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Medication continued... Drug Category: Leukotriene receptor antagonists Alternative to oral antihistamine to treat allergic rhinitis. One of the leukotriene receptor antagonists, montelukast (Singulair), has been approved in the United States for treatment of seasonal and perennial allergic rhinitis. When used as single agent, produces modest improvement in allergic rhinitis symptoms. | Drug Name | Montelukast (Singulair) | | Description | Selective leukotriene receptor antagonist that inhibits the cysteinyl leukotriene (CysLT 1) receptor. Selectively prevents action of leukotrienes released by mast cells and eosinophils. When used as a single agent, has been shown to result in a reduction of seasonal allergic rhinitis symptoms, similar in degree to that of loratadine. | | Adult Dose | 10 mg PO qd | | Pediatric Dose | <2 years: Not established
2-6 years: 4 mg PO qd
6-15 years: 5 mg PO qd
>15 years: Administer as in adults | | Contraindications | Documented hypersensitivity | | Interactions | Phenobarbital and rifampin may reduce AUC of montelukast | | Pregnancy | B - Usually safe but benefits must outweigh the risks.
| | Precautions | Not indicated to reverse acute asthma attacks; not for use as monotherapy in management of exercise-induced bronchospasm; patients with known aspirin sensitivity should continue avoidance of aspirin or NSAIDS while taking montelukast | Drug Category: First-generation antihistamines The older, first-generation H1 antagonists (eg, diphenhydramine, hydroxyzine) are effective in reducing most symptoms of allergic rhinitis, but they produce a number of adverse effects (eg, drowsiness, anticholinergic effects). They can be used prn, but adverse effects may limit their usefulness when taken on a daily basis. Some patients tolerate the adverse effects with prolonged use, but they may experience cognitive impairment, and driving skills may be affected. Administration at bedtime may help with drowsiness, but sedation and impairment of cognition may continue until the next day. The second-generation antihistamines are nonsedating in most patients and are preferred as first-line therapy. Few adverse effects are reported (cetirizine may cause drowsiness in as many as 10% of patients); therefore, many specialists prefer the use of second-generation agents for allergic rhinitis. Caution patients taking medications with sedative effects about driving and operating heavy machinery. | Drug Name | Chlorpheniramine (Chlor-Trimeton) | | Description | First-generation agent, available OTC in the United States. One of the safest antihistamines to use during pregnancy. Competes with histamine on H1-receptor sites on effector cells in blood vessels and respiratory tract. | | Adult Dose | 4 mg PO q4-6h; alternatively, 8 mg SR PO q8h or 12 mg SR PO q12h; not to exceed 24 mg/d | | Pediatric Dose | <2 years: Not established
2-6 years: 1 mg PO q4-6h; not to exceed 4 mg/d
6-12 years: 2 mg PO q4-6h; not to exceed 12 mg/d
>12 years: Administer as in adults | | Contraindications | Documented hypersensitivity; severe asthma; narrow-angle glaucoma; symptomatic prostate hypertrophy; bladder neck obstruction; pyloroduodenal obstruction | | Interactions | Toxicity increases with coadministration of other CNS depressants, TCAs, MAOIs, and phenothiazines | | Pregnancy | B - Usually safe but benefits must outweigh the risks.
| | Precautions | May cause significant confusion |
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