Fexofenadine: Drug information

For additional information see "Fexofenadine: Patient drug information" and "Fexofenadine: Pediatric drug information"

For abbreviations, symbols, and age group definitions show table

Brand Names: US

Allegra Allergy Childrens [OTC];
Allegra Allergy [OTC];
Allegra Hives 24HR [OTC];
Allergy 24-HR [OTC];
Allergy Childrens [OTC];
Allergy Relief [OTC];
Allergy Relief/Indoor/Outdoor [OTC];
FT Allergy Relief 12 Hour [OTC];
FT Allergy Relief 24 Hour [OTC];
FT Allergy Relief [OTC]

Pharmacologic Category

Histamine H₁ Antagonist;
Histamine H₁ Antagonist, Second Generation;
Piperidine Derivative

Dosing: Adult

Upper respiratory allergies

Upper respiratory allergies:

Twice-daily formulations: Oral: 60 mg every 12 hours (maximum: 120 mg/day).

Once-daily formulations: Oral: 180 mg once daily (maximum: 180 mg/day).

Urticaria, new onset and chronic spontaneous

Urticaria, new onset and chronic spontaneous (off-label use):

New onset: Oral: Initial: 180 mg once daily. If symptom control is inadequate, may immediately increase to 180 mg twice daily (Ref).

Chronic spontaneous: Oral: 180 mg once daily (Ref). If symptom control is inadequate, add a different second-generation antihistamine; higher doses of fexofenadine have not been shown to be more effective in controlling urticaria symptoms in most patients (Ref).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Adult

The renal dosing recommendations are based upon the best available evidence and clinical expertise. Senior Editorial Team: Bruce Mueller, PharmD, FCCP, FASN, FNKF; Jason A. Roberts, PhD, BPharm (Hons), B App Sc, FSHP, FISAC; Michael Heung, MD, MS.

Note: Use of the once-daily formulation is not recommended in patients with eGFR <50 mL/minute/1.73 m² or on renal replacement therapies (Ref).

Altered kidney function (Ref):

eGFR ≥50 mL/minute/1.73 m²: Oral: No dosage adjustment necessary.

eGFR 10 to <50 mL/minute/1.73 m²: Oral: 60 mg every 12 to 24 hours.

eGFR <10 mL/minute/1.73 m²: Oral: 60 mg every 24 hours. Note: Results of a pharmacokinetic study suggest that nonrenal clearance of fexofenadine is impaired in patients with end-stage kidney disease (ESKD) (Ref); monitor patients for signs and symptoms of drug accumulation and toxicity.

Augmented renal clearance (measured urinary CrCl ≥130 mL/minute/1.73 m²):

Note: Augmented renal clearance (ARC) is a condition that occurs in certain critically ill patients without organ dysfunction and with normal serum creatinine concentrations. Younger patients (<55 years of age) admitted post trauma or major surgery are at highest risk for ARC, as well as those with sepsis, burns, or hematologic malignancies. An 8- to 24-hour measured urinary CrCl is necessary to identify these patients (Ref).

Oral: No dosage adjustment necessary (Ref).

Hemodialysis, intermittent (thrice weekly): Not dialyzable (Ref):

Oral: 60 mg every 24 hours (Ref).

Note: Results of a pharmacokinetic study suggest that nonrenal clearance of fexofenadine is impaired in patients with ESKD (Ref); monitor patients for signs and symptoms of drug accumulation and toxicity.

Peritoneal dialysis: Significant removal unlikely (large V_d) (Ref):

Oral: 60 mg every 24 hours (Ref).

CRRT:

Note: Drug clearance is dependent on the effluent flow rate, filter type, and method of renal replacement. Recommendations are based on high-flux dialyzers and effluent flow rates of 20 to 25 mL/kg/hour (or ~1,500 to 3,000 mL/hour) and minimal residual kidney function unless otherwise noted. Close monitoring of response and adverse reactions (eg, excess sedation) due to drug accumulation is important.

Oral: 60 mg every 24 hours (Ref).

PIRRT (eg, sustained, low-efficiency diafiltration):

Note: Drug clearance is dependent on the effluent flow rate, filter type, and method of renal replacement. Close monitoring of response and adverse reactions (eg, excess sedation) due to drug accumulation is important.

Oral: 60 mg every 24 hours (Ref).

Dosing: Hepatic Impairment: Adult

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

Dosing: Older Adult

Refer to adult dosing.

Dosing: Pediatric

(For additional information see "Fexofenadine: Pediatric drug information")

Allergic symptoms/rhinitis

Allergic symptoms/rhinitis: Product-specific dosing:

Twice-daily formulations (eg, oral suspension, oral disintegrating tablet, regular tablet):

Oral suspension:

Infants ≥6 months and Children <2 years: Limited data available (Ref):

<10.5 kg: Oral: 15 mg every 12 hours.

≥10.5 kg: Oral: 30 mg every 12 hours.

Dosing based on a safety and tolerability study on patients with allergic rhinitis receiving fexofenadine 15 mg twice daily (weight <10.5 kg, n=85) and fexofenadine 30 mg twice daily (weight ≥10.5 kg, n=108) compared to placebo (n=199); adverse events were similar between fexofenadine and placebo (Ref).

Children ≥2 to <12 years: Oral: 30 mg every 12 hours; maximum daily dose: 60 mg/day.

