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BY-
MADHUMITA DIXIT
JR-3
PHARMACOLOGY DEPARTMENT
MLN MEDICAL COLLEGE
2nd generation
Antihistaminic-Part II
Fexofenadine is sold under the brand
name Allegra.
It is a selective peripheral H1 blocker. It is classified
as a second-generation antihistamine because it is
less able to pass the blood–brain barrier and causes
lesser sedation, as compared to first-generation
antihistamines.
It is on the World Health Organization's List of
Essential Medicines. Fexofenadine has been
manufactured in generic form since 2011.
Fexofenadine is the active metabolite
of terfenadine, the first nonsedating SGA that was
withdrawn because of several deaths due to
polymorphic ventricular tachycardia (Torsades de
pointes) occurring with its higher doses or when it was co
administered with CYP3A4 inhibitors (erythromycin,
clarithromycin,ketoconazole, itraconazole, etc.)
Fexofenadine does not prolong QTc interval.
Fexofenadine is a substrate of CYP3A4, but only about
5% is metabolized by the liver. Since it is minimally
metabolized. no interaction with CYP3A4 inhibitors
have been reported.
It is largely free of arrhythmogenic potential, but
some cases of ventricular arrhythmia in patients with
preexisting long QT interval have been reported .Thus,
it is not entirely safe in patients with long QT,
bradycardia or hypokalemia.
PHARMACOKINETICS-
Bioavailability30–41%
Protein binding60- 70% mostly albumin
Metabolism-Hepatic (≤5% of dose)
onset of action 1 hour
Duration of action >24 hours
Elimination half-life14.4 hours
Excretion-Feces (~80%)
urine (~10%) as unchanged drug
Uses-
1)Allergic rhinitis- Their effect is confined to the
suppression of symptoms attributable to
the histamine released by the antigen-antibody
reaction. It provides relief from repeated
sneezing, runny nose, itchy eyes or skin, and
general body fatigue.
2)Also used in t/t of chronic urticaria.
Adverse effects- >10%-
1)headache
2)Vomiting (children 6months to 5 years)
Dosage forms:
• Suspension
•Tablet
•DispersibleTablet
•Usual Adult Dose for Allergic Rhinitis and urticaria-
180 mg orally OD OR 60 mg orally BD
-Maximum dose: 180 mg/day
Fexofenadine tablets and orally disintegrating tablets
are not FDA approved for children less than 6 years of
age, while oral suspension is FDA approved for
prescription use in those 6 months and older and for
over-the-counter use in those 2 Years and older
Pediatric Dose for Allergic Rhinitis and urticaria -
6 months to 2 years: 15 mg orally BD
2 years to 11 years: 30 mg orally BD
12 years and older: 180 mg orally OD OR 60 mg orally
BD
Renally Impairement-
•There is increase in bioavailability and half-life
therefore a dose of 60 mg OD is recommended as the
starting dose in adult patients with decreased renal
function.
•For pediatric patients with decreased renal function,
the recommended starting dose of Fexofenadine is
30 mg OD for patients 2 to 11 years of age and
15 mg OD for patients 6 months to less than 2 years of
age.
Hepatic impairement-no dose adjustment required
FEXOFENADINE IN PREGNANCY-
Category C: Animal reproduction studies have shown an
adverse effect on the fetus and there are no adequate
and well-controlled studies in humans, but potential
benefits may warrant use of the drug in pregnant
women despite potential risks.
Drug Interactions-
1. Fexofenadine + Antacids
Fexofenadine hydrochloride should not be taken closely
in time with aluminum and magnesium containing
antacid. Antacids neutralize fexofenadine hydrochloride
leading to several products resulting in insoluble
compounds.
2. ketoconazole, erythromycin + fexofenadine
Fexofenadine has been shown to exhibit minimal ( 5%)
metabolism. However, co administration of
Fexofenadine hydrochloride with either ketoconazole or
erythromycin led to increased plasma concentrations of
Fexofenadine in healthy adult subjects .
ketoconazole will increase the level or effect of
fexofenadine by inhibiting P-gps efflux transporter.
reduced P-gp activity in the intestinal membranes may
result in increased systemic absorption owing to a
reduction in the amount of drug that is actively
pumped back into the intestinal tract. Fexofenadine is
a well-identified substrate of P-gp
3.Fruit Juices + fexofenadine
Fruit juices such as grapefruit, orange and apple may
reduce the bioavailability and exposure of
Fexofenadine.
