From the Guidelines
Loratadine is not included in the Beers Criteria. The Beers Criteria is a list of medications that are potentially inappropriate for use in older adults due to increased risk of adverse effects, but loratadine is considered a relatively safe antihistamine option for elderly patients. Unlike older first-generation antihistamines such as diphenhydramine (Benadryl) and chlorpheniramine, which are included in the Beers Criteria, loratadine is a second-generation antihistamine that does not significantly cross the blood-brain barrier. This means it causes minimal sedation and has fewer anticholinergic effects, making it a preferred antihistamine choice for older adults. Loratadine is typically dosed at 10 mg once daily for allergic symptoms and can be used safely in most elderly patients without dose adjustment unless there is severe renal or hepatic impairment. When treating older adults with allergies, loratadine represents a safer alternative to the first-generation antihistamines that are explicitly cautioned against in the Beers Criteria, as supported by the most recent evidence from 1.
Some key points to consider when prescribing loratadine to older adults include:
- The potential for sedation, although minimal, especially at higher doses or in patients with low body mass 1
- The importance of monitoring for adverse effects, such as dry mouth and urinary retention, although these are less common with second-generation antihistamines like loratadine 1
- The consideration of alternative treatments, such as intranasal corticosteroids, which may be more effective for severe allergic rhinitis 1
- The need for careful patient instruction on the use of intranasal decongestants to avoid rhinitis medicamentosa 1
Overall, loratadine is a safe and effective option for older adults with allergies, and its use is supported by the most recent evidence from 1.
From the Research
Loratadine and the Beers Criteria
- The Beers Criteria is a list of potentially inappropriate medications for older adults, but loratadine is not explicitly mentioned in the provided studies as being part of this list 2, 3.
- Loratadine is a long-acting antihistamine with a high selectivity for peripheral histamine H1-receptors and lacks central nervous system depressant effects 4, 5, 6.
- The studies provided focus on the pharmacological properties, therapeutic use, and safety of loratadine in allergic disorders, but do not discuss its inclusion in the Beers Criteria 4, 5, 6.
Relevance of the Beers Criteria Studies
- The 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults does not mention loratadine as a potentially inappropriate medication 2.
- The 2019 updated AGS Beers Criteria also does not mention loratadine as a potentially inappropriate medication 3.
- There is no evidence in the provided studies to suggest that loratadine is included in the Beers Criteria 4, 2, 5, 6, 3.