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1. Brown & Burk Once-A-Day Hayfever & Allergy 10mg Tablets
2. Brown & Burk Once-A-Day Hayfever & Allergy 10mg Tablets

1    NAME OF THE MEDICINAL PRODUCT

Brown & Burk Once-A-Day Hayfever & Allergy 10mg Tablets

2    QUALITATIVE AND QUANTITATIVE COMPOSITION

Each tablet contains 10 mg loratadine For excipients, see section 6.1

3    PHARMACEUTICAL FORM

Tablet

White or almost white, 8mm round, flat tablets, embossed with a letter ‘L’ on one side and with a scoreline on the other.

4    CLINICAL PARTICULARS

4.1    Therapeutic indications

Brown & Burk Once-A-Day Hayfever & Allergy 10mg Tablets is indicated for the symptomatic treatment of allergic rhinitis and chronic idiopathic urticaria.

4.2    Posology and method of administration

Adults and children 12 years of age and over:

10mg once daily (one tablet). The tablet may be taken without regard to mealtime.

Children 2 to 12 years of age with:

Body weight more than 30 kg: 10 mg once daily (one tablet)

Body weight 30 kg or less: 5 ml (5 mg) of the syrup once daily. The 10 mg strength tablet is not appropriate in children with a body weight less than 30 kg.

Efficacy and safety of Brown & Burk Once-A-Day Hayfever & Allergy 10mg Tablets in children under 2 years of age has not been established.

Patient with severe liver impairment should be administered a lower intial dose because they may have reduced clearance of loratadine. An initial dose of 10 mg every other day is recommended for adults and children weighing more than 30 kg, and for children weighing 30 kg or less, 5 ml (5 mg) every other day is recommended.

No dosage adjustments are required in the elderly or in patients with renal insufficiency.

4.3 Contraindications

Brown & Burk Once-A-Day Hayfever & Allergy 10mg Tablets are contra-indicated in patients who are hypersensitive to the active substance or to any of the excipients in these formulations.

4.4    Special warnings and precautions for use

Brown & Burk Once-A-Day Hayfever & Allergy 10mg Tablets should be administered with caution in patients with severe liver impairment (see 4.2)

Patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption should not take this medicine.

The administration of Brown & Burk Once-A-Day Hayfever & Allergy 10mg Tablets should be discontinued at least 48 hours before skin tests since antihistamines may prevent or reduce otherwise positive reactions to dermal reactivity index.

4.5    Interaction with other medicinal products and other forms of interaction

When administered concomitantly with alcohol, Brown & Burk Once-A-Day Hayfever & Allergy 10mg Tablets has no potentiating effects as measured by psychomotor performance studies.

Due to the wide therapeutic index of loratadine no clinically relevant interactions are expected and none were observed in the conducted clinical trials (see 5.2).

4.6 Pregnancy and lactation

Loratadine was not teratogenic in animal studies. The safe use of loratadine during pregnancy has not been established. The use of Brown & Burk Once-A-Day Hayfever & Allergy 10mg Tablets during pregnancy is therefore not recommended.

Loratadine is excreted in breast milk, therefore the use of loratadine is not recommended in breast-feeding women.

4.7 Effects on ability to drive and use machines

In clinical trials that assessed driving ability, no impairment occurred in patients receiving loratadine. However, patients should be informed that very rarely some people rarely experience drowsiness, which may affect their ability to drive or use machines.

4.8 Undesirable effects

In clinical trials in a paediatric population, children aged 2 through 12 years, common adverse reactions reported in excess of placebo were headache (2.7%), nervousness (2.3%), and fatigue (1%).

In clinical trials involving adults and adolescents in a range of indications including AR and CIU, at the recommended dose of 10 mg daily, adverse reactions with loratadine were reported in 2% of patients in excess of those treated with placebo. The most frequent adverse reactions reported in excess of placebo were somnolence (1.2%), headache (0.6%), increased appetite (0.5%) and insomnia (0.1%). Other adverse reactions reported very rarely during post marketing period are listed in the following table.

Immune disorders	anaphylaxis
Nervous system disorders	Dizziness
Cardiac	Tachycardia,
disorders	palpitation
Gastrointestinal	Nausea, dry
disorders	mouth, gastritis
Hepato-bilary	Abnormal
disorders	hepatic function
Skin and subcutaneous tissue disorders	Rash, alopecia
General disorders and administration site conditions	Fatigue

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

4.9 Overdose

Overdosage with loratadine increased the occurrence of anticholinergic symptoms. Somnolence, tachycardia and headache have been reported with overdoses.

