Is it Dangerous to Use Loratadine and Fexofenadine HCL at Same Time?
A Healthtap patient asked:
Is it okay to take ½ of any 2 types of 24hour allergy pill t/g? specifically, can I take ½ of a loratadine 10mg tab & ½ of a fexofenadine HCl 180 t/g?
Taking combination of allergy pills can be dangerous depending on general medical health, & even your glasses rx (rarely narrow angles can occur from hyperopia –being farsighted & cause headaches with certain meds like loratadne & fexofenadine. What is your weight? How is your general health? History of headaches & hyperopia?
If one gets headaches everytime one takes an anti-allergy pill or benadryl or sleep pill or anti-anxiety pill, it could be narrow angle and a Pentacam exam and Gonioscopy is needed to be sure no narrow angle is present. I have personally seen about 20 patients loose the majority of their vision permanently from an acute attack of glaucoma. The risk is not worth it so be careful and see your EyeMD if you have frequent headaches.
Sympathomimetic agents can induce transient mydriasis via stimulation of alpha-1 adrenergic receptors. In patients with anatomically narrow angles or narrow-angle glaucoma, pupillary dilation can provoke an acute attack. In patients with other forms of glaucoma, mydriasis may occasionally increase intraocular pressure. Therapy with sympathomimetic agents should be administered cautiously in patients with or predisposed to glaucoma, particularly narrow-angle glaucoma.
Fexofenadine (Allegra) and Loratadine are antihistamines used to treat the symptoms of allergies, such as sneezing, watery eyes, and runny nose. It is also used to treat hives and itching in people with skin reactions.
If you have narrow angles or narrow angle glaucoma (aka closed-angle glaucoma), you should avoid antihistamines or use them with caution under the supervision of a health care provider. Antihistamines may cause enlargement (dilation) of the pupil which can trigger an attack of closed-angle glaucoma. Consult with your eyeMD & physician before using antihistamines.
Also, in case of an overdoes: Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.
Overdose symptoms may include dry mouth, dizziness, or drowsiness.
Sandra Lora Cremers, MD, FACS
References:
Allegra-D 24 Hour (fexofenadine / pseudoephedrine) Disease Interactions
There are 7 disease interactions with Allegra-D 24 Hour (fexofenadine / pseudoephedrine):
Major
Sympathomimetics (Includes Allegra-D 24 Hour) ↔ Cardiovascular Disease
Sympathomimetic agents may cause adverse cardiovascular effects, particularly when used in high dosages and/or in susceptible patients. In cardiac tissues, these agents may produce positive chronotropic and inotropic effects via stimulation of beta-1 adrenergic receptors. Cardiac output, oxygen consumption, and the work of the heart may be increased. In the peripheral vasculature, vasoconstriction may occur via stimulation of alpha-1 adrenergic receptors. Palpitations, tachycardia, arrhythmia, hypertension, reflex bradycardia, coronary occlusion, cerebral vasculitis, myocardial infarction, cardiac arrest, and death have been reported. Some of these agents, particularly ephedra alkaloids (ephedrine, ma huang, phenylpropanolamine), may also predispose patients to hemorrhagic and ischemic stroke. Therapy with sympathomimetic agents should generally be avoided or administered cautiously in patients with sensitivity to sympathomimetic amines, hyperthyroidism, or underlying cardiovascular or cerebrovascular disorders. These agents should not be used in patients with severe coronary artery disease or severe/uncontrolled hypertension.
References
- Covington TR, Lawson LC, Young LL, eds. “Handbook of Nonprescription Drugs. 10th ed.” Washington, DC: American Pharmaceutical Association (1993):
- Horowitz JD, Lang WJ, Howes LG, Fennessy MR, Christophidis N, Rand MJ, Louis WJ “Hypertensive responses induced by phenylpropanolamine in anorectic and decongestant preparations.” Lancet 1 (1980): 60-1
- Frewin DB “Phenylpropanolamine. How safe is it?” Med J Aust 2 (1983): 54-5
Moderate
Fexofenadine (Includes Allegra-D 24 Hour) ↔ Renal Dysfunction
Fexofenadine is primarily eliminated by the kidney, and the risk of toxic reactions may be greater in patients with renal impairment due to decreased drug clearance. Care should be taken in dose selection and it may be useful to monitor renal function.