Children ≥12 years and Adolescents: Oral: 60 mg every 12 hours; maximum daily dose: 120 mg/day.

Orally-disintegrating tablet (ODT):

Children ≥6 years to <12 years: Oral: 30 mg every 12 hours; maximum daily dose: 60 mg/day.

Children ≥12 years and Adolescents: Oral: 60 mg every 12 hours; maximum daily dose: 120 mg/day.

12-hour tablet: Children ≥12 years and Adolescents: Oral: 60 mg every 12 hours; maximum daily dose: 120 mg/day.

Once-daily formulation:

Children ≥12 years and Adolescents: Oral: 180 mg once daily.

Urticaria, acute

Urticaria, acute: Limited data available (Ref):

Children ≥6 to 11 years: Twice-daily formulations (eg, oral suspension, oral disintegrating tablet, regular tablet): Oral: 30 mg every 12 hours.

Children ≥12 years and Adolescents: Twice-daily formulations (eg, oral suspension, oral disintegrating tablet, regular tablet): Oral: 60 mg every 12 hours.

Urticaria, chronic spontaneous

Urticaria, chronic spontaneous: Limited data available: Note: Considered first-line therapy for management of chronic urticaria; if response inadequate after 2 to 4 weeks of therapy or symptoms intolerable, consider increasing the dose of fexofenadine (as age and weight permits) as second-line treatment rather than changing therapy (Ref).

Infants ≥6 months to Children <2 years: Twice-daily formulations (eg, oral suspension): Oral: 15 mg every 12 hours (Ref).

Children ≥2 to <12 years: Twice-daily formulations (eg, oral suspension, orally-disintegrating tablet, regular tablet): Oral: 30 mg twice daily (Ref).

Children ≥12 years and Adolescents:

Twice-daily formulations (eg, oral suspension, orally-disintegrating tablet, regular tablet): Oral: 60 mg every 12 hours (Ref).

Once-daily formulation: Oral: 180 mg once daily (Ref).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Pediatric

Twice-daily formulations (eg, oral suspension, oral disintegrating tablet, regular tablet):

There are no dosage adjustments provided in the OTC manufacturer's labeling; previous prescribing information (Ref) suggested the following

Infants ≥6 months to Children <2 years: Any degree of kidney impairment: Initial: 15 mg once daily.

Children 2 to 11 years: Any degree of kidney impairment: 30 mg once daily.

Children ≥12 years and Adolescents: Any degree of kidney impairment: 60 mg once daily.

Others have suggested the following: Children ≥12 years and Adolescents (Ref):

CrCl 10 to 50 mL/minute: 60 mg once daily.

CrCl <10 mL/minute: 30 mg once daily.

Hemodialysis: Not effectively removed by hemodialysis: 30 mg once daily.

Peritoneal dialysis: 30 mg once daily.

Once-daily formulation: There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Hepatic Impairment: Pediatric

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

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

>10%: Gastrointestinal: Vomiting (infants and children: 12%)

1% to 10%:

Gastrointestinal: Diarrhea (infants and children: 4%), stomach discomfort (adolescents and adults: 2%)

Genitourinary: Dysmenorrhea (adolescents and adults: 2%)

Nervous system: Dizziness (adolescents and adults: 2%), drowsiness (infants and children: ≤3%), fatigue (infants and children: ≤3%), headache (adolescents and adults: 5% to 10%)

Neuromuscular & skeletal: Back pain (adolescents and adults: 2% to 3%), limb pain (adolescents and adults: 2%)

Respiratory: Cough (children: 4%), rhinorrhea (infants and children: 2%), upper respiratory tract infection (children: 3%)

Miscellaneous: Fever (children: 2%)

Postmarketing (any population):

Dermatologic: Skin rash (Wahn 2003), Stevens-Johnson syndrome (Teo 2017), toxic epidermal necrolysis (Teo 2017)

Gastrointestinal: Dyspepsia (Meltzer 2004), nausea (Wahn 2003)

Hypersensitivity reaction: Anaphylaxis, angioedema, hypersensitivity reaction

Nervous system: Insomnia, nervousness, nightmares, sleep disorder

Respiratory: Epistaxis (Wahn 2003)

Contraindications

OTC labeling: When used for self-medication do not use if you ever had an allergic reaction to fexofenadine or any component of the formulation.

Warnings/Precautions

Disease-related concerns:

• Renal impairment: Use with caution in patients with renal impairment; dosage adjustment may be recommended.

Dosage form specific issues:

• Orally disintegrating tablet: Some products may contain phenylalanine.

Other warnings/precautions:

• OTC labeling: When used for self-medication (OTC), do not exceed recommended dosage or administer at the same time with aluminum or magnesium antacids or with fruit juices.

Warnings: Additional Pediatric Considerations

Safety and efficacy for the use of cough and cold products in pediatric patients <4 years of age is limited; the AAP warns against the use of these products for respiratory illnesses in young children. Serious adverse effects including death have been reported. Many of these products contain multiple active ingredients, increasing the risk of accidental overdose when used with other products. The FDA does not recommend OTC uses for these products in pediatric patients <2 years of age and recommends to use with caution in pediatric patients ≥2 years of age. Health care providers are reminded to ask caregivers about the use of OTC cough and cold products in order to avoid exposure to multiple medications containing the same ingredient (AAP 2018; CDC 2007; FDA 2017; FDA 2018).

