Desloratadine (Clarinex) - Uses, Dose, Side effects, MOA, Brands

Desloratadine (Clarinex) is the active metabolite of loratadine that selectively blocks the histamine (H-1) receptors. It is used for the symptomatic treatment of allergic symptoms associated with allergic rhinitis and chronic idiopathic urticaria.

Desloratadine Uses:

Allergic rhinitis:
- It is indicated for the symptomatic treatment of nasal and non-nasal symptoms of seasonal (SAR) and perennial (PAR) allergic rhinitis.
Urticaria:
- It is used for the symptomatic treatment of pruritus and for the reduction in the number and size of hives associated with chronic idiopathic urticaria (CIU)
Off Label Use in Adults:
- It may be used as a prophylactic treatment of NSAID-associated urticaria.

Desloratadine (Clarinex) Dose in Adults

Desloratadine (Clarinex) Dose in the treatment of chronic idiopathic urticaria:

5 mg orally once a day.

Desloratadine (Clarinex) Dose in the treatment of Seasonal or perennial allergic rhinitis:

5 mg orally once a day.

Desloratadine (Clarinex) Dose in the prophylaxis of NSAID-associated urticaria (off-label):

5 mg administered orally 30 minutes before a strong COX-1 inhibitor.

Desloratadine (Clarinex) Dose in Childrens

Desloratadine (Clarinex) Dose in the treatment of Perennial allergic rhinitis: Oral:

Infants 6 months to 11 months:
- 1 mg once daily
Children 1 year to 5 years:
- 2.5 mg once a day.
Children 6 years to 11 years:
- 5 mg once a day.
Children ≥12 years and Adolescents:
- 5 mg once a day.

Desloratadine (Clarinex) Dose in the treatment of Seasonal allergic rhinitis: Oral:

Children 2 years to 5 years:
- 2.5 mg once a day.
Children 6 years to 11 years:
- 5 mg once a day.
Children ≥12 years and Adolescents:
- 5 mg once a day.

Desloratadine (Clarinex) Dose in the treatment of chronic idiopathic Urticaria: Oral:

Infants 6 months to 11 months:
- 1 mg once a day
Children 1 year to 5 years:
- 2.5 mg once a day.
Children 6 years to 11 years:
- 5 mg once a day.
Children ≥12 years and Adolescents:
- 5 mg once a day.

Pregnancy Risk Factor C

Its use in pregnancy is not well documented.
It is recommended that it be used in both pregnant and not-pregnant women.
For the treatment of allergic rhinitis, urticaria, or other symptoms, second-generation antihistamines are safe to use during pregnancy.

Use during breastfeeding:

Breast milk contains desloratadine.
Manufacturers recommend weighing the benefits and risks to the mother of being exposed to drugs in her infant.
For more information, see loratadine.

Dose in Kidney Disease:

Mild to severe impairment:
- 5 mg on alternate days.

Dose in Liver disease:

Mild to severe impairment:
- 5 mg on alternate days.

Common Side Effects of Desloratadine (Clarinex):

Central Nervous System:
- Headache
- Irritability
Gastrointestinal:
- Diarrhea
Respiratory:
- Upper Respiratory Tract Infection
- Cough
Miscellaneous:
- Fever

Less Common Side Effects Of Desloratadine (Clarinex):

Central Nervous System:
- Drowsiness
- Insomnia
- Fatigue
- Dizziness
- Emotional Lability
Dermatologic:
- Erythema Of Skin
- Maculopapular Rash
Gastrointestinal:
- Vomiting
- Anorexia
- Nausea
- Dyspepsia
- Increased Appetite
- Xerostomia
Genitourinary:
- Urinary Tract Infection
Infection:
- Varicella Zoster Infection
- Parasitic Infection
Neuromuscular & Skeletal:
- Myalgia
Otic:
- Otitis Media
Respiratory:
- Bronchitis
- Rhinorrhea
- Pharyngitis
- Epistaxis

Contraindications to Desloratadine (Clarinex):

Allergic reactions to desloratadine, loratadine, or any component of the formulation.

Warnings and precautions

Hypersensitivity
- Anaphylaxis can occur in patients with allergic reactions. If you notice signs of an allergic reaction, stop taking any medication immediately.
Hepatic impairment
- Patients with impaired liver function should be cautious when using the drug. Dosage adjustments may be necessary.
Renal impairment
- Patients with impaired renal function should be cautious when using the drug. A dosage adjustment may also be necessary.

