Type of Drug:Loosens excessive respiratory secretions, mucus, and other foreign debris.

How the Drug Works:

Expectorants thin mucous secretions in the lungs and make the phlegm less sticky. The mucus is easier to cough up. This reduces chest congestion and makes coughs more productive. The exact mechanism by which expectorants thin mucous secretions in the lung is not known.

Uses:

Guaifenesin: For symptomatic relief of respiratory conditions characterized by dry, nonproductive cough and in the presence of mucus in the respiratory tract.

Precautions:

Pregnancy: Guaifenesin – Adequate studies have not been done in pregnant women. Use only if clearly needed and the benefits outweigh the possible risks.

Potassium iodide – Studies have shown a potential risk to the fetus, including abnormal thyroid function and goiter development. Use only if clearly needed and potential benefits outweigh the Possible risks.

Breastfeeding: It is not known if guaifenesin appears in breast milk. Potassium iodide appears in breast milk and may cause skin rash and thyroid suppression in the infant. Decide whether to discontinue nursing or the drug. Consult your doctor.

Children: Safety and effectiveness in children under 2 years of age have not been established for guaifenesin. Safety and effectiveness in children have not been established for potassium iodide.

Drug Interactions:

Tell your doctor or pharmacist if you are taking, have recently discontinued, or are planning to take any over-the-counter or prescription medications with these expectorants. Doses of one or both drugs may need to be modified or a different drug may need to be prescribed. The following drugs and drug classes may interact with guaifenesin or potassium iodide expectorants.

• Angiotensin-converting enzyme (ACE)
• Inhibitors (eg, captopril)
• Antithyroid agents (eg, propylthiouracil (PTU),methimazole)
• Lithium (eg, Eskalith)
• Monoamine oxidase inhibitors (MAOls) (eg, phenelzine sulfate)
• Potassium products (eg, Slow-K)
• Potassium-sparing diuretics (eg, spironolactone, triamterene, amiloride)

Side Effects:

Every drug is capable of producing side effects. Many expectorant users experience no, or minor, side effects. The frequency and severity of side effects depend on many factors including dose, duration of therapy, and individual susceptibility. Possible side effects include:

Guaifenesin - Nausea; vomiting; diarrhea; gas; abnormal urine tests. Potassium iodide –

Iodism or chronic iodine poisoning: Sore or burning mouth or throat; severe headache; productive cough; metallic taste; sneezing; eyelid swelling; increased salivation; acneiform skin lesions in oily skin areas; severe skin eruptions.

Allergic Reactions: Nerve swelling; skin and mucous membrane bleeding; serum sickness-like symptoms (eg, fever, bloating, lymph node enlargement, joint pain, blood disorder, fluid in lungs).

Digestive Tract: Nausea; vomiting; diarrhea; stomach upset or pain; bleeding.

Nervous System: Mental confusion; numbness. Skin: Acne; rash; minor skin eruptions.

Other: Benign thyroid tumor; goiter; myxedema (hypothyroidism); irregular heartbeat; swelling of salivary glands, neck, or throat; tingling, pain, or weakness in hands or feet; weakness or heaviness of legs; fever; abnormal thyroid tests; unusual tiredness; metallic aftertaste.

Guidelines for Use:

• Dosage is individualized. Take exactly as prescribed.
• Do not change the dose or stop taking, unless directed by your doctor.
• Do not take these products for persistent or chronic cough such as OCcurs with smoking, asthma, chronic bronchitis, or emphysema, or when cough is accompanied by excessive phlegm, unless directed by your doctor.
• A perSistent cough may be a sign of a serious condition. If cough persists for more than 1 week, tends to recur, or is accompanied by fever, rash, or persistent headache, consult a doctor.
• Guaifenesin is the only expectorant approved by the FDA as safe and effective. It is well tolerated. IOdine-containing Products have the potential to produce many adVerse effects.
• Drink a glass of water or other fluid with each dose of expectorant. Most authorities believe a well hydrated body (due to fluid intake) is responsible for thinning respiratory tract mucus and may be as valuable as or more so than the expectorant itself.
• Do not cut, crush, or chew sustained-release tablets or capsules.
• IOdine-containing expectorants – Stop taking if stomach pain, rash, nausea, vomiting, bloating, gastrointestinal bleeding, or a metallic taste develops.