References
- Russell T, Stoltz M, Weir S “Pharmacokinetics, pharmacodynamics, and tolerance of single- and multiple-dose fexofenadine hydrochloride in healthy male volunteers.” Clin Pharmacol Ther 64 (1998): 612-21
- “Product Information. Allegra (fexofenadine).” Hoechst Marion-Roussel Inc, Kansas City, MO.
Moderate
Pseudoephedrine (Includes Allegra-D 24 Hour) ↔ Gi Narrowing
The extended-release formulation of pseudoephedrine (Sudafed 24 Hour) contains a non-deformable material. There have been rare reports of obstructive symptoms in patients with known strictures following the ingestion of similar sustained-release products. Therapy with the extended-release formulation of pseudoephedrine should be administered cautiously in patients with preexisting severe gastrointestinal narrowing or obstruction, whether pathologic or iatrogenic.
References
- “Product Information. Sudafed (pseudoephedrine).” Glaxo Wellcome, Research Triangle Park, NC.
Moderate
Pseudoephedrine (Includes Allegra-D 24 Hour) ↔ Pku
Chewable products frequently may contain aspartame, which is metabolized in the gastrointestinal tract to phenylalanine. Sudafed (brand of pseudoephedrine) chewable 15 mg tablets provide the equivalent of 0.78 mg of phenylalanine per each tablet. The aspartame/phenylalanine content should be considered when this and similar products are used in patients who must restrict their intake of phenylalanine (i.e. phenylketonurics).
References
- “Product Information. Sudafed (pseudoephedrine).” Glaxo Wellcome, Research Triangle Park, NC.
Moderate
Sympathomimetics (Includes Allegra-D 24 Hour) ↔ Bph
Sympathomimetic agents may cause or worsen urinary difficulty in patients with prostate enlargement due to smooth muscle contraction in the bladder neck via stimulation of alpha-1 adrenergic receptors. Therapy with sympathomimetic agents should be administered cautiously in patients with hypertrophy or neoplasm of the prostate.
References
- “Product Information. Sudafed (pseudoephedrine).” Glaxo Wellcome, Research Triangle Park, NC.
- Covington TR, Lawson LC, Young LL, eds. “Handbook of Nonprescription Drugs. 10th ed.” Washington, DC: American Pharmaceutical Association (1993):
- Williams DM “Phenylpropanolamine hydrochloride” Am Pharm NS30 (1990): 47-50
Moderate
Sympathomimetics (Includes Allegra-D 24 Hour) ↔ Diabetes
Sympathomimetic agents may cause increases in blood glucose concentrations. These effects are usually transient and slight but may be significant with dosages higher than those normally recommended. Therapy with sympathomimetic agents should be administered cautiously in patients with diabetes mellitus. Closer monitoring of blood glucose concentrations may be appropriate.
References
- “Product Information. Sudafed (pseudoephedrine).” Glaxo Wellcome, Research Triangle Park, NC.
- American Medical Association, Division of Drugs and Toxicology “Drug evaluations annual 1994.” Chicago, IL: American Medical Association; (1994):
- Covington TR, Lawson LC, Young LL, eds. “Handbook of Nonprescription Drugs. 10th ed.” Washington, DC: American Pharmaceutical Association (1993):
Moderate
Sympathomimetics (Includes Allegra-D 24 Hour) ↔ Glaucoma
Sympathomimetic agents can induce transient mydriasis via stimulation of alpha-1 adrenergic receptors. In patients with anatomically narrow angles or narrow-angle glaucoma, pupillary dilation can provoke an acute attack. In patients with other forms of glaucoma, mydriasis may occasionally increase intraocular pressure. Therapy with sympathomimetic agents should be administered cautiously in patients with or predisposed to glaucoma, particularly narrow-angle glaucoma.
