Oral Allergic Rhinitis Treatments (Prescription, Examples)

SECOND-GENERATION ANTIHISTAMINES
GENERIC/BRAND STRENGTH FORMULATIONS DOSING
Desloratadine
Clarinex reditabs 2.5 mg, 5 mg Orally disintegrating Anak 6-11 bln : 1 mg/
tablet hari
Clarinex Tablets 5 mg Tabs Anak 12 bln 5 thn :
1.25 mg / hari
Clarinex Syrup 0.5 mg/mL Syrup Anak 6-11 thn : 2.5
mg / hari
Remaja sampai
dewasa >12 thn : 5
mg / hari

Levocetirizine dihydrochloride
Xyzal Oral Solution 0.5 mg/mL Solution 6 bln- 5 thn : max
1.25 mg / hari pada
malam hari.
6-11 thn :max 2.5 mg
/ hari pada malam
hari

LEUKOTRIENE ANTAGONIST
Montelukast
Singulair 10 mg Tablets 6 bln- 5 thn : 4 mg /
hari
SIngulair Chewabes 4 mg, 5 mg Chewable tablets 6- 14 thn : 5 mg / hari
Singulair oral granules 4 mg/ packet Oral granules .14 thn : 10mg / hari

Oral allergic rhinitis treatment (Nonprescription, Examples)

FIRST-GENERATION H, ANTAGONISTS
GENERIC/BRAND STRENGTH FORMULATION DOSING
Chlorpheniramine maleate
Chlor-trimeton 4 mg Tablets 2-5 thn : 1mg / 4-6 jam (max 6 mg/hari)
Chlor-trimeton 2 mg/5ml Syrup 6-11 thn : 2 mg / 4-6 jam (max 12
Syrup mg/hari
>12 thn 4 mg/ 4-6 jam (max 24 mg/hari)
SECOND-GENERATION H1 ANTAGONIS
Cetirizine
Childrens Zyrtec 1 mg/ml Syrup 6-12 bln : 2.5 mg per hari
Allergy-Syrup
Childrens Zyrtec 5 mg, 10 mg Chewable 12-13 bln : inisial : 2.5 mg per hari, dapat
tablets dinaikan 2.5 mg/12 jam
Chewable
Zyrtectablets 5 mg, 10 mg Tablets 2-5 thn: 2,5 mg/hari dapat dinaikan
hingga max 5 mg/hari dapat diberikan
sebagai dosis tunggal atau terbagi 2
Zyrtec Liquid Gels 10 mg Liquid-Filled >6 thn : 5-10 mg/hari dapat diberikan
gels sebagai dosis tunggal atau terbagi 2

Fexofenadine HCL
ChildrensAllerga 30 mg Tablet
ChildrensAllerga 30 mg Orally 6 bln 2 thn : 15 mg (2.5 mL) per 12 jam.
ODT disintegrating
tablets
Childrens Allerga 30 mg/5 mL Suspension >2-11 thn : 30 mg per 12 jam
Oral
Suspension
Allegra Tabs 30, 60, Tablet >12 thn dewasa: 60 mg/12 jam,
180 mg 180 mg/ hari

Loratadine
Alavert ODT 10 mg Orally 2-5 thn : 5 mg / hari
disintegrating
tablets
10 mg tablets >6 thn : 10 mg / hari, atau 5 mg 2x1
10 mg Liquid-filled
caps
10 mg Chewable
tablets
1 mg/mL Syrup
 Combination Antihistamine + Sympathomimetic (Examples)
GENERIC STRENGTH FORMULATIONS DOSING
Chlorpheniramine 4 mg Tablets >12 thn : 1 tab / 4
maleate jam, tidak melebihi 6
tab / hari
Phenylephrine HCL 10 mg
Sudafed Sinus &
Allergy

Cetirizine + 5 mg cetirizine + 120 Extended release >12 thn : 1 tab / 12

Pseudoephedrine mg tablet jam
Zyrtec-D 12 jam Pseudoephedrine

Miscallaneous Intranasal Spray

DRUG INDICATIONS (I), MECHANISM(s) COMMENTS, CAUTIONS,

Ipratropium bromide:
Atrovent nasal spray (0.06%)
OF ACTION (M), AND DOSING ADVERSE EVENTS, AND
MONITORING
i : Symptomatic relief of rhinorrhea Atrovent inhalation
M: Anticholinergic aerosol is
Colds (symptomatic relief of contraindicated in
rhinorrhea): patients with
5-12 yr: 2 sprays in each nostril 3 hypersensitivity to soy
times/day lecithin.
>12 yr and adults: 2 Sprays in each
nostril 3-4 times/day Safety and efficacy of
use beyond 4 days in
patients with the
common cold have not
been established

