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Loratadine Part 1

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Loratadine is a second generation antihistamine available over the counter worldwide.

So this is the third video that i’ve made on an antihistamine medication so i’ve previously made videos on cetirizine and phexophenidine and this video is going to be on loratadine now whilst the two previous videos the tyrosine and vexophenidine have had some overlap there has also been other parts of the video where i’ve discussed completely different interesting

Information about antihistamine prescription so for instance in the video effects of benedine i discussed a huge number of different types of antihistamines and focus really on the information about which ones you prescribe in which situations whereas in the video of satirizing i discussed much less about that and instead focused much more on the indications for

Cetirizine prescriptions i talked a lot about the different medical conditions that might warrant an antihistamine prescription in this video on the ratatine there again is going to be some overlap some of the basic information however i’m going to again focus on a different interesting point about antihistamine prescription and that is going to be the question

Of why you don’t want people ideally to be on long term antihistamine prescriptions so we’ll come to that in just a moment so let’s start off with the basics so loratadine is an over-the-counter medicine in the uk and i think all around the world it’s an over-the-counter medicine there may be some countries where it’s not uh but in the uk certainly you don’t even

Need to go to a chemist to buy it you can buy it on supermarket shelves really cheaply on supermarket shelves as well you can get about 28 tablets or months worth uh if you’re taking the standard prescription of it for about three pounds in most major supermarkets there is a famous brand name for it that you might occasionally hear people use instead of saying the

Ratadine and that is claritin so sometimes i’ve watched films even where they reference the antihistamines and they’ll instead of calling the rating the ratatine they’ll refer to it as claritin so classically loratadine is claritin cetirizine is either allegra if you’re talking about the united states and the movies that i’ve watched generally made in the united

States they’re generally uh calling flexophene allegra but in the uk it’s also called telfest so loratadine is an over-the-counter antihistamine however we do prescribe it i work as a hospital doctor at present and you know if a patient has problems with itchiness we do sometimes prescribe the ratatine as an anti-itch medicine so that’s it’s indication it’s an

Antihistamine drug all of the antihistamines do the same thing and the main reason that they’re prescribed is as anti-itch medicines um so we prescribe them for people with itchy skin conditions and people with itchy eye conditions those are the two main indications and the reason we want to do it is to take away the itch and they really do work fantastically

Antihistamines they reduce the itchiness and itchiness is not good for you because if you do scratch your skin condition or if you do even worse scratch your eye condition you generally just make the information a whole lot worse so it’s not good for the condition it’s a bad thing that the body wants us to do and getting rid of the itching will help stop you

From worsening the condition by itching so i’ve just written that here it’s an over-the-counter antihistamine and really antihistamines are anti-itch medicines this is kind of the colloquial name for antihistamines we call them anti-itch medicines in front of patients um and then here i’ve written the names loratidine cetirizine infexophenidine because by far

These are the three main antihistamines that are used all over the world and this is actually the order in which we would generally go through them the treatment ladder if you like so the first line one is actually usually loratadine so if someone comes to you uh wanting a prescription to prevent them from itching the first drug we recommend is loratadine and

We might prescribe it to them or we might say actually if you pay for your prescriptions in the uk it’ll cost you nine pounds to actually get a pharmacist to dispense the medicine if i prescribe it whereas actually you can buy two months supply which is all i’m going to prescribe you for six pounds in a supermarket so it’s actually cheaper for you just to buy

It yourself so we often just recommend it um and they can buy it on the supermarket shelves and then if the rastine doesn’t work the next stage up on the treatment ladder is then viewed as cetirizine which is again is an over-the-counter medicine in most countries around the world including in the uk so if that one isn’t strong enough they can go on to try and

Steer us in or if they go don’t get along with their attitude maybe to get some side effects from the ratadine and the main side effect of all of the antihistamines is sedation they make you gay tired usually these three are the best for not making you that’s higher there are other antihistamines that aren’t on this list such as uh pyriton which is chlorphenamine