Some dosage forms may contain propylene glycol; in neonates, large amounts of propylene glycol delivered orally, intravenously (eg, >3,000 mg/day), or topically have been associated with potentially fatal toxicities which can include metabolic acidosis, seizures, renal failure, and CNS depression; toxicities have also been reported in children and adults including hyperosmolality, lactic acidosis, seizures, and respiratory depression; use caution (AAP 1997; Shehab 2009).

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Suspension, Oral, as hydrochloride:

Allegra Allergy Childrens: 30 mg/5 mL (240 mL) [alcohol free, dye free; contains butylparaben, edetate (edta) disodium, propylene glycol, propylparaben; berry flavor]

Allegra Allergy Childrens: 30 mg/5 mL (120 mL) [alcohol free, dye free; contains butylparaben, edetate (edta) disodium, propylene glycol, propylparaben; raspberry creme flavor]

Allergy Childrens: 30 mg/5 mL (118 mL, 237 mL) [alcohol free, dye free; contains butylparaben, edetate (edta) disodium, propylene glycol, propylparaben; berry flavor]

Tablet, Oral, as hydrochloride:

Allegra Allergy: 60 mg, 180 mg

Allegra Allergy: 180 mg [contains fd&c blue #1 (brilliant blue)]

Allegra Hives 24HR: 180 mg

Allergy 24-HR: 180 mg

Allergy Relief: 60 mg [contains corn starch]

Allergy Relief: 180 mg

Allergy Relief: 180 mg [contains corn starch]

Allergy Relief/Indoor/Outdoor: 180 mg [contains corn starch]

FT Allergy Relief: 180 mg

FT Allergy Relief 12 Hour: 60 mg [contains corn starch, fd&c red #40 (allura red ac dye)]

FT Allergy Relief 24 Hour: 180 mg [contains corn starch, fd&c red #40 (allura red ac dye)]

Generic: 60 mg, 180 mg

Tablet Disintegrating, Oral, as hydrochloride:

Allegra Allergy Childrens: 30 mg [dye free; contains aspartame; orange cream flavor]

Generic Equivalent Available: US

May be product dependent

Pricing: US

Suspension (Allegra Allergy Childrens Oral)

30 mg/5 mL (per mL): $0.13

Tablet, orally-disintegrating (Allegra Allergy Childrens Oral)

30 mg (per each): $0.91

Tablets (Allegra Allergy Oral)

60 mg (per each): $1.17

180 mg (per each): $0.95

Tablets (Allegra Hives 24HR Oral)

180 mg (per each): $1.88

Tablets (Fexofenadine HCl Oral)

60 mg (per each): $0.16 - $0.22

180 mg (per each): $0.16 - $0.42

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Administration: Adult

Orally disintegrating tablet: Administer on an empty stomach. Remove tablet from individual blister and place immediately on tongue; tablet will disintegrate with or without water (do not administer with fruit juices).

Oral suspension, tablet: Administer with water only; do not administer with fruit juices. Shake suspension well before use. Use suspension only with enclosed dosing cup.

Administration: Pediatric

Oral:

Twice-daily formulations:

Suspension, regular tablet: May administer without respect to food. Take with water; avoid administration with fruit juices; shake suspension well before use. Administer suspension with an accurate measuring device; do not use a household teaspoon.

Orally-disintegrating tablet: Administer on an empty stomach. Do not remove from blister pack until ready to administer. Using dry hands, place immediately on tongue. Tablet will dissolve within seconds and may be swallowed with or without liquid; avoid administering with fruit juices.

Once-daily formulation: Swallow whole with water; do not take with fruit juices.

Use: Labeled Indications

Upper respiratory allergies: Temporary relief of runny nose, sneezing, itching of the nose or throat, and/or itchy, watery eyes due to hay fever or other upper respiratory allergies.

Use: Off-Label: Adult

Urticaria, new onset and chronic spontaneous

Medication Safety Issues

Sound-alike/look-alike issues:

Allegra may be confused with Allegra Anti-Itch Cream (diphenhydramine/allantoin), Viagra

Fexofenadine may be confused with fesoterodine

Mucinex Allergy may be confused with Mucinex

High alert medication:

The Institute for Safe Medication Practices (ISMP) includes this medication among its list of drugs (pediatric liquid medications requiring measurement) which have a heightened risk of causing significant patient harm when used in error (High-Alert Medications in Community/Ambulatory Care Settings).

International issues:

Allegra [US, Canada, and multiple international markets] may be confused with Allegro brand name for fluticasone [Israel] and frovatriptan [Germany]

Metabolism/Transport Effects

Substrate of CYP3A4 (minor), OAT1/3, OATP1B1/1B3 (SLCO1B1/1B3), P-glycoprotein/ABCB1 (minor); Note: Assignment of Major/Minor substrate status based on clinically relevant drug interaction potential

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.