Desloratadine: Drug Interaction

Note: Drug Interaction Categories:

Risk Factor C: Monitor When Using Combination
Risk Factor D: Consider Treatment Modification
Risk Factor X: Avoid Concomitant Use

Risk Factor C (Monitor therapy).
Alcohol (Ethyl)	CNS Depressants can increase the CNS depressant effects of Alcohol (Ethyl).
Alizapride	CNS Depressants may increase the CNS depressant effects.
Amezinium	Amezinium may have a stronger stimulatory effect if it is combined with antihistamines.
Amphetamines	May decrease the sedative effects of Antihistamines.
Betahistine	Betahistine's therapeutic effects may be diminished by antihistamines.
Brexanolone	CNS Depressants can increase the CNS depressant effects of Brexanolone.
Brimonidine (Topical)	CNS Depressants may increase the CNS depressant effects.
Bromopride	CNS Depressants may increase the CNS depressant effects.
Cannabidiol	CNS Depressants may increase the CNS depressant effects.
Cannabis	CNS Depressants may increase the CNS depressant effects.
Chlorphenesin Carbamate	CNS Depressants may have an adverse/toxic effect that can be exacerbated by them.
CNS Depressants	Can increase the toxic/adverse effects of CNS Depressants.
Moderate CYP2C8 inhibitors	Might increase serum Desloratadine concentrations.
Strong CYP2C8 inhibitors	Might increase serum Desloratadine concentrations.
Dimethindene (Topical).	CNS Depressants may increase the CNS depressant effects.
Doxylamine	CNS Depressants may have a greater CNS depressant effect if taken with other CNS Depressants. Management: The manufacturer of Diclegis (doxylamine/pyridoxine), intended for use in pregnancy, specifically states that use with other CNS depressants is not recommended.
Dronabinol	CNS Depressants may increase the CNS depressant effects.
Erdafitinib	Increased serum concentrations of P-glycoprotein/ABCB1 Substrates may be possible.
Esketamine	CNS Depressants may increase the CNS depressant effects.
HydrOXYzine	CNS Depressants may increase the CNS depressant effects.
Kava Kava	CNS Depressants may have an adverse/toxic effect that can be exacerbated by them.
Lofexidine	CNS Depressants may have a greater depressant effect on the brain. Management: Separate drug interaction monographs are available for drugs listed as an exception to this monograph.
Lumacaftor	May lower the serum concentrations of P-glycoprotein/ABCB1 Substrates. Lumacaftor could increase serum levels of P-glycoprotein/ABCB1 Substrates.
Magnesium Sulfate	CNS Depressants may increase the CNS depressant effects.
MetyroSINE	MetyroSINE may have a sedative effect that can be enhanced by CNS depressants.
Minocycline	CNS Depressants may increase the CNS depressant effects.
Mirtazapine	CNS Depressants can increase the CNS depressant effects of Mirtazapine.
Nabilone	CNS Depressants may increase the CNS depressant effects.
P-glycoprotein/ABCB1 Inducers	The serum concentrations of Pglycoprotein/ABCB1 Substrates may be decreased. Inducers of pglycoprotein may limit the distribution to certain cells/tissues/organs in which p-glycoprotein exists in high amounts (e.g. brain, testes and T-lymphocytes). .
P-glycoprotein/ABCB1 Inhibitors	Increases serum concentrations of Pglycoprotein/ABCB1 substrates. P-glycoprotein inhibitors can also increase the distribution of pglycoprotein substrates to certain cells/tissues/organs in which p-glycoprotein exists in high amounts (e.g. brain, T-lymphocytes and testes). .
Piribedil	CNS Depressants could increase the CNS depressant effects of Piribedil.
Pitolisant	Pitolisant's therapeutic effects may be diminished by antihistamines.
Pramipexole	Pramipexole may have a greater sedative effect if it is combined with CNS depressants.
Ranolazine	Increased serum concentrations of P-glycoprotein/ABCB1 Substrates may be possible.
ROPINIRole	CNS Depressants can increase the sedative effects of ROPINIRole.
Rotigotine	CNS Depressants can increase the sedative effects of Rotigotine.
Rufinamide	CNS Depressants may have an adverse/toxic effect that can be exacerbated by this. Particularly, dizziness and sleepiness may be increased.
Selective Serotonin Reuptake inhibitors	CNS Depressants can increase the toxic/adverse effects of Selective Serotonin Resuptake Inhibitors. Particularly, psychomotor impairment could be increased.
Tetrahydrocannabinol	CNS Depressants may increase the CNS depressant effects.
Tetrahydrocannabinol, and Cannabidiol	CNS Depressants may increase the CNS depressant effects.
Trimeprazine	CNS Depressants may increase the CNS depressant effects.
Risk Factor D (Consider therapy modifications)
Benzylpenicilloyl polylysine	Antihistamines can reduce the diagnostic effectiveness of Benzylpenicilloyl Polylysine. Management: Suspend systemic H1 antagonists for benzylpenicilloyl-polylysine skin testing and delay testing until systemic antihistaminic effects have dissipated. To assess for persistent antihistaminic effects, a histamine skin test can be performed.
