Summary of medicine characteristics - DR. REDDYS HISTEASE ALLERGY RELIEF 10 MG TABLETS, TESCO ALLERGY AND HAYFEVER RELIEF 10 MG TABLETS, EM PHARMA ALLERGY AND HAYFEVER RELIEF 10 MG TABLETS, ASDA ALLERGY & HAYFEVER RELIEF 10 MG TABLETS, POLLENASE ALLERGY & HAYFEVER RELIEF 10 MG TABLETS,
1 NAME OF THE MEDICINAL PRODUCT
Dr. Reddy’s Histease Allergy Relief 10mg Tablets
Tesco Allergy & Hayfever Relief 10mg Tablets
EM Pharma Allergy & Hayfever Relief 10mg Tablets essential Waitrose hayfever & allergy relief tablets Asda Allergy & Hayfever Relief 10mg Tablets Pollenase Allergy & Hayfever Relief 10mg Tablets
2 QUALITATIVE AND QUANTITATIVE COMPOSITION
Each tablet contains Cetirizine hydrochloride 10mg.
For the full list of excipients, see section 6.1.
3 PHARMACEUTICAL FORM
Film-coated tablet.
White circular biconvex film-coated tablets, embossed ‘C’ on one side and a deep score on the other.
4 CLINICAL PARTICULARS
4.1 Therapeutic indications
In adults and paediatric patients 6 years and above:
– Cetirizine is indicated for the relief of nasal and ocular symptoms of seasonal and perennial allergic rhinitis.
– Cetirizine is indicated for the relief of symptoms of urticaria.
4.2 Posology and method of administration
Children aged from 6 to 12 years: 5mg twice daily (a half tablet twice daily).
Adults and adolescents over 12 years of age: 10mg once daily (1 tablet)
The tablets need to be swallowed with a glass of liquid.
Elderly subjects: data do not suggest that the dose needs to be reduced in elderly subjects provided that the renal function is normal.
Patients with moderate to severe renal impairment: there are no data to document the efficacy/safety ratio patients with renal impairment. Since cetirizine is mainly excreted via renal route (see section 5.2), in cases where no alternative treatment can be used, the dosing intervals must be individualized according to renal function. Refer to the following table and adjust the dose as indicated. To use the dosing table, an estimate of the patient’s creatinine clearance (CLcr) in ml/min is needed. The CLcr (ml/min) may be estimated from serum creatinine (mg/dl) determination using the following formula:
CLCT = [ 140 – age (years)] x weight (kg) (x 0.85 for woman)
72 z serum creatinine (mg/dl)
Dosing adjustment for adult patients with impaired renal function
| Group | Creatinine clearance (ml/min) | Dosage and frequency |
| Normal | >80 | 10 mg once daily |
| Mild | 50–79 | 10 mg once daily |
| Moderate | 30–49 | 5 mg once daily |
| Severe | < 30 | 5 mg once every 2 days |
| End-stage renal disease -Patients undergoing dialysis | < 10 | Contra-indicated |
In paediatric patients suffering from renal impairment, the dose will have to be adjusted on an individual basis taking into account the renal clearance of the patient, their age and body weight.
Patients with hepatic impairment: no dose adjustment is needed in patients with solely hepatic impairment.
Patients with hepatic impairment and renal impairment: dose adjustment is recommended (see Patients with moderate to severe renal impairment above).
4.3 Contraindications
Hypersensitivity to cetirizine hydrochloride, to any of the excipients listed in section 6.1, to hydroxyzine or to any piperazine derivatives.
Patients with severe renal impairment at less than 10 ml/min creatinine clearance.