Adverse effects:
Epistaxis, nasal dryness,
nausea
Azelastine: l: Treatment of rhinorrhea, May cause drowsiness
sneezing, and nasal pruritus M: Adverse effects:
Antagonism of histamine H1- Headache, somnolence,
receptor bitter taste
Astelin 6-12 yr: 1 spray bid
>12 yr: 1-2 sprays bid
Cromolyn sodium: I: AR
M: Inhibition of mast cell
degranulation
NasalCrom >2 yr: 1 spray tid-qid; max x6 /day
Oxymetazoline: l: Symptomatic relief of nasal
mucosal congestion
M: Adrenergic agonist,
vasoconstricting agent
Afrin, Nostrilla 0.05% solution: instill 2-3 sprays
into each nostril twice daily;
therapy should not exceed 3 days
Phenylephrine: l: Symptomatic relief of nasal
mucosal congestion
M: Adrenergic, vasoconstricting
agent
Neo-Synephrine 2-6 yr: 1 drop every 2-4 hr of
0.125% solution as needed. Note:
Therapy should not
exceed 3 continuous days
6-12 yr: 1-2 sprays or 1-2 drops
every 4 hr of 0.25% solution as
needed. Note: Therapy should not
Not effective
immediately; requires
frequent administration
Excessive dosage may
cause profound central
nervous system (CNS)
depression
Use in excess of 3 days
may result in severe
rebound nasal
congestion
Do not repeat more than
once a month
Use with caution in
patients with
hyperthyroidism, heart
disease, hypertension,
and diabetes
Adverse effects:
Hypertension,
palpitations, reflex
bradycardia,
nervousness, dizziness,
insomnia, headache,
CNS depression,
convulsions,
hallucinations, nausea,
vomiting, mydriasis,
elevated intraocular
pressure, blurred vision
Use in excess of 3 days
may result in severe
rebound nasal
congestion
Do not repeat more than
once a month
0.16% and 0.125%
solutions are not
commercially available
Adverse effects: Reflex
bradycardia,excitability,
headache, anxiety, and
dizziness
 exceed 3 continuous days
>12 yr: 1-7 sprays or 1-7 drops
every 4 hr of 0.25% to O.5%
solution as needed; 1% solution
may be used in adults with extreme
nasal congestion. Note: Therapy
should not exceed 3 continuous
days

Intranasal inhaled corticosteroids

DRUG INDICATIONS (I), COMMENTS, CAUTIONS,
MECHANISM(s) OF ACTION ADVERSE EVENTS, AND
(M), AND DOSING MONITORING
Beclomethasone: I: AR Shake container before use;
M: Antiinflammatory, immune blow nose; occlude 1 nostril,
modulator administer dose to the other
nostril
Beconase AG (42 fig/spray) 6-12 yr: 1 spray in each nostril Adverse effects: Burning and
Qnasl (80 pg/spray) bid; may increase if needed to irritation of nasal mucosa,
2 sprays in each nostril bid epistaxis
>12 yr: 1 or 2 sprays in each Monitor growth
nostril bid
Flunisolide 6-14 yr: 1 spray each nostril 3 Shake container before use;
times daily or 2 Shake blow nose; occlude 1
container before use; blow nostril, administer dose to the
nose; occlude 1 exceed 4 other nostril
sprays/day in each nostril Adverse effects: Burning and
>15 yr: 2 sprays each nostril irritation of nasal mucosa,
twice daily (morning and epistaxis
evening); may increase to 2 Monitor growth
sprays 3 times daily;
maximum dose: 8 sprays/day
in each nostril (400 gig/day)
Triamcinolone I: AR Shake container before use;
M: Antiinflammatory, immune blow nose; occlude 1 nostril,
modulator administer dose to the other
nostril
Nasacort Ao (55 pg/spray) 2-6 yr; 1 spray in each nostril Adverse effects: Burning and
qd irritation of nasal mucosa,
6-12 yr: 1-2 sprays in each epistaxis
nostril qd Monitor growth
>12 yr: 2 sprays in each nostril
qd
Fluticasone propionate I: AR Shake container before use;
(available as a generic M: Antiinflammatory, immune blow nose; occlude 1 nostril,
preparation): modulator administer dose to the other
nostril
Ritonavir significantly
increases fluticasone serum
concentrations and may result
in systemic corticosteroid
effects
Use fluticasone with caution
in patients receiving
ketoconazole or other potent
cytochrome P450 3A4
isoenzyme inhibitor
Adverse effects: Burning and
irritation of nasal mucosa,
epistaxis
Monitor growth
Flonase (50 pg/spray) >4 yr: 1-2 sprays in each
nostril qd
Fluticasone furoate: 2-12 yr:
Veramyst (27.5 pg/spray) Initial dose: 1 spray (27.5
pg/spray) per nostril once
daily (55 pg/day)
Patients who do not show
adequate response may use 2
sprays per nostril once daily
(110 pg/day)
Once symptoms are
controlled, dosage may be
reduced to 55 pg once daily
Total daily dosage should not
exceed 2 sprays in each nostril
(110 pg)/day
>12 yr and adolescents:
Initial dose: 2 sprays (27.5
pg/spray) per nostril once
daily (110 pg/day)
Once symptoms are
controlled, dosage may be
reduced to 1 spray per nostril
once daily (55 pg/day)
Total daily dosage should not
exceed 2 sprays in each nostril