Blonanserin	CNS Depressants can increase the CNS depressant effects of Blonanserin.
Buprenorphine	CNS Depressants can increase the CNS depressant effects of buprenorphine. Management: Consider reduced doses of other CNS depressants, and avoiding such drugs in patients at high risk of buprenorphine overuse/self-injection. Buprenorphine patches (Butrans) should be initiated at 5 mg/hr for adults. This is when it is combined with other CNS depression drugs.
Chlormethiazole	CNS Depressants may increase the CNS depressant effects. Monitoring: Look out for signs of CNS depression. If a combination of chlormethiazole and other drugs is required, a reduced dose should be used.
Droperidol	CNS Depressants may increase the CNS depressant effects. Management: Droperidol and other CNS agents, such as opioids, may be reduced or used in combination with droperidol. Separate drug interaction monographs provide more detail on exceptions to this monograph.
Flunitrazepam	CNS Depressants can increase the CNS depressant effects of Flunitrazepam.
Hyaluronidase	Hyaluronidase's therapeutic effects may be diminished by antihistamines. Management: Patients who are taking antihistamines, especially at higher doses, may not have the desired clinical response to standard doses hyaluronidase. Higher doses of hyaluronidase might be necessary.
HYDROcodone	CNS Depressants can increase the CNS depressant effects of HYDROcodone. When possible, avoid concomitant use with hydrocodone and other CNS depressants. Combining these agents is not recommended unless there are other options. Limit the amount and duration of each drug when combined.
Methotrimeprazine	Methotrimeprazine may have a higher CNS depressant activity than CNS Depressants. Methotrimeprazine can increase the CNS depressant effects of CNS Depressants. Management: Lower the adult dose of CNS Depressants by 50% and start concomitant methotrimeprazine treatment. After clinically proven efficacy of methotrimeprazine, further CNS depressant dose adjustments should only be made.
Opioid Agonists	CNS Depressants can increase the CNS depressant effects of Opioid Aggonists. Management: When possible, avoid concomitant use opioid agonists, benzodiazepines, or other CNS depressionants. Combining these agents is not recommended unless there are other options. Limit the amount and duration of each drug when combined.
OxyCODONE	CNS Depressants can increase OxyCODONE's CNS depressant effects. When possible, avoid the simultaneous use of oxycodone and other CNS depressants. Combining these agents is not recommended unless there are other options. Limit the amount and duration of each drug when combined.
Perampanel	CNS Depressants may have a greater CNS depressant effect. Perampanel and any other CNS depressant drug should be used in combination. Patients who take perampanel together with other drugs that have CNS depressant activity should not engage in complex or high-risk activities until they are familiar with the combination.
Sodium Oxybate	CNS Depressants may have a greater depressant effect if taken in combination. Management: Look for alternatives to the combination use. If you must combine use, reduce the doses of any one or more drugs. It is not recommended to combine sodium oxybate and alcohol, or any sedative hypnotics.
Suvorexant	CNS Depressants can increase the CNS depressant effects of Suvorexant. Management: Suvorexant or any other CNS depressionant can be reduced in doses. Suvorexant should not be taken with alcohol. It is also not recommended to take suvorexant along with any other drugs for insomnia.
Tapentadol	CNS Depressants may increase the CNS depressant effects. Tapentadol, benzodiazepines and other CNS depressants should be avoided when possible. Combining these agents is not recommended unless there are other options. Limit the amount and duration of each drug when combined.
Zolpidem	CNS Depressants can increase the CNS depressant effects of Zolpidem. Management: For men who also take CNS depressants, reduce the adult Intermezzo brand sublingual Zolpidem dose to 1.75mg. For women, no dose adjustment is advised. Avoid using CNS depressants at night; do not use alcohol.
Risk Factor X (Avoid Combination)
Azelastine (Nasal)	CNS Depressants could increase the CNS depressant effects of Azelastine.
Bromperidol	CNS Depressants may increase the CNS depressant effects.
Orphenadrine	Orphenadrine may be more effective against CNS depression than other drugs.
Oxomemazine	CNS Depressants may increase the CNS depressant effects.
Paraldehyde	Paraldehyde may be enhanced by CNS depressants.
Thalidomide	CNS Depressants can increase Thalidomide's CNS depressant effects.