4.4 Special warnings and precautions for use
| At therapeutic doses, no clinically significant interactions have been demonstrated with alcohol (for a blood alcohol level of 0.5 g/L). Nevertheless, precaution is recommended if alcohol is taken concomitantly. Caution should be taken in patients with predisposition factors or urinary retention (e.g. spinal cord lesion, prostatic hyperplasia) as cetirizine may increase the risk of urinary retention. Caution is recommended in epileptic patients and patients at risk of convulsions. Response to allergy skin tests are inhibited by antihistamines and a wash-out period (of 3 days) is required before performing them. Patients with rare hereditary problems of galactose intolerance, total lactase deficiency or glucose-galactose malabsorption should not take this medicine. Pruritus and/or urticaria may occur when cetirizine is stopped even if those symptoms were not present before treatment initiation. In some cases, the symptoms may be intense and may require treatment to be restarted. The symptoms should resolve when the treatment is restarted. Paediatric population The use of the film-coated tablet formulation is not recommended in children aged less than 6 years since this formulation does not allow for appropriate dose adaptation. It is recommended to use a paediatric formulation of cetirizine. | |
| 4.5 | Interaction with other medicinal products and other forms of interaction Due to pharmacokinetic, pharmacodynamic and tolerance profile of cetirizine, no interactions are expected with this antihistamine. Actually, neither pharmacodynamic nor significant pharmacokinetic interaction was reported in drug-drug interactions studies performed, notably with pseudoephedrine or theophylline (400 mg/day). The extent of absorption of cetirizine is not reduced with food, although the rate of absorption is decreased. In sensitive patients, the concurrent use of alcohol or other CNS depressants may cause additional reductions in alertness and impairment of performance, although cetirizine does not potentiate the effect of alcohol (0.5 g/L blood levels). |
| 4.6 | Fertility, pregnancy and lactation Pregnancy For cetirizine prospectively collected data on pregnancy outcomes do not suggest potential for maternal or foetal/embryonic toxicity above background rates. Animal studies do not indicate direct or indirect harmful effects with respect to pregnancy, embryonal/foetal development, parturition or postnatal development. Caution should be exercised when prescribing to pregnant women. Breast-feeding Cetirizine passes into breast milk. A risk of side effects in breastfed infants cannot be excluded. Cetirizine is excreted in human milk at concentrations representing 25% to 90% those measured in plasma, depending on sampling time after administration. |
Therefore, caution should be exercised when prescribing cetirizine to lactating women.
Fertility
Limited data is available on human fertility but no safety concern has been identified. Animal data show no safety concern for human reproduction.
4.7 Effects on ability to drive and use machines
Objective measurements of driving ability, sleep latency and assembly line performance have not demonstrated any clinically relevant effects at the recommended dose of 10 mg.
However patients who experience somnolence should refrain from driving, engaging in potentially hazardous activities or operating machinery. They should not exceed the recommended dose and should take their response to the medicinal product into account.
4.8 Undesirable effects
Clinical studies
Overview
Clinical studies have shown that cetirizine at the recommended dosage has minor undesirable effects on the CNS, including somnolence, fatigue, dizziness and headache. In some cases, paradoxical CNS stimulation has been reported.
Although cetirizine is a selective antagonist of peripheral H1-receptors and is relatively free of anticholinergic activity, isolated cases of micturition difficulty, eye accommodation disorders and dry mouth have been reported.
Instances of abnormal hepatic function with elevated hepatic enzymes accompanied by elevated bilirubin have been reported. Mostly this resolves upon discontinuation of the treatment with cetirizine hydrochloride.
Listing of ADRs
Double blind controlled clinical trials comparing cetirizine to placebo or other antihistamines at the recommended dosage (10 mg daily for cetirizine), of which quantified safety data are available, included more than 3200 subjects exposed to cetirizine.
From this pooling, the following adverse events were reported for cetirizine 10 mg in the placebo-controlled trials at rates of 1.0% or greater.
| Adverse event (WHO-ART) | Cetirizine 10mg (n = 3260) | Placebo (n = 3061) |
| General disorders and administration site conditions | ||
| Fatigue | 1.63% | 0.95% |
| Nervous system disorders | ||
| Dizziness | 1.10% | 0.98% |
| Headache | 7.42% | 8.07% |
| Gastro-intestinal disorders | ||
| Abdominal pain | 0.98% | 1.08% |
| Dry mouth | 2.09% | 0.82% |
| Nausea | 1.07% | 1.14% |
| Psychiatric disorders | ||
| Somnolence | 9.63% | 5.00% |
| Respiratory thoracic and mediastinal disorders | ||
| Pharyngitis | 1.29% | 1.34% |
Although statistically more common than under placebo, somnolence was mild to moderate in the majority of cases. Objective tests as demonstrated by other studies have demonstrated that usual daily activities are unaffected at the recommended daily dose in healthy young volunteers.
