Loratadine Dosing for Allergic Rhinitis
For allergic rhinitis, loratadine should be dosed at 10 mg once daily in adults and children ≥6 years, 5 mg (1 teaspoon) once daily in children 2 to under 6 years, and requires physician consultation for children under 2 years. 1
FDA-Approved Dosing by Age
The official FDA labeling provides clear age-based dosing 1:
- Adults and children ≥6 years: 10 mg (2 teaspoonfuls) once daily; do not exceed 10 mg in 24 hours 1
- Children 2 to under 6 years: 5 mg (1 teaspoonful) once daily; do not exceed 5 mg in 24 hours 1
- Children under 2 years: Ask a doctor 1
- Patients with liver or kidney disease: Ask a doctor 1
Each 5 mL teaspoonful contains 5 mg of loratadine. 1
Clinical Efficacy Evidence
Loratadine is effective as monotherapy for allergic rhinitis but is less effective than intranasal corticosteroids. 2 The 2008 Joint Task Force guidelines establish that second-generation oral antihistamines like loratadine are appropriate for continuous use in seasonal and perennial allergic rhinitis, with relatively rapid onset making them suitable for as-needed use in episodic allergic rhinitis. 2
Key efficacy points:
- Loratadine shows no significant difference in efficacy compared to leukotriene receptor antagonists (montelukast being the usual comparator). 2
- Loratadine is less effective than intranasal corticosteroids for overall symptom control. 2
- Loratadine is particularly less effective for nasal congestion compared to other nasal symptoms. 2
- Clinical trials demonstrate loratadine 10 mg once daily is comparable in efficacy to clemastine 1 mg twice daily, with significantly lower sedation rates. 3
Safety Profile
Loratadine, fexofenadine, and desloratadine are the second-generation antihistamines without sedation at recommended doses. 2 This distinguishes them from cetirizine, which can cause sedation even at standard dosing. 2
The American Academy of Allergy, Asthma, and Immunology recommends second-generation antihistamines (including loratadine) for young children due to their good safety profiles. 4 Studies in children aged 3-12 years showed no adverse reactions with loratadine syrup 5-10 mg daily over 3 weeks. 5
Upper Respiratory Infections: Critical Caveat
Loratadine is NOT indicated for upper respiratory infections. The evidence provided addresses allergic rhinitis specifically. While oral decongestants may be useful for nasal congestion caused by upper respiratory infections 2, antihistamines like loratadine are generally ineffective for nonallergic rhinitis. 2
For upper respiratory infection symptoms, the guidelines note that ipratropium bromide nasal spray 0.06% is effective for rhinorrhea produced by the common cold. 2
Practical Considerations
Continuous daily use is most effective for seasonal and perennial allergic rhinitis, though the rapid onset of action makes loratadine appropriate for as-needed use in episodic allergic rhinitis. 2
Common pitfalls to avoid:
- Do not use loratadine as first-line therapy when nasal congestion is the predominant symptom—consider intranasal corticosteroids or combination therapy instead. 2
- Loratadine should be discontinued 5-7 days before allergy testing, as recommended by the American Academy of Allergy, Asthma, and Immunology. 4
- In patients with renal impairment, dose adjustment is necessary—the National Kidney Foundation recommends halving the dose in moderate renal impairment. 4
Pediatric Dosing Algorithm
For children with allergic rhinitis 6, 1:
- Age ≥6 years: Loratadine 10 mg once daily
- Age 2 to <6 years: Loratadine 5 mg once daily
- Age 6 months to <2 years: Cetirizine is the only FDA-approved antihistamine option; loratadine requires physician consultation
- Age <6 months: Intranasal corticosteroids are first-line per American Academy of Allergy, Asthma, and Immunology guidelines 6
Studies in children demonstrate that loratadine 5-10 mg once daily significantly improved total symptom scores compared to placebo, with effectiveness maintained over 14-21 days of treatment. 5, 7