Loratadine 10 mg Tablets (GSL)

Tablet. White, small, round tablet.

4.1 Therapeutic indications Loratadine 10 mg Tablets are indicated for the symptomatic treatment of allergic rhinitis and chronic idiopathic urticaria.4.2 Posology and method of administration ****Posology**** Adults: 10 mg once daily (one tablet once daily). ****Paediatric population**** *Children 6 years of age and older:* Bodyweight more than 30 kg: 10 mg once daily (one tablet once daily). Bodyweight 30 kg or less: The 10 mg strength tablet is not appropriate in children with a body weight less than 30 kg. Children under 6 years of age: For appropriate dosing in children younger than 6 years or body weight of 30 kg or less, there are other formulations more suitable. Children under 2 years of age: Efficacy and safety of loratadine in children under 2 years of age has not been established. No data available. **Hepatic impairment** Patients with severe liver impairment should be administered a lower initial dose because they may have reduced clearance of loratadine. An initial dose of 10 mg every other day is recommended for adults and children weighing more than 30 kg. **Renal impairment** No dosage adjustments are required in patients with renal insufficiency. **Elderly** No dosage adjustments are required in the elderly. **Method of administration** Oral use. The tablet may be taken without regard to mealtime.4.3 Contraindications Loratadine 10 mg Tablets are contraindicated in patients who are hypersensitive to the active substance or to any of the excipients in the formulation listed in section 6.1.4.4 Special warnings and precautions for use Loratadine 10 mg Tablets should be administered with caution in patients with severe liver impairment (see section 4.2). This medicinal product contains lactose. Patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption should not take this medicine. The administration of Loratadine 10 mg Tablets should be discontinued at least 48 hours before skin tests since antihistamines may prevent or reduce otherwise positive reactions to dermal reactivity index.4.5 Interaction with other medicinal products and other forms of interaction When administered concomitantly with alcohol, Loratadine 10 mg Tablets have no potentiating effects as measured by psychomotor performance studies. Potential interaction may occur with all known inhibitors of CYP3A4 or CYP2D6 resulting in elevated levels of loratadine (see Section 5.2), which may cause an increase in adverse events. Increase in plasma concentrations of loratadine has been reported after concomitant use with ketoconazole, erythromycin, and cimetidine in controlled trials, but without clinically significant changes (including electrocardiographic). **Paediatric population** Interaction studies have only been performed in adults.4.6 Fertility, pregnancy and lactation **Pregnancy** A large amount of data on pregnant women (more than 1000 exposed outcomes) indicate no malformative nor feto/ neonatal toxicity of loratadine. Animal studies do not indicate direct or indirect harmful effects with respect to reproductive toxicity (see section 5.3). As a precautionary measure, it is preferable to avoid the use of Loratadine 10mg Tablets during pregnancy. **Breast-feeding** Loratadine is excreted in breast milk, therefore the use of loratadine is not recommended in breast-feeding women. **Fertility** There are no data available on male and female fertility.4.7 Effects on ability to drive and use machines In clinical trials that assessed driving ability, no impairment occurred in patients receiving loratadine. Loratadine 10 mg Tablets have no or negligible influence on the ability to drive and use machines. However, patients should be informed that very rarely some people experience drowsiness, which may affect their ability to drive or use machines.4.8 Undesirable effects **Summary of the safety profile** In clinical trials involving adults and adolescents in a range of indications including allergic rhinitis (AR) and chronic idiopathic urticaria (CIU), at the recommended dose of 10 mg daily, adverse reactions with loratadine were reported in 2% of patients in excess of those treated with placebo. The most frequent adverse reactions reported in excess of placebo were somnolence (1.2%), headache (0.6%), increased appetite (0.5%) and insomnia (0.1%). **Tabulated list of adverse reactions** The following adverse reactions reported during the post-marketing period are listed in the following table by System Organ Class. Frequencies are defined as very common (≥ 1/10), common (≥ 1/100 to < 1/10), uncommon (≥ 1/1,000 to < 1/100), rare (≥ 1/10,000 to < 1/1,000), very rare (< 1/10,000) and not known (cannot be estimated from the available data). Within each frequency grouping, adverse reactions are presented in order of decreasing seriousness. | | | | | --- | --- | --- | | **System Organ Class** | **Frequency Adverse** | **Experience Term** | | **Immune system disorders** | Very rare | Hypersensitivity reactions (including angioedema and anaphylaxis) | | **Nervous system disorders** | Very rare | Dizziness, convulsion | | **Cardiac disorders** | Very rare | Tachycardia, palpitation | | **Gastrointestinal disorders** | Very rare | Nausea, dry mouth, gastritis | | **Hepatobiliary disorders** | Very rare | Abnormal hepatic function | | **Skin and subcutaneous tissue disorders** | Very rare | Rash, alopecia | | **General disorders and administration site conditions** | Very rare | Fatigue | | **Investigations** | Not known | Weight increase | **Paediatric population** In clinical trials in a paediatric population, children aged 2 through 12 years, common adverse reactions reported in excess of placebo were headache (2.7%), nervousness (2.3%), and fatigue (1%). **Reporting of suspected adverse reactions** Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme, website www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store.4.9 Overdose Overdosage with loratadine increased the occurrence of anticholinergic symptoms. Somnolence, tachycardia and headache have been reported with overdoses. In the event of overdose, general symptomatic and supportive measures are to be instituted and maintained for as long as necessary. Administration of activated charcoal as a slurry with water may be attempted. Gastric lavage may be considered. Loratadine is not removed by haemodialysis and it is not known if loratadine is removed by peritoneal dialysis. Medical monitoring of the patient is to be continued after emergency treatment.