Alcohol (Ethyl): CNS Depressants may enhance the CNS depressant effect of Alcohol (Ethyl). Risk C: Monitor therapy

Alizapride: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Amezinium: Antihistamines may enhance the stimulatory effect of Amezinium. Risk C: Monitor therapy

Antacids: May decrease the serum concentration of Fexofenadine. Management: Separate the administration of fexofenadine and aluminum- or magnesium-containing antacids. Risk D: Consider therapy modification

Azelastine (Nasal): May enhance the CNS depressant effect of CNS Depressants. Risk X: Avoid combination

Benzylpenicilloyl Polylysine: Antihistamines may diminish the diagnostic effect of Benzylpenicilloyl Polylysine. Management: Suspend systemic H1 antagonists for benzylpenicilloyl-polylysine skin testing and delay testing until systemic antihistaminic effects have dissipated. A histamine skin test may be used to assess persistent antihistaminic effects. Risk D: Consider therapy modification

Betahistine: Antihistamines may diminish the therapeutic effect of Betahistine. Betahistine may diminish the therapeutic effect of Antihistamines. Risk C: Monitor therapy

Blonanserin: CNS Depressants may enhance the CNS depressant effect of Blonanserin. Management: Use caution if coadministering blonanserin and CNS depressants; dose reduction of the other CNS depressant may be required. Strong CNS depressants should not be coadministered with blonanserin. Risk D: Consider therapy modification

Brexanolone: CNS Depressants may enhance the CNS depressant effect of Brexanolone. Risk C: Monitor therapy

Brimonidine (Topical): May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Bromopride: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Bromperidol: May enhance the CNS depressant effect of CNS Depressants. Risk X: Avoid combination

Buprenorphine: CNS Depressants may enhance the CNS depressant effect of Buprenorphine. Management: Consider reduced doses of other CNS depressants, and avoiding such drugs in patients at high risk of buprenorphine overuse/self-injection. Initiate buprenorphine at lower doses in patients already receiving CNS depressants. Risk D: Consider therapy modification

Cannabinoid-Containing Products: CNS Depressants may enhance the CNS depressant effect of Cannabinoid-Containing Products. Risk C: Monitor therapy

Chlormethiazole: May enhance the CNS depressant effect of CNS Depressants. Management: Monitor closely for evidence of excessive CNS depression. The chlormethiazole labeling states that an appropriately reduced dose should be used if such a combination must be used. Risk D: Consider therapy modification

Chlorphenesin Carbamate: May enhance the adverse/toxic effect of CNS Depressants. Risk C: Monitor therapy

CNS Depressants: May enhance the adverse/toxic effect of other CNS Depressants. Risk C: Monitor therapy

Daridorexant: May enhance the CNS depressant effect of CNS Depressants. Management: Dose reduction of daridorexant and/or any other CNS depressant may be necessary. Use of daridorexant with alcohol is not recommended, and the use of daridorexant with any other drug to treat insomnia is not recommended. Risk D: Consider therapy modification

DexmedeTOMIDine: CNS Depressants may enhance the CNS depressant effect of DexmedeTOMIDine. Management: Monitor for increased CNS depression during coadministration of dexmedetomidine and CNS depressants, and consider dose reductions of either agent to avoid excessive CNS depression. Risk D: Consider therapy modification

Difelikefalin: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Dimethindene (Topical): May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Doxylamine: CNS Depressants may enhance the CNS depressant effect of Doxylamine. Risk C: Monitor therapy

DroPERidol: May enhance the CNS depressant effect of CNS Depressants. Management: Consider dose reductions of droperidol or of other CNS agents (eg, opioids, barbiturates) with concomitant use. Risk D: Consider therapy modification

Esketamine: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Flunarizine: CNS Depressants may enhance the CNS depressant effect of Flunarizine. Risk X: Avoid combination

Flunitrazepam: CNS Depressants may enhance the CNS depressant effect of Flunitrazepam. Management: Reduce the dose of CNS depressants when combined with flunitrazepam and monitor patients for evidence of CNS depression (eg, sedation, respiratory depression). Use non-CNS depressant alternatives when available. Risk D: Consider therapy modification

Grapefruit Juice: May decrease the serum concentration of Fexofenadine. Risk C: Monitor therapy

Hyaluronidase: Antihistamines may diminish the therapeutic effect of Hyaluronidase. Risk C: Monitor therapy

HydrOXYzine: May enhance the CNS depressant effect of CNS Depressants. Management: Consider a decrease in the CNS depressant dose, as appropriate, when used together with hydroxyzine. Increase monitoring of signs/symptoms of CNS depression in any patient receiving hydroxyzine together with another CNS depressant. Risk D: Consider therapy modification

Ixabepilone: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Kava Kava: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Kratom: May enhance the CNS depressant effect of CNS Depressants. Risk X: Avoid combination

Lemborexant: May enhance the CNS depressant effect of CNS Depressants. Management: Dosage adjustments of lemborexant and of concomitant CNS depressants may be necessary when administered together because of potentially additive CNS depressant effects. Close monitoring for CNS depressant effects is necessary. Risk D: Consider therapy modification

Lisuride: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Lofexidine: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Loxapine: CNS Depressants may enhance the CNS depressant effect of Loxapine. Risk D: Consider therapy modification

Magnesium Sulfate: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Methotrimeprazine: CNS Depressants may enhance the CNS depressant effect of Methotrimeprazine. Methotrimeprazine may enhance the CNS depressant effect of CNS Depressants. Management: Reduce the usual dose of CNS depressants by 50% if starting methotrimeprazine until the dose of methotrimeprazine is stable. Monitor patient closely for evidence of CNS depression. Risk D: Consider therapy modification

Metoclopramide: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

MetyroSINE: CNS Depressants may enhance the sedative effect of MetyroSINE. Risk C: Monitor therapy

Minocycline (Systemic): May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Nabilone: May enhance the CNS depressant effect of CNS Depressants. Risk X: Avoid combination