In the event of overdose, general symptomatic and supportive measures are to be instituted and maintained for as long as necessary. Administration of activated charcoal as a slurry with water may be attempted. Gastric lavage may be considered. Loratadine is not removed by haemodialysis and it is not known if loratadine is removed by peritoneal dialysis. Medical monitoring of the patient is to be continued after emergency treatment.

5 PHARMACOLOGICAL PROPERTIES

Pharmacodynamic properties

Pharmacotherapeutic group: antihistamines - H1 antagonist, ATC code R06A X13

Loratadine the active ingredient in Brown & Burk Once-A-Day Hayfever & Allergy 10mg Tablets is a tricyclic antihistamine with selective, peripheral H1 receptor activity.

Loratadine has no clinically significant sedative or anticholinergic properties in the majority of the population and when used at the recommended dosage.

During long-term treatment there were no clinically significant changes in vital signs, laboratory test values, physical examinations or electrocardiograms.

Loratadine has no significant H₂-receptor activity. It does not inhibit noradrenaline uptake and has practically no influence on cardiovascular function or on intrinsic cardiac pacemaker activity.

5.2 Pharmacokinetic properties

After oral administration, loratadine is rapidly and well absorbed and undergoes an extensive first pass metabolism, mainly by CYP 3A4 and CYP 2D6. The major metabolite - desloratadine (DL) - is pharmacologically active and responsible for a large part of clinical effect. Loratadine and DL achieve maximum plasma concentrations (T_max) between 1 - 1.5 hours and 1.5 - 3.7 hours after administration, respectively.

Increase in plasma concentrations of loratadine has been reported after concomitant use with ketoconazole, erythromycin and cimetidine in controlled trials, but without clinically significant changes (including electrocardiography).

Loratadine is highly bound (97% to 99%) and its active metabolite moderately bound (73% to 76%) to plasma proteins.

In healthy subjects, plasma distribution half-lives for loratadine and its active metabolite are approximately 1 and 2 hours, respectively. The mean elimination half-lives in healthy adult subjects were 8.4 hours (range = 3 to 20 hours) for loratadine and 28 hours (range = 8.8 to 92 hours) for the major active metabolite.

Approximately 40% of the dose is excreted in the urine and 42% in the faeces over a 10-day period (mainly in the form of conjugated metabolites). Approximately 27% of the dose is eliminated in the urine during the first 24 hours. Less than 1% of the active substance is excreted unchanged in active form, as loratadine or DL.

The bioavailability parameters of loratadine and of the active metabolite are dose proportional.

The pharmacokinetic profile of loratadine and its metabolites is comparable in healthy adult volunteers and healthy geriatric volunteers.

Concomitant ingestion of food can delay slightly the absorption of loratadine but without influencing the clinical effect.

In patients with chronic renal impairment, both the AUC and the peak plasma levels (C_max) increased for loratadine and its metabolite as compared with the AUCs and C_max of patients with normal renal function. The mean elimination half-lives of loratadine and its metabolite were not significantly different from that observed in normal subjects. Haemodialysis does not have an effect on the pharmacokinetic profile of loratadine or its active metabolite in subjects with chronic renal impairment.

In patients with chronic alcoholic liver disease, the AUC and Cmax of loratadine were double while the pharmacokinetic profile of the active metabolite was not significantly changed from that in patients with normal liver function. The elimination half-lives for loratadine and its metabolite were 24 hours and 37 hours, respectively, and increased with increasing severity of liver disease.

Loratadine and its active metabolite are excreted in the breast milk of lactating women.

5.3 Preclinical safety data

Preclinical data reveal no special hazard based on conventional studies of safety, pharmacology, repeated dose toxicity, genotoxicity and carcinogenic potential.

In reproductive toxicity studies, no teratogenic effects were observed. However, prolonged parturition and reduced viability of offspring were observed in rats at plasma levels (AUC) 10 times higher than those achieved with clinical doses.

No evidence of mucous membrane irritation was observed after daily administration of up to 12 tablets (120 mg) of oral lyophilisates into the hamster cheek pouch for five days.

6    PHARMACEUTICAL PARTICULARS

6.1    List of excipients

Lactose monohydrate Cellulose, microcrystalline Maize starch Magnesium stearate

6.2    Incompatibilities

Not applicable

6.3    Shelf life

3 years

6.4    Special precautions for storage

None