Paediatric population
Adverse drug reactions at rates of 1% or greater in children aged from 6 months to 12 years, included in placebo-controlled clinical trials are:
| Adverse event (WHO-ART) | Cetirizine 10mg (n =1656) | Placebo (n =1294) |
| Gastro-intestinal system disorders | ||
| Diarrhoea | 1.0% | 0.6% |
| Psychiatric disorders | ||
| Somnolence | 1.8% | 1.4% |
| Respiratory thoracic and mediastinal disorders | ||
| Rhinitis | 1.4% | 1.1% |
| General disorders and administration site conditions | ||
| Fatigue | 1.0% | 0.3% |
Post marketing experience
In addition to the adverse effects reported during clinical studies and listed above, the following undesirable effects have been reported in post-marketing experience.
Undesirable effects are described according to MedDRA System Organ Class and by estimated frequency based on post-marketing experience.
Frequencies are defined as follows: 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), not known (cannot be estimated from the available data)
Blood and lymphatic disorders:
Very rare: thrombocytopenia
Immune system disorders:
Rare: hypersensitivity
Very rare: anaphylactic shock
Metabolism and nutrition disorders:
Not known: increased appetite
Psychiatric disorders:
Uncommon: agitation
Rare: aggression, confusion, depression, hallucinations, insomnia
Very rare: tics
Not known: suicidal ideation, nightmare
Nervous system disorders:
Uncommon: paraesthesia
Rare: convulsions
Very rare: dysgeusia, syncope, tremor, dystonia, dyskinesia
Not known: amnesia, memory impairment
Eye disorders:
Very rare: accommodation disorder, blurred vision, oculogyration
Ear and labyrinth disorders:
Not known: vertigo
Cardiac disorders:
Rare: tachycardia
Gastro-intestinal disorders:
Uncommon: diarrhoea
Hepatobiliary disorders:
Rare: hepatic function abnormal (increased transaminases, alkaline phosphatises, Y-GT and bilirubin)
Not known: hepatitis
Skin and subcutaneous tissue disorders:
Uncommon: pruritis, rash
Rare: urticaria
Very rare: angioneurotic oedema, fixed drug eruption
Not known: acute generalized exanthematous pustulosis
Musculoskeletal and connective tissue disorders
Not known: arthralgia
Renal and urinary disorders:
Very rare: dysuria, enuresis
Not known: urinary retention
General disorders and administration site conditions:
Uncommon: asthenia, malaise
Rare: oedema
Investigations:
Rare: weight increased
Description of selected adverse reactions
After discontinuation of cetirizine, pruritus (intense itching) and/or urticaria have been reported.
Reporting of suspected adverse reactions
Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store.
4.9 Overdose
4.9 OverdoseSymptoms
Symptoms observed after an overdose of cetirizine are mainly associated with CNS effects or with effects that could suggest an anticholinergic effect. Adverse events reported after an intake of at least 5 times the recommended daily dose are: confusion, diarrhoea, dizziness, fatigue, headache, malaise, mydriasis, pruritus, restlessness, sedation, somnolence, stupor, tachycardia, tremor, and urinary retention.
Management
There is no known specific antidote to cetirizine. Should overdose occur symptomatic or supportive treatment is recommended. Gastric lavage should be considered following ingestion of the drug. Alternatively consider activated charcoal.
Cetirizine is not effectively removed by dialysis.
5 PHARMACOLOGICAL PROPERTIES
5.1 Pharmacodynamic properties
Pharmacotherapeutic group: antihistamine for systemic use, piperazine derivatives.
ATC code: R06A E07
Mechanism of action
Cetirizine, a human metabolite of hydroxyzine, is a potent and selective antagonist of peripheral H1-receptors.. In vitro receptor binding studies have shown no measurable affinity for other than H1-receptors.
Pharmacodynamics effects
In addition to its anti-H1 effect, cetirizine was shown to display anti-allergic activities: at a dose of 10 mg once or twice daily, it inhibits the late phase recruitment of eosinophils, in the skin and conjunctiva of atopic subjects submitted to allergen challenge.
Clinical efficacy and safety
Studies in healthy volunteers show that cetirizine, at doses of 5 and 10 mg strongly inhibits the wheal and flare reactions induced by very high concentrations of histamine into the skin, but the correlation with efficacy is not established.
In a six-week, placebo-controlled study of 186 patients with allergic rhinitis and concomitant mild to moderate asthma, cetirizine 10mg once daily improved rhinitis symptoms and did not alter pulmonary function. This study supports the safety of administering cetirizine to allergic patients with mild to moderate asthma.
