levocetirizine dihydrochloride: clinical use

Prescribing considerations

• Assess renal function because elimination is mainly renal and prescribing must be individualised in renal impairment.
• Consider urinary-retention risk, seizure history, potential sedation and concurrent CNS depressants.
• Check formulation-specific excipients and age suitability.
• Pregnancy and lactation evidence is limited; document the clinical rationale when used.

Contraindications and cautions

• Hypersensitivity to levocetirizine, cetirizine, hydroxyzine, another piperazine derivative or a formulation excipient.
• End-stage renal disease requiring dialysis.
• Formulation-specific hereditary sugar intolerance where listed in the relevant product information.

Monitoring

• Renal function where impairment is known or suspected.
• Somnolence, fatigue and functional impairment.
• Urinary retention or worsening seizure control in susceptible patients.
• Breastfed infant for sedation, irritability, poor feeding and weight gain if maternal treatment is required.

Clinical pharmacology

Levocetirizine is cetirizine’s active R-enantiomer and a selective peripheral H1-receptor antagonist. It is rapidly absorbed, undergoes limited metabolism and is eliminated mainly through the kidneys.

Formulation and product differences

• Film-coated tablets are swallowed whole and contain lactose in the selected product.
• Orodispersible tablets dissolve on the tongue and contain lactose, aspartame and sorbitol in the selected product.
• Oral solution is measured with the supplied syringe and contains maltitol and parahydroxybenzoate preservatives. It has a younger licensed age range than the selected tablets.

Dispersible tablet

Route: Oral

Strengths: 5 mg

Oral solution

Route: Oral

Strengths: 0.5 mg/mL

Tablet

Route: Oral

Strengths: 5 mg