Levocabastine nasal spray (Livostin) is a potent and selective antihistamine that is used for the symptomatic treatment of patients with allergic rhinitis and allergic symptoms associated with cold, flu, and other viral illnesses.

Levocabastine Uses:

• Allergic rhinitis:

  • It is indicated for the symptomatic treatment of allergic rhinitis in patients 12 years of age or older.

Read: Azelastine for allergic and vasomotor rhinitis

Levocabastine Dose in Adults:

Levocabastine Nasal Spray (Livostin) Dose in the treatment of Allergic rhinitis:

• Adults ≤65 years:

  • Intranasal:
    • Two sprays in each nostril two times a day.
    • The dose may be increased to 2 sprays 3 to 4 times a day.
    • Consider treatment discontinuation if no clinical response is noted within 3 days.
    • Continuous treatment for a prolonged duration such as exceeding 10 weeks has not been evaluated.

Use in Children:

Refer to adults dosing

Pregnancy Category: C

• Human and animal pregnancy studies have not examined the nasal spray. Animal reproduction studies have shown adverse reactions to oral dosing.

Use during breastfeeding:

• Intranasal administration of the drug has been shown to cause minimal systemic absorption or excretion into breastmilk.
• It is recommended that you use it with caution if you are lactating.

Dose in Kidney Disease:

There are no dosage adjustments provided in the manufacturer's labeling; Use it with caution.

Dose in Liver disease:

There are no dosage adjustments provided in the manufacturer's labeling.

Most of the side effects of the drug are transient and the frequency of the side effects is not always defined.

Less Common Side Effects of Levocabastine Nasal Spray (Livostin):

• Central nervous system:

  • Fatigue

• Local:

  • Application site burning
  • Application site irritation
  • Application site pain
  • Application site reaction (dryness, discomfort)

• Ophthalmic:

  • Eye irritation

• Respiratory:

  • Epistaxis
  • Pharyngolaryngeal pain, sinusitis

Contraindications to Levocabastine Nasal Spray (Livostin):

Hypersensitivity to any drug component or drug ingredient

Warnings and precautions

• Renal impairment

  • Patients with impaired renal function should be cautious when using the drug.
  • Its use in patients with impaired renal function is not well documented.

Monitoring Parameters:

None mentioned. Monitor the response to treatment.

How to administer Levocabastine Nasal Spray (Livostin)?

Intranasal:

• Before using the nasal spray, shake the bottle well. Prime the spray until a fine spray is delivered prior to the first spray.
• Instruct the patients to blow nose and clear the nostrils before administering the spray and then inhale via the nose while spraying the medicine.

Mechanism of action of Levocabastine (Livostin):

It is a potent and selective antihistamine that blocks the histamine (H-1) receptors present in the nostrils and eyes when administered locally.

Onset of action:

• 10 minutes

Absorption:

• Incomplete

Protein binding:

• ~55%

Metabolism:

• Hepatic (minimal)

Bioavailability:

• 60% to 80%

Half-life elimination:

• 35 to 40 hours

Time to peak:

• 3 hours

Excretion:

• Urine (65% to 70% as unchanged drug);
• feces (10% to 20% as unchanged drug).

International Brand Names of Levocabastine:

• Livostin
• Bilina
• Livocab

Levocabastine Brand Names in Pakistan:

No Brands Available in Pakistan.