References
- Covington TR, Lawson LC, Young LL, eds. “Handbook of Nonprescription Drugs. 10th ed.” Washington, DC: American Pharmaceutical Association (1993):
- Fraunfelder FT, Fraunfelder FW; Randall JA “Drug-Induced Ocular Side Effects 5th” Boston, MA: Butterworth-Heinemann (2001):
- “Product Information. Sudafed (pseudoephedrine).” Glaxo Wellcome, Research Triangle Park, NC.
Allegra-D 24 Hour (fexofenadine / pseudoephedrine) drug Interactions
There are 318 drug interactions with Allegra-D 24 Hour (fexofenadine / pseudoephedrine)
Allegra-D 24 Hour (fexofenadine / pseudoephedrine) alcohol/food Interactions
There is 1 alcohol/food interaction with Allegra-D 24 Hour (fexofenadine / pseudoephedrine)
See also…
Drug Interaction Classification
The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables.
| Major | Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit. |
| Moderate | Moderately clinically significant. Usually avoid combinations; use it only under special circumstances. |
| Minor | Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan. |
Do not stop taking any medications without consulting your healthcare provider.
Allegra-D 24 Hour (fexofenadine / pseudoephedrine) Disease Interactions
There are 7 disease interactions with Allegra-D 24 Hour (fexofenadine / pseudoephedrine):
Major
Sympathomimetics (Includes Allegra-D 24 Hour) ↔ Cardiovascular Disease
Sympathomimetic agents may cause adverse cardiovascular effects, particularly when used in high dosages and/or in susceptible patients. In cardiac tissues, these agents may produce positive chronotropic and inotropic effects via stimulation of beta-1 adrenergic receptors. Cardiac output, oxygen consumption, and the work of the heart may be increased. In the peripheral vasculature, vasoconstriction may occur via stimulation of alpha-1 adrenergic receptors. Palpitations, tachycardia, arrhythmia, hypertension, reflex bradycardia, coronary occlusion, cerebral vasculitis, myocardial infarction, cardiac arrest, and death have been reported. Some of these agents, particularly ephedra alkaloids (ephedrine, ma huang, phenylpropanolamine), may also predispose patients to hemorrhagic and ischemic stroke. Therapy with sympathomimetic agents should generally be avoided or administered cautiously in patients with sensitivity to sympathomimetic amines, hyperthyroidism, or underlying cardiovascular or cerebrovascular disorders. These agents should not be used in patients with severe coronary artery disease or severe/uncontrolled hypertension.
References
- Covington TR, Lawson LC, Young LL, eds. “Handbook of Nonprescription Drugs. 10th ed.” Washington, DC: American Pharmaceutical Association (1993):
- Horowitz JD, Lang WJ, Howes LG, Fennessy MR, Christophidis N, Rand MJ, Louis WJ “Hypertensive responses induced by phenylpropanolamine in anorectic and decongestant preparations.” Lancet 1 (1980): 60-1
- Frewin DB “Phenylpropanolamine. How safe is it?” Med J Aust 2 (1983): 54-5
Moderate
Fexofenadine (Includes Allegra-D 24 Hour) ↔ Renal Dysfunction
Fexofenadine is primarily eliminated by the kidney, and the risk of toxic reactions may be greater in patients with renal impairment due to decreased drug clearance. Care should be taken in dose selection and it may be useful to monitor renal function.
References
- Russell T, Stoltz M, Weir S “Pharmacokinetics, pharmacodynamics, and tolerance of single- and multiple-dose fexofenadine hydrochloride in healthy male volunteers.” Clin Pharmacol Ther 64 (1998): 612-21
- “Product Information. Allegra (fexofenadine).” Hoechst Marion-Roussel Inc, Kansas City, MO.
Moderate
Pseudoephedrine (Includes Allegra-D 24 Hour) ↔ Gi Narrowing
The extended-release formulation of pseudoephedrine (Sudafed 24 Hour) contains a non-deformable material. There have been rare reports of obstructive symptoms in patients with known strictures following the ingestion of similar sustained-release products. Therapy with the extended-release formulation of pseudoephedrine should be administered cautiously in patients with preexisting severe gastrointestinal narrowing or obstruction, whether pathologic or iatrogenic.
