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Drug overview for ALLERGY RELIEF (FEXOFENADINE) (fexofenadine hcl):
Generic name: fexofenadine HCl (FEX-oh-FEN-a-deen)
Drug class: Antihistamines
Therapeutic class: Respiratory Therapy Agents
Fexofenadine, a second-generation antihistamine, is the active carboxylic acid metabolite of terfenadine.
Fexofenadine shares the uses of other antihistamines, including the management of allergic rhinitis and chronic idiopathic urticaria. For additional information on these and other uses of antihistamines,see Uses in the Antihistamines General Statement 4:00. Fexofenadine is the active carboxylic acid metabolite of terfenadine (no longer commercially available in the US).
Fexofenadine is thought to provide essentially all the therapeutic benefits of terfenadine while avoiding the serious cardiotoxic and drug interaction risks of the parent drug, and therefore is considered a relatively safe alternative to terfenadine. Although other relatively nonsedating (second generation) antihistamines that lack the cardiotoxic and drug interaction potentials of terfenadine also are commercially available in the US, individual patients vary in their response to antihistamines, and a specific antihistamine that provides dramatic relief without adverse effects to one patient may be ineffective or poorly tolerated in another. Trial of various antihistamines may be necessary to determine which drug will cause relief while causing minimal adverse effects.
Generic name: fexofenadine HCl (FEX-oh-FEN-a-deen)
Drug class: Antihistamines
Therapeutic class: Respiratory Therapy Agents
Fexofenadine, a second-generation antihistamine, is the active carboxylic acid metabolite of terfenadine.
Fexofenadine shares the uses of other antihistamines, including the management of allergic rhinitis and chronic idiopathic urticaria. For additional information on these and other uses of antihistamines,see Uses in the Antihistamines General Statement 4:00. Fexofenadine is the active carboxylic acid metabolite of terfenadine (no longer commercially available in the US).
Fexofenadine is thought to provide essentially all the therapeutic benefits of terfenadine while avoiding the serious cardiotoxic and drug interaction risks of the parent drug, and therefore is considered a relatively safe alternative to terfenadine. Although other relatively nonsedating (second generation) antihistamines that lack the cardiotoxic and drug interaction potentials of terfenadine also are commercially available in the US, individual patients vary in their response to antihistamines, and a specific antihistamine that provides dramatic relief without adverse effects to one patient may be ineffective or poorly tolerated in another. Trial of various antihistamines may be necessary to determine which drug will cause relief while causing minimal adverse effects.
DRUG IMAGES
WAL-FEX ALLERGY 180 MG TABLET
EQ ALLERGY RELIEF 180 MG TAB
The following indications for ALLERGY RELIEF (FEXOFENADINE) (fexofenadine hcl) have been approved by the FDA:
Indications:
Allergic rhinitis
Chronic idiopathic urticaria
Seasonal allergic rhinitis
Professional Synonyms:
Intermittent allergic rhinitis
Periodic runny nose
Seasonal allergy
Indications:
Allergic rhinitis
Chronic idiopathic urticaria
Seasonal allergic rhinitis
Professional Synonyms:
Intermittent allergic rhinitis
Periodic runny nose
Seasonal allergy
The following dosing information is available for ALLERGY RELIEF (FEXOFENADINE) (fexofenadine hcl):
Adjustment of fexofenadine hydrochloride dosage may be necessary in patients with renal impairment. Peak plasma fexofenadine concentrations increased by 87 or 111%, and elimination half-life increased by 59 or 72% in patients with mild (e.g., creatinine clearance of 41-80 mL/minute) or severe (creatinine clearance of 11-40 mL/minute) renal impairment, respectively, when compared with those observed in healthy individuals. In addition, peak plasma fexofenadine concentration increased by 82% and elimination half-life increased by 31% in those on hemodialysis (creatinine clearance of 10 mL/minute or less) compared with healthy individuals.
