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Allergic Rhinitis: Hay Fever Treatments |
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Tuesday, 26 February 2008 |
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Page 14 of 16
Medication continued... Drug Category: Intranasal antihistamines Alternative to oral antihistamines to treat allergic rhinitis. Currently, azelastine is only agent available in the United States. | Drug Name | Azelastine (Astelin) | | Description | Use prn or on a regular basis. Use alone or in combination with other medications. Unlike oral antihistamines, has some effect on nasal congestion. Helpful for vasomotor rhinitis. Some patients experience a bitter taste. Systemic absorption may occur, resulting in sedation (reported in approximately 11% of patients). | | Adult Dose | 2 puffs/nostril (137 mcg/puff) bid | | Pediatric Dose | <5 years: Not established
5-11 years: 1 puff/nostril (137 mcg/puff) bid
>11 years: Administer as in adults | | Contraindications | Documented hypersensitivity | | Interactions | Potentiates CNS depression with alcohol and other CNS depressants; caution with concurrent oral antihistamines; cimetidine increases serum levels | | Pregnancy | C - Safety for use during pregnancy has not been established.
| | Precautions | Avoid contact with eyes; may cause sedation; caution in pregnancy and breastfeeding | Drug Category: Intranasal cromolyns Produce mast cell stabilization and antiallergic effects that inhibit degranulation of mast cells. Have no direct anti-inflammatory or antihistaminic effects. Effective for prophylaxis. May be used just before exposure to a known allergen (eg, animal, occupational). Begin treatment 1-2 wk before pollen season and continue daily to prevent seasonal allergic rhinitis. Effect is modest compared with that of intranasal corticosteroids. Excellent safety profile and are thought to be safe for use in children and pregnancy. | Drug Name | Cromolyn sodium (Nasalcrom) | | Description | Available OTC in the United States. Used daily for seasonal or perennial allergic rhinitis. Significant effect may not be observed for 4-7 d. For patients with isolated and predictable periods of exposure (eg, animal allergy, occupational allergy), administer just before exposure. Generally less effective than nasal corticosteroids. Protective effect lasts 4-8 h, frequent dosing is necessary. | | Adult Dose | 1 puff/nostril (5.3 mg/puff) q4-6h | | Pediatric Dose | <2 years: Not established
>2 years: Administer as in adults | | Contraindications | Documented hypersensitivity | | Interactions | None reported | | Pregnancy | B - Usually safe but benefits must outweigh the risks.
| | Precautions | Not for use in severe renal or hepatic impairment; symptoms may recur when withdrawing drug | Drug Category: Intranasal anticholinergic agents Used for reducing rhinorrhea in patients with allergic or vasomotor rhinitis. No significant effect on other symptoms. Can be used alone or in conjunction with other medications. In the United States, ipratropium bromide (Atrovent Nasal Spray) is available in a concentration of 0.03% (officially indicated for treatment of allergic and nonallergic rhinitis) and 0.06% (officially indicated for the treatment of rhinorrhea associated with common cold). The 0.03% strength is discussed. | Drug Name | Ipratropium bromide (Atrovent Nasal Spray 0.03%) | | Description | Chemically related to atropine. Has anti-secretory properties, and when applied locally, inhibits secretions from serous and seromucous glands lining the nasal mucosa. Poor absorption by nasal mucosa; therefore, not associated with adverse systemic effects. Local adverse effects (eg, dryness, epistaxis, irritation) may occur. | | Adult Dose | 2 puffs/nostril (21 mcg/puff) bid/tid | | Pediatric Dose | <6 years: Not established
>6 years: Administer as in adults | | Contraindications | Documented hypersensitivity | | Interactions | Drugs with anticholinergic properties (eg, dronabinol) may increase toxicity | | Pregnancy | B - Usually safe but benefits must outweigh the risks.
| | Precautions | Avoid contact with eyes; caution in narrow-angle glaucoma, prostatic hypertrophy, and bladder neck obstruction |
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