References
- “Product Information. Sudafed (pseudoephedrine).” Glaxo Wellcome, Research Triangle Park, NC.
Moderate
Pseudoephedrine (Includes Allegra-D 24 Hour) ↔ Pku
Chewable products frequently may contain aspartame, which is metabolized in the gastrointestinal tract to phenylalanine. Sudafed (brand of pseudoephedrine) chewable 15 mg tablets provide the equivalent of 0.78 mg of phenylalanine per each tablet. The aspartame/phenylalanine content should be considered when this and similar products are used in patients who must restrict their intake of phenylalanine (i.e. phenylketonurics).
References
- “Product Information. Sudafed (pseudoephedrine).” Glaxo Wellcome, Research Triangle Park, NC.
Moderate
Sympathomimetics (Includes Allegra-D 24 Hour) ↔ Bph
Sympathomimetic agents may cause or worsen urinary difficulty in patients with prostate enlargement due to smooth muscle contraction in the bladder neck via stimulation of alpha-1 adrenergic receptors. Therapy with sympathomimetic agents should be administered cautiously in patients with hypertrophy or neoplasm of the prostate.
References
- “Product Information. Sudafed (pseudoephedrine).” Glaxo Wellcome, Research Triangle Park, NC.
- Covington TR, Lawson LC, Young LL, eds. “Handbook of Nonprescription Drugs. 10th ed.” Washington, DC: American Pharmaceutical Association (1993):
- Williams DM “Phenylpropanolamine hydrochloride” Am Pharm NS30 (1990): 47-50
Moderate
Sympathomimetics (Includes Allegra-D 24 Hour) ↔ Diabetes
Sympathomimetic agents may cause increases in blood glucose concentrations. These effects are usually transient and slight but may be significant with dosages higher than those normally recommended. Therapy with sympathomimetic agents should be administered cautiously in patients with diabetes mellitus. Closer monitoring of blood glucose concentrations may be appropriate.
References
- “Product Information. Sudafed (pseudoephedrine).” Glaxo Wellcome, Research Triangle Park, NC.
- American Medical Association, Division of Drugs and Toxicology “Drug evaluations annual 1994.” Chicago, IL: American Medical Association; (1994):
- Covington TR, Lawson LC, Young LL, eds. “Handbook of Nonprescription Drugs. 10th ed.” Washington, DC: American Pharmaceutical Association (1993):
Moderate
Sympathomimetics (Includes Allegra-D 24 Hour) ↔ Glaucoma
Sympathomimetic agents can induce transient mydriasis via stimulation of alpha-1 adrenergic receptors. In patients with anatomically narrow angles or narrow-angle glaucoma, pupillary dilation can provoke an acute attack. In patients with other forms of glaucoma, mydriasis may occasionally increase intraocular pressure. Therapy with sympathomimetic agents should be administered cautiously in patients with or predisposed to glaucoma, particularly narrow-angle glaucoma.
References
- Covington TR, Lawson LC, Young LL, eds. “Handbook of Nonprescription Drugs. 10th ed.” Washington, DC: American Pharmaceutical Association (1993):
- Fraunfelder FT, Fraunfelder FW; Randall JA “Drug-Induced Ocular Side Effects 5th” Boston, MA: Butterworth-Heinemann (2001):
- “Product Information. Sudafed (pseudoephedrine).” Glaxo Wellcome, Research Triangle Park, NC.
Allegra-D 24 Hour (fexofenadine / pseudoephedrine) drug Interactions
There are 318 drug interactions with Allegra-D 24 Hour (fexofenadine / pseudoephedrine)
Allegra-D 24 Hour (fexofenadine / pseudoephedrine) alcohol/food Interactions
There is 1 alcohol/food interaction with Allegra-D 24 Hour (fexofenadine / pseudoephedrine)
See also…
Drug Interaction Classification
The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables.
| Major | Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit. |
| Moderate | Moderately clinically significant. Usually avoid combinations; use it only under special circumstances. |
| Minor | Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan. |
Do not stop taking any medications without consulting your healthcare provider.c