The manufacturer states that adults and children 12 years of age and older with impaired renal function or those on hemodialysis should receive an initial fexofenadine hydrochloride dosage of 60 mg daily (either given alone or in fixed combination with 120 mg of pseudoephedrine hydrochloride (Allegra-D(R) 12 Hour)). The fixed-combination preparation containing 180 mg of fexofenadine hydrochloride and 240 mg of pseudoephedrine hydrochloride (Allegra-D(R) 24 Hour) generally should be avoided in patients with renal impairment because of a possible risk of accumulation of pseudoephedrine.
Children 6 to younger than 12 years of age with impaired renal function should receive an initial fexofenadine hydrochloride dosage of 30 mg daily.
Since the pharmacokinetics of fexofenadine do not appear to be altered in patients with hepatic impairment, the manufacturer states that dosage adjustment is not necessary in such patients. The manufacturer of Allegra-D(R) 12 Hour and Allegra-D(R) 24 Hour does not make specific recommendations for dosage adjustment in patients with hepatic impairment, although it is not known if pharmacokinetics of pseudoephedrine are altered in patients with hepatic impairment.
The manufacturer states that adults and children 12 years of age and older with impaired renal function or those on hemodialysis should receive an initial fexofenadine hydrochloride dosage of 60 mg daily (either given alone or in fixed combination with 120 mg of pseudoephedrine hydrochloride (Allegra-D(R) 12 Hour)). The fixed-combination preparation containing 180 mg of fexofenadine hydrochloride and 240 mg of pseudoephedrine hydrochloride (Allegra-D(R) 24 Hour) generally should be avoided in patients with renal impairment because of a possible risk of accumulation of pseudoephedrine.
Children 6 to younger than 12 years of age with impaired renal function should receive an initial fexofenadine hydrochloride dosage of 30 mg daily.
Since the pharmacokinetics of fexofenadine do not appear to be altered in patients with hepatic impairment, the manufacturer states that dosage adjustment is not necessary in such patients. The manufacturer of Allegra-D(R) 12 Hour and Allegra-D(R) 24 Hour does not make specific recommendations for dosage adjustment in patients with hepatic impairment, although it is not known if pharmacokinetics of pseudoephedrine are altered in patients with hepatic impairment.
Fexofenadine hydrochloride is administered orally. The manufacturer states that when fexofenadine hydrochloride is given alone (i.e., not in fixed combination with pseudoephedrine hydrochloride) the drug may be given without regard to meals. Since absorption and peak plasma concentrations of fexofenadine are decreased by concomitant administration of an aluminum and magnesium hydroxides antacid (Maalox(R)) (see Pharmacokinetics: Absorption and see Drug Interactions: Antacids), the manufacturer recommends that the drug not be taken closely in time with an antacid containing aluminum and magnesium.
Since food appears to substantially affect the rate and extent of absorption of fexofenadine hydrochloride when administered as the extended-release tablets of the drug in fixed combination with pseudoephedrine hydrochloride, the manufacturer states that such extended-release tablets should be administered on an empty stomach with water. (See Pharmacokinetics: Absorption and see Drug Interactions: Fruit Juices.) Extended-release tablets containing fexofenadine hydrochloride in fixed combination with pseudoephedrine hydrochloride should be swallowed intact, and patients should be instructed not to break, crush, or chew such tablets.
Since food appears to substantially affect the rate and extent of absorption of fexofenadine hydrochloride when administered as the extended-release tablets of the drug in fixed combination with pseudoephedrine hydrochloride, the manufacturer states that such extended-release tablets should be administered on an empty stomach with water. (See Pharmacokinetics: Absorption and see Drug Interactions: Fruit Juices.) Extended-release tablets containing fexofenadine hydrochloride in fixed combination with pseudoephedrine hydrochloride should be swallowed intact, and patients should be instructed not to break, crush, or chew such tablets.
| DRUG LABEL | DOSING TYPE | DOSING INSTRUCTIONS |
|---|---|---|
| EQ ALLERGY RELIEF 180 MG TAB | Maintenance | Adults take 1 tablet (180 mg) by oral route once daily |
| DRUG LABEL | DOSING TYPE | DOSING INSTRUCTIONS |
|---|---|---|
| FEXOFENADINE HCL 180 MG TABLET | Maintenance | Adults take 1 tablet (180 mg) by oral route once daily |
| SM FEXOFENADINE HCL 180 MG TAB | Maintenance | Adults take 1 tablet (180 mg) by oral route once daily |
The following drug interaction information is available for ALLERGY RELIEF (FEXOFENADINE) (fexofenadine hcl):
There are 0 contraindications.
