From the Guidelines
Loratadine can be safely used in hemodialysis patients without dose adjustment, as it is primarily metabolized by the liver and not significantly removed by hemodialysis. The standard adult dose of 10 mg once daily is appropriate for patients on hemodialysis. According to the guidelines for evaluation and management of urticaria in adults and children 1, loratadine is one of the nonsedating H1 antihistamines that can be taken once daily.
Some key points to consider when prescribing loratadine to hemodialysis patients include:
- Loratadine has minimal renal excretion, making it a preferred antihistamine choice for patients with kidney failure compared to some other antihistamines that require dose adjustments 1.
- Patients should be monitored for potential side effects such as headache, dry mouth, or fatigue.
- If the patient is taking multiple medications, it's essential to check for drug interactions, particularly with medications that affect CYP3A4 or CYP2D6 enzymes.
- For elderly hemodialysis patients or those with hepatic impairment, extra caution may be warranted, though formal dose adjustments are not typically required.
It's also important to note that the use of sedating antihistamines as monotherapy is now less common due to concerns about reduced concentration and performance, but they can be effective and well-tolerated by some individuals 1. However, loratadine is generally well-tolerated with minimal sedative effects, which is beneficial for dialysis patients who may already experience fatigue.
From the FDA Drug Label
ASK A DOCTOR BEFORE USE IF YOU HAVE liver or kidney disease. Your doctor should determine if you need a different dose. The use of loratadine in a hemodialysis patient requires caution, as the patient has kidney disease.
- The patient should consult a doctor before taking loratadine.
- The doctor should determine the appropriate dose for the patient, considering their kidney disease. 2
From the Research
Loratadine in Hemodialysis Patients
- The pharmacokinetics of loratadine in patients with renal insufficiency, including those on hemodialysis, were studied in 1990 3.
- The study found that the disposition of loratadine is not significantly altered in patients with severe renal insufficiency, and hemodialysis is not an effective means of removing loratadine or its metabolite from the body.
- The terminal elimination half-life of loratadine was similar in patients with normal renal function, chronic renal failure, and those on hemodialysis (8.7 +/- 5.9,7.6 +/- 6.9,8.6 +/- 1.6 hrs, respectively) 3.
- The apparent total body clearance and apparent volume of distribution of loratadine also did not differ significantly among the three groups 3.
Comparison with Other Antihistamines
- A study on cetirizine in chronic hemodialysis patients found that the serum concentration-time profiles of cetirizine were measured in 8 male end-stage renal failure patients on chronic hemodialysis 4.
- The study concluded that a prescription of 5 mg cetirizine three times a week during the predialysis period will be the effective and safety renal dosage for ESRD patients on HD 4.
- Another study compared the efficacy and side effects of gabapentin and desloratadine in patients with dialysis pruritus, and found that desloratadine provides significant relief of uremic pruritus compared with no therapy, while gabapentin has marginal efficacy 5.
Hemodialysis and Anticoagulation
- A study on the effect of haemodialysis on the pharmacokinetics of cetirizine found that haemodialysis does not produce a clinically significant alteration in cetirizine elimination, and no supplemental dose should be necessary after dialysis 6.
- A review of anticoagulation strategies for long-term haemodialysis found that the evidence supporting clinical decision-making for different forms of anticoagulant strategies for HD is of low and very low certainty 7.