Olopatadine (Nasal): May enhance the CNS depressant effect of CNS Depressants. Risk X: Avoid combination

Opioid Agonists: CNS Depressants may enhance the CNS depressant effect of Opioid Agonists. Management: Avoid concomitant use of opioid agonists and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. Risk D: Consider therapy modification

Orphenadrine: CNS Depressants may enhance the CNS depressant effect of Orphenadrine. Risk X: Avoid combination

Oxomemazine: May enhance the CNS depressant effect of CNS Depressants. Risk X: Avoid combination

Oxybate Salt Products: CNS Depressants may enhance the CNS depressant effect of Oxybate Salt Products. Management: Consider alternatives to this combination when possible. If combined, dose reduction or discontinuation of one or more CNS depressants (including the oxybate salt product) should be considered. Interrupt oxybate salt treatment during short-term opioid use Risk D: Consider therapy modification

OxyCODONE: CNS Depressants may enhance the CNS depressant effect of OxyCODONE. Management: Avoid concomitant use of oxycodone and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. Risk D: Consider therapy modification

Paraldehyde: CNS Depressants may enhance the CNS depressant effect of Paraldehyde. Risk X: Avoid combination

Perampanel: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

P-glycoprotein/ABCB1 Inducers: May decrease the serum concentration of Fexofenadine. Risk C: Monitor therapy

Piribedil: CNS Depressants may enhance the CNS depressant effect of Piribedil. Risk C: Monitor therapy

Pitolisant: Antihistamines may diminish the therapeutic effect of Pitolisant. Risk X: Avoid combination

Pramipexole: CNS Depressants may enhance the sedative effect of Pramipexole. Risk C: Monitor therapy

Procarbazine: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

RifAMPin: May decrease the serum concentration of Fexofenadine. RifAMPin may increase the serum concentration of Fexofenadine. Risk C: Monitor therapy

Ropeginterferon Alfa-2b: CNS Depressants may enhance the adverse/toxic effect of Ropeginterferon Alfa-2b. Specifically, the risk of neuropsychiatric adverse effects may be increased. Management: Avoid coadministration of ropeginterferon alfa-2b and other CNS depressants. If this combination cannot be avoided, monitor patients for neuropsychiatric adverse effects (eg, depression, suicidal ideation, aggression, mania). Risk D: Consider therapy modification

ROPINIRole: CNS Depressants may enhance the sedative effect of ROPINIRole. Risk C: Monitor therapy

Rotigotine: CNS Depressants may enhance the sedative effect of Rotigotine. Risk C: Monitor therapy

Rufinamide: May enhance the adverse/toxic effect of CNS Depressants. Specifically, sleepiness and dizziness may be enhanced. Risk C: Monitor therapy

Suvorexant: CNS Depressants may enhance the CNS depressant effect of Suvorexant. Management: Dose reduction of suvorexant and/or any other CNS depressant may be necessary. Use of suvorexant with alcohol is not recommended, and the use of suvorexant with any other drug to treat insomnia is not recommended. Risk D: Consider therapy modification

Thalidomide: CNS Depressants may enhance the CNS depressant effect of Thalidomide. Risk X: Avoid combination

Trimeprazine: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Valerian: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Zolpidem: CNS Depressants may enhance the CNS depressant effect of Zolpidem. Management: Reduce the Intermezzo brand sublingual zolpidem adult dose to 1.75 mg for men who are also receiving other CNS depressants. No such dose change is recommended for women. Avoid use with other CNS depressants at bedtime; avoid use with alcohol. Risk D: Consider therapy modification

Zuranolone: May enhance the CNS depressant effect of CNS Depressants. Management: Consider alternatives to the use of zuranolone with other CNS depressants or alcohol. If combined, consider a zuranolone dose reduction and monitor patients closely for increased CNS depressant effects. Risk D: Consider therapy modification

Food Interactions

High-fat meals decrease the bioavailability of fexofenadine by ~50%. Fruit juice (apple, grapefruit, orange) may decrease bioavailability of fexofenadine by ~36%. Management: Separating fexofenadine administration and fruit juice consumption by at least 4 hours may decrease the significance of this possible interaction.

Pregnancy Considerations

Agents other than fexofenadine are preferred for the treatment of allergic conditions, such as rhinitis, pruritus, and urticaria, in pregnant women (BSACI [Powell 2015]; BSACI [Scadding 2017]; Murase 2014; Zuberbier 2018).

Breastfeeding Considerations

Information specific to fexofenadine and breastfeeding has not been located.

Fexofenadine is present in breast milk following administration of its parent compound, terfenadine, to breastfeeding mothers (Lucas 1995).

Drowsiness and irritability have been reported in breastfed infants exposed to antihistamines; only irritability was reported in infants exposed to fexofenadine’s parent compound, terfenadine (Ito 1993). In general, second generation antihistamines are less sedating as compared to their first generation counterparts. If a breastfed infant is exposed to a second generation antihistamine via breast milk, they should be monitored for irritability, jitteriness, or drowsiness (Butler 2014).

When treatment with an antihistamine is needed in breastfeeding women, other second generation antihistamines with more information available regarding their use in this patient population are preferred (BSACI [Powell 2015]; BSACI [Scadding 2017]; Butler 2014; Zuberier 2018).

Dietary Considerations

Some products may contain phenylalanine and/or sodium. Take suspension and tablets preferably with water; separate administration with grapefruit or other fruit juices by at least 4 hours.