There are 2 severe interactions.
These drug interactions can produce serious consequences in most patients. Actions required for severe interactions include, but are not limited to, discontinuing one or both agents, adjusting dosage, altering administration scheduling, and providing additional patient monitoring. Review the full interaction monograph for more information.
| Drug Interaction | Drug Names |
|---|---|
| Radioactive Iodide/Agents that Affect Iodide SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Many compounds can affect iodide protein binding and alter iodide pharmacokinetics and pharmacodynamics.(1) CLINICAL EFFECTS: Compounds that affect iodide pharmacokinetics and pharmacodynamics may impact the effectiveness of radioactive iodide.(1) PREDISPOSING FACTORS: Compounds that affect iodide pharmacokinetics and pharmacodynamics are expected to have the most impact during therapy using radioactive iodide. Diagnostic procedures would be expected to be impacted less. PATIENT MANAGEMENT: Discuss the use of agents that affect iodide pharmacokinetics and pharmacodynamics with the patient's oncologist.(1) DISCUSSION: Many agents interact with radioactive iodine. The average duration of effect is: anticoagulants - 1 week antihistamines - 1 week anti-thyroid drugs, e.g: carbimazole, methimazole, propylthiouracil - 3-5 days corticosteroids - 1 week iodide-containing medications, e.g: amiodarone - 1-6 months expectorants - 2 weeks Lugol solution - 3 weeks saturated solution of potassium iodine - 3 weeks vitamins - 10-14 days iodide-containing X-ray contrast agents - up to 1 year lithium - 4 weeks phenylbutazone - 1-2 weeks sulfonamides - 1 week thyroid hormones (natural or synthetic), e.g.: thyroxine - 4 weeks tri-iodothyronine - 2 weeks tolbutamide - 1 week topical iodide - 1-9 months (1) |
ADREVIEW, JEANATOPE, MEGATOPE, SODIUM IODIDE I-123 |
| Sodium Iodide I 131/Agents that Affect Iodide SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Many compounds can affect iodide protein binding and alter iodide pharmacokinetics and pharmacodynamics.(1,2) CLINICAL EFFECTS: Compounds that affect iodide pharmacokinetics and pharmacodynamics may impact the effectiveness of radioactive iodide.(1,2) PREDISPOSING FACTORS: Compounds that affect iodide pharmacokinetics and pharmacodynamics are expected to have the most impact during therapy using radioactive iodide. Diagnostic procedures would be expected to be impacted less. PATIENT MANAGEMENT: Discuss the use of agents that affect iodide pharmacokinetics and pharmacodynamics with the patient's oncologist.(1,2) DISCUSSION: Many agents interact with radioactive iodine. The average duration of effect is: anticoagulants - 1 week antihistamines - 1 week anti-thyroid drugs, e.g: carbimazole, methimazole, propylthiouracil - 3-5 days corticosteroids - 1 week iodide-containing medications, e.g: amiodarone - 1-6 months expectorants - 2 weeks Lugol solution - 3 weeks saturated solution of potassium iodine - 3 weeks vitamins - 10-14 days iodide-containing X-ray contrast agents - up to 1 year lithium - 4 weeks phenylbutazone - 1-2 weeks sulfonamides - 1 week thyroid hormones (natural or synthetic), e.g.: thyroxine - 4 weeks tri-iodothyronine - 2 weeks tolbutamide - 1 week topical iodide - 1-9 months (1,2) |
HICON, SODIUM IODIDE I-131 |
There are 0 moderate interactions.