In a placebo-controlled study, cetirizine given at the high daily dose of 60 mg for seven days did not cause statistically significant prolongation of QT interval.
At the recommended dosage, cetirizine has demonstrated that it improves the quality of life of patients with perennial and seasonal allergic rhinitis.
Paediatric population
In a 35-day study in children aged 5 to 12, no tolerance to the antihistamine effect (suppression of wheal and flare) of cetirizine was found. When a treatment with cetirizine is stopped after repeated administration, the skin recovers its normal reactivity to histamine within 3 days.
5.2 Pharmacokinetic properties
Absorption
The steady-state peak plasma concentrations is approximately 300 ng/mL and is achieved within 1.0 ± 0.5 h. The distribution of pharmacokinetic parameters such as peak plasma concentration (Cmax) and area under curve (AUC) is unimodal in human volunteers.
The extent of absorption of cetirizine is not reduced with food, although the rate of absorption is decreased. The extent of bioavailability is similar when cetirizine is given as solutions, capsules or tablets.
Distribution
The apparent volume of distribution is 0.50 l/kg. Plasma protein binding of cetirizine is 93 ± 0.3%. Cetirizine does not modify the protein binding of warfarin.
Biotransformation
Cetirizine does not undergo extensive first pass metabolism.
Elimination
The terminal half-life is approximately 10 hours and no accumulation is observed for cetirizine following daily dose of 10 mg for 10 days. About two thirds of the dose are excreted unchanged in urine. The terminal half-life is approximately 10 hours.
Linearity/Non-linearity
Cetirizine exhibits linear kinetics over the range of 5 to 60 mg.
Renal impairment
The pharmacokinetics of the drug were similar in patients with mild impairment (creatinine clearance higher than 40 ml/min) and healthy volunteers. Patients with moderate renal impairment had a 3-fold increase in half-life and 70% decrease in clearance compared to healthy volunteers.
Patients on hemodialysis (creatinine clearance less than 7 ml/min) given a single oral 10 mg dose of cetirizine had a 3-fold increase in half-life and a 70% decrease in clearance compared to normals. Cetirizine was poorly cleared by haemodialysis. Dosing adjustment is necessary in patients with moderate or severe renal impairment (see section 4.2).
Hepatic impairment
Patients with chronic liver disease (hepatocellular, Cholestatic, and biliary cirrhosis) given 10 or 20 mg of cetirizine as a single dose had a 50 % increase in half-life along with a 40 % decrease in clearance compared to healthy subjects.
Dosing adjustment is only necessary in patient with hepatic impairment if concomitant renal impairment is present.
Elderly: Following a single 10 mg oral dose, half life increased by about 50% and clearance decreased by 40% in 16 elderly subjects compared to the normal subjects. The decrease in cetirizine clearance in these elderly volunteers appeared to be related to their decreased renal function.
Paediatric population
The half-life of cetirizine was about 6 hours in children of 6 – 12 years and 5 hours in children 2 – 6 years. In infants and toddlers aged 6 to 24 months, it is reduced to 3.1 hours.
5.3 Preclinical safety data
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.
6. PHARMACEUTICAL PARTICULARS
6.1 List of excipients
Lactose Monohydrate, Microcrystalline Cellulose, Maize Starch, Colloidal Anhydrous Silica, Magnesium Stearate & Talc.
Film coat contains:
Hypromellose, Lactose monohydrate, Titanium Dioxide, Macrogol 4000 & Sodium Citrate.
6.2 Incompatibilities
Not applicable.
6.3 Shelf life
Three years.
6.4 Special precautions for storage
No special precautions for storage.
6.5 Nature and contents of container
Blister strips composed of transparent PVC and aluminium foil.
Pack sizes: 7, 14, 30 tablets.
6.6 Special precautions for disposal
No special requirements.
Any unused medicinal product or waste material should be disposed of in accordance with local requirements.
7. MARKETING AUTHORISATION HOLDER
Dr. Reddy's Laboratories UK Ltd
6 Riverview Road
Beverley
East Yorkshire
HU17 0LD
United Kingdom
8. MARKETING AUTHORISATION NUMBER
8. MARKETING AUTHORISATION NUMBERPL 08553/0194
9 DATE OF FIRST AUTHORISATION/RENEWAL OF THE AUTHORISATION
16 June 2004