Table 1 Detailed summary of approved pharmacotherapy options available in Canada

Histamine H1 receptor antagonist

 Bilastine (^PrBLEXTEN™)

Prescription

Treatment of nasal and non-nasal symptoms of SAR in patients

Treatment of symptoms of CSU in patients

1 × 20 mg tablet qd

1 h

26 h

Abdominal pain, dizziness, and headache

Insufficient data at this time

 Cetirizine hydrochloride (REACTINE^®)

OTC: 10 mg

Prescription: 20 mg*

Treatment of nasal and non-nasal symptoms of SAR, PAR

Treatment of symptoms of CSU

1−2 × 5 mg tablets qd

1x 10 mg tablet qd

1× 20 mg tablet qd

1× 10 mg capsule qd

5–10 mL of syrup 5 mg/5 mL qd (2–12 yo)

10 mL of syrup 5 mg/5 mL qd (> 12 yo)

20−60 min

Up to 24 h

Somnolence, headache, and dry mouth

B

 Desloratadine AERIUS^®

OTC

Treatment of nasal and non-nasal symptoms of SAR, PAR

Treatment of symptoms of CSU

1× 5 mg tablet qd (> 12 yo)

2.5–5 mL of syrup 0.5 mg/mL qd (2–12 yo)

75 min

24 h

Dry mouth and headache

C

 Fexofenadine ALLEGRA^®

OTC

Treatment of symptoms of SAR, PAR and CSU

1× 60 mg tablet q12h (12 h formulation)

1 × 120 mg tablet qd (24 h formulation)

2–3 h

12 h

Dizziness, drowsiness, and dry mouth

C

 Loratadine CLARITIN^®

OTC

Treatment of symptoms of SAR and PAR

Treatment of symptoms and signs of CSU and other dermatologic disorders

1–2 × 5 mg tablets qd (> 12 yo)

1 × 10 mg tablet qd (> 12 yo)

5–10 mL of oral solution 1 mg/mL qd (2–12 yo)

2 h

Up to 24 h

Fatigue, headache, dry mouth, sedation, gastrointestinal disorders such as nausea, gastritis, and also allergic symptoms like rash

B

 Loratadine CLARITIN^®

OTC

Treatment of symptoms of SAR and PAR

Treatment of symptoms and signs of CSU and other dermatologic disorders

1−2× 5 mg tablets qd (> 12 yo)

1 × 10 mg tablet qd (> 12 yo)

5–10 mL of oral solution 1 mg/mL qd (2–12 yo)

2 h

Up to 24 h

Fatigue, headache, dry mouth, sedation, gastrointestinal disorders such as nausea, gastritis, and also allergic symptoms like rash

B

Histamine H1 receptor antagonist platelet activating factor receptor antagonist

 Rupatadine (^PrRUPALL™)

Prescription

Treatment of symptoms of SAR, PAR and CSU

1 × 10 mg tablet qd (≥ 12 yo)

2.5 mL of oral Solution, 1 mg/mL qd (2–11 yo with body weight of 10-25 kg)

5 mL of oral solution, 1 mg/mL qd (2-11 yo with body weight of > 25 kg)

1–2 h

Up to 24 h

Somnolence, headache, tiredness, asthenia, dry mouth, nausea, and dizziness

Insufficient data at this time

Intranasal antihistamines

 Levocabastine hydrochloride ^PrLIVOSTIN^®

Prescription

Treatment of symptoms of SAR and PAR

2 sprays (0.5 mg/mL) EN 2qd (≥ 12 yo)**

10 min

24 h

Nasal irritation, epistaxis, somnolence, headaches, dizziness, eye irritation, dry mouth and tiredness

Intranasal corticosteroids

 Beclomethasone dipropionate BECONASE^®

Prescription

Treatment of SAR and PAR

2 sprays (50 mcg/metered dose) EN bid

1–2 weeks; max benefit 3–4 weeks

Unknown

Headache, nosebleed or blood-tinged mucus, burning or irritation inside the nose, sneezing or sore throat

C

 Fluticasone propionate FLONASE^®

OTC

Treatment of SAR and PAR

2 sprays (50 mcg/metered dose) EN qd or q12h for severe rhinitis (≥ 12 yo)

1–2 sprays (50 mcg/metered dose) EN qd (4–11 yo)

1–2 weeks; max benefit 3–4 weeks

Unknown

Headache, nosebleed or blood-tinged mucus, burning or irritation inside the nose, sneezing or sore throat

C

 Mometasone furoate monohydrate ^PrNASONEX^®

Prescription

Treatment of the symptoms of SAR and PAR

Adjunctive treatment to antibiotics in acute episodes of rhinosinusitis in patients ≥12 years, where signs or symptoms of bacterial infection are present

Treatment of symptoms of mild to moderate uncomplicated acute rhinosinusitis in patients ≥12 years, where signs or symptoms of bacterial infection are not present

Treatment of nasal polyps in patients ≥18 year

2 sprays (50 mcg/metered dose) EN qd (≥ 12 yo)

1 spray (50 mcg/metered dose) EN qd (3–12 yo)

1–2 weeks; max benefit 3–4 weeks

Unknown

Headache, nosebleed or blood-tinged mucus, burning or irritation inside the nose, sneezing or sore throat.

C

 Budesonide RHINOCORT^®

Prescription

Treatment of SAR and PAR perennial, and vasomotor rhinitis unresponsive to conventional therapy

Treatment of nasal polyps and in the prevention of nasal polyps after polypectomy

1–2 sprays (64 mcg/metered spray) EN q12h (≥ 12 yo)

1–2 weeks; max benefit 3-4 weeks

Unknown

Cough, throat irritation, hoarseness, bad taste, headache, nausea and dryness of the throat

B

Leukotriene receptor antagonist

 Montelukast SINGULAIR^®

Prescription

Treatment and prevention of asthma

Treatment of symptoms of SAR

1 × 10 mg tablet qd (≥ 15 yo)

1 4–5 mg chewable tablets qd*** (≤ 14yo)

4 mg oral granules qd (2–5 yo)

2 h

24 h

Abdominal pain and headache

In rare circumstances, psychiatric side effects (insomnia, nightmares, suicidal ideation)

B

Antihistamine and Corticosteroid Agent

 Futicasone-azelastine DYMISTA^®

Prescription

Treatment of moderate to severe SAR and associated ocular symptoms

1 spray (137 mcg/50 mcg per metered spray) EN q12hr (≥ 12 yo)

15 min

26 h

Dysgeusia, epistaxis, and headache

Insufficient data at this time