Desta

Film-coated tablet: Blue, round, biconvex film-coated tablet, plain on both sides.
Each tablet contains 5 mg desloratadine.
Syrup: Clear, light purple-colored, grape-flavored syrup.
Each ml contains Desloratadine 0.5 mg.
Excipients/Inactive Ingredients: Film-coated tablet: Tablet core: Microcrystalline cellulose, anhydrous dibasic calcium phosphate, corn starch, talc.
Tablet coating: Polyvinyl alcohol, polyethylene glycol, talc, titanium dioxide, lake indigo carmine.

Pharmacotherapeutic group: Antihistamines - H1 antagonist. ATC code: R06AX27.
Pharmacology: Pharmacodynamics: Mechanism of action: Desloratadine is a non-sedating, long-acting histamine antagonist with selective peripheral H1-receptor antagonist activity.
Film-coated tablet: After oral administration, desloratadine selectively blocks peripheral histamine H1-receptors because the substance is excluded from entry to the central nervous system.
Desloratadine has demonstrated antiallergic properties from in vitro studies. These include inhibiting the release of proinflammatory cytokines such as IL-4, IL-6, IL-8, and IL-13 from human mast cells/basophils, as well as inhibition of the expression of the adhesion molecule P-Selectin on endothelial cells. The clinical relevance of these observations remains to be confirmed.
Syrup: Desloratadine has demonstrated antiallergic, antihistaminic, and anti-inflammatory activity.
Clinical efficacy and safety: Film-coated tablet: In a multiple dose clinical trial, in which up to 20 mg of desloratadine was administered daily for 14 days, no statistically or clinically relevant cardiovascular effect was observed. In a clinical pharmacology trial, in which desloratadine was administered at a dose of 45 mg daily (nine times the clinical dose) for ten days, no prolongation of QTc interval was seen.
No clinically relevant changes in desloratadine plasma concentrations were observed in multiple-dose ketoconazole and erythromycin interaction trials.
Desloratadine does not readily penetrate the central nervous system. In controlled clinical trials, at the recommended dose of 5 mg daily, there was no excess incidence of somnolence as compared to placebo. Desloratadine given at a single daily dose of 7.5 mg did not affect psychomotor performance in clinical trials. In a single dose study performed in adults, desloratadine 5 mg did not affect standard measures of flight performance including exacerbation of subjective sleepiness or tasks related to flying.
In clinical pharmacology trials, co-administration with alcohol did not increase the alcohol-induced impairment in performance or increase in sleepiness. No significant differences were found in the psychomotor test results between desloratadine and placebo groups, whether administered alone or with alcohol.
In patients with allergic rhinitis, desloratadine was effective in relieving symptoms such as sneezing, nasal discharge and itching, as well as ocular itching, tearing and redness, and itching of palate. Desloratadine effectively controlled symptoms for 24 hours.
Paediatric population: The efficacy of desloratadine tablets has not been clearly demonstrated in trials with adolescent patients 12 through 17 years of age.
In addition to the established classifications of seasonal and perennial, allergic rhinitis can alternatively be classified as intermittent allergic rhinitis and persistent allergic rhinitis according to the duration of symptoms. Intermittent allergic rhinitis is defined as the presence of symptoms for less than 4 days per week or for less than 4 weeks. Persistent allergic rhinitis is defined as the presence of symptoms for 4 days or more per week and for more than 4 weeks.
Desloratadine was effective in alleviating the burden of seasonal allergic rhinitis as shown by the total score of the rhino-conjunctivitis quality of life questionnaire. The greatest amelioration was seen in the domains of practical problems and daily activities limited by symptoms.
Chronic idiopathic urticaria was studied as a clinical model for urticarial conditions, since the underlying pathophysiology is similar, regardless of etiology, and because chronic patients can be more easily recruited prospectively. Since histamine release is a causal factor in all urticarial diseases, desloratadine is expected to be effective in providing symptomatic relief for other urticarial conditions, in addition to chronic idiopathic urticaria, as advised in clinical guidelines.