Monitoring Parameters

Relief of symptoms

Mechanism of Action

Fexofenadine is an active metabolite of terfenadine and like terfenadine it competes with histamine for H₁-receptor sites on effector cells in the gastrointestinal tract, blood vessels and respiratory tract; it appears that fexofenadine does not cross the blood-brain barrier to any appreciable degree, resulting in a reduced potential for sedation

Pharmacokinetics (Adult Data Unless Noted)

Onset of action: 2 hours (Simons 2004)

Duration of action: 24 hours (Simons 2004)

Absorption: Rapid

Protein binding: 60% to 70% (Markham 1998); primarily albumin and alpha₁-acid glycoprotein

Metabolism: Minimal (Hepatic: ~5%); 3.6% transformed into methylester metabolite found only in feces

Bioavailability: ~33%

Half-life elimination: 14.4 hours (59% longer in patients with mild to moderate renal impairment [CrCl 41 to 80 mL/minute]; 72% longer in patients with severe renal impairment [CrCl 11 to 40 mL/minute]) (Markham 1998; Simons 2004)

Time to peak, serum: ODT: 2 hours (4 hours with high-fat meal); Tablet: ~2.6 hours (Simons 2004); Suspension: ~1 hour

Excretion: Feces (80%) and urine (12%) as unchanged drug (Simons 2004)

Pharmacokinetics: Additional Considerations (Adult Data Unless Noted)

Altered kidney function: Mild to moderate impairment with CrCl 41 to 80 mL/minute has an 87% increase in C_max. Severe impairment with CrCl 11 to 40 mL/minute has a 111% increase in C_max.

Older adult: C_max is increased 99%.

Brand Names: International

International Brand Names by Country

For country code abbreviations (show table)

