Rx
Notes
In emergency
Disease annotations
Rx
- Avoid exposure to allergen
- Rhinocort 64mcg/dose one spray per nostril once daily.8
If there are excessive secretions and sneezing add:
- L-cet 5mg tab orally once a day
If there is nasal obstruction add :
- Sterimar nasal spray1puff 2-6 times daily
In more sever cases add:
- Motrinex 10mg once daily at bed time
Notes
Levocetirizine
Available forms:
- Xyzal, Levosyn, levar, Levozal, Zolix, Cetazal :5mg tab
- Layal : 5mg tab, 2.5 mg /5ml syrup
- L-cet : 5mg tab, 0.5mg/ml syrup
- Hpi –levocetirizine : 5mg tab
- Lesonal : 5mg tab, 0.5 mg /ml syrup
Theraputic indications:
- allergic rhinitis (including persistent allergic rhinitis);
- nettle rash (urticaria).
Dose:
Adults :
- 5 milligrams (mg) or 10 mL) (2 teaspoons) once a day taken in the evening. Some patients may be given 2.5 mg or 5 mL (1 teaspoon) once a day taken in the evening.
Children 6 to 11 years of age :
- 2.5 mg or 5 mL (1 teaspoon) once a day taken in the evening. Do not take more than 2.5 mg per day.
Children 6 months to 5 years of age :
- 1.25 mg or 2.5 mL (1/2 teaspoon) once a day taken in the evening. Do not take more than 1.25 mg per day.
For oral dosage form (tablets):
- Adults and children 12 years of age and older—5 mg (1 tablet) once a day taken in the evening. Some patients may be given 2.5 mg (1/2 tablet) once a day taken in the evening. Do not take more than 5 mg per day.
- Children 6 to 11 years of age—2.5 mg (1/2 tablet) once a day taken in the evening. Do not take more than 2.5 mg per day.
Side effect:
- dry mouth,
- headache,
- tiredness
- somnolence/drowsiness.
Pregnancy : category B
Sterimar Isotonic sea water spray
- Is a natural nasal decongestant spray
- Is an isotonic filtered sea water solution, 100% natural and free from preservatives
- Restores natural moisture of the nose (air conditioning, heating, travel). To assist when ENT disorders (sinusitis, colds, hayfever, allergies, dry & stuffy noses).
Dose:
- 1puffs 2 to 6 times a day in each nostril as required or as needed.
Pregnancy and lactation:
- Save
Corticosteroids nasal spray (Budesonide)
Available forms:
- Rhinocort :32mcg/dose,64mcg/dose
Indications:
- corticosteroid indicated for the management of thenasal symptoms of perennial nonallergic rhinitis in adult and pediatric patients aged 6years and older.
Dose:
- Rhinocort :32mcg/dose For intranasal use only.
Starting dosage:
Adult and children >6 years:
- 64 mcg (one spray per nostril ) once daily.
Maximum dosages:
- Adults: 256 mcg (four sprays per nostril of Rhinocort :32mcg/dose) once daily.
- Pediatric patients (6 to <12 years of age): 128 mcg (two sprays per nostril Rhinocort :32mcg/dose) once daily.
Montelukast
Available forms :
- Singulair
- Lukast
- Unicast
- Sincast
- Motrinex
- 4mg 5mg, 10mg Chewable tab
Action:
- Montelukast is in the leukotriene receptor antagonist family of medications. It works by blocking the action of leukotriene D4 in the lungs resulting in decreased inflammation and relaxation of smooth muscle
- Leukotrienes cause tightening of airway muscles and the production of excess mucus and fluid. These chemicals play a key role in allergies, allergic rhinitis, and asthma, also causing a tightening of your airways, making it difficult to breathe.
Indications
- Indicated in the treatment of asthma as add-on therapy in adults and adolescents from 15 years of age and older with mild to moderate persistent asthma who are inadequately controlled on inhaled corticosteroids and in whom “as-needed” short acting β-agonists provide inadequate clinical control of asthma.
- Montelukast Film-coated tablet can also provide symptomatic relief of seasonal allergic rhinitis.
- Indicated in the prophylaxis of asthma in which the predominant component is exercise-induced bronchoconstriction.
Pregnancy
- Montelukast may be used during pregnancy only if it is considered to be clearly essential.
Lactation
- Studies in rats have shown that montelukast is excreted in milk. It is not known if montelukast is excreted in human milk.
- May be used in breast-feeding only if it is considered to be clearly essential.
- Side effects:
- Headache
- Abdominal pain
- Upper respiratory infection
- Diarrhea, nausea, vomiting
- Elevated levels of serum transaminases (ALT, AST)
- Rash
- Pyrexia
Dose:
- Adult: 10mg once daily at bed time
- Children 6-14y: 5mg once daily at bed time
- 2-5 y: 4mg once daily at bed time
In emergency
In Emergency room:
- Give Antihistamine In sneezing and rhinorrhea :
- Allerfin 10mg/ml IM injection :
Dose:
- 1-5 year : 25-5mg (½ ml )
- 6-12 year: 5-10mg (1ml )
- Adult : 10-20 mg (1-2 ml )
- Give Dexamethasone 4mg/1ml
Dose:
Pediatrics:
- 0.3 mg/kg/day IV / IM divided q6hr or q12hr
Adult:
- 4-8 mg IM /IV
Disease annotations
Allergic rhinitis
Presentation :
- Rhinorrhea
- Repetitive sneezing
- nasal congestion, obstruction
- postnasal drainage
- Pruritus
- Itching of the palate, nose, ears, eye
- Snoring
- Frequent sore throats
- Cough
- Headache
- Itching redness watery eyes
Lines of management :
- Avoid exposure to allergens
- In excessive secretions and sneezing: oral antihistamine
- If nasal obstruction: Nasal decongestant
- For ocular symptoms: intranasal antihistamine
- If Symptoms persist and affect quality of life: Intranasal Corticosteroid
- Sever and persistent symptoms: Intranasal Corticosteroid + oral or intranasal antihistamine+ Oral leukotriene receptors antagonist