In two placebo-controlled six-week trials in patients with chronic idiopathic urticaria, desloratadine was effective in relieving pruritus and decreasing the size and number of hives by the end of the first dosing interval. In each trial, the effects were sustained over the 24 hour dosing interval. As with other antihistamine trials in chronic idiopathic urticaria, the minority of patients who were identified as non-responsive to antihistamines was excluded. An improvement in pruritus of more than 50% was observed in 55% of patients treated with desloratadine compared with 19% of patients treated with placebo. Treatment with desloratadine also significantly reduced interference with sleep and daytime function, as measured by a four-point scale used to assess these variables.
Pharmacokinetics: Film-coated tablet: Absorption: Desloratadine plasma concentrations can be detected within 30 minutes of administration. Desloratadine is well absorbed with maximum concentration achieved after approximately 3 hours; the terminal phase half-life is approximately 27 hours. The degree of accumulation of desloratadine was consistent with its half-life (approximately 27 hours) and a once daily dosing frequency. The bioavailability of desloratadine was dose proportional over the range of 5 mg to 20 mg.
In a pharmacokinetic trial in which patient demographics were comparable to those of the general seasonal allergic rhinitis population, 4% of the subjects achieved a higher concentration of desloratadine. This percentage may vary according to ethnic background. Maximum desloratadine concentration was about 3-fold higher at approximately 7 hours with a terminal phase half-life of approximately 89 hours. The safety profile of these subjects was not different from that of the general population.
Distribution: Desloratadine is moderately bound (83%-87%) to plasma proteins. There is no evidence of clinically relevant medicine accumulation following once daily dosing of desloratadine (5 mg to 20 mg) for 14 days.
Biotransformation: The enzyme responsible for the metabolism of desloratadine has not been identified yet, and therefore, some interactions with other medicinal products cannot be fully excluded. Desloratadine does not inhibit CYP3A4 in vivo, and in vitro studies have shown that the medicinal product does not inhibit CYP2D6 and is neither a substrate nor an inhibitor of P-glycoprotein.
Elimination: In a single dose trial using a 7.5 mg dose of desloratadine, there was no effect of food (high-fat, high caloric breakfast) on the disposition of desloratadine. In another study, grapefruit juice had no effect on the disposition of desloratadine.
Renal impaired patients: The pharmacokinetics of desloratadine in patients with chronic renal insufficiency (CRI) was compared with that of healthy subjects in one single-dose study and one multiple dose study. In the single-dose study, the exposure to desloratadine was approximately 2 and 2.5-fold greater in subjects with mild to moderate and severe CRI, respectively, than in healthy subjects. In the multiple-dose study, steady state was reached after Day 11, and compared to healthy subjects the exposure to desloratadine was ~1.5-fold greater in subjects with mild to moderate CRI and ~2.5-fold greater in subjects with severe CRI. In both studies, changes in exposure (AUC and C_max) of desloratadine and 3-hydroxydesloratadine were not clinically relevant.
Syrup: Desloratadine is well absorbed with maximum concentration achieved after approximately 3 hours; the terminal phase half-life is approximately 27 hours. The degree of accumulation of desloratadine was consistent with its half-life (approximately 27 hours) and a once daily dosing frequency. The bioavailability of desloratadine was dose proportional over the range of 5 mg to 20 mg.
Desloratadine is moderately bound (83%-87%) to plasma proteins.
The enzyme responsible for the metabolism of desloratadine has not been identified yet, and therefore some interactions with other drugs cannot be fully excluded.
Toxicology: Preclinical safety data: Film-coated tablet: Desloratadine is the primary active metabolite of loratadine. Non-clinical studies conducted with desloratadine and loratadine demonstrated that there are no qualitative or quantitative differences in the toxicity profile of desloratadine and loratadine at comparable levels of exposure to desloratadine.
Non-clinical data reveal no special hazard for humans based on conventional studies of safety pharmacology, repeated dose toxicity, genotoxicity, carcinogenic potential, toxicity to reproduction and development. The lack of carcinogenic potential was demonstrated in studies conducted with desloratadine and loratadine.