Type of Drug: Respiratory inhalant.

How the Nedocromil Sodium Works:

Nedocromil sodium inhibits the activity of inflammatory cells associated with asthma.

Uses of The Nedocromil Sodium:

As maintenance therapy in the management of mild to moderate bronchial asthma. Nedocromil sodium is not used to reverse acute bronchospasm.

Precautions:

Do not use in the following situations: Allergy to nedocromil sodium or any ingredient in the product.

Pregnancy: Adequate studies have not been done in pregnant women. Use only if clearly needed and potential benefits outweigh the possible hazards to the fetus.

Breastfeeding: It is not known if nedocromil sodium appears in breast milk.

Consult your doctor before you begin breastfeeding.

Children: Safety and effectiveness in children under 12 have not been established.

Side Effects of Nedocromil Sodium:

Every drug is capable of producing side effects. Many nedocromil sodium users experience no, or minor, side effects. The frequency and severity of side effects depend on many factors including dose, duration of therapy and individual susceptibility. Possible side effects include:

Digestive Tract: Nausea; vomiting; indigestion; diarrhea; stomach pain. Nervous System: Dizziness; headache; fatigue; difficulty speaking.

Respiratory System: Coughing; sore throat; congestion; upper respiratory tract infection; increased sputum; bronchitis; difficulty breathing; wheezing.

Other: Dry mouth; chest pain; viral infection; unpleasant taste.

Guidelines for Use:

• Proper inhalation technique is very important. Follow the directions that are in the patient information leaflet that is included with the medicine.
• Use continuously. Effectiveness depends on regularity of use, even during symptom-free periods.
• Notify your doctor if coughing or wheezing Occurs.
• Not for the treatment of an existing asthma attack. Nedocromil sodium should generally be continued during an asthma attack though, unless intolerance develops.
• This medicine should be added to your existing treatment therapy. Once a positive response is made to the inhaler, and the asthma is under good control, your doctor may gradually reduce your other medicine usage.

Type of Drug:

Nasal decongestants.

How the Drug Works:

Nasal decongestants shrink swollen and congested nasal tissues (mucous membranes) by constricting blood vessels. This should relieve congestion (stuffy feeling), promote drainage of mucus, and improve breathing. Local application (eg, nasal drops, sprays) causes moro into use and rapid nasal de congestion than oral drugs (eg, tablets, sylph). Only drugs generally last longer, cause less local irritation, and are not associated with round nasal congestions (rhinitis mrdicamentose).

Uses:

For temporary relief of nasal congestion due to the common cold, hay fever,

and other upper respiratory allergies, and sinusitis.

To treat eustachian tube congestion (plugged ears). To promote nasal or sinus drainage.

To relieve ear pressure and pain in air travel.

Sodium chloride: To restore moisture to nasal tissue, thin nasal secretions, and relieve dry, crusted, and inflamed nasal membranes due to colds, low humidity, nasal decongestant overuse, allergies, nosebleeds, sinus infection, and other irritations.

Precautions:

Excessive use: Excessive use of topical decongestants may cause side effects (eg, nervousness, dizziness, sleeplessness) that are more likely in infants and in the elderly. Long-term high-dose therapy may be habit forming (eg, rebound congestion).

Hypertension (high blood pressure): Use these products only with medical advice. You may experience a change in blood pressure because of the increased narrowing of the blood vessels.

Phenylketonuria patients: Some of these drugs contains phenylalanine. Consult your doctor or pharmacist.

Rebound congestion: Rebound congestion (rhinitis medicaments) may occur following several days of regular topical application. Rebound , which is worse than the original symptoms, occurs when the drug wears off Increasing the amount of drug or frequency of use only worsens rebound congestion and increases the risks of medication toxicity.Talk to your doctor or pharmacist if congestion continues to return when the drug effect wears off.

