Second-generation antihistamine
Brand names: Aerius, Neoclarityn, Clarinex
Updated · Methodology
First line
First-line for seasonal and perennial allergic rhinitis under ARIA 2020 and 2022 alongside other second-generation antihistamines. Standard dose 5 mg once daily. Children 1–5 years: 1.25 mg (2.5 mL syrup) once daily. Tolerability and sedation comparable to bilastine and fexofenadine.
Sources
ICD-10: J30.9 · ICD-11: CA08.0
First line
First-line for chronic spontaneous urticaria under /GA²LEN/EDF/ 2022 at 5 mg once daily. With insufficient response, up-dosing to 20 mg/day is acceptable (off-label, EAACI consensus). When symptoms persist at quadruple dose, add omalizumab.
Sources
ICD-10: L50.1 · ICD-11: EB00.1
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
Not recommended
Desloratadine is a second-generation antihistamine and the active metabolite of loratadine. It is prescribed for seasonal and perennial allergic rhinitis and urticaria ( 2024, AEMPS Ficha Técnica). Desloratadine is recommended for viral runny nose and for general immunity, conflating the common cold with allergic rhinitis. The Cochrane review by De Sutter 2015 in people with ordinary colds did not confirm significant effect of antihistamines as monotherapy. If desloratadine was prescribed for a cold without confirmed allergic rhinitis, consider seeking a second opinion.
An active metabolite of loratadine. A selective peripheral H1-antagonist with a long half-life (27 hours). Minimal blood-brain barrier penetration – sedation is close to placebo. Metabolized primarily by 3-hydroxylation; data on specific CYP isoenzymes are limited and drug interactions are minimal.
AEMPS summary of product characteristics (section 4.6): a large amount of data in pregnant women (more than 1,000 pregnancies) indicates that desloratadine causes no malformations and no fetal or neonatal toxicity. Animal studies do not suggest direct or indirect harmful effects with respect to reproductive toxicity. As a precaution, it is preferable to avoid desloratadine during pregnancy.
Fully compatible. Hale L1. RID 0.04%, same as loratadine. Drug of choice for nursing mothers with allergic rhinitis or chronic urticaria.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
Verbatim lines from the interaction sections, in the language of the label
«Inhibitors of Cytochrome P450 3A4: In controlled clinical studies co-administration of desloratadine with ketoconazole, erythromycin, or azithromycin resulted in increased plasma concentrations of…»FDA, section 7 · Open on DailyMed
«No se han observado interacciones clínicamente relevantes en ensayos clínicos con desloratadina comprimidos en los que se administraron conjuntamente eritromicina o ketoconazol (ver sección 5.1).»AEMPS, section 4.5 · Open on CIMA
«Inhibitors of Cytochrome P450 3A4: In controlled clinical studies co-administration of desloratadine with ketoconazole, erythromycin, or azithromycin resulted in increased plasma concentrations of…»FDA, section 7 · Open on DailyMed
«Fluoxetine: In controlled clinical studies co-administration of desloratadine with fluoxetine, a selective serotonin reuptake inhibitor (SSRI), resulted in increased plasma concentrations of…»FDA, section 7 · Open on DailyMed
«No se han observado interacciones clínicamente relevantes en ensayos clínicos con desloratadina comprimidos en los que se administraron conjuntamente eritromicina o ketoconazol (ver sección 5.1).»AEMPS, section 4.5 · Open on CIMA
«Inhibitors of Cytochrome P450 3A4: In controlled clinical studies co-administration of desloratadine with ketoconazole, erythromycin, or azithromycin resulted in increased plasma concentrations of…»FDA, section 7 · Open on DailyMed
«Fluoxetine: In controlled clinical studies co-administration of desloratadine with fluoxetine, a selective serotonin reuptake inhibitor (SSRI), resulted in increased plasma concentrations of…»FDA, section 7 · Open on DailyMed
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Desloratadine is evaluated for the following indications with varying evidence strength: Allergic rhinitis (evidence tier A), Chronic urticaria (evidence tier A), Immune support and respiratory infection care (evidence tier F). See the full indication matrix with dosing and citations above on this page.
Common side effects of Desloratadine (≥ 1 in 100): Fatigue, Dry mouth, Headache, Drowsiness (~2%, placebo-level). See the Safety section for uncommon and serious reactions.
AEMPS summary of product characteristics (section 4.6): a large amount of data in pregnant women (more than 1,000 pregnancies) indicates that desloratadine causes no malformations and no fetal or neonatal toxicity. Animal studies do not suggest direct or indirect harmful effects with respect to reproductive toxicity. As a precaution, it is preferable to avoid desloratadine during pregnancy.
Fully compatible. Hale L1. RID 0.04%, same as loratadine. Drug of choice for nursing mothers with allergic rhinitis or chronic urticaria.
Desloratadine is contraindicated in: Hypersensitivity to desloratadine, loratadine, or excipients; Age under 6 months. Full list in the Safety section.
Direct links to regulator labels. Open in a new tab.
Dexchlorpheniramine, Dimenhydrinate, Diphenhydramine, Doxylamine/pyridoxine, Fexofenadine, Loratadine, Bilastine, Ebastine