5.1 Pharmacodynamic properties Phamacotherapeutic group: antihistamines – H1 antagonist, ATC code: R06A X13. **Mechanism of action** Loratadine, the active ingredient in Loratadine 10 mg Tablets, is a tricyclic antihistamine with selective, peripheral H1-receptor activity. **Pharmacodynamic effects** Loratadine has no clinically significant sedative or anticholinergic properties in the majority of the population and when used at the recommended dosage. During long-term treatment there were no clinically significant changes in vital signs, laboratory test values, physical examinations or electrocardiograms. Loratadine has no significant H2-receptor activity. It does not inhibit norepinephrine uptake and has practically no influence on cardiovascular function or on intrinsic cardiac pacemaker activity. Human histamine skin wheal studies following a single 10mg dose has shown that the antihistamine effects are seen within 1-3 hours reaching a peak at 8-12 hours and lasting in excess of 24 hours. There was no evidence of tolerance to this effect after 28 days of dosing with loratadine. **Clinical efficacy and safety** Over 10,000 subjects (12 years and older) have been treated with loratadine 10mg tablets in controlled clinical trials. Loratadine 10mg tablets once daily was superior to placebo and similar to clemastine in improving the effects on nasal and non-nasal symptoms of AR. In these studies somnolence occurred less frequently with loratadine than with clemastine and about the same frequency as terfenadine and placebo. Among these subjects (12 years and older), 1000 subjects with CIU were enrolled in placebo controlled studies. A once daily 10mg dose of loratadine was superior to placebo in the management of CIU as demonstrated by the reduction of associated itching, erythema and hives. In these studies the incidence of somnolence with loratadine was similar to placebo. **Paediatric population** Approximately 200 paediatric subjects (6 to 12 years of age) with seasonal allergic rhinitis received doses of loratadine syrup up to 10mg once daily in controlled clinical trials. In another study, 60 paediatric subjects (2 to 5 years of age) received 5mg of loratadine syrup once daily. No unexpected adverse events were observed. The paediatric efficacy was similar to the efficacy observed in adults.5.2 Pharmacokinetic properties **Absorption** Loratadine is rapidly and well-absorbed. Concomitant ingestion of food can delay slightly the absorption of loratadine but without influencing the clinical effect. The bioavailability parameters of loratadine and of the active metabolite are dose proportional. **Biotransformation** After oral administration, loratadine is rapidly and well absorbed and undergoes an extensive first pass metabolism, mainly by CYP3A4 and CYP2D6. The major metabolite – desloratadine (DL) – is pharmacologically active and responsible for a large part of the clinical effect. Loratadine and DL achieve maximum plasma concentrations (Tmax) between 1-1.5 hours and 1.5-3.7 hours after administration, respectively. **Distribution** Loratadine is highly bound (97% to 99%) and its active metabolite desloratadine (DL) moderately bound (73% to 76%) to plasma proteins. In healthy subjects, plasma distribution half-lives of loratadine and its active metabolite are approximately 1 and 2 hours, respectively. **Elimination** The mean elimination half-lives in healthy adult subjects were 8.4 hours (range = 3 to 20 hours) for loratadine and 28 hours (range = 8.8 to 92 hours) for the major active metabolite. Approximately 40% of the dose is excreted in the urine and 42% in the faeces over a 10 day period and mainly in the form of conjugated metabolites. Approximately 27% of the dose is eliminated in the urine during the first 24 hours. Less than 1% of the active substance is excreted unchanged in active form, as loratadine or DL. **Elderly** The pharmacokinetic profile of loratadine and its metabolites is comparable in healthy adult volunteers and in healthy geriatric volunteers. **Renal impairment** In patients with chronic renal impairment, both the AUC and peak plasma levels (Cmax) increased for loratadine and its active metabolite as compared to the AUCs and peak plasma levels (Cmax) of patients with normal renal function. The mean elimination half-lives of loratadine and its active metabolite were not significantly different from those observed in normal subjects. Haemodialysis does not have an effect on the pharmacokinetics of loratadine or its active metabolite in subjects with chronic renal impairment. **Hepatic impairment** In patients with chronic alcoholic liver disease, the AUC and peak plasma levels (Cmax) of loratadine were double while the pharmacokinetic profile of the active metabolite was not significantly changed from that in patients with normal liver function. The elimination half-lives for loratadine and its metabolite were 24 hours and 37 hours respectively, and increased with increasing severity of liver disease.5.3 Preclinical safety data Non-clinical data reveal no special hazard for humans based on conventional studies of safety, pharmacology, repeated dose toxicity, genotoxicity and carcinogenic potential. In reproductive toxicity studies, no teratogenic effects were observed. However, prolonged parturition and reduced viability of offspring were observed in rats at plasma levels (AUC) 10 times higher than those achieved with clinical doses.

6.1 List of excipients Lactose Maize starch Magnesium stearate6.2 Incompatibilities None known.6.3 Shelf life 36 months.6.4 Special precautions for storage Do not store above 25°C. Store in the original package.6.5 Nature and contents of container PVC/aluminium foil containing small, white round tablets. Pack size: 5, 7, 14 and 30 tablets.6.6 Special precautions for disposal and other handling Any unused medicinal product or waste material should be disposed of in accordance with local requirements.