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Table 1 Detailed summary of approved pharmacotherapy options available in Canada

From: Towards definitive management of allergic rhinitis: best use of new and established therapies

Product nameOTC/ prescriptionIndicationDosageOnset of actionDuration of actionToxicityPregnancy category
Histamine H1 receptor antagonist
 Bilastine (PrBLEXTEN™)PrescriptionTreatment of nasal and non-nasal symptoms of SAR in patients
Treatment of symptoms of CSU in patients
1 × 20 mg tablet qd1 h26 hAbdominal pain, dizziness, and headacheInsufficient 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 minUp to 24 hSomnolence, headache, and dry mouthB
 Desloratadine AERIUS®OTCTreatment 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 min24 hDry mouth and headacheC
 Fexofenadine ALLEGRA®OTCTreatment of symptoms of SAR, PAR and CSU1× 60 mg tablet q12h (12 h formulation)
1 × 120 mg tablet qd (24 h formulation)
2–3 h12 hDizziness, drowsiness, and dry mouthC
 Loratadine CLARITIN®OTCTreatment 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 hUp to 24 hFatigue, headache, dry mouth, sedation, gastrointestinal disorders such as nausea, gastritis, and also allergic symptoms like rashB
 Loratadine CLARITIN®OTCTreatment 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 hUp to 24 hFatigue, headache, dry mouth, sedation, gastrointestinal disorders such as nausea, gastritis, and also allergic symptoms like rashB
Histamine H1 receptor antagonist platelet activating factor receptor antagonist
 Rupatadine (PrRUPALL™)PrescriptionTreatment of symptoms of SAR, PAR and CSU1 × 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 hUp to 24 hSomnolence, headache, tiredness, asthenia, dry mouth, nausea, and dizzinessInsufficient data at this time
Intranasal antihistamines
 Levocabastine hydrochloride PrLIVOSTIN®PrescriptionTreatment of symptoms of SAR and PAR2 sprays (0.5 mg/mL) EN 2qd (≥ 12 yo)**10 min24 hNasal irritation, epistaxis, somnolence, headaches, dizziness, eye irritation, dry mouth and tiredness 
Intranasal corticosteroids
 Beclomethasone dipropionate BECONASE®PrescriptionTreatment of SAR and PAR2 sprays (50 mcg/metered dose) EN bid1–2 weeks; max benefit 3–4 weeksUnknownHeadache, nosebleed or blood-tinged mucus, burning or irritation inside the nose, sneezing or sore throatC
 Fluticasone propionate FLONASE®OTCTreatment of SAR and PAR2 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 weeksUnknownHeadache, nosebleed or blood-tinged mucus, burning or irritation inside the nose, sneezing or sore throatC
 Mometasone furoate monohydrate PrNASONEX®PrescriptionTreatment 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 weeksUnknownHeadache, nosebleed or blood-tinged mucus, burning or irritation inside the nose, sneezing or sore throat.C
 Budesonide RHINOCORT®PrescriptionTreatment 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 weeksUnknownCough, throat irritation, hoarseness, bad taste, headache, nausea and dryness of the throatB
Leukotriene receptor antagonist
 Montelukast SINGULAIR®PrescriptionTreatment 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 h24 hAbdominal pain and headache
In rare circumstances, psychiatric side effects (insomnia, nightmares, suicidal ideation)
B
Antihistamine and Corticosteroid Agent
 Futicasone-azelastine DYMISTA®PrescriptionTreatment of moderate to severe SAR and associated ocular symptoms1 spray (137 mcg/50 mcg per metered spray) EN q12hr (≥ 12 yo)15 min26 hDysgeusia, epistaxis, and headacheInsufficient data at this time
  1. Health Canada. Drug Product Database. https://health-products.canada.ca/dpd-bdpp/index-eng.jsp. Accessed Dec 11, 2019
  2. CSU, Chronic Spontaneous Urticaria; PAR, Perennial Allergic Rhinitis; SAR, Seasonal Allergic Rhinitis
  3. * 20 mg tablet is prescription only
  4. ** It is not useful to continue the treatment for more than 3 days if no improvement is seen. There are no clinical trials to support continuous treatment duration of greater than 10 weeks
  5. *** The dosage for pediatric patients 6 to 14 years of age is one 5 mg chewable tablet daily to be taken in the evening. The dosage for pediatric patients 2 to 5 years of age is one 4 mg chewable tablet daily to be taken in the evening or one packet of 4 mg granules to be taken orally once a day in the evening