(AE) United Arab Emirates: Celera | Fenadex | Fexigra | Fexodine | Fexogen | Fexon | Fexotel | Sarfast | Telfast | Telife | Zyhist;
(AR) Argentina: Alercas | Alerfedine | Allegra | Mudantil f | Vagran 120 | Vagran 180;
(AT) Austria: Telfast;
(AU) Australia: Allerfexo | Amcal Fexo | Apohealth fexofenadine hayfever & allergy relief | Blooms the chemist fexofenadine | Chemists Own Fexo | Chemists' Own Fexo | Chemmart fexofenadine | Chemplus fexofenadine | Discount drug stores fexofenadine | Fexal | Fexo | Fexofenadine | Fexofenadine hayfever & allergy relief | Fexorelief | Fexotabs | Guardian Fexo | Hayfexo | Pharmacist fexofenadine | Pharmacists own fexofenadine | Pharmacy care fexo | Pharmacy health fexofenadine | Priceline pharmacy fexofenadine hayfever & allergy relief | Tefodine | Telfast | Terry white chemists fexofenadine | Trust fex | Xergic | Your pharmacy fexofenadine;
(BD) Bangladesh: Afexa | Alafree | Alagra | Alanil | Alerfast | Alerfex | Alfex | Axodin | Axofen | Delfex | Dinafex | Elfexo | Fastel | Fegra | Fenadin | Fenofex | Fexo | Fexobest | Fexocold | Fexocon | Fexodin | Fexofast | Fexofen | Fexomin | Fexon | Fexona | Fexonaaf | Fexoral | Fexotab | Fexten | Fixal | Fixen | Furia | Nolargy | Odafen | Perfex | Rafex | Rinofen | Ritch | Rynofex | Sardin | SB fexec | Sifena | Telfadin | Telfast | Telfex | Vifas | X din | Xofast | Xofena;
(BE) Belgium: Allegratab | Allergo Rhinathiol | Fexofenadine Sandoz | Telfast;
(BF) Burkina Faso: Telfast | Xafen;
(BG) Bulgaria: Allegra | Ewofex | Telfast;
(BR) Brazil: Allegra | Allexofedrin | Allexofedrin pediatrico | Altiva | Cloridrato de fexofenadina | Desrinite | Fexodane | Fexolerg | Fexoliv | Fexx | Lexler | Rafex;
(CH) Switzerland: Fexo mepha allergie | Fexo pollen sandoz | Fexofenadin mepha | Fexofenadin sandoz | Fexofenadin spirig | Fexofenadine Zentiva | Telfast | Telfastin | Telfastin allergo;
(CI) Côte d'Ivoire: Rifex | Xafen | Xonadine;
(CL) Chile: Alexia | Allegra;
(CN) China: A te la | Lai duo fei | Min jie | Raltiva | Rui fei | Sai le xi;
(CO) Colombia: Aleraliv | Alerfast | Allegra | Fentradol | Fexodina | Fexofem | Fexofenadina | Fexofenadina hcl | Fexu | Fexuped | Fexy | Garmisch fentradol | Gyets | Hismanal | Pedialab | Rinolast;
(CZ) Czech Republic: Ewofex | Fexigra;
(DE) Germany: Fexofenaderm | Fexofenadin hexal | Fexofenadin Winthrop | Fexofenadine cipla | Telfast;
(DK) Denmark: Alnodine | Nefoxef;
(DO) Dominican Republic: Alercas | Allegra pediatrico | Fexofast | Fexofran | Ronoprin;
(EC) Ecuador: Alerfast | Alerfedine | Alexia | Allegra | Fexofen | Fexofenadina | Fexofenadina mk | Rinolast;
(EG) Egypt: Alertam | Allerfen | Allergyna | Elballerge | Fastel | Fexodine | Fexolerg | Fexon | Histafree | Histamedizen | Linofenadine | Sanzalera | Telfast;
(ES) Spain: Fexofenadina cipla | Fexofenadina Tevagen;
(FI) Finland: Fexofenadine Bmm Pharma | Fexofenadine ratiopharm | Fexorin | Telfast;
(FR) France: Fexofenadine Biogaran | Fexofenadine mylan | Telfast;
(GB) United Kingdom: Fexofenadine | Fexofenadine cipla | Fexofenadine Teva | Telfast | Treathay;
(GR) Greece: Allegra;
(HK) Hong Kong: Allegix | Allerfast | Axodin | Bosnum | Fenadin | Fexet | Fexodine | Fexofenadine HCL | Fexostad | Fixdep | Telfast | Zafil;
(HR) Croatia: Allegra | Feksofenadinklorid cipla | Telfast;
(HU) Hungary: Allegra | Ewofex | Fexgen | Fexofep | Telfast;
(ID) Indonesia: Fexomin | Fexoven | Sanolergic | Telfast | Telfast bd | Telfast hd;
(IE) Ireland: Fexofast | Fexofenadine | Telfast | Telfast allergy;
(IL) Israel: Fexofenadine Teva | Fexofenadine trima | Telfast;
(IN) India: Afexdine | Air | Alafex | Alarrest | Alecloz | Alerfex | Alernex | Alert | Alexo | Alfexo | Alifex | Allegix | Allegra | Allerfast | Allerfex | Allergix | Allergo | Allofex | Altiva | Belfexin | Cnf plus | Curifex | Delpodine | Effectin | Ethifex | Etofex | F din | Fax | Faxodas | Fegra | Fenagra | Fenixa | Fenq | Fex | Fexair | Fexeit | Fexidine | Fexigra | Fexo | Fexobit | Fexocet | Fexoday | Fexodin | Fexodine | Fexofast | Fexofen | Fexoleb | Fexolife | Fexona | Fexotrol | Fexova | Fext | Fextim | Fextral | Fextro | Fexy | Finide | Finista | Fx 24 | Fxla | Hhfexo | Histafree | Histagra | Histakind | Histaloc | Histeas | Histos | Klm fx | Lcfex | Luracise | Nexofex | Odifex | Ofena | Ofine | Radifex | Rhinofex | Sinarest fx | Tadil | Ultigra | Verifine | Wexodine | X dine | Xaria Kidz | Zietex;
(IS) Iceland: Nefoxef;
(IT) Italy: Fexallegra | Fexofenadina dr reddy's | Fexofenadina MG | Fexofenadina sanofi | Fexofenadina sanofi aventis | Fixodin | Kalicet | Telfast;
(JO) Jordan: Exofen | Feksine | Fexadine | Fexodex | Fexofast | Telfast;
(JP) Japan: Allegra | Allegra fx | Allerbi | Fexofenadine alpha | Fexofenadine hydrochloride dk | Fexofenadine hydrochloride ffp | Fexofenadine hydrocloride bmd | Nospole rhinitis fx | Nosupol bien jyou fx | Skyblon HI;
(KE) Kenya: Allegix | Allerfast | Allerfex | Allergo | Allerstat | Arest | Axodin | Bosnum | Fexet | Fexidine | Fexipas 120 | Fexo | Fexofen | Telfast | Ultigra | Xonadine;
(KR) Korea, Republic of: Alfenadine | Allecot | Allegra | Allerdin | Alletoc | Fexigra | Fexofen | Fexomin | Fexon | Fexonadine;
(KW) Kuwait: Fexodine | Telfast;
