Urticaria Drug Summary

Last updated: 17 December 2025
Reviewed by

Antiasthmatic & COPD Preparations

Drug Dosage Remarks
Other Antihistamines for Systemic Use 
Ketotifen Children 6 months-3 years old:
0.25 mL/kg PO 12 hourly
Children >3 years old and adults:
1 mg PO 12 hourly or 2 mg PO in the evening
To minimize initial sedation, give 0.5 mg PO 12 hourly
 Adverse Reactions
  • CNS effects (sedation, dizziness, insomnia, agitation, nervousness); Other effects (dry mouth, increased appetite, weight gain)
Special Instructions
  • Avoid alcohol and in patients with acute asthma attacks, epilepsy or seizure history; hypersensitivity
  • Use with caution when using concomitantly with CNS depressants and oral antidiabetic agents, in patients with galactose or fructose intolerance, severe lactase deficiency or glucose-galactose malabsorption
  • Withdraw gradually over a period of `1 week
Other Systemic Drugs Used in the Treatment of Obstructive Airway Diseases 
Omalizumab  Children ≥12 years old and adults: 150 or 300 mg SC every 4 weeks 

Adverse Reactions

  • GI effects (upper abodminal pain, nausea/vomiting, diarrhea); CNS effects (somnolence, paresthesia, syncope, dizziness); Other effect (pyrexia)

Special Instructions

  • Not recommended for patients <6 years old with allergic asthma
  • Not indicated for acute asthma exacerbations, acute bronchospasms or status asthmaticus
  • Avoid abrupt discontinuation of corticosteroids
  • Use with caution in patients with autoimmune diseases and immune complex-mediated conditions, high-risk parasitic infections, allergic reactions, renal or hepatic impairment

Antidepressant

Drug Dosage Remarks
Doxepin 10 mg PO 8 hourly or 10-30 mg PO 24 hourly at bedtime
 Adverse Reactions
  • Side effects are mostly due to antimuscarinic actions and may be decreased if started at low dose and increased gradually
  • CV effects (hypotension, tachycardia); CNS effects (drowsiness, nervousness, insomnia, headache, peripheral neuropathy, ataxia, tremor, confusion/delirium, can occur especially in older patients); GI effects (constipation which may lead to paralytic ileus, nausea/vomiting, gastric irritation); Other effects (dry mouth, blurred vision, increased intraocular pressure, urinary retention, hyperthermia, sweating, weight gain)
Special Instructions
  • Start with low dose to minimize side effects and titrate to the desired response
  • Elderly patients may be sensitive to side effects; lower dose should be used 
  • Use with caution in patients with urinary retention, prostatic hyperplasia, chronic constipation, untreated angle-closure glaucoma, patients with CV disease, history of epilepsy, diabetes mellitus (DM), impaired hepatic function
  • Do not stop medication abruptly; taper dose over several weeks

Antihistamines - Oral

Drug Dosage Remarks
 Children Adult 

First Generation
Azatadine  6-12 years old: 0.5-1 mg PO 12 hourly  1-2 mg PO 12 hourly 

Adverse Reactions

  • Most common: CNS effects (drowsiness, lassitude, dizziness, incoordination, paradoxical stimulation)
  • Other common: CNS effects (headache, psychomotor impairment); Antimuscarinic effects (dry mouth, viscous secretions, urinary retention, blurred vision)
  • Occasionally can cause GI effects (nausea/vomiting, diarrhea, epigastric pain, anorexia or increased appetite); CV effects (palpitations, arrhythmias, rarely hazardous ventricular arrhythmias); Hypersensitivity reactions (rashes angioedema, anaphylaxis); Other effects (convulsion, sweating, myalgia, tremor, hypotension)

Special Instructions

  • Avoid use in patients who need mental alertness (eg driving or using machineries) and with alcohol intake
  • Use with caution in patients with angle-closure glaucoma, urinary retention, prostatic hyperplasia, epilepsy, renal or hepatic impairment
    • Reduction of dosage may be needed