The following contraindication information is available for ALLERGY RELIEF (FEXOFENADINE) (fexofenadine hcl):
Drug contraindication overview.
No enhanced Contraindications information available for this drug.
No enhanced Contraindications information available for this drug.
There are 0 contraindications.
There are 0 severe contraindications.
There are 1 moderate contraindications.
Clinically significant contraindication, where the condition can be managed or treated before the drug may be given safely.
| Moderate List |
|---|
| Kidney disease with reduction in glomerular filtration rate (GFr) |
The following adverse reaction information is available for ALLERGY RELIEF (FEXOFENADINE) (fexofenadine hcl):
Adverse reaction overview.
No enhanced Common Adverse Effects information available for this drug.
No enhanced Common Adverse Effects information available for this drug.
There are 5 severe adverse reactions.
| More Frequent | Less Frequent |
|---|---|
| None. | None. |
| Rare/Very Rare |
|---|
|
Acute bacterial otitis media Anaphylaxis Hypersensitivity drug reaction Upper respiratory infection Urticaria |
There are 26 less severe adverse reactions.
| More Frequent | Less Frequent |
|---|---|
| None. |
Back pain Dizziness Drowsy Dysmenorrhea Dyspepsia Fatigue Headache disorder Myalgia Nausea Pharyngitis Sinusitis Skin rash Viral infection Vomiting Xerostomia |
| Rare/Very Rare |
|---|
|
Abdominal pain with cramps Agitation Blurred vision Cough Earache Fever Insomnia Nervousness Nightmares Pain Pruritus of skin |
The following precautions are available for ALLERGY RELIEF (FEXOFENADINE) (fexofenadine hcl):
No enhanced Pediatric Use information available for this drug.
Contraindicated
Severe Precaution
Severe Precaution
Management or Monitoring Precaution
Contraindicated
| None |
Severe Precaution
| Fexofenadine | 1 Day – 179 Days | Safety & efficacy in children less than 6 months not established. |
Severe Precaution
| Fexofenadine (select) | 180 Days – 12 Years | Dose form inappropriate for <12 years, consult clinician. |
Management or Monitoring Precaution
| None |
Reproduction studies in mice receiving fexofenadine doses up to 3730 mg/kg (approximately 10-15 times the maximum recommended daily oral human dosage of fexofenadine hydrochloride in adults) have not revealed evidence of adverse or teratogenic effects during gestation. Reproduction studies in rats and rabbits using oral terfenadine dosages up to 300 mg/kg resulting in fexofenadine exposure levels calculated to be about 3-4 and 25-31 times, respectively, those resulting from the maximum recommended daily oral human dosage of fexofenadine hydrochloride in adults have not revealed evidence of teratogenicity. However, in rats, oral terfenadine dosages of 150 mg/kg, resulting in fexofenadine exposure levels calculated to be about 3-4 times those resulting from the maximum recommended daily oral human dosage of fexofenadine hydrochloride in adults (based on comparison of the AUC), were associated with decreased weight gain and neonatal survival in the pups.
Reproduction studies in rats and rabbits using terfenadine and pseudoephedrine hydrochloride in a fixed-combination ratio of 1:2 at dosages of 150/300 (corresponding to fexofenadine AUCs of about 3-4 times the maximum recommended adult therapeutic value and to pseudoephedrine hydrochloride dosages about 10 times the maximum recommended human adult daily oral dosage, on a mg/m2 basis) and 100/200 mg/kg daily (corresponding to fexofenadine AUCs of about 8-10 times the maximum recommended adult therapeutic value and to pseudoephedrine hydrochloride dosages about 15 times the maximum recommended human adult daily oral dosage, on a mg/m2 basis), respectively, have revealed evidence of reduced fetal weight; delayed ossification with wavy ribs also was observed in rats receiving the drug at these dosages. There are no adequate and controlled studies to date using fexofenadine in pregnant women, and fexofenadine hydrochloride alone or in fixed combination with pseudoephedrine hydrochloride should be used during pregnancy only when the potential benefits justify the possible risks to the fetus.
