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5HT1A activity than aripiprazole (1) · 5HT2A (1) · 5HT2A/D2 antagonist with proposed differential pre/post-synaptic D2 activity (1) · Anti-CGRP ligand monoclonal antibody (3) · Anti-CGRP receptor monoclonal antibody (1) · Atypical antipsychotic (3) · CGRP receptor antagonist (1) · D2/5HT1A partial agonist with stronger α1A (1) · D2/D3/5HT1A partial agonist (1) · Gepant (1) · gut-restricted)]] (1) · Multimodal antidepressant: SERT inhibitor + 5HT1A agonist + 5HT1B partial agonist + 5HT3/5HT7 antagonist (1) · NMDA receptor antagonist + sigma-1 agonist + NDRI (combination) (1) · Serotonin partial agonist reuptake inhibitor (SPARI) (1) · [[:Category:Antidiarrheals|Antidiarrheal]] (1) · [[:Category:Antihistamines|Antihistamine]] (4) · [[:Category:Antioxidants|Antioxidant]] (2) · [[:Category:B-vitamins|B-vitamin]] (1) · [[:Category:Diphenylmethane_laxatives|Diphenylmethane laxative]] (1) · [[:Category:Expectorants|Expectorant]] (1) · [[:Category:Fat-soluble_vitamins|Fat-soluble vitamin]] (1) · [[:Category:H1_receptor_antagonists|Histamine H1 receptor antagonist (second-generation)]] (4) · [[:Category:H1_receptor_antagonists|Histamine H1 receptor antagonist]] (1) · [[:Category:Hematinics|Hematinic]] (1) · [[:Category:Iron_supplements|Iron supplement]] (1) · [[:Category:Mast_cell_stabilizers|Mast cell stabilizer]] (1) · [[:Category:Mucolytics|Mucolytic]] (1) · [[:Category:Ophthalmic_antihistamines|Ophthalmic antihistamine]] (1) · [[:Category:Opioid_receptor_agonists|Peripheral opioid receptor agonist (μ-selective (1) · [[:Category:Stimulant_laxatives|Stimulant laxative]] (1) · [[:Category:Stool_softeners|Stool softener]] (1) · [[:Category:Surfactants|Surfactant]] (1) · [[:Category:Vitamins|Vitamin]] (3) · [[:Category:Water-soluble_vitamins|Water-soluble vitamin]] (1)
mechanism:
None (10) · Humanized IgG1 monoclonal antibody binding CGRP peptide; IV infusion enables fastest onset of any CGRP mAb (1) · Humanized IgG2 monoclonal antibody binding both isoforms of CGRP peptide (1) · Humanized IgG2 monoclonal antibody binding the CGRP receptor (not the peptide); blocks CGRP-mediated vasodilation and nociceptive signaling (1) · Humanized IgG4 monoclonal antibody binding CGRP peptide; prevents CGRP from activating its receptor (1) · Partial agonist at D2 and 5HT1A. Antagonist at 5HT2A, α1A, α1B, α2C. More potent 5HT2A antagonism, 5HT1A partial agonism, and α1 antagonism (relative to D2 partial agonism) than aripiprazole, proposed to reduce akathisia and enhance affective/cognitive effects. (1) · Small-molecule CGRP receptor antagonist; intranasal formulation (1) · '"`UNIQ--vote-00000391-QINU`"' Minimal CYP metabolism; mostly renally cleared unchanged. Cetirizine is the active racemate; levocetirizine is the active R-enantiomer marketed separately'"`UNIQ--ref-00000392-QINU`"'. (1) · '"`UNIQ--vote-0000061E-QINU`"' Less reliably anticholinergic than first-generation H1s; minimal antiemetic effect. Desloratadine (Clarinex) is the active enantiomer-of-metabolite version marketed as a Rx alternative. (1) · '"`UNIQ--vote-00000950-QINU`"' Mostly renally cleared unchanged; dose-reduce in renal impairment. Like cetirizine, retains slightly more sedation than fexofenadine in some users'"`UNIQ--ref-00000951-QINU`"'. (1) · '"`UNIQ--vote-00000CC9-QINU`"' Mostly excreted unchanged in feces and urine; P-glycoprotein substrate (the basis of the fruit-juice interaction). (1) · '"`UNIQ--vote-0000104D-QINU`"' Adequate hydration is at least as