Sulfite sensitivity: Some of these products contain sulfites, which may cause allergic-type reactions (eg, rash, hives, itching, wheezing) in certain susceptible persons. Although the overall prevalence of sensitivity in the general population is probably low, it is seen more frequently in asthmatics or in a topic non asthmatic persons.

Treatment for rebound congestion: A simple but uncomfortable solution is to completely withdraw the topical medication. A more acceptable method is to gradually withdraw therapy by discontinuing the medication in one nostril, followed by total withdrawal. Substituting an oral decongestant for a topical one also may be useful.

Pregnancy: There are no adequate and well-controlled studies in pregnant women. Use only if clearly needed and the potential benefits to the mother outweigh the possible hazards to the fetus.

Breastfeeding: Consult your doctor before taking an oral decongestant while breastfeeding. It is not known if topical decongestants appear in breast milk. Use caution when administering to a nursing woman.

Children: Dosage restrictions may vary according to product instructions; refer to individual product information for dosage and administration.

Elderly: Patients 60 years of age and older are more likely to experience side effects. Over dosage may cause hallucinations, convulsions, depression, and death.

Drug Interactions:

Tell your doctor or pharmacist if you are taking or planning to take any over­the-counter or prescription medications or dietary supplements with nasal decongestants. Doses of one or both drugs may need to be modified or a different drug may need to be prescribed. The following drugs and drug classes interact with nasal decongestants:

• Furazolidone (Furoxone)
• Guanethidine (lsmelin)
• MAOls (eg, phenelzine)
• Methyldopa (eg, Aldomet)
• Rauwolfia alkaloids (eg, reser pine)
• Tricyclic antidepressants (eg, amitriptyline)

Side Effects:

Every drug is capable of producing side effects. Many nasal decongestant users experience no, or minor, side effects. The frequency and severity of side effects depend on many factors including dose, duration of therapy, individual susceptibility, and method of administration. Side effects are more likely to occur with oral nasal decongestants. Oral agents, however, cause less local irritation and are not associated with rebound congestion (rhinitis medicamentosa). Possible side effects include:

Topical Use: Burning; stinging; sneezing; dryness; local irritation; rebound congestion; nasal discharge; weakness.

Digestive Tract: Nausea; vomiting; appetite loss; indigestion.

Nervous System: Anxiety; restlessness; tremor; CNS depressions; weakness tenseness; headache; dizziness; drowsinoss; sleeplessness lightheadedness; nervousness.

Circulatory System: Irregular heartbeat; changes in blood pressure; palpitations (pounding in the chest).

Other: Sweating; pale skin; chest pain; eye sensitivity to light; painful or difficult urination; rash; hives.

Guidelines for Use:

• Dosage is individualized. Take exactly as prescribed.
• Do not change the dose or stop taking, unless directed by your doctor.
• Patients with high blood pressure or other cardiovascular diseases, thyroid disease, glaucoma, diabetes mellitus, or enlarged prostate should use these products only with medical advice .
• To prevent pressure pain in air travel or other situations where there is a rapid change in altitude, nose drops and nasal sprays act quickly. Talk oral dosage 10rms 1 to 2 hours prior to a major altitude change.
• Side effects are most likely in the elderly and children. Excessive us( (misuse) increases risk for side effects.
• Stop using and contact your doctor if you experience persistent stomach pain or vomiting.
• Oral _ If symptoms do not improve within 7 days or are accompanied by a high fever, consult your doctor before continuing use. Do not exceed recommended dosage. Higher doses may cause nervousness, irregular heartbeat, dizziness, or sleeplessness. If these occur, stop use and contact your doctor. Do not split, dissolve, crush, or chew extended-release preparations.
• Topical _ Use only as needed. Avoid excessive use. Stop using and contact your doctor if you experience sleeplessness, dizziness, weakness, tremor, or irregular heartbeat. Do not exceed recommended dos age and do not use longer than 3 days, unless directed by your doctor. Stinging or burning sensations or drying of the nose may occur. This often disappears after a jaw applications. If rebound congestion Occurs from excessive doses and frequent use, withdraw the topical drug gradually. Stop using the medication in one nostril, then both nostril:. An oral decongestant may be used instead. Notify your doctor if Symptoms persist.
• Nasal spray – Hold head upright, insert nozzle into nostril, spray quickly and firmly and sniff deeply while blocking off other nostril. Wipe nozzle clean after use.
• Nasal drops _ Recline on a bed and hang your head over the edge Instill nose drops. Remain in this position for several minutes after using the drops, turning your head from side to side while gently “sniffing” and squeezing the nostrils.
• Use of the same container 01 nasal spray or drops by more than 1 person may spread infection. Do not allow the tip of the container or drop per to touch the nasal passage. Store as directed on package labeling.