 
Brompheniramine  2-6 years old: 1 mg PO 4-6 hourly
>6-12 years old: 2 mg PO 4-6 hourly
>12 years old: 4 mg PO 4-6 hourly 		 4 mg PO 4-6 hourly 
Buclizine  5-10 years old: 12.5-30 mg PO 24 hourly  25-50 mg PO 24 hourly 
Carbinoxamine  Immediate-release preparation: 
2-5 years old: As solution: 1-2 mg PO 6-8 hourly
6-11 years old: As tab/solution: 2-4 mg PO 6-8 hourly
≥12 years old: As tab/solution:
4-8 mg PO 6-8 hourly
Extended-release suspension: 
2-3 years old: 3-4 mg PO 12 hourly
4-5 years old: 3-8 mg PO 12 hourly
6-11 years old: 6-12 mg PO 12 hourly
≥12 years old: 6-16 mg PO 12 hourly 		 Immediate-release tab/solution
4-8 mg PO 6-8 hourly
Extended-release suspension:
6-16 mg PO 12 hourly 
Chlorphenamine (Chlorpheniramine)  1-<2 years old: 1 mg PO 12 hourly 
Max dose: 4 mg/day
2-5 years old: 1 mg PO 4-6 hourly
Max dose: 6 mg/day
6-<12 years old: 2 mg PO 4-6 hourly
Max dose: 12 mg/day
≥12 years old: Same as adult dose		 2-4 mg PO 4-6 hourly 
or 8-12 mg PO 12 hourly
Max dose: 24 mg/day 
Clemastine (base)  1-3 years old: 0.25-0.5 mg PO 12 hourly
3-6 years old: 0.5 mg PO 12 hourly
6-12 years of age: 0.5-1 mg PO 12 hourly 		 1 mg PO 12 hourly
Max dose: 6 mg/day 
Cyproheptadine  2-6 years old: 2 mg PO 8-12 hourly
Max dose: 12 mg/day
7-14 years old: 4 mg PO 8-12 hourly
Max dose: 16 mg/day 		 4 mg PO 8 hourly 
May increase as necessary up to
Max dose: 32 mg/day 
Dexchlorpheniramine1  2-5 years old: 0.5 mg PO 4-6 hourly
Max dose: 3 mg/day
6-12 years old: 1 mg PO 4-6 hourly
Max dose: 6 mg/day 		 1-2 mg PO 4-6 hourly
or 2 mg PO 6-8 hourly
Max dose: 12 mg/day 
Dimethindene   -- 1-2 mg PO 8 hourly 
Diphenhydramine  2-<6 years old: 6.25 mg PO 4-6 hourly
6-12 years old: 12.5-25 mg PO 4-6 hourly
>12 years old:  25-50 mg PO 6-8 hourly 		 25-50 mg PO 6-8 hourly
Max dose: 300 mg/day 
Homochlorcyclizine  5-10 mg PO 6-12 hourly  10-20 mg PO 8 hourly 
Hydroxyzine  6 months-6 years old: 5-15 mg/day PO in divided doses
>6 years old: 
≤40 kg: 15-25 mg/day PO in divided doses
>40 kg: 25 mg PO at night, may be increased to 25 mg PO 6-8 hourly 		 Initial dose: 25 mg PO at night, may be increased to 25 mg PO 6-8 hourly
Mebhydrolin napadisylate  <2 years old: 50-100 mg/day PO in divided doses
2-5 years old: 50-150 mg/day PO in divided doses
5-10 years old: 100-200 mg/day PO in divided doses
>10 years old: 100-300 mg/day PO in divided doses 		 100-300 mg/day PO in divided doses 
Oxatomide  0.5-1 mg/kg PO 12 hourly  30 mg PO 12 hourly 
Pheniramine  >10 years old: 15-30 mg PO 8-12 hourly
Max dose: 3 mg/kg/day 		 15-30 mg PO 8-12 hourly
Max dose: 3 mg/kg/day 
Promethazine  2-5 years old: 5-15 mg PO 24 hourly
>5-10 years old: 10-25 mg PO 24 hourly 		 20-25 mg PO at night
May be increased to 25 mg PO 8-12 hourly or
10-20 mg PO 8-12 hourly
Max dose: 60 mg/day 
Second Generation 
Acrivastine  ≥12 years old: 8 mg PO 8 hourly 8 mg PO 8 hourly 

Adverse Reactions

  • Cause little or no drowsiness and antimuscarinic effect as compared with first generation antihistamines
    • Cetirizine may cause higher incidence of drowsiness as compared with other second generation antihistamines