important as the drug in producing the expectorant effect clinically. Used in combination with dextromethorphan, decongestants, or antihistamines in many proprietary OTC cold preparations. (1) · '"`UNIQ--vote-00001067-QINU`"' Chronic use is associated with cathartic colon (colonic dilation, loss of haustration), hypokalemia, and laxative dependence; reserved for short-term use or bowel prep with breaks between courses'"`UNIQ--ref-00001068-QINU`"'. (1) · '"`UNIQ--vote-0000124C-QINU`"' The 400 mg/d dose for migraine prophylaxis is supported by randomized trials (Schoenen 1998) and remains a low-risk evidence-based supplement option. Characteristic bright-yellow urine fluorescence with high-dose oral supplementation. (1) · '"`UNIQ--vote-00001284-QINU`"' Systemic oral ketotifen (available outside US) has historical use for asthma adjunct therapy via the same dual mechanism, but oral use produces sedation and weight gain — the topical ophthalmic application largely avoids both'"`UNIQ--ref-00001285-QINU`"'. (1)
uses:
Acute treatment of migraine with or without aura in adults (1) · Major depressive disorder in adults (FDA-approved 2011) (1) · Major depressive disorder in adults (FDA-approved 2013). Notable for evidence of cognitive benefit (processing speed) that distinguishes it from other antidepressants. (1) · Major depressive disorder in adults (FDA-approved August 2022) (1) · Preventive treatment of migraine in adults (1) · Preventive treatment of migraine in adults (episodic and chronic) (2) · Preventive treatment of migraine in adults; episodic cluster headache (1) · Schizophrenia (FDA-approved 2015). Acute manic or mixed episodes of bipolar I disorder. Bipolar I depression (FDA-approved 2019). Adjunctive treatment of major depressive disorder (FDA-approved Dec 2022). (1) · Schizophrenia (FDA-approved 2015). Adjunctive treatment of major depressive disorder (2015). '''Agitation associated with dementia due to Alzheimer disease''' (FDA-approved May 2023, first agent specifically approved for this problem). Investigational for PTSD (combined with sertraline). (1) · Schizophrenia (FDA-approved Dec 2019). Bipolar depression as monotherapy or adjunct to lithium/valproate (FDA-approved Dec 2021). (1) · '"`UNIQ--vote-00000393-QINU`"', '"`UNIQ--vote-00000394-QINU`"', '"`UNIQ--vote-00000395-QINU`"' (1) · '"`UNIQ--vote-0000059A-QINU`"', '"`UNIQ--vote-0000059B-QINU`"' (1) · '"`UNIQ--vote-0000061F-QINU`"', '"`UNIQ--vote-00000620-QINU`"' (1) · '"`UNIQ--vote-00000952-QINU`"', '"`UNIQ--vote-00000953-QINU`"' (1) · '"`UNIQ--vote-00000CCA-QINU`"', '"`UNIQ--vote-00000CCB-QINU`"' (1) · '"`UNIQ--vote-00000FCF-QINU`"', '"`UNIQ--vote-00000FD0-QINU`"', '"`UNIQ--vote-00000FD1-QINU`"' (1) · '"`UNIQ--vote-0000104E-QINU`"', '"`UNIQ--vote-0000104F-QINU`"' (1) · '"`UNIQ--vote-00001069-QINU`"', '"`UNIQ--vote-0000106A-QINU`"' (1) · '"`UNIQ--vote-0000124D-QINU`"', '"`UNIQ--vote-0000124E-QINU`"', '"`UNIQ--vote-0000124F-QINU`"' (1) · '"`UNIQ--vote-00001286-QINU`"' (1) · '"`UNIQ--vote-000012CE-QINU`"', '"`UNIQ--vote-000012CF-QINU`"', '"`UNIQ--vote-000012D0-QINU`"' (1) · '"`UNIQ--vote-000012E5-QINU`"', '"`UNIQ--vote-000012E6-QINU`"', '"`UNIQ--vote-000012E7-QINU`"', '"`UNIQ--vote-000012E8-QINU`"' (1) · '"`UNIQ--vote-00001341-QINU`"', '"`UNIQ--vote-00001342-QINU`"' (1)
starting dose:
1 tablet (dextromethorphan 45 mg / bupropion 105 mg) PO daily × 3 days, then increase to 1 tablet BID (1) · 10 mg (one spray) intranasally in one nostril (1) · 10 mg PO once daily (1) · 10 mg PO once daily (5 mg in older adults or if sedation occurs) (1) · 10 mg PO once daily × 7 days, then 20 mg × 7 days, then 40 mg as target dose (take with food) (1) · 10 mg PO once daily; may increase to 20 mg as tolerated, or decrease to 5 mg if needed (1) · 100 mg IV every 3 months; may increase to 300 mg IV every 3 months (1) · 100-200 mg PO once or twice daily; pediatric weight-based (1) · 200-400 mg PO q4h (IR); 600-1200 mg PO q12h (Mucinex 12-Hour ER) (1) · 225 mg SC monthly, or 675 mg SC every 3 months (quarterly) (1) · 325 mg PO daily to TID (=65 mg elemental iron/tablet); alternate-day dosing is now favored by hepcidin physiology for better absorption with less GI burden (1) · 4 mg PO initially, then 2 mg after each loose stool, '''not to exceed 16 mg/d''' (8 mg OTC); chronic-use lower (1) · 42 mg PO once daily with food (no titration) (1) · 5 mg PO once daily in the evening (1) · 5-15 mg PO once at bedtime; 10 mg PR for faster effect; bowel prep regimens use higher single doses (1) · 60 mg PO BID or 180 mg PO once daily (1) · 70 mg SC monthly; may increase to 140 mg monthly (1) · General supplementation 75-90 mg/d (RDA); scurvy treatment 100-1000 mg/d for several weeks; megadose claims unsupported (1) · Migraine prophylaxis: 400 mg PO daily; deficiency replacement 5-30 mg/d (1) · Migraine: 240 mg SC loading dose, then 120 mg SC monthly. Cluster: 300 mg SC at onset of cluster period, then monthly during cluster. (1) · Ophthalmic 1 drop in each eye every 8-12 hours (1) · Replacement: 15-30 mg (22.5-45 IU) daily; NASH: 800 IU daily; AREDS-2: 400 IU daily (in combination formula) (1) · Schizophrenia: 1 mg PO daily × 4 days, then 2 mg daily × 3 days, then 4 mg daily. MDD adjunct: 0.5-1 mg daily, increase to 2 mg max. AD agitation: 0.5 mg daily, titrate to 2-3 mg daily. (1) · Schizophrenia: 1.5 mg PO daily, increase to 1.5-6 mg as tolerated. Bipolar mania: 1.5 mg, may increase to 3-6 mg. Bipolar depression: 1.5 mg daily for 14 days, then 3 mg. MDD adjunct: 1.5 mg, may increase to 3 mg. (1)
preparations:
0.025%, 0.035% ophthalmic solutions (1) · 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg tablets (1) · 1.5 mg, 3 mg, 4.5 mg, 6 mg capsules (1) · 10 mg tablets; 5 mg ODT and chewables; 1 mg/mL oral syrup; combo Claritin-D (with pseudoephedrine, behind-counter) (1) · 10 mg, 20 mg, 40 mg tablets (1) · 10 mg/spray nasal solution (1) · 100 mg/mL vial for IV infusion (1) · 100, 200, 400 IU softgels and capsules; many proprietary OTC blends; combined formulations (AREDS-2) (1) · 100, 200, 400 mg IR tablets; 600 mg, 1200 mg Mucinex ER tablets; many liquid formulations and combination products with dextromethorphan, pseudoephedrine, antihistamines (1) · 100, 250, 500, 1000 mg tablets, chewables, gummies, effervescent; IV (specialty) (1) · 120 mg/mL prefilled syringe or autoinjector (1) · 2 mg capsules and tablets; 1 mg/5 mL oral solution; combined with simethicone (Imodium Multi-Symptom) (1) · 225 mg/1.5 mL prefilled syringe or autoinjector (1) · 25, 50, 100, 250, 400 mg tablets; OTC (1) · 30, 60, 180 mg tablets; 30 mg ODT; 6 mg/mL oral suspension; all OTC (1) · 325 mg tablets (65 mg elemental Fe); 220 mg/5 mL liquid (44 mg elemental Fe/5 mL); 142 mg/mL drops; OTC and Rx (1) · 42 mg capsules (1) · 5 mg enteric-coated tablets; 10 mg rectal suppositories; OTC and Rx (1) · 5 mg tablets; 2.5 mg/5 mL oral solution; OTC (1) · 5 mg, 10 mg tablets; 5 mg, 10 mg chewables; 1 mg/mL oral syrup; OTC (1) · 5 mg, 10 mg, 20 mg tablets (1) · 50, 100, 250 mg capsules; 50 mg/5 mL syrup; OTC (1) · 70 mg/mL or 140 mg/mL prefilled autoinjector (1) · Dextromethorphan 45 mg + bupropion 105 mg ER tablets (1)