Combination products are frequently used in the therapy of respiratory conditions. These fixed-dose combination products may present two problems: (1) The patient may not need all the components in the product; (2) the patient may need the components, but in different strengths or at different dosing intervals.Product Selection Guidelines: The following guidelines should be employed when choosing a respiratory combination product.

Symptoms - Pain, fever, congestion, runny nose, cough (productive or nonproductive).

Medical history and health - Age, allergy history, pregnancy, heart disease, high blood pressure, asthma, bronchitis, glaucoma, hyperthyroidism (overactive thyroid), diabetes, depression.

Drugs you are currently taking - Other cold or allergy medications; medications for high blood pressure, diabetes, etc.

Do not exceed the recommended dosage - Do not take a nonprescription (otc) respiratory product for more than 7 days. If symptoms do not improve or are accompanied by fever, consult a doctor.

Humidification - Humidification of room air and adequate fluid intake (6 to 8 glasses/day) are important in treating cold symptoms.

Sulfites and Tartrazine - Some of these products contain sulfites or tartrazine, which may cause allergic type reactions (eg, rash, hives, itching, wheezing) in certain susceptible persons. Although the overall prevalence of sensitivity in the general population is probably low, it is seen more frequently in asthmatics or in a topic non asthmatic persons (sulfites) or in patients who have aspirin allergy (tartrazine).

Sugar free liquid products - The small amount of sugar in usual doses of medication is probably insignificant to the well-controlled diabetic. However, consider the effects of alcohol and sympathomimetics in addition to the sugar content of these formulations.

Sustained release formulations - Products with identical active ingredients are listed together. Due to formulation differences, do not consider them bio equivalent.

Groups: These combination products are presented in groups based on their formulations. Products with identical or similar ingredients are listed next to each other, regardless of therapeutic claims, which may differ even for identical formulas. Pediatric preparations (those products intended mainly or exclusively for children) are grouped together at the end of the main sections.

Antiasthmatic Combinations: Anti asthmatic Combinations contain xanthine derivatives and sympathomimetics for bronchodilation (widening of air passages). Many products also contain expectorants to facilitate break up and removal of mucwl.

Upper Respiratory Combinations: Upper Respiratory Combinations are used primarily for relief of symptoms associated with colds, upper respiratory infections and allergies (eg, inflammation of nose and sinuses, etc). Cough preparations include an antitussive (cough suppressant) or expectorant, but may also contain ingredients for relief of other symptoms.

• Decongestant and Analgesic Combinations
• Pediatric Decongestant and Analgesic Combinations Decongestant and Expectorant Combinations
• Pediatric Decongestant and Expectorant Combinations Antihistamine and Analgesic Combinations
• Decongestant, Antihistamine, and Expectorant Combinations Pediatric Decongestant, Antihistamine, and Expectorant Combinations
• Decongestants and Antihistamines
• Pediatric Decongestants and Antihistamines
• Decongestant, Antihistamine, and Analgesic Combinations Decongestant, Antihistamine, and Anticholinergic Combinations Pediatric Decongestant, Antihistamine, and Anticholinergic Combinations
• Antitussive Combinations
• Pediatric Antitussive Combinations Antitussive and Expectorant Combinations
• Pediatric Antitussive and Expectorant Combinations Antitussives with Expectorants
• Pediatric Antitussives with Expectorants Topical Combinations

Ingredients:

Antihistamines: Antihistamines are used for relief from allergic symptoms (hay fever) including runny nose, sneezing, itching of the nose or throat and itchy, watery eyes. The anticholinergic (drying) effects of antihistamines may cause a thickening of lung secretions; therefore, these agents may not be helpful in respiratory conditions characterized by congestion. Antihistamines may cause drowsiness. Antihistamines can also cause drying of the eyes. This can be a problem for people who wear contact lenses. Appropriate lubricating drops may be indicated.