Mometasone:
Nasonex (50 pg/spray)
Budesonide:
Rhinocort Aqua (32 pg/spray)
Ciclesonide:
Omnaris
Zetonna (50 pg/spray)
Azelastine/fluticasone (137 pg
azelastine/SO pg fluticasone)
Dymista
(110 pg)/day
I: AR Mometasone and its major
metabolites are
M: Antiinflammatory, immune undetectable in plasma after
modulator nasal administration of
2-12 yr: 1 spray in each nostril recommended doses
qd Preventive treatment of
>12 yr: 2 sprays in each nostril seasonal AR should begin 2-4
qd wk prior to pollen season
Shake container before use;
blow nose; occlude 1 nostril,
administer dose to the other
nostril
Adverse effects: Burning and
irritation of nasal mucosa,
epistaxis
Monitor growth
I: AR Shake container before use;
M: Antiinflammatory, immune blow nose; occlude 1 nostril,
modulator administer dose to the other
nostril
6-12 yr: 2 sprays in each Adverse effects: Burning and
nostril qd irritation of nasal mucosa,
>12 yr: up to 4 sprays in each epistaxis
nostril qd (maximum dose) Monitor growth
I: AR Prior to initial use, gently
shake, then prime the pump
M: Antiinflammatory immune modulator by
actuating 8 times
2-12 yr: 1-2 sprays in each If the product is not used for 4
nostril qd consecutive days
>12 yr: 2 sprays in each nostril gently shake and reprime with
qd 1 spray or until a fine mist
appears
>12 yr: 1 spray in each nostril Shake bottle gently before
bid using. Blow nose to clear
nostrils. Keep head tilted
downward when spraying.
Insert applicator tip A to A
inch into nostril, keeping
bottle upright, and close off
the other nostril. Breathe in
through nose. While inhaling,
press pump to release spray
 Miscallaneous Intranasal Spray
DRUG INDICATIONS (I), MECHANISM(s)
OF ACTION (M), AND DOSING
Ipratropium bromide: i: Kelainan rhinorrhea secara
simtomatik
Atrovent nasal spray (0.06%) M: Antikolinergik
Pilek (relief rhinorrhea):
5-12 thn: 2 semprotan di setiap lubang
hidung 3 kali
Azelastine: l: Pengobatan rhinore, bersin, dan
pruritus hidung M: Antagonisme
reseptor histamin H1
6-12 thn: 1 penawaran semprot
> 12 thn: 1-2 semprotan bid
Astelin
Cromolyn sodium: i: AR
M: Penghambatan degranulasi sel
mast
NasalCrom > 2 thn: 1 semprotan tid-qid; maks x6
Oxymetazoline: l: Kelenturan gejala kongesti mukosa
hidung
M: Agonis adrenergik, agen
vasokonstriksi
Larutan 0,05%: masukkan 2-3
Afrin, Nostrilla semprotan ke setiap lubang hidung
dua kali sehari; Terapi sebaiknya tidak
melebihi 3 hari
COMMENTS, CAUTIONS,
ADVERSE EVENTS, AND
MONITORING
Atosfer inhalasi aerosol
dikontraindikasikan pada
pasien dengan
hipersensitivitas terhadap
lesitin kedelai.
Keselamatan dan
keampuhan penggunaan di
luar 4 hari pada pasien
dengan flu biasa belum
terbentuk
Efek samping: Epistaksis,
kekeringan hidung, mual
Dapat menyebabkan
kantuk Efek samping: Sakit
kepala, mengantuk, rasa
pahit
Tidak efektif segera;
membutuhkan
administrasi yang sering
Dosis berlebihan dapat
menyebabkan depresi
sistem saraf pusat yang
dalam (SSP)
Penggunaan lebih dari 3
hari bisa mengakibatkan
kemacetan hidung yang
parah
Jangan ulangi lebih dari
sebulan sekali

