What are the age- and weight-based dosing recommendations for levocetirizine in children?

Levocetirizine Dosing for Children

For children 6-11 years of age, administer 2.5 mg (½ tablet) once daily in the evening; for children 12 years and older, administer 5 mg once daily in the evening. 1

Age-Based Dosing Recommendations

Children 6-11 Years

• Dose: 2.5 mg once daily in the evening 1
• Do not exceed 2.5 mg in 24 hours 1
• This represents half of the adult tablet strength 1

Children 12 Years and Older (up to 64 years)

• Dose: 5 mg once daily in the evening 1
• Do not exceed 5 mg in 24 hours 1
• For less severe symptoms, 2.5 mg once daily may be appropriate 1

Children Under 6 Years

• Do not use tablet formulation 1
• For children 1-5 years with allergic rhinitis or chronic urticaria, oral liquid drops at 1.25 mg twice daily have been studied and found safe 2
• For infants 6-11 months with allergic rhinitis or chronic urticaria, oral liquid drops at 1.25 mg once daily have been studied and found safe 2

Weight-Based Dosing for Very Young Children (Research-Supported)

For children 12-24 months requiring treatment, research supports 0.125 mg/kg twice daily when using oral liquid formulations 3, 4, 5:

• This dosing achieves appropriate plasma concentrations comparable to adult therapeutic levels 6
• Pharmacokinetic studies demonstrate that weight-normalized clearance is higher in young children, necessitating twice-daily dosing 4
• Long-term safety (18 months) has been established at this dose in atopic children 5

Critical Contraindications

Do not use levocetirizine in patients with kidney disease 1

This is an absolute contraindication per FDA labeling, as levocetirizine is primarily renally excreted and accumulation occurs with renal impairment 1.

Important Clinical Caveats

• Evening dosing is preferred to minimize any potential sedative effects during daytime activities 1
• The tablet formulation (5 mg scored tablets) is only approved for children 6 years and older 1
• For children under 6 years requiring treatment, oral liquid drop formulations should be used rather than attempting to split tablets 2
• Elderly patients (≥65 years) should consult a physician before use due to age-related decline in renal function 1

Safety Profile in Pediatric Populations

Long-term studies demonstrate excellent tolerability 5:

• No clinically significant changes in growth parameters, developmental milestones, or laboratory values over 18 months 5
• Adverse event rates similar to placebo in children as young as 6 months 2
• Most adverse events are mild and related to concurrent respiratory infections rather than medication 5