Special Instructions

  • Use with caution in patients who need mental alertness (eg driving or using machineries), may rarely affect performance of skilled task; in patients with hepatic or renal impairment, epilepsy and in the elderly
Bilastine  6-11 years old (with body weight of at least 20 kg): 10 mg orodispersible tab PO 24 hourly
≥12 years old: 20 mg PO 24 hourly		 20 mg PO 24 hourly 
Cetirizine2 6 months-<12 months old: 2.5 mg PO 24 hourly
12 months-<2 years old: 2.5 mg PO 12-24 hourly
2-5 years old: 5 mg PO 24 hourly or
2.5 mg PO 12 hourly
6-12 years old: 10 mg PO 24 hourly
or 5 mg PO 12 hourly 		 10 mg PO 24 hourly or 5 mg PO 12 hourly 
Desloratadine  6-11 months old: 1 mg PO 24 hourly
1-5 years old: 1.25 mg PO 24 hourly
6-11 years old: 2.5 mg PO 24 hourly
≥12 years old: 5 mg PO 24 hourly		 5 mg PO 24 hourly 
Ebastine3  6-12 years old: 5-19 mg PO 24 hourly
> 12 years old: 10 mg PO 24 hourly 		 10-20 mg PO 24 hourly 
Fexofenadine  6-23 months old: 15 mg PO 12 hourly
2-11 years old: 30 mg PO 12 hourly
≥12 years old: 60 mg PO 12 hourly or 180 mg PO 24 hourly		 180 mg PO 24 hourly 
Levocetirizine3,4  6 months-5 years old: 1.25 mg PO 24 hourly
6-11 years old: 2.5 mg PO 24 hourly
≥12 years old: 2.5-5 mg PO 24 hourly 		 2.5-5 mg PO 24 hourly 
Loratadine4  2-12 years old
≤30 kg: 5 mg PO 24 hourly
>30 kg: 10 mg PO 24 hourly
>12 years old: 10 mg PO 24 hourly 		 10 mg PO 24 hourly 
Mequitazine  6-12 years old
20-30 kg: 2.5 mg PO 12 hourly
30-40 kg: 2.5 mg PO in the morning then 5 mg PO in the evening
 ≥12 years old: 5 mg PO 12 hourly 		 5 mg PO 12 hourly 
Rupatadine  2-11 years old
≥10-<25 kg: 2.5 mg PO 24 hourly
≥25 kg: 5 mg PO 24 hourly
≥12 years old: 10 mg PO 24 hourly		 10 mg PO 24 hourly 

1Combination with Dexamethasone is available. Please see the latest MIMS for specific formulations and prescribing information.
2Combination with Montelukast or Phenylephrine HCL are available. Please see the latest MIMS for specific formulations and prescribing information.
3Combination with Betamethasone is available. Please see the latest MIMS for specific formulations and prescribing information.
4Combination with Montelukast is available. Please see the latest MIMS for specific formulations and prescribing information.

Cardiac Drug

Drug Dosage Remarks
Epinephrine (Adrenaline) Children: 0.01 mg/kg (0.01 mL/kg of 1 mg/mL solution) IM (preferred)/SC not to exceed 0.3-0.5 mg every 5-15 minutes
Adult: 0.3-0.5 mL solution IM/SC every 1-2 hours
or
0.2-0.5 mL of 1 mg/mL solution IM (preferred)/SC every 5-15 minutes as condition requires		 Adverse Reactions
  • CV effects (tachycardia, flushing, hypertension, pallor, chest pain, arrhythmias); CNS effects (nervousness, anxiety, restlessness, headache); Other effects (nausea/vomiting, xerostomia, acute urinary retention in patients with bladder outflow obstruction, trembling, exacerbation of narrow-angle glaucoma)
Special Instructions
  • Use with caution in the elderly, in patients with DM, CV, thyroid and Parkinson's disease

Corticosteroid - Oral

Drug Dosage Remarks
Dexamethasone1 Adult: 0.5-9 mg/day PO in divided doses
 Adverse Reactions
  • CNS effects (mental disturbances, intracranial hypertension); Other effects (fluid and electrolyte retention, increased susceptibility to infection, growth retardation, Cushingoid states, amenorrhea, hyperhidrosis, acute pancreatitis, aseptic osteonecrosis)
Special Instructions
  • Take with food; use with caution in patients with congestive heart failure (CHF), hypertension, DM, infectious disease, chronic renal failure, uremia
  • Avoid in patients with peptic ulcer, osteonecrosis, acute infection; live vaccines
Methylprednisolone  Adult: 4-48 mg/day PO as single or in divided doses 

Adverse Reactions

  • CNS effects (intracranial hypertension, muscle weakness); Other effects (fluid and electrolyte disturbance, increased susceptibility to infection, growth retardation, Cushingoid states, adrenal suppression, glaucoma, amenorrhea, pancreatitis, peptic ulcer)

Special Instructions

  • Take with food; use with caution in patients with hypertension or cardiac insufficiency, DM, hypothyroidism, hepatic cirrhosis, tuberculosis (TB); prolonged use. May mask signs of infection
  • Avoid in patients with gastric ulcers, osteonecrosis, psychiatric disorders, acute infection, narrow or open-angle glaucoma
Prednisolone2 (or equivalent)  Children: 0.5-1 mg/kg/day PO 
Dose to be tapered over 5-7 days
Adult: 2.5-80 mg/day PO in divided doses 

Adverse Reactions

  • Gastritis; if administered long-term, may cause weight gain, hypertension, cataracts, adrenocortical insufficiency, osteoporosis, muscle wasting, pain or weakness, increased susceptibility to infection, impaired wound healing, electrolyte imbalances