Xanthines: Xanthines primarily theophylline, relieve spasms of the air passages by direct action on the bronchial smooth muscle in asthma and chronic bronchitis. Some xanthine-containing combination products are avail­able over-the-counter, but asthmatic patients should use them only under supervision of a doctor.

Sympathomimetics: Decongestants are used for their decongestant or bronchodilator (widening of air passages) effects. Side effects may include nervous­ness, heart stimulation and high blood pressure if taken orally.

Decongestants: Decongestants- Used for temporary relief of nasal congestion due to colds or allergy. Given orally, they are less effective than topical nasal decongestants, and they have a potential for side effects. Frequent or prolonged topical use may lead to local irritation and rockbound congesting

Bronchodilators: Bronchodilators – Ephedrine is common in these combinations; how­ever, it may stimulate the heart. Bronchodilation effects may decrease congestion of mucous membranes. Pseudo ephedrine is not an effective bronchial.

Narcotic Antitussives Narcotic Antitussives- The antitussive dose is lower than that required for pain relief. Consider general precautions for the use of narcotics, including the potential for abuse, when using these products.

Nonnarcotic Antitussives: Non narcotic Intrusive decrease the cough reflex without inducing many of the common characteristics of narcotic preparations. Examples include: Dextromethorphan, diphenhydramine, carbetapentane and caramiphen edisylate.

Expectorants: Expectorants may be of limited value in loosening and liquefying respiratory mucus, in soothing the irritated lining of the lungs (bronchial mucosa) and in making coughs more productive. Guaifenesin is the only FDA-recognized safe and effective ingredient for use in otc cough and cold medicines to loosen phlegm. Humidification of room air and adequate fluid intake (6 to 8 glasses/day) are important measures as well.

Analgesics: Analgesics(eg, pain relievers, acetaminophen, aspirin, ibuprofen) are frequently included for symptoms of headache, fever, muscle aches and pain.

Anticholinergics: Anticholinergics are included for their drying effects on mucus secretions. This action may be beneficial in acute runny nose; however, drying of respiratory secretions may lead to obstruction. Traditionally, anticholinergics have been avoided in patients with asthma or chronic obstructive pulmonary disease (COPD); however, some patients respond well to these agents. Caution is still advised, particularly among patients with heart disease.

An anticholinergic for oral inhalation is available as a bronchodilator for maintenance of air passage spasms (bronchospasms) associated with COPD, including chronic bronchitis and emphysema.

Papaverine: Papaverine relaxes the smooth muscle of the air passageways tree. Barbiturates are included for their sedative effects in combination with xanthines or sympathomimetics which may cause CNS stimulation. The sedative effectiveness of low doses (eg, 8 mg phenobarbital) is questionable. OTC avaiiability of phenobarbital-containing products may be limited according to state laws.

Caffeine: Caffeine is included in some combinations for CNS stimulation to counteract antihistamine depression and to enhance the effects of pain relievers.

Ipratropium Bromide – Guidelines for Using Ipratropium Bromide – Uses and Benefits

Type of Drug:

Respiratory inhalant; bronchodilator.

How the Ipratropium Bromide Works:

Ipratropium bromide blocks the action of the chemical transmitter acetylcholine when inhaled orally. Acetylcholine stimulates the muscles around the bronchial tubes (air passages in the lung) to spasm or constrict. This closes the bronchial tubes and makes it harder to breath. By blocking acetylcholine, ipratropium allows the muscles around the bronchial tubes to relax. This allow the bronchial tubes to open wider (bronchodilation) and makes it easier to breath.

Uses of The Ipratropium Bromide:

To treat bronchospasms (spasms of air passages) occurring in chronic obstructive pulmonary disease (COPD), including chronic bronchitis, and emphysema.