Monitoring Parameters:

None mentioned.

How to administer Desloratadine (Clarinex)?

It can be taken with or without meals.
RediTabs formulation disintegrates when they are kept over the tongue.
It should be immediately kept on the tongue when taken from the blister package.
After the tablet dissolves completely, it may be swallowed with or without a cup of water.

Mechanism of action of Desloratadine (Clarinex):

It is a tricyclic, long-acting antihistamine. It selectively blocks the H1 receptors of peripheral histamines.

Start of action:

Within one hour

Time:

24 hours

Protein binding:

Desloratadine: 82% to 87%;
3-hydroxydesloratadine (active metabolite): 85% to 89%

Metabolism:

It is metabolized in the liver to the active metabolite, 3-hydroxydesloratadine (specific enzymes not identified) that subsequently undergoes glucuronidation.
The metabolism of the drug is reduced in individuals who are slow metabolizers of the drug.
When administered in normal doses, drugs that affect CYP enzymes have little effect on the metabolism of desloratadine.

Half-life elimination:

27 hours

Time to peak:

3 hours

Excretion:

87% is excreted in the urine as metabolites.
feces as metabolites.

International Brand Names of Desloratadine:

Clarinex
Aeriallerg
Aerius
Aler Free
Alergaway
Aleros
Alersis
Allergostop
Allora
Aloret
Apitus
Aviant
Azomyr
Brevy
Campos
Claramax
Dasselta
Deline
Delopa
Delorat
Denosin 5
Desa
Desalex
Desarius
Desatrol
Deschu
Desdin
Deslatyne
Desloderma 5
Deslodine
Deslogen
Deslor
Deslora
Desloran
Deslorastal
Deslotine
Desora
Desorus
Despej
Destina
Edem
Efestad
Eridez
Eslorat
Flynise
Histacare
Iris
Larinex
Letizia
Lomid
Loralergan
Lorax
Lorius
Mailen
Neo-Loridin
Neoclaritine
Neoclarityn
Rina
Rinofil
Ruradin
Sedno
Sednox
Supraler

Desloratadine Brand Names in Pakistan:

Desloratadine Syrup 0.5 mg/ml in Pakistan
Delergia	Pharmevo (Pvt) Ltd.
Neo-Antial	Sami Pharmaceuticals (Pvt) Ltd.

Desloratadine Syrup 0.5 mg/5ml in Pakistan
Desora	S.J. & G. Fazul Ellahie (Pvt) Ltd.
Desora	S.J. & G. Fazul Ellahie (Pvt) Ltd.

Desloratadine Syrup 2.5 mg/5ml in Pakistan
Alenor	Macter International (Pvt) Ltd.
Allorx	Raazee Theraputics (Pvt) Ltd.
Deslet	Efroze Chemical Industries (Pvt) Ltd.
Slorit	Hiranis Pharmaceuticals Pvt Ltd

Desloratadine Tablets 5 mg in Pakistan
Alenor	Macter International (Pvt) Ltd.
Alenor Reditab	Macter International (Pvt) Ltd.
Alerfass	Fassgen Pharmaceuticals
Aloret	Pharma Health Pakistan (Pvt) Ltd
Atmos	Scotmann Pharmaceuticals
D-Lor	Everest Pharmaceuticals
D-Loraata	Weather Folds Pharmaceuticals
Dastak	Shrooq Pharmaceuticals
Descover	Kinsa Pharmaceuticals
Desgen	Envoy Pharma
Desgood	Goodman Laboratories
Deslo	Neutro Pharma (Pvt) Ltd.
Desloradvan	Advanced Pharmaceuticals
Desloreal	Wns Field Pharmaceuticals
Deslort	Panacea Pharmaceuticals
Desmak	Makson Pharmaceuticals
Desoline	Candid Pharmaceuticals
Desora	S.J. & G. Fazul Ellahie (Pvt) Ltd.
Destazine	Sante (Pvt) Limited
Destidine	Wellborne Pharmachem And Biologicals
Destina	Hilton Pharma (Pvt) Limited
Destra	Zephyr Pharmatec (Pvt) Ltd.
Destrex	Wns Field Pharmaceuticals
Dictrin	Barrett Hodgson Pakistan (Pvt) Ltd.
Disdine	Wisdom Therapeutics
Dulin	Genome Pharmaceuticals (Pvt) Ltd
E-Din	English Pharmaceuticals Industries
Histanil D	Wilshire Laboratories (Pvt) Ltd.
Histanil D	Wilshire Laboratories (Pvt) Ltd.
Larinex	Getz Pharma Pakistan (Pvt) Ltd.
Loratolive	Olive Pharmaceuticals
Lotodine	Lotus Pharmaceuticals (Pvt) Ltd
Neo-Antial	Sami Pharmaceuticals (Pvt) Ltd.
Novak	Rogen Pharmaceuticals
Reetag	Tagma Pharma (Pvt) Ltd.
Retoret	Pharma Health Pakistan (Pvt) Ltd
Rinex	Jawa Pharmaceuticals(Pvt) Ltd.
Slorit	Hiranis Pharmaceuticals Pvt Ltd