levocetirizine + pseudoephedrine (HCP 0703 / Cossac L / HCP0703)

Levocetirizine-induced paradoxical fixed drug eruption: A case report with causality assessment.

Remesh Ambili A, Lekshmi Madhavi S MS, Reshmi Subramaniam S

Fixed drug eruptions (FDE) are drug-induced skin reactions that repeatedly occur at the same anatomical site. The skin lesions are usually clear hyperpigmented patches that may develop into blisters. The skin response involves type IV delayed hypersensitivity reactions and is caused by drug-specific memory CD8 T-cells located at the affected skin site. Levocetirizine, an H1-selective second-generation piperazine antihistamine, has a good safety profile and is used to treat the skin reactions. Its nonprescription availability leads to self-medication and unrecognised adverse drug reactions (ADR). FDE due to levocetirizine, as well as with cetirizine, is less common in the literature. This case was reported to our ADR Monitoring Center and causality was assessed as probable and preventable. This case shows that antihistamines such as levocetirizine can trigger FDE in susceptible individuals. Improving clinical awareness through robust Pharmacovigilance activities, educating patients about triggers, and discouraging self-medication are crucial for preventing recurrence.

Pseudoephedrine for Central Sympathetic Insufficiency.

Wcislo Jessica J, Posen Andrew A, Davis Jared J

Second-generation H1 antihistamines for the treatment of chronic urticaria: a network meta-analysis.

Li Zixuan Z, Zhang Juan J, Zheng Yaqi Y, Zhang Mingyan M et al.

To evaluate the efficacy and safety of 10 commonly used second-generation H1 antihistamines (cetirizine, levocetirizine, loratadine, desloratadine, ebastine, bilastine, olopatadine, rupatadine, fexofenadine, and mizolastine) at licensed doses in treating chronic urticaria using network meta-analysis. Seven electronic databases were searched, including PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Data Knowledge Service Platform, and Chinese Biomedical Literature Service System. Relevant literature from inception to the end of December 2025 was retrieved. Studies meeting the criteria were selected, and network meta-analysis was performed using Stata 16 software. A total of 54 studies involving 7,290 patients were included. Network meta-analysis indicated that olopatadine, mizolastine, bilastine, and levocetirizine were more effective than placebo in improving total symptom scores. All 10 drugs were superior to placebo in reducing itching scores, although only fexofenadine achieved statistical significance. For reducing wheal scores, ebastine was significantly more effective than mizolastine and loratadine. Regarding adverse reactions, no significant differences were observed between any of the drugs and placebo, with fexofenadine having the lowest adverse reaction rate. Sensitivity analyses excluding highrisk studies confirmed the robustness of findings across all outcomes. Based on current evidence, olopatadine at licensed dose exhibited the best efficacy in reducing total symptom scores. Fexofenadine was most effective for improving itching scores and ebastine was optimal for reducing wheal scores. In addition, fexofenadine had the lowest incidence of adverse reactions. However, the conclusions of this study still need to be validated by further high-quality randomized controlled trials.

The impact of patient age on the pharmacist's recommendation of OTC anti-common cold products before and during the COVID-19 pandemic.

Kopa-Stojak Paulina Natalia PN, Pietrusiewicz Malgorzata M, Pawliczak Rafal R

A pharmacist is the first point of contact when a patient seeks the most effective over-the-counter treatment, usually for a self-diagnosed disease, especially in the case of difficult or limited access to medical practitioners. The aim of this study is to determine the impact of the patient's age on the pharmacist's recommendation of over-the-counter anti-common cold treatment before and during the COVID-19 pandemic. This study is based on a self-developed questionnaire about pharmacists' recommendations for patients with cold symptoms collected in four large network community pharmacies in Lodz, Poland, before and during the COVID-19 pandemic. Pearson's chi-square test and odds ratios with 95% confidence intervals were used to determine the relationship between the patient's age and frequency of medication recommendations. The Mann-Whitney U test was used to determine differences in recommendations between the analyzed periods. We report higher odds of pharmacists' recommendations (odds ratio > 1; p < 0.01667) for ibuprofen with pseudoephedrine for patients aged 18-40 years, paracetamol with ascorbic acid, and phenylephrine HCl, acetylcysteine, other soluble products, and other tablets/capsules for patients aged 61-90 years before the COVID-19 pandemic. Moreover, there were higher odds of recommendations for paracetamol with ascorbic acid and phenylephrine HCl, inosines, and other soluble products for the 41-60 age cohort, and for homeopathic and herbal products for the 61-90 age cohort during the pandemic. Patients, especially older people who take several medications, require special attention when being advised about over-the-counter (OTC) medications. Our findings clearly demonstrated the constant need for improving pharmacists' counseling regarding OTC medicines (i.e., age-, comorbidities-, and drug-drug-interaction-adapting recommendations) by training and increasing professional skills.