Phenylephrine: l: Kelenturan gejala kongesti mukosa
hidung
M: Adrenergik, agen vasokonstriksi
2-6 thn: 1 tetes setiap 2-4 jam larutan
0,125% sesuai kebutuhan. Catatan:
Neo-Synephrine Terapi seharusnya tidak
melebihi 3 hari terus menerus
6-12 thn: 1-2 semprotan atau 1-2 tetes
setiap 4 jam larutan 0,25% sesuai
kebutuhan. Catatan: Terapi tidak boleh
melebihi 3 hari kontinyu
> 12 thn: 1-7 semprotan atau 1-7 turun
setiap 4 jam dari 0,25% sampai larutan
O.5% sesuai kebutuhan; Larutan 1%
dapat digunakan pada orang dewasa
dengan congesti nasal yang ekstrem.
Catatan: Terapi tidak boleh melebihi 3
hari kontinyu
Gunakan dengan hati-hati
pada penderita
hipertiroidisme, penyakit
jantung, hipertensi, dan
diabetes
Efek samping: Hipertensi,
palpitasi, refleks
bradikardia, kegelisahan,
pusing, insomnia, sakit
kepala, depresi SSP,
kejang, halusinasi, mual,
muntah, mydriasis,
tekanan intraokular tinggi,
penglihatan kabur
Penggunaan lebih dari 3
hari bisa mengakibatkan
kemacetan hidung yang
parah
Jangan ulangi lebih dari
sebulan sekali
0,16% dan 0,125% solusi
tidak
tersedia secara komersial
Efek samping: Refleks
bradikardia, rangsangan,
sakit kepala, cemas, dan
pusing

Intranasal inhaled corticosteroids

DRUG INDICATIONS (I),
MECHANISM(s) OF ACTION
(M), AND DOSING
Beclomethasone: I: AR
M: Antiinflammatory, immun
modulator
6-12 tahun: 1 semprotkan pada
Beconase AG (42 fig/spray)
setiap lubang hidung; Bisa
Qnasl (80 pg/spray)
meningkat jika diperlukan untuk
COMMENTS, CAUTIONS,
ADVERSE EVENTS, AND
MONITORING
Kocok wadah sebelum
digunakan; meniup hidung;
Menyembunyikan 1 lubang
hidung, berikan dosis ke lubang
hidung yang lain
Efek samping: Pembakaran dan
iritasi mukosa hidung, epistaksis
 2 semprotan di setiap tawaran
nostril
> 12 thn: 1 atau 2 semprotan di
setiap lubang hidung
Flunisolide 6-14 tahun: 1 semprotkan
masing-masing lubang hidung 3
kali sehari atau 2 wadah goyang
sebelum digunakan; meniup
hidung; Menyembunyikan 1
melebihi 4 semprotan
Triamcinolone I: AR
M: Antiinflammatory, immun
modulator
2-6 tahun; 1 semprot di setiap
Nasacort Ao (55 pg/spray)
lubang hidung qd
6-12 thn: 1-2 semprotan di
setiap lubang hidung qd
> 12 thn: 2 semprotan di setiap
lubang hidung qd
Saya: AR
Fluticasone propionate M: Antiinflammatory, immun
(available as a generic modulator
preparation):
> 4 thn: 1-2 semprotan di setiap
lubang hidung qd
Flonase (50 pg/spray)
Fluticasone furoate: 2-12 yr:
Veramyst (27.5 pg/spray) Initial dose: 1 spray (27.5
pg/spray) per nostril once
daily (55 pg/day)
Pantau pertumbuhan
Kocok wadah sebelum
digunakan; meniup hidung;
menutup 1
lubang hidung, berikan dosis ke
lubang hidung yang lain
Efek samping: Pembakaran dan
iritasi mukosa hidung, epistaksis
Pantau pertumbuhan
Kocok wadah sebelum
digunakan; meniup hidung;
Menyembunyikan 1 lubang
hidung, berikan dosis ke lubang
hidung yang lain
Efek samping: Pembakaran dan
iritasi mukosa hidung, epistaksis
Pantau pertumbuhan
Kocok wadah sebelum
digunakan; meniup hidung;
Menyembunyikan 1 lubang
hidung, berikan dosis ke lubang
hidung yang lain
Ritonavir secara signifikan
meningkatkan konsentrasi serum
fluticasone dan dapat
menyebabkan efek
kortikosteroid sistemik
Gunakan fluticasone dengan
hati-hati pada pasien yang
menerima ketoconazole atau
sitokrom p450 3A4 isoenzyme
inhibitor kuat lainnya.
Efek samping: Pembakaran dan
iritasi mukosa hidung, epistaksis
Pantau pertumbuhan