High fat meals also decrease BA of fexofenadine by
approx 50%
Azelastine-This newer H1 blocker has good topical
activity: in addition it inhibits histamine release and
inflammatory reaction triggered by LTs and PAF. Given
by nasal spray for seasonal and perennial allergic
rhinitis it provides quick symptomatic relief lasting 12
hrs.
Rupatidine- It has PAF antagonistic property leading
to anti-inflammatory effect.
parame
ter
cetirizin
e
Levo-
cetirizin
e
fexofen
adine
loratidi
ne
deslorat
idine
azelastin
e
ebastin
e
rupatidi
ne
tmax 0.8hr 0.9 hr 1.2hr 1.5hr 4hr 2-3 hrs 2.6-4 45 min-
1 hr
Onset of
action
(hrs)
1-1.5 1 hr 1-2 1.5 0.5-3 15
minutes
(nasal
spray)
1-3 Within
2 hrs
F% >70 77 30-41 Almost
100%
87 40%
(intranasa
l)
40% NA
Food
effects
delay Delay Decreas
ed
(25%)
Increase
d
(43%)
No
effect
NA No
effect
no
effect
Vd
(L/kg)
0.5 0.4 5.6 74-120 49 14.5 - -
Protein
binding
(%)
88-96 90 60-70 97-99 73-77 - >95 98-99
paramet
ers
cetirizin
e
levoc
etirizi
ne
fexofen
adine
loratidin
e
deslor
atidin
e
azelast
ine
ebastine rupatidine
1st pass
metab-
olism
Limited limite
d
limited extensive mode
rate
extensi
ve
extensive -
Hepatic
Metab-
olism
negligi-
ble
14%
by
cyp3A
4
<5%of
dose
CYP3A4,
CYP2D6
Mediate-
d
CYP3
A4
Media
ted
CYP3A
4,CYP2
D6,CY
P1A2
Med.
CYP3A4
Mediated
CYP3A4
Mediated
Active
metaboli
tes
none none none deslorati
dine
hydro
xylate
d
Desme
thyl-
azelasti
ne
carbastin
e
desloratidi
ne
Eliminati
on(%)
Urine-
70-85
feces-
10-13
Urine
85.4
Feces
12.9
Urine-
10%
Feces-
80%
Urine-
40%
Feces
40%
Urine-
40%
Feces
40%
For oral
dose
Feces-
75%
Urine-6%
Feces-
93%
Urine-
34.6
Feces-60.9
T1/2(hr) 6.5-10 6-10 14.4 8hrs >24 24 hrs 10-16 5.9
DOA >24 hrs >24 hr 24hrs >24hrs 24 hrs - 24 hrs -
ThankYou

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2nd generation Antihistaminic-Part II.pptx

  • 1. BY- MADHUMITA DIXIT JR-3 PHARMACOLOGY DEPARTMENT MLN MEDICAL COLLEGE 2nd generation Antihistaminic-Part II
  • 2. Fexofenadine is sold under the brand name Allegra. It is a selective peripheral H1 blocker. It is classified as a second-generation antihistamine because it is less able to pass the blood–brain barrier and causes lesser sedation, as compared to first-generation antihistamines. It is on the World Health Organization's List of Essential Medicines. Fexofenadine has been manufactured in generic form since 2011.
  • 3. Fexofenadine is the active metabolite of terfenadine, the first nonsedating SGA that was withdrawn because of several deaths due to polymorphic ventricular tachycardia (Torsades de pointes) occurring with its higher doses or when it was co administered with CYP3A4 inhibitors (erythromycin, clarithromycin,ketoconazole, itraconazole, etc.) Fexofenadine does not prolong QTc interval.
  • 4. Fexofenadine is a substrate of CYP3A4, but only about 5% is metabolized by the liver. Since it is minimally metabolized. no interaction with CYP3A4 inhibitors have been reported. It is largely free of arrhythmogenic potential, but some cases of ventricular arrhythmia in patients with preexisting long QT interval have been reported .Thus, it is not entirely safe in patients with long QT, bradycardia or hypokalemia.
  • 5. PHARMACOKINETICS- Bioavailability30–41% Protein binding60- 70% mostly albumin Metabolism-Hepatic (≤5% of dose) onset of action 1 hour Duration of action >24 hours Elimination half-life14.4 hours Excretion-Feces (~80%) urine (~10%) as unchanged drug
  • 6. Uses- 1)Allergic rhinitis- Their effect is confined to the suppression of symptoms attributable to the histamine released by the antigen-antibody reaction. It provides relief from repeated sneezing, runny nose, itchy eyes or skin, and general body fatigue. 2)Also used in t/t of chronic urticaria.
