Allergic rhinitis, perennial or seasonal: Oral: 5 mg once daily.
Angioedema, acute allergic or recurrent idiopathic (off-label use):
Note: Not indicated for angioedema associated with anaphylaxis; use epinephrine if anaphylaxis symptoms are present (ie, risk of airway or cardiovascular compromise) (James 2017; Zuraw 2022).
Oral: 5 mg once or twice daily; may increase up to 10 mg twice daily (Cicardi 2014; James 2017; Zuraw 2022).
Urticaria, new onset (off-label use) and chronic spontaneous (labeled use):
New onset: Oral: Initial: 5 mg once daily. If symptom control is inadequate, may immediately increase to 5 mg twice daily (Asero 2021).
Chronic spontaneous: Oral: Initial: 5 mg once daily. If symptom control is inadequate, may increase in 5 mg/day increments every 1 to 4 weeks up to 10 mg twice daily; periodically reevaluate necessity for continued treatment (EAACI [Zuberbier 2018]; Khan 2021; Staevska 2010).
Urticaria, nonsteroidal anti-inflammatory drug associated, prophylaxis (off-label use): Oral: 5 mg 30 minutes before intake of a strong COX-1 inhibitor (Trautmann 2016).
Moderate to severe impairment: No dosage adjustment necessary; use with caution in severe impairment. Although the US manufacturer’s labeling recommends a dose reduction to 5 mg every other day in patients with mild to severe renal impairment, the increased exposure (Cmax and AUC) observed in single- and multiple-dose pharmacokinetic studies is not considered clinically relevant (Aerius Canadian product monograph 2019; Aerius Netherlands prescribing information 2018; Geha 2001).
Hemodialysis: Poorly dialyzable: No dosage adjustment necessary; use with caution. Although the US manufacturer’s labeling recommends a dose reduction to 5 mg every other day in patients on dialysis, the increased exposure (Cmax and AUC) observed in single- and multiple-dose pharmacokinetic studies is not considered clinically relevant (Aerius Canadian product monograph 2019; Aerius Netherlands prescribing information 2018; Geha 2001).
No dosage adjustment necessary; use with caution in severe impairment. Although the US manufacturer’s labeling recommends a dose reduction to 5 mg every other day in patients with mild to severe hepatic impairment, the increased exposure (Cmax and AUC) observed in single- and multiple-dose pharmacokinetic studies is not considered clinically relevant (Aerius Canadian product monograph 2019; Geha 2001).
Refer to adult dosing.
(For additional information see "Desloratadine: Pediatric drug information")
Allergic rhinitis, perennial: Oral:
Infants 6 to ≤11 months: 1 mg once daily.
Children ≤5 years: 1.25 mg once daily.
Children 6 to ≤11 years: 2.5 mg once daily.
Children ≥12 years and Adolescents: 5 mg once daily.
Allergic rhinitis, s easonal: Oral:
Children 2 to ≤5 years: 1.25 mg once daily.
Children 6 to ≤11 years: 2.5 mg once daily.
Children ≥12 years and Adolescents: 5 mg once daily.
Urticaria, chronic idiopathic: Oral:
Infants 6 to ≤11 months: 1 mg once daily.
Children ≤5 years: 1.25 mg once daily.
Children 6 to ≤11 years: 2.5 mg once daily.
Children ≥12 years and Adolescents: 5 mg once daily.
There are no dosage adjustments provided in manufacturer's labeling for pediatric patients (has not been studied); based on adult information, dosage adjustment may be necessary.
There are no dosage adjustments provided in manufacturer's labeling for pediatric patients (has not been studied); based on adult information, dosage adjustment may be necessary.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Adverse reactions reported in children, adolescents, and adults unless otherwise indicated.