Precautions:

Do not use in the following situations:

allergy to ipratropium bromide, atropine, or any of its anticholinergic derivatives

allergy to soya lecithin or related food products (eg, soybeans, peanuts) (aerosol only)

Use with caution in the following situations:

Acute bronchospasm attacks (eg, asthma attacks) enlarged prostate

Glaucoma, narrow-angle obstruction of the neck of the urinary bladder

Pregnancy: There are no adequate and well-controlled studies in pregnant women. Use only if clearly needed and benefits outweigh the possible hazards to the fetus.

Breastfeeding: It is not known if ipratropium bromide appears in breast milk.

Consult your doctor before you begin breastfeeding.

Children: Safety and effectiveness in children younger than 12 years of age have not been established.

Side Effects:

Every drug is capable of producing side effects. Many patients experience no, or minor, side effects. The frequency and severity of side effects depend on many factors including dose, duration of therapy, and individual susceptibility. Possible side effects include:

Digestive Tract: Nausea; stomach ache.

Nervous System: Headache; nervousness; dizziness; sleeplessness.

Circulatory System: Increased heart rate or irregular heartbeat; palpitations (pounding in the chest); low blood pressure; increased blood pressure.

Skin: Rash; itching; hives; flushing; hair loss.

Respiratory System: Cough; difficulty breathing; bronchitis; bronchospasm; increased sputum; upper respiratory tract infection; respiratory disorder; sore throat; dry mouth or throat; hoarseness; sinus infection; nasal irritation or congestion; runny nose; blood-tinged mucus.

Other: Worsening of narrowangle glaucoma with acute eye pain; blurred vision; eye irritation; eye inflammation; ear ringing; tremors; pain; flu­like symptoms; joint, back, or chest pain; general pain; difficult urination; thirst.

Guidelines for Use:

• Dosage is individualized. Use exactly as prescribed.
• Do not stop taking or change the dose unless directed by your doctor.
• If a dose is missed, inhale it as soon as possible. If several hours have passed or it is nearing time for the next dose, do not double the dose to catch up, unless advised to do so by your doctor. If more than one dose is missed or it is necessary to establish a new dosage schedule, contact your doctor or pharmacist.
• Shake the aerosol canister well before using.
• The pump requires 7 actuations to initiate first dose. If not used for more than 24 hours, the pump will require 2 actuations; if not used for more than 7 days, the pump will require 7 actuations to reprime.
• Use of a spacer (eg, OptiHaler) with the aerosol may increase the amount of medicine that gets into the bronchial tubes and its effectiveness.
• The aerosol contains enough medication for 200 inhalations. Discard the canister after you have used 200 inhalations. Use of the aerosol after ,200 inhalations will not provide the correct amount of medication.
• The aerosol total daily dose should not exceed 12 inhalations in
• 24 hours. If the recommended dosage does not provide relief or symptoms become worse, contact your doctor immediately.
• Do not use the aerosol with other inhaled drugs unless directed by your doctor.
• Do not use for the treatment of acute episodes of bronchospasm in which rapid response is required. This medicine is considered maintenance therapy. Drugs with faster action may be preferred for initial therapy in this situation.
• Temporary blurring of vision, causing or worsening of narrow-angle glaucoma, or eye pain may occur if the drug comes into contact with the eye. For the solution form, use of a nebulizer with a mouthpiece (rather than a face mask) may be preferable to reduce the chance of getting the solution in the eyes.
• The solution can be mixed in the nebulizer with albuterol. The combination should then be used within 1 hour.
• Inform your doctor if you are pregnant, become pregnant, are planning to become pregnant, or are breastfeeding.
• Aerosol- Store at room temperature (59° to 86°F). Avoid excessive humidity.
• Solution – Store at room temperature (59° to 86° F) away from light. Store unused vials in the foil pouch.

Antihistamines Information – Side Effects, Uses and Benefits

Type of Drug:

Antihistamine; allergy medications.

