Medications For Hives (Urticaria) Treatment | Samar Borhani, PharmD | RxEconsult

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Review of Medications For Hives (Urticaria) Treatment Category: Dermatology by - June 4, 2014 | Views: 77056 | Likes: 2 | Comment: 0  

H1 Antihistamines Used in Treatment of Hives

Oral antihistamines block histamine release resulting in relieve of symptoms of urticaria. They consist of two different categories, 1st generation (older) antihistamines such as;

  • Benadryl (diphenhydramine)
  • Vistaril (hydroxyzine)
  • Chlorphen (chlorpheniramine)

And 2nd generation (newer) antihistamines such as;

  • Claritin (loratadine)
  • Allegra (fexofenadine)
  • Zyrtec (cetirizine)

Second generation antihistamines are considered the first-line treatment of hives and work by blocking histamine (H1) receptors on cells. Histamine is a chemical released from cells called mast cells and attaches to the histamine receptors on other cells resulting in initiation of signs and symptoms of hives such as itching or redness. Compared to 1st generation antihistamines, 2nd generation antihistamines will have fewer drug-drug interactions, can be dosed less frequently, and will cause less drowsiness. Some of the possible side effects of 2nd generation antihistamines include;

  • Headache
  • Drowsiness (Allegra causes the least drowsiness amongst 2nd generation antihistamines)
  • Fatigue
  • Dry mouth
  • Diarrhea

Patients diagnosed with hives, especially chronic hives, should begin a two-week treatment of a non-sedating H1 antihistamine. If the symptoms still persist, the dose of the antihistamine may be increased above standard doses. The efficacy of using a 2nd generation antihistamine has been studied in number of clinical trials and there has been an overall improvement in symptoms of urticaria such as redness, itching, and swelling in 50 to 95% of patients.

Claritin (loratadine) 5 mg and 10 mg Tablets

Claritin is used for the treatment of symptoms of chronic urticaria and upper respiratory allergies (seasonal allergies) in patients older than 6 years of age. It is a long-acting selective 2nd generation H1 antihistamine and considered less potent when compared to other agents such as Allegra or Zyrtec. Claritin 5 mg dose is given to children between the ages of 2 to 5 and for patients with renal or hepatic impairment where the standard dose is given every other day.

Allegra (fexofenadine) 30, 60 and 180 mg Tablets or 30 mg/5 ml Suspension

Allegra is indicated for chronic urticaria and seasonal allergies in patients older than 12 years of age. It is best taken without food and especially drinks such as orange, apple, or grapefruit juice. The standard dosing for urticaria is 60 mg twice daily or 180 mg once a day. The recommended dosing adjustment in renal impairment is 60 mg once a day.

Zyrtec (cetirizine) 5 mg and 10 mg Tablets

Zyrtec is indicated for the treatment of symptoms due to chronic urticaria and upper respiratory allergies in patients over the age of 6. Compared to other 2nd generation antihistamines, Zyrtec has a rapid onset of action. Although the standard dose is 10 mg a 5 mg dose is also used depending on the severity of the symptoms. Lower doses of Zyrtec (2.5-5 mg) may be given to children between the ages of 2 to 5. 


Next: Leukotriene Receptor Antagonist for Hives


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