Diphenhydramine which is benadryl um promethazine which is fenergon those are all extremely sedating there’s one called cyproheptadine which is also very famous antihistamine again extremely sedating hydroxyzine is another example so there’s all these very very powerful ones in the background but the problem is they’re much more sedating and therefore their use

Is more limited we because people don’t want to take those for instance at the start of the day because they’ll be asleep by 11 o’clock whereas these ones are much more tolerated ones because their side effect of making you sleepy is much usually much less but sometimes people will get a much more profound effect than other people so some people will take

Thoracitine and actually get quite a sedating effect from it so they will feel very tired after taking it but for the majority of people that’s not an issue so uh back onto the treatment ladder so usually it goes the rating and then if that one’s either they’re not getting along with that one or if it’s not strong enough so it’s not getting rid of the itchy

Sensation adequately then we would go up to satirism which is still over the counter in the uk and then above that is the absolutely wonderful effects of feminine which is a truly wonderful anti-itch medicine extremely potent at getting rid of itchy sensations unfortunately this isn’t available of the country is a prescription only antihistamine in the united

Kingdom however in america and in other countries around the world this is also an over-the-counter antihistamine dose-wise loracidine comes as 10 milligram tablets and the standard adult dose of it is 110 milligram tablet can be taken in a 24-hour period so one once daily and really ideally it should only be taken when required so if on that day they think

They’re going to have a really bad day for wanting to itch their condition then they would take their attitude into habit but if they’re having a good day and their condition isn’t that itchy then ideally they wouldn’t take it however many people have have such severe problems with this itching that they end up having to take these tablets on a daily basis and as

I say the main emphasis for this video is going to be a discussion in just a moment of why ideally you do not want to be on these medicines daily long term the dose however can be taken higher this is the official dose this is the dose that you will see on the packaging of the medicine and in the instruction leaflet for the medicine and this is the dose that you

Will see actually in all official prescribing um advisories so the bnf is the one we use in the uk which tells us how to prescribe medicines and what doses to prescribe them in and that that book uh tells us that 10 milligrams once daily is the only dose that’s licensed for this medicine to be prescribed in however despite it not being licensed you can prescribe

It in higher doses it’s usually a prescription that’s only done by a specialist or by a dermatologist usually or maybe an eye doctor if we’re talking about an itchy eye condition however it can be safely prescribed in higher doses and the sort of maximum dose you will ever see people on the ratatine is a dose of 10 milligrams twice oh sorry actually it can go

Higher than that so it can actually go to 20 milligrams bd so i’ll just correct that so there we go so um the standard approved licensed dose is just one ten milligram tablet for an adult in a 24 24-hour period however you can see people on higher doses and it is safe for people to be on doses as high as four of the tablets in a 24-hour period so they could

Be on a dose of 10 milligrams twice daily or they could be on a dose of 20 milligrams in the morning 10 milligrams at night or they could be on the four dose of 20 milligrams twice daily as i say this is not an approved dose it’s an off license dose so if you are prescribing that be aware that you’re prescribing it off license and usually it should be done by a

Specialist such as a dermatologist or a ophthalmologist a consultant who is um respected and has done this before and has truly assessed that this is necessary and that there isn’t an alternative way of getting rid of the patient’s itchiness whenever i prescribe this medicine to patients as a junior doctor i would never ever prescribe it in doses higher than

The licensed dose as i would only ever prescribe 10 milligrams in a 24-hour period but i would prescribe this if the patient was already on it on emissions if the patient was on long-term anti-histamine therapy so they were on these higher doses long term and they came in on that then obviously i would continue them on that medicine unless it was causing some

Sort of side effect was relevant to the reason they’d been admitted so i do see people on these larger doses and i continue them on those larger doses if they’ve been taking them prior to admission but i would never ever initiate that unless i was a consultant dermatologist or consultant art pharmacist

Transcribed from video
Loratadine Part 1 By Elliot Nicholson