Loratadine is NOT Listed in the Beers Criteria as a Potentially Inappropriate Medication
Loratadine is considered safe and appropriate for use in older adults according to the 2019 AGS Beers Criteria, as it is not included in any category of potentially inappropriate medications. 1
Why Loratadine is Preferred in Geriatrics
Loratadine is a second-generation antihistamine with minimal anticholinergic effects and limited central nervous system penetration, making it fundamentally different from first-generation antihistamines that ARE listed in the Beers Criteria.
Key Distinctions:
First-generation antihistamines (like diphenhydramine, hydroxyzine, chlorpheniramine) are explicitly listed as potentially inappropriate medications in the Beers Criteria due to their strong anticholinergic properties, which can cause:
- Cognitive impairment and confusion
- Increased fall risk
- Urinary retention
- Constipation
- Dry mouth
Loratadine, as a second-generation antihistamine, lacks these problematic anticholinergic effects and does not cross the blood-brain barrier significantly
Clinical Application
When treating allergic conditions in older adults:
- Use loratadine (or other second-generation antihistamines like cetirizine or fexofenadine) as first-line therapy 2
- Avoid first-generation antihistamines entirely in patients ≥65 years old
- Standard adult dosing applies: 10 mg daily (or 2 teaspoonfuls of 5 mg/5 mL solution) 2
- Dose adjustment needed in patients with severe liver or kidney disease 2
Important Caveat
While loratadine itself is not on the Beers Criteria, clinicians should still monitor for:
- Drug-drug interactions with other medications
- Individual patient response, particularly in those with hepatic or renal impairment
- Cumulative anticholinergic burden from other medications the patient may be taking
The 2023 update of the Beers Criteria 3 continues to exclude loratadine from the list of potentially inappropriate medications, reinforcing its safety profile in geriatric populations.