>10%:
Gastrointestinal: Diarrhea (infants and children: 15% to 20%)
Nervous system: Headache (14%), irritability (infants: 12%)
Respiratory: Cough (infants and children: 11%), upper respiratory tract infection (infants and children: 11% to 21%)
Miscellaneous: Fever (infants and children: 5% to 17%)
1% to 10%:
Dermatologic: Erythema of skin (infants: 3%), maculopapular rash (children: 3%)
Gastrointestinal: Anorexia (infants: 5%), dyspepsia (3%), increased appetite (children: 3%), nausea (infants, children, adolescents, and adults: 3% to 5%), vomiting (infants: 6%), xerostomia (3%)
Genitourinary: Urinary tract infection (children: 4%)
Infection: Parasitic infection (children: 3%), varicella zoster infection (children: 4%)
Nervous system: Dizziness (4%), drowsiness (infants: 9%), emotional lability (children: 3%), fatigue (2% to 5%), insomnia (infants: 5%)
Neuromuscular & skeletal: Myalgia (3%)
Respiratory: Bronchitis (infants: 6%), epistaxis (children: 3%), pharyngitis (infants, children, adolescents, and adults: 3% to 5%)
Postmarketing (any population):
Cardiovascular: Palpitations, tachycardia
Dermatologic: Pruritus, skin rash
Hepatic: Hepatitis, increased liver enzymes (including increased serum bilirubin)
Hypersensitivity: Hypersensitivity reaction (including anaphylaxis)
Nervous system: Movement disorder (including dystonia, extrapyramidal reaction, tic disorder), psychomotor agitation, seizure
Respiratory: Dyspnea
Hypersensitivity to desloratadine, loratadine, or any component of the formulation
Concerns related to adverse effects:
• Hypersensitivity: Hypersensitivity reactions (including anaphylaxis) have been reported with use; discontinue therapy immediately with signs/symptoms of hypersensitivity.
Disease-related concerns:
• Hepatic impairment: Use with caution in patients with severe hepatic impairment.
• Renal impairment: Use with caution in patients with severe renal impairment.
Concurrent drug therapy issues:
• Sedatives: Effects may be potentiated when used with other sedative drugs or ethanol.
Special populations:
• Slow metabolizers: Use with caution in patients known to be slow metabolizers of desloratadine (incidence of side effects may be increased).
Dosage form specific issues:
• Phenylalanine: Some products may contain phenylalanine.
Desloratadine may increase susceptibility to seizures in pediatric patients, particularly in patients with a history of seizure disorders; 1 case series described 4 patients (ages: 5 to 16 years) who experienced seizures after initiation of desloratadine. 3 of the 4 patients had known seizure disorders that were controlled prior to treatment with desloratadine. The final patient, who developed absence seizures after initiation of desloratadine, had a family history of febrile seizures but no personal history of seizure disorder (Cerminara 2013).
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. 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).
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Tablet, Oral:
Clarinex: 5 mg [contains corn starch, fd&c blue #2 (indigo carm) aluminum lake]
Clarinex: 5 mg [DSC] [contains fd&c blue #2 (indigo carm) aluminum lake]
Generic: 5 mg
Tablet Disintegrating, Oral:
Generic: 2.5 mg, 5 mg
Yes
Tablet, orally-disintegrating (Desloratadine Oral)
2.5 mg (per each): $5.83
5 mg (per each): $5.83
Tablets (Clarinex Oral)
5 mg (per each): $10.07
Tablets (Desloratadine Oral)
5 mg (per each): $5.02 - $8.69
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.
May be taken with or without food.
Orally disintegrating tablets should be placed on the tongue; tablet will disintegrate immediately. Take immediately after removing from blister package. Allow tablet to dissolve completely before swallowing. May be taken with or without water.
Oral: May administer without regard to food.
Orally-dissolving tablet: Place orally-dissolving tablet directly on the tongue; tablet will disintegrate immediately; may be taken with or without water. Take immediately after removing from blister package.
Syrup: A commercially available measuring dropper or syringe calibrated to deliver 2 mL or 2.5 mL should be used to administer appropriate dose.
