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http://pediatriceducation.org/2014/07/07/how-much-cetirizine-can-be-used/
PediatricEducation.org
A Pediatric Digital Library and Learning Collaboratory intended to serve as a source of continuing pediatric
education, curated by Donna M. D'Alessandro M.D. and Michael P. D'Alessandro M.D.
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http://pediatriceducation.org/2014/07/07/how-much-cetirizine-can-be-used/
to help his symptoms. As things improve with the summer then you can decrease the amount of the medicine too. The physician also prescribed
antihistamine eye drops to help control the eye symptoms, but his mother did not want to use nasal steroids at that time. Call me in about 5 days or so and
let me know how things are going, and we can decide if he needs more of the medicine and also about continuing the eye drops, he instructed. The
patients clinical course over the next two weeks showed him needing 20 mg BID to control his symptoms but he was now not using his eye drops. He was
not having any medicine side effects and was able to sleep and play. Over the next few months, the boy was able to decrease the cetirizine to 10 mg a day
in the summer, but needed 20 mg BID of cetirizine again in the fall.
Discussion
Antihistamine medications have been available for over 70 years. The original H1-antihistamines, while effective in treated allergic rhinitis, urticaria and other
allergic problems, easily penetrated the blood-brain barrier and caused somnolence. The newer, second generation H1-antihistamines have much less
somnolent side effects because of poor penetrance.
Fexofenadine (Allegra), desloratadine (Claritin) and levocetirizine (Zyrtec) are commonly used H1-antihistamines in the US today. Previously Astemazole
(Hismanal) and Terfanadine (Seldane) were used but were withdrawn because of problems with cardiac arrhythmias with a propensity to prolong the QT
interval. Fexofenadine in studies has the same somnolence producing effect as placebo. Desloratadine and cetirizine both can have some sedative effects.
Cetirizine is extensively and rapidly absorbed by the gut allowing a rapid onset of action. It interacts with target receptors at effective concentrations, and
organs where it would not be effective or toxic are avoided. There is no hepatic metabolism (thus avoiding many potential drug-drug interactions) and the
drug is excreted unchanged by the kidney. The half-life is about 10.5 hours in adults. Cetirizine has higher binding affinity for receptors than other similar
drugs thus it has a more potent, faster onset and longer duration of action when used for seasonal allergic rhinitis. [T]here is evidence that
continuous treatment with cetirizine is more effective than on-demand treatment in achieving significantly greater inflammatory and clinical control in [allergic
rhinitis] patients. Cetirizine does not have cardiotoxic side effects, and is a pregnancy category B medicine ( = without harm to animal fetus and no human
studies available). It is excreted in breast milk therefore is not recommended during lacatation. Cetirizine is contraindicated for people with known
hypersensitivity to its components or hydroxyzine.
Learning Point
Cetirizine is a safe and effective medication, and because of this some allergists will use it off label in higher doses. As with any time a medicine is used
off-label, it is important to monitor the patient closely for efficacy and especially for potential side effects. It is the human metabolite of hydroxyzine
(Atarax) that is used for severe urticaria/pruritis and seasonal allergic rhinitis.
Normal dosing for cetirizine is:
6 months-2 years, 2.5 mg daily to BID
2-5 years, 2.5 mg daily to BID
6-11 years, 5-10 mg daily to BID
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