(LB) Lebanon: Exofen | Fenadex | Fexofen | Telfast;
(LT) Lithuania: Altiva | Telfast;
(LU) Luxembourg: Allegratab | Telfast;
(LV) Latvia: Allegra | Altiva;
(MA) Morocco: Telfast;
(MX) Mexico: Afernidin | Aldifex | Allegra | Apertum OX | Biostafex | Clareve | Desrotan | Fexofenadin | Fexofenadin Landsteiner | Fexofenadina | Fexofenadina rayere | Fexoff R | Pirquet | Ranfast;
(MY) Malaysia: Altiva | Fexofenadin Stada | Fexofin | Fexovid | Telfast;
(NG) Nigeria: Allerstat | Fexet | Fexidine | Fexofenadine;
(NL) Netherlands: Allegra Fexotabs | Fexofenadine HCL | Fexofenadine hcl amarox | Fexofenadine hcl mylan | Fexofenadine HCl Sandoz | Telfast;
(NO) Norway: Allegra | Altifex | Telfast;
(NZ) New Zealand: Fexaclear | Fexofast | Hayfexo | Pharmacy health fexofenadine hayfever & allergy relief | Telfast;
(PE) Peru: Allegra | Allegra pediatrico | Allemax | Fenamax | Fenax | Fexaller | Fexofast | Fexofenadina | Libberafex | Xendixtal;
(PH) Philippines: Eofen | Fenafex | Fexet | Fexoral | Fexotab | Rhinogan | Sensitin | Telfast;
(PK) Pakistan: Adine | Afex | Allergia | Alofex | Alrin | Altiva | Callfast | Demxet | Enadin | Faasfodine | Fanamed | Fanasel | Faxid | Faxodine | Fegix | Fenacare | Fenadex | Fendina-f | Fenix | Fenoxy | Fescot | Fexamed | Fexera | Fexet | Fexheal | Fexidine | Feximor | Fexine | Fexinol | Fexmit | Fexo | Fexofast | Fexofin | Fexokure | Fexolis | Fexolyd | Fexoprime | Fexosure | Fexsel | Fidaxo | Fifex | Fiofen | Fix it | Fixfast | Fluzip | Font | Genfix | Geridin | Hifast | Infex | Lenodine | Lixifil | Mafodin | Mb fex | Meadow | Megafast | Neofexa | Nifty | Novahist | Obfex | Odifex | Plexid | Plifast | Raltiva | Ramfex | Remast | Revofex | Saifex | Sb Din | Simfexo | Sizzle | Sneez | Softin f | Tansidin | Tefend | Telfast | Telfex | Telwin | Tilast | Vasofax | Welfast | Xadine | Xfr | Xyfex;
(PL) Poland: Allegra | Allegra telfast | Allertec fexo | Fexogen | Telfast | Telfexo;
(PR) Puerto Rico: Allegra | Allegra allergy non drowsy | Allegra hives | Allergy relief | Children's allegra allergy | Fexofenadine | Fexofenadine HCL | Mucinex allergy;
(PT) Portugal: Fexofenadina Generis | Fexofenadina Mylan | Nalerge;
(PY) Paraguay: Alercas | Alermid | Allegra | Allegra pediatrico | Congex | Novo alergiol | Restaler nf | Tolston nf;
(QA) Qatar: Exofen | Fenadex | Fexa | Fexodine | Qfexine | Telfadin | Telfast;
(RO) Romania: Altiva | Ewofex | Telfast;
(RU) Russian Federation: Allegra | Bexist sanovel | Dinox | Fexadin | Fexo | Fexofenadine akrikhin | Telfast;
(SA) Saudi Arabia: Fenadex | Fexodine | Fexofin | Fexotel | Sarfex | Telfast;
(SE) Sweden: Allegra | Fexofenadin | Fexofenadin abacus medicine | Fexofenadin ABECE | Fexofenadin apofri | Fexofenadin Cipla | Fexofenadin Ebb | Fexofenadin orifarm | Nefoxef | Telfast;
(SG) Singapore: Exodin | Fexofen | Telfast;
(SI) Slovenia: Allegra | Feksofenadin Mylan | Telfast;
(SK) Slovakia: Allegra | Ewofex | Fixit | Telfast;
(TH) Thailand: Avafast | Bosnum | Fenafex | Fexofast | Medifast | Sanik | Telfast | Tofexo | Vifas;
(TN) Tunisia: Fenadex | Telfast;
(TR) Turkey: Feksine | Fexadyne | Fexofen | Mayfex | Telfast;
(TW) Taiwan: Alledine | Fe Min | Fenadin | Fexodine | Fexofenadine | Fynadin | Jfs fct "root" | Nasaga | Naxodine | Su Min;
(UA) Ukraine: Alexofast | Alfast | Allegra | Allergo | Altiva | Fexofen | Telfast | Tigofast;
(UG) Uganda: Exofen | Fexofen | Fixdep | Xonadine;
(UY) Uruguay: Alergistin nf | Allegra | Fexofen | Norinal | Novo Alerfedine | Tolston;
(VE) Venezuela, Bolivarian Republic of: Alermid | Allegra | Fenax | Fexofenadina | Fexoril | Rinofen | Rinolast;
(VN) Viet Nam: Agimfast | Alerday | Allerphast | Apifexo | Cadifast | Fedimtast | Fefasdin | Fexfed | Fexodinefast | Fexophar | Gimfastnew | Hasalfast | Imexofen | Inflex | Lerphat | Loxcip | Malag | Telanhis | Telfor | Telgate | Ternafast | Tinfoten | Tinifast | Tiphafast | Tocimat | Usaallerz | Xonatrix;
(ZA) South Africa: Afex | Fenofex | Fexaway | Fexo | Fexofenadine biotech | Telfast | Tellerge;
(ZM) Zambia: Allerfast | Allerstat | Fixdep | Ultigra;
(ZW) Zimbabwe: Telfast

Allegra (fexofenadine) [prescribing information]. Bridgewater, NJ: sanofi-aventis U.S. LLC; July 2007.
Allegra (fexofenadine) [product monograph]. Laval, Quebec, Canada: sanofi-aventis Canada; September 2006.
Allegra Allergy 12 Hour (fexofenadine) [prescribing information]. Chatanooga, TN: Chattam; received April 2020.
Allegra Allergy 24 Hour (fexofenadine) [prescribing information]. Chatanooga, TN: Chattam; received April 2020.
Allegra Allergy Childrens (fexofenadine oral suspension) [prescribing information]. Chatanooga, TN: Chattam; received December 2022.
Allegra Allergy Childrens (fexofenadine orally disintegrating tablets) [prescribing information]. Chatanooga, TN: Chattam; received February 2021.
American Academy of Pediatrics (AAP). Cough and cold medicines should not be prescribed, recommended or used for respiratory illnesses in young children. Updated June 12, 2018. Available at http://www.choosingwisely.org/clinician-lists/american-academy-pediatrics-cough-and-cold-medicines-for-children-under-four/
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Fexofenadine: Drug information