Reproduction studies in rats and rabbits using terfenadine and pseudoephedrine hydrochloride in a fixed-combination ratio of 1:2 at dosages of 150/300 (corresponding to fexofenadine AUCs of about 3-4 times the maximum recommended adult therapeutic value and to pseudoephedrine hydrochloride dosages about 10 times the maximum recommended human adult daily oral dosage, on a mg/m2 basis) and 100/200 mg/kg daily (corresponding to fexofenadine AUCs of about 8-10 times the maximum recommended adult therapeutic value and to pseudoephedrine hydrochloride dosages about 15 times the maximum recommended human adult daily oral dosage, on a mg/m2 basis), respectively, have revealed evidence of reduced fetal weight; delayed ossification with wavy ribs also was observed in rats receiving the drug at these dosages. There are no adequate and controlled studies to date using fexofenadine in pregnant women, and fexofenadine hydrochloride alone or in fixed combination with pseudoephedrine hydrochloride should be used during pregnancy only when the potential benefits justify the possible risks to the fetus.
| Drug/Drug Class | Severity | Precaution Description | Pregnancy Category Description |
|---|---|---|---|
| Fexofenadine | 2 | Insufficient human data available. | No fda rating but may have precautions or warnings; may have animal and/or human studies or pre or post marketing information. |
It is not known if fexofenadine hydrochloride is distributed into breast milk; however, pseudoephedrine hydrochloride distributes into breast milk. Since there are no adequate and controlled studies to date on the use of fexofenadine during lactation in humans and because many drugs are excreted in human milk, the manufacturer states that fexofenadine alone or in fixed combination with pseudoephedrine hydrochloride should be used with caution in nursing women, and a decision should be made whether to discontinue nursing or the drug, taking into account the importance of the drug to the woman.
Precaution Exists
Precaution exists. (No data or inconclusive human data.) Use of this drug by breast feeding mothers should be evaluated carefully.
Precaution Exists
Precaution exists. (No data or inconclusive human data.) Use of this drug by breast feeding mothers should be evaluated carefully.
| Drug Name | Excretion Potential | Effect on Infant | Notes |
|---|---|---|---|
| Fexofenadine | Excreted.This drug is known to be excreted in human breast milk. | It is not known whether this drug has an adverse effect on the nursing infant. (No data or inconclusive human data) | Insufficient data available; limited data suggest minimal amounts excreted |
No enhanced Geriatric Use information available for this drug.
Precaution Exists
Geriatric management or monitoring precaution exists.
Precaution Exists
Geriatric management or monitoring precaution exists.
| Drug Name | Narrative | REN | HEP | CARDIO | NEURO | PULM | ENDO |
|---|---|---|---|---|---|---|---|
| Fexofenadine | Decrease daily dose for declining renal function (CLCR<80ml/min). | Y | N | N | N | N | N |
The following prioritized warning is available for ALLERGY RELIEF (FEXOFENADINE) (fexofenadine hcl):
No warning message for this drug.
No warning message for this drug.
The following icd codes are available for ALLERGY RELIEF (FEXOFENADINE) (fexofenadine hcl)'s list of indications:
| Allergic rhinitis | |
| J30.1 | Allergic rhinitis due to pollen |
| J30.2 | Other seasonal allergic rhinitis |
| J30.5 | Allergic rhinitis due to food |
| J30.8 | Other allergic rhinitis |
| J30.81 | Allergic rhinitis due to animal (cat) (dog) hair and dander |
| J30.89 | Other allergic rhinitis |
| J30.9 | Allergic rhinitis, unspecified |
| Chronic idiopathic urticaria | |
| L50.1 | Idiopathic urticaria |
| Seasonal allergic rhinitis | |
| J30.1 | Allergic rhinitis due to pollen |
| J30.2 | Other seasonal allergic rhinitis |
Formulary Reference Tool