Allergic rhinitis: Relief of nasal and non-nasal symptoms of seasonal (SAR) and perennial (PAR) allergic rhinitis
Urticaria, chronic spontaneous: Symptomatic relief of pruritus, reduction in number of hives, and reduction in size of hives associated with chronic spontaneous urticaria.
Angioedema, acute allergic or recurrent idiopathic; Urticaria, new onset; Urticaria, nonsteroidal anti-inflammatory drug associated (prophylaxis)
Clarinex may be confused with Celebrex
Substrate of CYP2C8 (major), P-glycoprotein/ABCB1 (minor); Note: Assignment of Major/Minor substrate status based on clinically relevant drug interaction potential
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 Lexicomp 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
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
CYP2C8 Inhibitors (Moderate): May increase the serum concentration of Desloratadine. Risk C: Monitor therapy
CYP2C8 Inhibitors (Strong): May increase the serum concentration of Desloratadine. 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: May enhance the CNS depressant effect of 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. 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
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
Lumacaftor and Ivacaftor: May decrease the serum concentration of CYP2C8 Substrates (High Risk with Inhibitors or Inducers). Lumacaftor and Ivacaftor may increase the serum concentration of CYP2C8 Substrates (High Risk with Inhibitors or Inducers). Risk C: Monitor therapy
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
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
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
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 does not affect bioavailability.
Guidelines for the use of antihistamines in the treatment of allergic rhinitis or urticaria in pregnancy are generally the same as in nonpregnant females. Second generation antihistamines may be used for the treatment of allergic rhinitis and urticaria during pregnancy; however, information related to the use of desloratadine in pregnancy is limited and other medications may be preferred (BSACI [Powell 2015]; BSACI [Scadding 2017]; Zuberbier 2018).
Desloratadine is present in breast milk.
According to the manufacturer, the decision to continue or discontinue breastfeeding during therapy should consider the risk of exposure to the infant and the benefits of treatment to the mother. When treatment with an antihistamine is needed in breastfeeding women, second generation antihistamines are recommended; however, agents other than desloratadine may be preferred (Butler 2014; BSACI [Powell 2015]; BSACI [Scadding 2017]; Zuberier 2018).
Desloratadine is the primary metabolite of Loratadine; refer to the loratadine monograph for additional information.
Some products may contain phenylalanine.
Desloratadine, a major active metabolite of loratadine, is a long-acting tricyclic antihistamine with selective peripheral histamine H1-receptor antagonistic activity.
Onset of action: Within 1 hour.
Duration: 24 hours.
Distribution: Vd: ~49 L/kg (Devillier 2008).
Protein binding: Desloratadine: 82% to 87%; 3-hydroxydesloratadine (active metabolite): 85% to 89%.
Metabolism: Hepatic to active metabolite, 3-hydroxydesloratadine (specific enzymes not identified); subsequently undergoes glucuronidation. Decreased in slow metabolizers of desloratadine.
Half-life elimination:
Children 2 to 5 years: Mean: 16.4 hours (Gupta 2007).
Children 6 to 11 years: Mean: 19.4 hours (Gupta 2007).
Adults: ~27 hours.
Time to peak:
Children 2 to 5 years: Mean: 3.17 hours (range: 1.5 to 8 hours) (Gupta 2007).
Children 6 to 11 years: Mean: 3.57 hours (range: 4 to 12 hours) (Gupta 2007).
Adults: ~3 hours.
Excretion: Urine (41% of radioactive dose); feces (47% of radioactive dose) (Devillier 2008).
Altered kidney function: AUC and Cmax are increased.
Hepatic function impairment: AUC and half-life are increased.
Pediatric: Systemic exposure in children (based on AUC and Cmax) is similar to adults (Gupta 2007).
Older adult: Cmax and AUC are 20% higher. The half-life is 33.7 hours.
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