Film-coated tablet: Desloratadine is indicated in adults and adolescents aged 12 years and older for the relief of symptoms associated with allergic rhinitis (see Pharmacology: Pharmacodynamics under Actions), urticaria (see Pharmacology: Pharmacodynamics under Actions).
Syrup: DESTA SYRUP is indicated for the rapid relief of symptoms associated with allergic rhinitis, such as sneezing, nasal discharge and itching, congestion/stuffiness, as well as ocular itching, tearing and redness, itching of palate and coughing.
DESTA syrup is also indicated for the relief of symptoms associated with urticaria such as the relief of itching and the size and number of hives.

Film-coated tablet: Posology: Adults and adolescents (12 years of age and over): The recommended dose of desloratadine is one tablet once a day.
Intermittent allergic rhinitis (presence of symptoms for less than 4 days per week or for less than 4 weeks) should be managed in accordance with the evaluation of patient's disease history and the treatment could be discontinued after symptoms are resolved and reinitiated upon their reappearance.
In persistent allergic rhinitis (presence of symptoms for 4 days or more per week and for more than 4 weeks), continued treatment may be proposed to the patients during the allergen exposure periods.
Pediatric population: There is limited clinical trial efficacy experience with the use of desloratadine in adolescents 12 through 17 years of age (see Adverse Reactions and Pharmacology: Pharmacodynamics under Actions).
The safety and efficacy of desloratadine 5 mg film-coated tablets in children below the age of 12 years have not been established.
Method of administration: Oral use.
The dose can be taken with or without food.
Syrup: Recommended Dose: Children 6 through 11 years of age: 5 ml (2.5 mg) DESTA SYRUP once a day, with or without a meal for the relief of symptoms associated with allergic rhinitis (including intermittent and persistent allergic rhinitis) and urticaria.
Children 1 through 5 years of age: 2.5 ml (1.25 mg) DESTA SYRUP once a day, with or without a meal for the relief of symptoms associated with allergic rhinitis (including intermittent and persistent allergic rhinitis) and urticaria.
Children 6 months through 11 months of age: 2 ml (1 mg) DESTA SYRUP once a day, with or without a meal for the relief of symptoms associated with allergic rhinitis (including intermittent and persistent allergic rhinitis) and urticaria.
In adults and adolescents (12 years of age and over): 10 ml (5 mg) DESTA SYRUP once a day, with or without a meal for the relief of symptoms associated with allergic rhinitis (including intermittent and persistent allergic rhinitis) and urticaria.
Intermittent allergic rhinitis (presence of symptoms for less than 4 days per week or for less than 4 weeks) should be managed in accordance with the evaluation of patient's disease history and the treatment could be discontinued after symptoms are resolved and reinitiated upon their reappearance. In persistent allergic rhinitis (presence of symptoms for 4 days or more per week and for more than 4 weeks), continued treatment may be proposed to the patients during allergen exposure periods.
Mode of Administration: May be taken without regard to meals.

The adverse event profile associated with overdosage, as seen during post-marketing use, is similar to that seen with therapeutic doses, but the magnitude of the effects can be higher.
Treatment: In the event of overdose, consider standard measures to remove unabsorbed active substance.
Symptomatic and supportive treatment is recommended.
Desloratadine is not eliminated by haemodialysis; it is not known if it is eliminated by peritoneal dialysis.
Symptoms: Based on a multiple dose clinical trial in adults and adolescents, in which up to 45 mg of desloratadine was administered (nine times the clinical dose), no clinically relevant effects were observed.
Film-coated tablet: Pediatric population: The adverse event profile associated with overdosage, as seen during post-marketing use, is similar to that seen with therapeutic doses, but the magnitude of the effects can be higher.

Hypersensitivity to the active substance, to any of the excipients listed in Description, or to loratadine.

Syrup: This medication may cause drowsiness in some patients. Individual response should be determined that it does not cause drowsiness before driving, operating machines or working in areas with risk of falling.
Should not use in breast-feeding women and children under 6 months. Should not use during pregnancy especially in first trimester unless the potential benefits outweigh the risk.
Use with caution in renal disease patients.
Serum levels of this medication may be increased when using with macrolides antimicrobials such as erythromycin or imidazole antifungal such as ketoconazole.

Film-coated tablet: In the case of severe renal insufficiency, desloratadine should be used with caution (see Pharmacology: Pharmacokinetics under Actions).
Desloratadine should be administered with caution in patients with medical or familial history of seizures, and mainly young children (see Adverse Reactions), being more susceptible to develop new seizures under desloratadine treatment. Healthcare providers may consider discontinuing desloratadine in patients who experience a seizure while on treatment.
Syrup: Efficacy and safety of DESTA SYRUP in children under 6 months of age have not been established.
This medication may cause drowsiness in some patients. Individual response should be determined that it does not cause drowsiness before driving, operating machines or working in areas with risk of falling.
Be careful in patients with renal disease. In the case of severe renal insufficiency (GFR <30 ml/min), DESTA SYRUP should be used as alternate day dosage until the physicians can determine the individual patient's response.
Serum levels of this medication may be increased when using with macrolides antimicrobials such as erythromycin or imidazole antifungal such as ketoconazole. No clinically relevant changes in desloratadine plasma concentrations were observed in multiple-dose ketoconazole and erythromycin interaction trials.
Desloratadine should be administered with caution in patients with a medical or family history of seizures. In particular, young children may be more susceptible to developing new seizures under desloratadine treatment. Healthcare providers may consider discontinuing desloratadine in patients who experience a seizure while on treatment.
Effects on ability to drive and use machines: Film-coated tablet: Desloratadine has no or negligible influence on the ability to drive and use machines. Patients should be informed that most people do not experience drowsiness. Nevertheless, as there is individual variation in response to all medicinal products, it is recommended that patients are advised not to engage in activities requiring mental alertness, such as driving a car or using machines, until they have established their own response to the medicinal product.
Syrup: No effects on the ability to drive and use machines have been observed (see Pharmacology: Pharmacodynamics under Actions).

