Ritch (Fexofenadine): A Non-Sedating Antihistamine

Ritch contains Fexofenadine Hydrochloride, a non-sedating antihistamine indicated for the relief of symptoms associated with seasonal and perennial allergic rhinitis, and for chronic idiopathic urticaria. It belongs to the therapeutic class of Non-sedating antihistamines.

How Ritch Works (Pharmacology)

Fexofenadine acts as a selective and potent inverse agonist of the H1 histamine receptor:

• Blocks Histamine Action: When allergens trigger the release of histamine from mast cells and basophils, histamine normally binds to H1 receptors, leading to allergic symptoms (e.g., itching, runny nose, watery eyes) and further release of pro-inflammatory cytokines.
• Stabilizes Inactive Receptor Form: Fexofenadine binds to and stabilizes the inactive form of the H1 receptor, preventing its activation. This inhibits the downstream effects of histamine binding, thus alleviating allergic symptoms.
• Non-Sedating: Fexofenadine does not readily cross the blood-brain barrier, which explains its low potential for causing significant central nervous system (CNS) effects like sedation.
• Specific Affinity: It has a potent and selective affinity for H1 receptors and lacks significant antidopaminergic, antiserotonergic, anticholinergic, or adrenergic blocking activity.

Key Indications & Benefits

Ritch is indicated for the relief of symptoms associated with:

• Allergic Rhinitis (Seasonal and Perennial): Effective for symptoms like sneezing, rhinorrhea (runny nose), lacrimation (tearing), itchy/red eyes, and itchy nose/palate/throat. Indicated for adults and children 12 years of age and over.
• Chronic Idiopathic Urticaria (Hives): For adults and children 12 years of age and older.

Dosage & Administration

Dosage varies by age, condition, and formulation (tablet or suspension), and may require adjustment for impaired renal function. Always consult a registered physician for specific dosage instructions.

Allergic Rhinitis:

• Adults and children 12 years and older (Tablet): 60 mg twice daily OR 120 mg once daily OR 180 mg once daily.
  • In case of impaired renal function: 60 mg once daily.
• Children 6 to 11 years (Tablet): 30 mg twice daily OR 60 mg once daily.
  • In case of impaired renal function: 30 mg once daily.
• Children 2 to 11 years (Suspension): 30 mg or 5 ml twice daily.
  • In case of impaired renal function: 30 mg or 5 ml once daily.

Chronic Idiopathic Urticaria:

• Adults and children 12 years and older (Tablet): 60 mg twice daily OR 120 mg once daily OR 180 mg once daily.
  • In case of impaired renal function: 60 mg once daily.
• Children 6 to 11 years (Tablet): 30 mg twice daily OR 60 mg once daily.
  • In case of impaired renal function: 30 mg once daily.
• Children 6 months to less than 2 years (Suspension): 15 mg or 2.5 ml (1/2 tsp) twice daily.
  • In case of impaired renal function: 15 mg or 2.5 ml (1/2 tsp) once daily.
• Children 2 to 11 years (Suspension): 30 mg or 5 ml (1 tsp) twice daily.
  • In case of impaired renal function: 30 mg or 5 ml (1 tsp) once daily.

Important Considerations & Warnings

It is crucial to discuss your full medical history with your doctor before taking Ritch.

Contraindications:

• Patients with known hypersensitivity to Fexofenadine Hydrochloride or any of its ingredients.

Side Effects:

• Common (incidence similar to placebo): Headache, drowsiness, dizziness, nausea, fatigue.
• Uncommon: Akathisia (restlessness), anxiety, arthralgia (joint pain), asthenia (weakness), abnormal behavior, depression, dry mouth, hemorrhage, irritability, malaise, muscle complaints, edema, seizure, abnormal sensation, sleep disorders.
• Rare (from post-marketing surveillance, frequency unknown): Hypersensitivity reactions (angioedema, chest tightness, dyspnea, flushing, systemic anaphylaxis), insomnia, nervousness, sleep disorders or nightmares/excessive dreaming, tachycardia (rapid heart rate), palpitations, diarrhea, rash, urticaria (hives), pruritus (itching).

Pregnancy & Lactation:

• Pregnancy:No adequate data on Fexofenadine use in pregnant women. Animal studies are limited and don't indicate direct harm to pregnancy or fetal development. Should be used during pregnancy only if clearly necessary.
• Lactation: No data on content in human milk. However, Fexofenadine has been found to cross into human breast milk when terfenadine (its parent drug) was administered. Therefore, not recommended for breastfeeding mothers.
• Fertility: No human data. No effect on fertility observed in mice studies.

Precautions & Warnings:

• Special Populations: Limited data in older people and renally or hepatically impaired patients. Ritch should be administered with care in these groups.
• Cardiovascular Disease: Patients with a history of or ongoing cardiovascular disease should be warned that antihistamines, as a class, have been associated with adverse reactions like tachycardia and palpitations.
• Driving and Using Machines: Based on its pharmacodynamic profile and reported adverse reactions, it is unlikely to affect the ability to drive or use machines significantly. Objective tests show no significant effects on CNS function. However, to identify sensitive individuals, it's advisable to check individual response before driving or performing complicated tasks.

Drug Interactions:

• No Hepatic Biotransformation: Ritch does not undergo metabolism in the liver, so it generally doesn't interact with other drugs through hepatic mechanisms.
• Erythromycin or Ketoconazole: Co-administration results in a 2-3 times increase in plasma Fexofenadine levels. This change was not associated with QT interval effects or increased adverse reactions compared to single drug use.
• Omeprazole: No interaction observed.
• Aluminum and Magnesium Hydroxide-containing Antacids: Administration of these antacids 15 minutes prior to Ritch causes a reduction in bioavailability, likely due to binding in the GI tract. It is advisable to leave 2 hours between administration of Ritch and these antacids.

Use in Special Populations

• Renal Impairment: Pharmacokinetics are altered (increased bioavailability and half-life). A starting dose of 60 mg once daily is recommended.
• Hepatic Impairment (Moderate to Severe): Does not substantially affect Fexofenadine pharmacokinetics.
• Elderly Patients (>65 years): Adverse events similar to younger patients. However, pharmacokinetics are altered (increased bioavailability).

Overdose Effects

• Reported symptoms: Dizziness, drowsiness, fatigue, and dry mouth.
• Tolerated Doses: Single doses up to 800 mg and chronic doses (e.g., 690 mg twice daily for 1 month, or 240 mg once daily for 1 year) have been administered to healthy subjects without clinically significant adverse reactions compared to placebo. The maximum tolerated dose is not established.
• Management: Standard supportive measures should be employed, such as removing unabsorbed medicinal product from the GI tract, clinical monitoring, and supportive therapy if required.
• Hemodialysis: Does not effectively remove Ritch from blood.

Storage Conditions

Keep in a dry place away from light and heat. Keep out of the reach of children.