  • 7. Adverse effects- >10%- 1)headache 2)Vomiting (children 6months to 5 years) Dosage forms: • Suspension •Tablet •DispersibleTablet •Usual Adult Dose for Allergic Rhinitis and urticaria- 180 mg orally OD OR 60 mg orally BD -Maximum dose: 180 mg/day
  • 8. Fexofenadine tablets and orally disintegrating tablets are not FDA approved for children less than 6 years of age, while oral suspension is FDA approved for prescription use in those 6 months and older and for over-the-counter use in those 2 Years and older Pediatric Dose for Allergic Rhinitis and urticaria - 6 months to 2 years: 15 mg orally BD 2 years to 11 years: 30 mg orally BD 12 years and older: 180 mg orally OD OR 60 mg orally BD
  • 9. Renally Impairement- •There is increase in bioavailability and half-life therefore a dose of 60 mg OD is recommended as the starting dose in adult patients with decreased renal function. •For pediatric patients with decreased renal function, the recommended starting dose of Fexofenadine is 30 mg OD for patients 2 to 11 years of age and 15 mg OD for patients 6 months to less than 2 years of age. Hepatic impairement-no dose adjustment required
  • 10. FEXOFENADINE IN PREGNANCY- Category C: Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.
  • 11. Drug Interactions- 1. Fexofenadine + Antacids Fexofenadine hydrochloride should not be taken closely in time with aluminum and magnesium containing antacid. Antacids neutralize fexofenadine hydrochloride leading to several products resulting in insoluble compounds. 2. ketoconazole, erythromycin + fexofenadine Fexofenadine has been shown to exhibit minimal ( 5%) metabolism. However, co administration of Fexofenadine hydrochloride with either ketoconazole or erythromycin led to increased plasma concentrations of Fexofenadine in healthy adult subjects .
  • 12. ketoconazole will increase the level or effect of fexofenadine by inhibiting P-gps efflux transporter. reduced P-gp activity in the intestinal membranes may result in increased systemic absorption owing to a reduction in the amount of drug that is actively pumped back into the intestinal tract. Fexofenadine is a well-identified substrate of P-gp 3.Fruit Juices + fexofenadine Fruit juices such as grapefruit, orange and apple may reduce the bioavailability and exposure of Fexofenadine. High fat meals also decrease BA of fexofenadine by approx 50%
  • 13. Azelastine-This newer H1 blocker has good topical activity: in addition it inhibits histamine release and inflammatory reaction triggered by LTs and PAF. Given by nasal spray for seasonal and perennial allergic rhinitis it provides quick symptomatic relief lasting 12 hrs. Rupatidine- It has PAF antagonistic property leading to anti-inflammatory effect.
  • 14. parame ter cetirizin e Levo- cetirizin e fexofen adine loratidi ne deslorat idine azelastin e ebastin e rupatidi ne tmax 0.8hr 0.9 hr 1.2hr 1.5hr 4hr 2-3 hrs 2.6-4 45 min- 1 hr Onset of action (hrs) 1-1.5 1 hr 1-2 1.5 0.5-3 15 minutes (nasal spray) 1-3 Within 2 hrs F% >70 77 30-41 Almost 100% 87 40% (intranasa l) 40% NA Food effects delay Delay Decreas ed (25%) Increase d (43%) No effect NA No effect no effect Vd (L/kg) 0.5 0.4 5.6 74-120 49 14.5 - - Protein binding (%) 88-96 90 60-70 97-99 73-77 - >95 98-99
  • 15. paramet ers cetirizin e levoc etirizi ne fexofen adine loratidin e deslor atidin e azelast ine ebastine rupatidine 1st pass metab- olism Limited limite d limited extensive mode rate extensi ve extensive - Hepatic Metab- olism negligi- ble 14% by cyp3A 4 <5%of dose CYP3A4, CYP2D6 Mediate- d CYP3 A4 Media ted CYP3A 4,CYP2 D6,CY P1A2 Med. CYP3A4 Mediated CYP3A4 Mediated Active metaboli tes none none none deslorati dine hydro xylate d Desme thyl- azelasti ne carbastin e desloratidi ne Eliminati on(%) Urine- 70-85 feces- 10-13 Urine 85.4 Feces 12.9 Urine- 10% Feces- 80% Urine- 40% Feces 40% Urine- 40% Feces 40% For oral dose Feces- 75% Urine-6% Feces- 93% Urine- 34.6 Feces-60.9 T1/2(hr) 6.5-10 6-10 14.4 8hrs >24 24 hrs 10-16 5.9 DOA >24 hrs >24 hr 24hrs >24hrs 24 hrs - 24 hrs -
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