bioavailability:
10-20% (oral; reduced by food, calcium, antacids, PPIs, tea/coffee; enhanced by ascorbate) (1) · 100% (IV) (1) · Adequate oral bioavailability (1) · High (oral); not significantly affected by food'"`UNIQ--ref-00000397-QINU`"' (1) · High (oral)'"`UNIQ--ref-00001051-QINU`"' (1) · High (oral; food prolongs absorption modestly)'"`UNIQ--ref-00000622-QINU`"' (1) · High with fat-containing meal; reduced in malabsorption (1) · Limited but adequate; take with food (1) · Local action; minimal systemic effect (1) · Low systemic absorption (enteric coating delivers drug to colon)'"`UNIQ--ref-0000106C-QINU`"' (1) · Not formally characterized for the combination (1) · Not formally established (1) · Not formally established (high SC) (1) · Topical with minimal systemic absorption'"`UNIQ--ref-00001288-QINU`"' (1) · ~0.3% (oral; extensive first-pass via CYP3A4 and P-glycoprotein-mediated efflux at the intestinal and blood-brain barriers limit systemic and CNS exposure at therapeutic doses)'"`UNIQ--ref-00000FD3-QINU`"' (1) · ~33% (oral; fruit juices including grapefruit, orange, and apple reduce absorption substantially via OATP1A2 inhibition — distinctive interaction not seen with most other H1s)'"`UNIQ--ref-00000CCD-QINU`"' (1) · ~5% intranasal (1) · ~50-60% (oral; food enhances) (1) · ~70-90% at typical doses; saturable at high doses (>500 mg) (1) · ~72% (with food); much lower fasting (~36%) (1) · ~75% (1) · ~82% SC (1) · ~85-90% (oral; not significantly affected by food)'"`UNIQ--ref-00000955-QINU`"' (1) · ~95% (1)
pregnancy:
Generally considered acceptable for short-term use.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Generally considered acceptable when needed.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Generally considered acceptable.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Generally considered safe (minimal systemic exposure).<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Generally considered safe.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Generally considered safe; loratadine and cetirizine have more pregnancy data and are typically preferred.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Generally considered safe; widely used. Cetirizine and loratadine remain the more-studied alternatives.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Generally considered safe; widely used. Levocetirizine (the R-enantiomer) is an alternative with similar safety.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Generally considered safe; widely used. Loratadine and cetirizine are the most-recommended 2nd-gen H1s in pregnancy and lactation.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Limited data (1) · Limited data; avoid (6) · Limited data; National Pregnancy Registry available (1) · Limited data; National Pregnancy Registry for Atypical Antipsychotics (1) · Limited data; weigh benefits/risks (2) · Routinely used; iron requirements rise substantially in pregnancy and lactation.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Safe at replacement and supplement doses.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Safe at replacement doses; high-dose use generally avoided.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1) · Safe at routine doses; routinely supplemented in pregnancy.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1)
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