How the Drug Works:

Antihistamines block the effects of histamine at H1 receptors in the body .Histamine is one of the chemicals released in the body during an allergic reaction. It causes redness, itching, and irritation of respiratory mucosal tissues, and can cause watery eyes, runny nose, sneezing, itchy nose, eyes, palate, and throat, and hives.

Uses:

To provide relief of symptoms associated with seasonal and year-round allergies causing runny nose, sneezing, itching of the nose or throat, or watery, itchy eyes; hives; and rash, insect bites, and stings where there is mild to moderate itching and no complications.

Certizine and fexofenadine: To treat chronic idiopathic urticaria (hives).

Diphenhydramine: To treat or prevent motion sickness, sleeplessness, and parkinsonism. Also used as a suppressant for coughs caused by colds or allergies .

Promethazine: To treat or prevent motion sickness, nausea, and vomiting associated with anesthesia and surgery, apprehension, and sleepless ­ness. Used with pain medication (eg, meperidine) to help control pain following surgery.

Unlabeled Uses: Occasionally doctors may prescribe cyproheptadine to stimulate appetite in underweight people (eg, anorexia nervosa) and to treat cluster headaches.

Precautions:

Pregnancy: Safety for use during pregnancy has not been established. Several possible associations with malformations have been found, but significance is unknown. Use only when, clearly needed and the potential benefits outweigh the possible hazards to the fetus. Do not use during the third trimester; newborns and premature infants may have severe reactions (eg, convulsions) to some antihistamines.

Breastfeeding: Antihistamines appear in breast milk. Breastfeeding should be discouraged while taking these medications, or antihistamines should be avoided during the breastfeeding months.

Children: Antihistamine over dosage in children may cause hallucinations, convulsions, or death. Antihistamines may decrease mental alertness or produce hyperactivity in young children. Consult your pharmacist or product label to determine the appropriate dose of nonprescription drugs to be given to children younger than 12 years of age. Do not give prescription antihistamines to children younger than 12 years of age unless advised by your doctor or approved in the package labeling.

Elderly: Elderly patients may require lower doses. Antihistamines are more likely to cause dizziness, sedation, confusion, disorientation, fainting, excitation, and decreased blood pressure.

Drug Interactions:

Tell your doctor or pharmacist if you are taking or planning to take any over­the-counter or prescription medications or dietary supplements while taking antihistamines. Doses of one or both drugs may need to be modified or a different drug may need to be prescribed. Alcohol, sedatives (sleeping pills), tranquilizers, antianxiety medications,and narcotic pain relievers all are known to interact with antihistamines. The following drug and drug classes also interact antisamines:

• aluminum- and magnesium-containing antacids (eg, Maalox)
• anesthesia (promethazine only)
• barbiturates (promethazine only)
• cimetidine (azelastine only)
• epinephrine (eg, Adrenalin)
• erythromycin (eg, E-Mycin) (fexofenadine only)
• ketoconazole (eg, Nizoral)
• MAOls (eg, phenelzine)
• tricyclic antidepressants (eg, Elavil)

Side Effects:

Every drug is capable of producing side effects. Many antihistamine users experience no, or minor, side effects. The frequency and severity of side effects depend on many factors including dose, duration of therapy, and individual susceptibility. Possible side effects include:

Digestive Tract: Stomachache; constipation; appetite changes; nausea; vomiting; diarrhea; indigestion; decreased salivation; gas; altered sense of taste; dry mouth.

Nervous System: Drowsiness; dizziness; confusion; disorientation; nervousness; restlessness; excitation; tremor; decreased coordination; fatigue; headache; sleeplessness; sedation; irritability; exaggerated sense of well being; fainting; migraine; abnormal skin sensations; feeling of whirling motion; impaired concentration; hallucination; hysteria; amnesia; abnormal thinking; agitation; anxiety; depersonalization; depression; convulsions.

Circulatory System: Changes in blood pressure; irregular heartbeat; fast heartbeat; shock; palpitations (pounding in the chest); chest pain.

Respiratory System: Dry nose and throat; cough; sore throat; thickening of mucus in respiratory tract; chest tightness; wheezing; nasal stuffiness; hyperventilation; upper respiratory tract infection; laryngitis; bronchospasm; nasal and throat burning; nosebleed; difficulty breathing; sneezing.

