Desloratadine
Place in Therapy
Place in Therapy
Desloratadine is a second generation, non-sedating antihistamine. A review of the current literature presents evidence that desloratadine is first line treatment for chronic idiopathic urticaria (CIU). It is a potent H1-receptor antagonist and thus blocks the histamine release in patients with CIU. It works on these receptors to decrease histamine release, but does little for already released histamine, thus needs to be taken chronically for CIU and not just during symptoms. There is also a secondary benefit to taking desloratadine as it downregulates parts of the inflammatory processes going on in CIU.
Desloratadine is taken once daily, as it has a rapid onset of action and last for 24 hours, demonstrated in the primary literature. Its pharmacokinetics are not affect by age, race or sex. Dose adjustments are recommended for patients with hepatic or renal impairment. Doses usually start at 5mg once daily, but if no effect is seen, can be increased up to four-fold to see a benefit.
In terms of safety of desloratadine use, the literature indicates that it is well-tolerated with no major adverse effects and the adverse effects seen, including somnolence, were similar in both desloratadine and placebo treatment groups. As it is an antihistamine, although second generation, drowsiness, sedation, dry mouth and other anticholinergic side effects are possible, but rarely seen. There is currently a lack of studies in infants, children under the age of 12 and other special populations in terms of treatment for CIU. Previous studies with first generation antihistamines for children have shown a benefit, but their adverse effect profile limits their use. Desloratadine, a second generation antihistamine, with minimal side effects and a very good safety and efficacy profile would likely be better in this population, but the evidence is currently lacking to support this claim.
Note: All the studies looked at compared desloratadine to placebo or desloratadine in combo with montelukast; antihistamines are first line treatment for CIU, but further studies comparing within class antihistamines may be required.
References
1. DuBuske L. Desloratadine for chronic idiopathic urticaria – a review of clinical efficacy. Am J Clin Dermatol 2007;8(5):271-283.
2. Zuberbier T, Asero R, Bindslev-Jensen C, Canonica GW, et al. EAACI/GA2LEN/EDF/WAO guideline: management of urticaria. Allergy 2009;64:1427-1443.
3. Tan JKL. Skin Disorders: Pruritus. https://www.e-therapeutics.ca/tc.showChapter.action?documentId=c0070 Accessed June 23rd, 2014. Last updated December 2013.
Desloratadine is a second generation, non-sedating antihistamine. A review of the current literature presents evidence that desloratadine is first line treatment for chronic idiopathic urticaria (CIU). It is a potent H1-receptor antagonist and thus blocks the histamine release in patients with CIU. It works on these receptors to decrease histamine release, but does little for already released histamine, thus needs to be taken chronically for CIU and not just during symptoms. There is also a secondary benefit to taking desloratadine as it downregulates parts of the inflammatory processes going on in CIU.
Desloratadine is taken once daily, as it has a rapid onset of action and last for 24 hours, demonstrated in the primary literature. Its pharmacokinetics are not affect by age, race or sex. Dose adjustments are recommended for patients with hepatic or renal impairment. Doses usually start at 5mg once daily, but if no effect is seen, can be increased up to four-fold to see a benefit.
In terms of safety of desloratadine use, the literature indicates that it is well-tolerated with no major adverse effects and the adverse effects seen, including somnolence, were similar in both desloratadine and placebo treatment groups. As it is an antihistamine, although second generation, drowsiness, sedation, dry mouth and other anticholinergic side effects are possible, but rarely seen. There is currently a lack of studies in infants, children under the age of 12 and other special populations in terms of treatment for CIU. Previous studies with first generation antihistamines for children have shown a benefit, but their adverse effect profile limits their use. Desloratadine, a second generation antihistamine, with minimal side effects and a very good safety and efficacy profile would likely be better in this population, but the evidence is currently lacking to support this claim.
Note: All the studies looked at compared desloratadine to placebo or desloratadine in combo with montelukast; antihistamines are first line treatment for CIU, but further studies comparing within class antihistamines may be required.
References
1. DuBuske L. Desloratadine for chronic idiopathic urticaria – a review of clinical efficacy. Am J Clin Dermatol 2007;8(5):271-283.
2. Zuberbier T, Asero R, Bindslev-Jensen C, Canonica GW, et al. EAACI/GA2LEN/EDF/WAO guideline: management of urticaria. Allergy 2009;64:1427-1443.
3. Tan JKL. Skin Disorders: Pruritus. https://www.e-therapeutics.ca/tc.showChapter.action?documentId=c0070 Accessed June 23rd, 2014. Last updated December 2013.