Film-coated tablet: Pregnancy: A large amount of data on pregnant women (more than 1,000 pregnancy outcomes) indicate no malformative nor foeto/neonatal toxicity of desloratadine.
Animal studies do not indicate direct or indirect harmful effects with respect to reproductive toxicity (see Toxicology: Preclinical safety data under Actions). As a precautionary measure, it is preferable to avoid the use of desloratadine during pregnancy.
Breast-feeding: Desloratadine has been identified in breastfed newborns/infants of treated women. The effect of desloratadine on newborns/infants is unknown. A decision must be made whether to discontinue breast-feeding or to discontinue/abstain from desloratadine therapy taking into account the benefit of breast-feeding for the child and the benefit of therapy for the woman.
Fertility: There are no data available on male and female fertility.
Syrup: No overall effect on rat fertility was observed with desloratadine at an exposure that was 34 times higher than the exposure in humans at the recommended clinical dose. No teratogenic or mutagenic effects were observed in animal trials with desloratadine. Since no clinical data on exposed pregnancies are available with desloratadine, the safe use of DESTA SYRUP during pregnancy has not been established. DESTA SYRUP is not to be used during pregnancy unless the potential benefits outweigh the risks.
Desloratadine is excreted into breast milk, therefore the use of DESTA SYRUP is not recommended in breast-feeding women.

Film-coated tablet: Summary of the safety profile: In clinical trials in a range of indications including allergic rhinitis and chronic idiopathic urticaria, at the recommended dose of 5 mg daily, undesirable effects with desloratadine were reported in 3% of patients in excess of those treated with placebo. The most frequent of adverse reactions reported in excess of placebo were fatigue (1.2%), dry mouth (0.8%) and headache (0.6%).
Paediatric population: In a clinical trial with 578 adolescent patients, 12 through 17 years of age, the most common adverse event was headache; this occurred in 5.9% of patients treated with desloratadine and 6.9% of patients receiving placebo.
Tabulated list of adverse reactions: The frequency of the clinical trial adverse reactions reported in excess of placebo and other undesirable effects reported during the post-marketing period are listed in the following table. Frequencies are defined as very common (≥1/10), common (≥1/100 to <1/10), uncommon (≥1/1,000 to <1/100), rare (≥1/10,000 to <1/1,000), very rare (<1/10,000) and not known (cannot be estimated from the available data). (See table.)

Click on icon to see table/diagram/image

Pediatric population: Other undesirable effects reported during the post-marketing period in Pediatric patients with an unknown frequency included QT prolongation, arrhythmia, bradycardia, abnormal behaviour, and aggression.
A retrospective observational safety study indicated an increased incidence of new-onset seizure in patients 0 to 19 years of age when receiving desloratadine compared with periods not receiving desloratadine. Among children 0-4 years old, the adjusted absolute increase was 37.5 (95% Confidence Interval (CI) 10.5-64.5) per 100,000 person years (PY) with a background rate of new onset seizure of 80.3 per 100,000 PY. Among patients 5-19 years of age, the adjusted absolute increase was 11.3 (95% CI 2.3-20.2) per 100,000 PY with a background rate of 36.4 per 100,000 PY. (See Precautions.)
Syrup: Desloratadine syrup, the most frequent adverse events reported in excess of placebo were diarrhea (3.7%), fever (2.3%) and insomnia (2.3%).
Desloratadine tablet, the most frequent adverse events reported in excess of placebo were fatigue (1.2%), dry mouth (0.8%), and headache (0.6%).
Very rare cases (<1:10,000) of hypersensitivity reactions (including anaphylaxis and rash), tachycardia, palpitations, psychomotor hyperactivity, seizures, somnolence, elevations of liver enzymes, hepatitis, increased appetite and increased bilirubin have been reported.

Film-coated tablet: No clinically relevant interactions were observed in clinical trials with desloratadine tablets in which erythromycin or ketoconazole were co-administered (see Pharmacology: Pharmacodynamics under Actions).
Pediatric population: Interaction studies have only been performed in adults.
In a clinical pharmacology trial, desloratadine tablets taken concomitantly with alcohol did not potentiate the performance impairing effects of alcohol (see Pharmacology: Pharmacodynamics under Actions). However, cases of alcohol intolerance and intoxication have been reported during post marketing use. Therefore, caution is recommended if alcohol is taken concomitantly.
Syrup: There was no effect of food or grapefruit juice on the disposition of desloratadine. DESTA SYRUP taken concomitantly with alcohol did not potentiate the performance impairing effects of alcohol.

Incompatibilities: Film-coated tablet: Not applicable.

Film-coated tablet: Store below 30°C, protect from excessive moisture.
Shelf life: 30 months.
Syrup: Keep in tight container, store below 30°C.
Once opened, store in room temperature (<30°C) and use within 3 months.

Antihistamines & Antiallergics

R06AX27 - desloratadine ; Belongs to the class of other antihistamines for systemic use.

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