LEVORID

1. Introduction

Levorid is a brand name for levocetirizine, an advanced third-generation antihistamine used to treat various allergic conditions. It’s the active R-enantiomer of cetirizine, offering enhanced efficacy with potentially fewer side effects.

2. Description

• Generic Name: Levocetirizine dihydrochloride

• Brand Names: Levorid (India), Xyzal (global brand)

• Dosage Forms:

  • Tablets (5 mg)

  • Oral drops (5 mg/mL)

  • Syrup (2.5 mg/5 mL)

• Manufacturer: Dr. Reddy’s Laboratories (Levorid brand)

3. Uses

✔ Allergic rhinitis (seasonal and perennial) ✔ Chronic idiopathic urticaria (hives) ✔ Allergic conjunctivitis ✔ Atopic dermatitis (as adjunct therapy) ✔ Food/drug allergy symptoms

4. Mechanism of Action

• Potent selective H1-receptor inverse agonist

• 2-fold greater affinity for H1 receptors than cetirizine

• Inhibits histamine at both early and late phases of allergic response

• Minimal anticholinergic effects

5. Side Effects

Common (usually mild):

• Somnolence (8-14% incidence)

• Headache (5-7%)

• Dry mouth (2-3%)

• Fatigue

Rare but serious:

• QT prolongation (in predisposed patients)

• Severe hypersensitivity reactions

• Seizures (in susceptible individuals)

6. Storage

• Store below 30°C

• Protect from light and moisture

• Oral drops/syrup: Use within 6 months after opening

7. Precautions & Warnings

⚠ Renal impairment:

• CrCl 30-50 mL/min: Max 2.5 mg daily

• CrCl 10-30 mL/min: Max 2.5 mg every other day

• CrCl <10 mL/min: Contraindicated

⚠ Contraindications:

• End-stage renal disease

• Hypersensitivity to piperazine derivatives

• Children <6 months

⚠ Special Populations:

• Pregnancy: Category B (caution advised)

• Elderly: Monitor for dizziness/sedation

8. Dosage

• Adults/children ≥12 years: 5 mg once daily (evening)

• Children 6-11 years: 2.5 mg once daily

• Children 2-5 years: 1.25 mg (oral drops) twice daily

• Max duration: Continuous use up to 6 months studied

9. Pharmacokinetics

• Onset: 1 hour

• Peak effect: 0.9 hours (Tmax)

• Duration: 24 hours

• Protein binding: 90%

• Half-life: 7-9 hours

• Excretion: Renal (85% unchanged)

10. Drug Interactions

• CNS depressants: Additive sedation • Theophylline: Reduces levo clearance by 16% • Ritonavir: Increases AUC by 40% • Food: Delays absorption but no clinical significance

11. Advantages Over Cetirizine

• 2-fold greater H1 receptor affinity

• Lower incidence of sedation (8% vs 14%)

• Faster onset (1 hr vs 1.5 hr)

• More consistent absorption

12. Conclusion

Levorid offers superior histamine blockade with reduced CNS penetration, making it an excellent choice for patients who experience drowsiness with other antihistamines. Its renal excretion profile necessitates dose adjustment in impaired kidney function.