Skin: Rash; hives; sweating; itching; flushing; dry skin; excessively oily skin; skin inflammation; red or purple patches under the skin; acne; excessive sweating; hair loss.

Other: Weight gain; joint pain; muscle pain; sensitivity to light; frequent, abnormal, or difficult urination; urine retention; ringing in the ears; blurred or double vision; itchy, watery eyes; yellowing of skin or eyes; chills; painful menstruation (loratadine and fexofenadine only); thirst; earache; fever; leg cramps; weakness; decreased sensitivity to stimulation; eye pain or abnormality; altered tearing; twitching eyes; tight muscles; breast pain; heavy menstruation; allergic reaction; back pain; “flu-like” symptoms; general body discomfort; pain in extremities; twitching; decreased sex drive; excessive movement; inflammation of the vagina with itching or abnormal discharge; urinary discoloration; distorted sense of smell; hot flasher; anemia.

Guidelines for Use:

• Dosage is individualized. Use exactly as prescribed.
• If a dose is missed, take it as soon as possible. If several hours have passed or it is nearing time for the next dose, do not double the dose to catch up, unless advised by your doctor. If more than one dose is missed or it is necessary to establish a new dosage schedule, contact your doctor or pharmacist.
• Loratadine tablets and syrup should be taken once daily on an empty stomach (1 hour before or 2 hours after a meal). Loratadine rapidly­disintegrating tablets break down quickly after being placed on the tongue; they may be given with or without water.
• Do not crush or chew sustained-release products.
• May cause drowsiness or dizziness. Avoid alcohol and other sedatives (eg, tranquilizers). Chlorpheniramine, loratadine, cetirizine, and fexofenadine cause the least amount of drowsiness; promethazine and diphenhydramine cause the most. Use caution while driving or performing tasks requiring alertness, coordination, or physical dexterity.
• Promethazine – Report any involuntary muscle movements or unusual sensitivity to sunlight.
• Use alone when sneezing and runny nose exist, but nasal congestion is slight. When nasal congestion accompanies sneezing and runny nose, an oral decongestant (eg, pseudoephedrine) may be added.
• Avoid therapy with combination products containing antihistamines, decongestants, anticholinergics, expectorants, pain medication, cough suppressants, caffeine, and vitamins. Deal with symptoms as specifically as possible. Combination products frequently contain some ingredients in ineffective amounts. They increase risk for side effects and drug interactions, and usually cost more than products with fewer ingredients.
• A persistent cough may be a sign of a serious condition. Contact your doctor if cough persists for more than 1 week, tends to recur, or is accompanied by a high fever, rash, or persistent headache.
• Do not take antihistamines for persistent or chronic cough, such as occurs with smoking, asthma, or emphysema or if cough is accompanied by excessive phlegm, unless directed by a doctor. Cough is a protective reflex that helps clear the respiratory tract of mucus and other debris.
• Do not take for 7 days before allergy skin testing.
• Contact your doctor immediately if you experience fainting, dizziness, unusual heartbeats, stomach pain, chest pain, vomiting, or any other unusual symptoms occur,
• If sleeplessness persists continuously for more than 2 weeks, consult your doctor.
• If the medication loses effectiveness with continued use, make sure you are taking it according to directions. Sometimes, loss of effectiveness indicates that your condition has gotten worse. Treatment may require a different medication or dose.
• May rarely cause photosensitivity (sensitivity to sunlight). Avoid prolonged exposure to the sun or other forms of ultraviolet (UV) light (eg, tanning beds). Use sunscreens and wear protective clothing until tolerance is determined.
• Azelastine – Prime the nasal spray delivery system before initial use and after storage for 3 or more days. Avoid spraying in the eyes.
• Store at room temperature (59° to 77° F) in a tightly closed container. Protect from heat, light, and moisture. Keep away from children.
• Suppositories and some syrups – Store in the refrigerator (36° to 46°F) in a tightly closed container. See individual labels for specific storage information.