Pseudoephedrine sulfate may cause excitability, especially in children.
Acute generalized exanthematous pustulosis (AGEP), a form of severe skin reaction, may occur with pseudoephedrine-containing products in isolated cases. If signs and symptoms such as fever, erythem or small (gemeralized) pustules are observed, patients should discontinue the drug and consult their physician.
Patients with severe liver impairment should be administered a lower initial dose because they may have reduced clearance of loratadine; an initial dose of 1 tablet every other day is recommended.
Patients who have a history of difficulty in swallowing tablets, or have had known upper gastrointestinal narrowing or abnormal esophageal peristalsis should not use this product.
Drug Abuse and Dependence: No data are available to indicate that abuse or dependency occurs with loratadine. Like other central nervous system stimulants, pseudoephedrine sulfate has a potential for abuse and increased doses may ultimately produce toxicity. Depression may follow rapid withdrawal.
Use in pregnancy & lactation: Safe use of Clarityn-D 24Hour Extended Release during pregnancy has not been established. Therefore, it should be used only if the potential benefit justifies the potential risk to the fetus.
Since loratadine and pseudoephedrine sulfate are excreted in breast milk, a decision should be made whether to discontinue nursing or to discontinue the use of Clarityn-D 24Hour Extended Release.
Use in children: Safety and efficacy of Clarityn-D 24Hour Extended Release in children <12 years have not been established.
Use in the elderly: In patients ≥60 years, sympathomimetics are more likely to cause adverse reactions eg, confusion, hallucination, convulsions, CNS depression and death. Consequently, caution should be exercised when administering a long-acting formulation to elderly patients.
Safe use of Clarityn-D 24Hour Extended Release during pregnancy has not been established. Therefore, it should be used only if the potential benefit justifies the potential risk to the fetus.
Since loratadine and pseudoephedrine sulfate are excreted in breast milk, a decision should be made whether to discontinue nursing or to discontinue the use of Clarityn-D 24Hour Extended Release.
In clinical studies, the most frequently reported adverse events associated with Clarityn-D 24 Hour Extended Release were headache and dry mouth. Less commonly reported events were somnolence and insomnia, which were reported also at a comparable rate with placebo and other new generation antihistamine controls.
Rarely reported events in decreasing order of frequency include dizziness, fatigue, anorexia, nervousness, nausea, epistaxis, rhinitis, lacrimal gland disorder, asthenia, hyperkinesia, constipation, dyspepsia, palpitation, tachycardia, thirst, agitation, irritability, coughing, dyspnea, nasal irritation and pharyngitis.
With the exception of headache, which was occasionally severe, most of the adverse events associated with Clarityn-D 24Hour Extended Release were mild to moderate in severity.
During the marketing of loratadine, alopecia, anaphylaxis and abnormal hepatic function have been reported rarely.
There have been rare post-marketing reports of mechanical upper gastrointestinal tract obstruction in patients taking Clarityn-D 24Hour Extended Release. In most of these cases, patients have had a history of difficulty in swallowing tablets or have had known upper gastrointestinal narrowing or abnormal esophageal peristalsis.
During the marketing of loratadine, alopecia, anaphylaxis and abnormal hepatic functions have been reported rarely.
Isolated cases of acute generalized exanthematous pustulosis (AGEP), a form of severe skin reaction have been reported post-market with pseudoephedrine-containing products.
When administered concomitantly with alcohol, loratadine has no potentiating effect as measured by psychomotor performance studies.
Increase in plasma concentrations of loratadine has been reported after concomitant use with ketoconazole, erythromycin or cimetidine in controlled clinical trials, but without clinically significant changes (including electrocardiographic). Other drugs known to inhibit hepatic metabolism should be co-administered with caution until definitive interaction studies can be completed.
When sympathomimetic drugs are given to patients receiving monoamine oxidase inhibitors (MAOIs), hypertensive reactions, including hypertensive crisis may occur. The antihypertensive effects of methyldopa, mecamylamine, reserpine and veratrum alkaloids may be reduced by sympathomimetics. Beta-adrenergic blocking agents also may interact with sympathomimetics. Increased ectopic pacemaker activity can occur when pseudoephedrine sulfate is used concomitantly with digitalis. Antacids increase the rate of pseudoephedrine sulfate absorption; kaolin decreases it.
Drug/Laboratory Test Interactions: Antihistamines should be discontinued approximately 48 hrs prior to skin testing procedures since these drugs may prevent or diminish otherwise positive reactions to dermal reactivity indicators.
The in vitro addition of pseudoephedrine to sera containing the cardiac isoenzyme MB of serum creatine phosphokinase progressively inhibits the activity of the enzyme. The inhibition becomes complete over 6 hrs.
Store at or below 25°C. Protect blister packs from excessive moisture.
R01BA52 - pseudoephedrine, combinations ; Belongs to the class of systemic sympathomimetic preparations used as nasal decongestants.
Clarityn-D 24Hour Extended Release XR tab
1 × 10's
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