Mometasone:
Nasonex (50 pg/spray)
Budesonide:
Rhinocort Aqua (32 pg/spray)
Patients who do not show
adequate response may use 2
sprays per nostril once daily
(110 pg/day)
Once symptoms are
controlled, dosage may be
reduced to 55 pg once daily
Total daily dosage should not
exceed 2 sprays in each nostril
(110 pg)/day
>12 yr and adolescents:
Initial dose: 2 sprays (27.5
pg/spray) per nostril once daily
(110 pg/day)
Once symptoms are
controlled, dosage may be
reduced to 1 spray per nostril
once daily (55 pg/day)
Total daily dosage should not
exceed 2 sprays in each nostril
(110 pg)/day
I: AR Mometason dan metabolit
utamanya adalah
M: Antiinflammatory, immun tidak terdeteksi dalam plasma
modulator setelah pemberian hidung dosis
2-12 thn: 1 semprot di setiap yang dianjurkan
lubang hidung qd Pengobatan pencegahan AR
> 12 thn: 2 semprotan di setiap musiman harus dimulai 2-4
lubang hidung qd minggu sebelum musim serbuk
sari
Kocok wadah sebelum
digunakan; meniup hidung;
Menyembunyikan 1 lubang
hidung, berikan dosis ke lubang
hidung yang lain
Efek samping: Pembakaran dan
iritasi mukosa hidung, epistaksis
Pantau pertumbuhan
Saya: AR Kocok wadah sebelum
M: Antiinflammatory, immun digunakan; meniup hidung;
modulator Menyembunyikan 1 lubang
hidung, berikan dosis ke lubang
6-12 thn: 2 semprotan di setiap hidung yang lain
lubang hidung qd Efek samping: Pembakaran dan
> 12 thn: sampai 4 semprotan di iritasi mukosa hidung, epistaksis
setiap lubang hidung qd (dosis Pantau pertumbuhan

Ciclesonide:
Omnaris
Zetonna (50 pg/spray)
Azelastine/fluticasone (137 pg
azelastine/SO pg fluticasone)
Dymista
maksimum)
I: AR
M: Antiinflammatory
2-12 thn: 1-2 semprotan di
setiap lubang hidung qd
> 12 thn: 2 semprotan di setiap selama 4 hari berturut-turut
lubang hidung qd
> 12 thn: 1 semprotkan pada
setiap lubang hidung
Sebelum digunakan awal,
goyangkan dengan lembut, lalu
masukkan modulator kekebalan
pompa dengan menggerakkan 8
kali
Jika produk tidak digunakan
dengan lembut kocok dan
rebahkan dengan 1 semprotan
atau sampai kabut halus muncul
Kocok botol dengan lembut
sebelum menggunakan. Meniup
hidung untuk membersihkan
lubang hidung. Terus kepala
miring ke bawah saat
menyemprot. Masukkan
aplikator ujung A sampai A inci
ke dalam lubang hidung, jaga
agar tutup botol, dan tutup
lubang hidung sebelahnya.
Bernapas masuk melalui hidung.
Sambil menghirup, tekan pompa
untuk melepaskan semprotan