Loratadine Dosing for Allergic Reactions
The standard dose of loratadine for allergic reactions is 10 mg once daily for adults and children 6 years and older, with a maximum of 10 mg in 24 hours. 1
Standard Dosing by Age
- Adults and children ≥6 years: 10 mg once daily (maximum 10 mg/24 hours) 2, 1
- Children 2-5 years: 5 mg once daily (maximum 5 mg/24 hours) 2, 1
- Children <2 years: Consult a physician before use 1
Special Populations Requiring Dose Adjustment
- Severe renal impairment: Use with caution; dose adjustment may be necessary 2
- Hepatic impairment: Use with caution; consult physician before standard dosing 2, 1
- Elderly patients: Standard adult dosing (10 mg daily) is appropriate 2
Clinical Context and Efficacy
Loratadine is a second-generation H1-receptor antagonist that provides effective relief for allergic rhinitis and chronic urticaria with once-daily dosing. 3, 4 The medication demonstrates rapid onset of action and maintains efficacy throughout 24 hours without requiring multiple daily doses. 4, 5
Key advantage: Unlike first-generation antihistamines, loratadine does not cause significant sedation or performance impairment at recommended doses. 2 This makes it suitable for daytime use without concerns about drowsiness that limit older antihistamines. 3
Higher Dose Considerations
While the manufacturer's maximum recommended dose is 10 mg daily, some clinical scenarios warrant discussion of higher dosing:
- Off-label higher dosing: It has become common practice to increase antihistamine doses above licensed recommendations for patients who do not respond to standard doses, particularly in urticaria management, when potential benefits outweigh risks. 3
- Important caveat: Exceeding recommended doses increases the risk of sedation and other adverse effects, as loratadine exhibits sedative properties at higher than recommended doses. 2
- Side effects at higher doses: Possible sedation, mucosal dryness, and urinary retention may occur. 2
Common Clinical Applications
For urticaria management: Loratadine 10 mg once daily is recommended as a first-line nonsedating antihistamine, with at least two different nonsedating options offered to patients since individual responses vary. 3
For premedication protocols: Loratadine 10 mg orally is used for symptom-directed treatment of urticaria in infusion reactions and as premedication before cluster/rush immunotherapy. 3
Timing adjustments: Adjustments to medication timing can ensure highest drug levels coincide with anticipated urticaria episodes. 3
Safety Profile
Loratadine demonstrates excellent tolerability at standard doses with low incidence of adverse effects (14% overall), minimal sedation (3%), and low rates of dry mouth (4%). 5 Serious ventricular arrhythmias reported with some other second-generation antihistamines have not been observed with loratadine. 4