Special Instructions

  • Take with food; use with caution in patients with hypertension, renal and hepatic impairment, CHF, thromboembolic disorders, epilepsy, thyroid disease, glaucoma, osteoporosis, measles
  • Avoid in patients with active systemic infections, mycobacterial infection, concomitant administration with live vaccines
Triamcinalone  Adult: 4-48 mg PO 24 hourly 

Adverse Reactions

  • CNS effects (steroid myopathy, muscle weakness, convulsions, headache); Dermatologic effects (purpura, striae, hyperpigmentation); Other effects (fluid and electrolyte disturbance, peptic ulcer, osteoporosis, growth suppression in children, Cushingoid state development, glaucoma)

Special Instructions

  • Take with food; use with caution in patients with hypertension, ocular herpes simplex, cirrhosis, hypothyroidism, non-specific ulcerative colitis, DM, renal insufficiency, CHF, thromboembolic tendencies, convulsive disorders
  • Avoid in patients with systemic fungal infections, TB, corticosteroid hypersensitivity, acute psychosis

1Combination with Dexchlorpheniramine maleate is available. Please see the latest MIMS for specific formulations and prescribing information. 
2Combination with Chlorphenamine maleate is available. Please see the latest MIMS for specific formulations and prescribing information. 

Corticosteroid - Topical

Drug Available Strength Dosage Remarks
Desonide 0.5% cream, ointment

Apply a thin layer to affected area 6-12 hourly

 Adverse Reactions
  • Dermatologic effects (burning sensation, itching, irritation, dry skin, folliculitis, hypertrichosis, acneiform eruption, hypopigmentation, perioral dermatitis, allergic contact dermatitis, skin maceration, secondary infection, skin atrophy, stria, miliaria)
Special Instructions
  • Contraindicated in patients with viral infection of the skin (vaccinia, herpes simplex, varicella), skin tuberculosis, rosacea
  • Discontinue application if irritation or sensitization occurs, and appropriate therapy should be administered

Histamine2-Receptor Antagonists

Drug Dosage Remarks
Cimetidine Adult: 300 mg IV in combination with an H1 blocker Adverse Reactions
  • GI effects (diarrhea, nausea/vomiting); CNS effects (headache, dizziness, drowsiness, agitation); Other effects (arthralgia, myalgia, rashes)
Special Instructions
  • Drug interactions may occur because of inhibition of cytochrome P450
  • Use with caution in patients taking Warfarin, Amiodarone, Theophylline, Carbamazepine and those with impaired renal function, liver cirrhosis
Ranitidine  Children: 
Max dose: 10 mg/kg/day PO or 4 mg/kg/day IV
Adult:
Max dose: 300 mg/day PO or 200 mg/day IV in combination with an H1 blocker 

Adverse Reactions

  • GI effects (diarrhea, nausea/vomiting); CNS effects (headache, dizziness, drowsiness, agitation); Other effects (arthralgia, myalgia, rashes)

Special Instructions

  • Use with caution in patients with impaired renal function, liver cirrhosis

Immunosuppressants

Drug Dosage Remarks
Canakinumab Children 2-<4 years old: 4 mg/kg SC 8 weekly as single dose
Children ≥4 years old, adolescent and adult: 
>40 kg: 150 mg SC 8 weekly as a single dose
15-40 kg: 2 mg/kg SC 8 weekly as a single dose
7.5-<15 kg: 4 mg/kg SC 8 weekly as a single dose
 Adverse Reactions
  • Respiratory effects (nasopharyngitis, pneumonia, sinusitis, pharyngitis, tonsilitis, bronchitis); CNS effects (dizziness, vertigo): GI effects (gastroenteritis, upper abdominal pain); Musculoskeletal effects (back pain, fatigue); Hematologic effects (leukopenia, neutropenia); GU effects (UTI, proteinuria, decreased creatinine renal clearance); Other effects (viral infection, cellulitis, ear infection)
Special Instructions
  • Use with caution in patients with serious infections, neutropenia, leukopenia, hepatic/renal impairment, immunosuppression
  • Avoid concomitant use with live vaccines and tumor necrosis factor (TNF) inhibitors
  • Perform TB screening test prior to initiation of treatment
  • Contraindicated in patients with active severe infection
Cyclosporin (Cyclosporine)  3 mg/kg/day PO divided 12 hourly 

Adverse Reactions

  • GI effects (abdominal pain, diarrhea, nausea, dyspepsia); CNS effects (tremors, headache); CV effects (hypertension, edema); Other effects (gingival hyperplasia, hirsutism, hypertrichosis, renal dysfunction, nephropathy, elevated creatinine, increased triglycerides, infection)

Special Instructions

  • Avoid in patients with renal dysfunction, uncontrolled hypertension, uncontrolled infections, persistently raised creatinine, malignancy, porphyria
  • Monitor renal and hepatic function, blood pressure, serum electrolytes and lipids regularly
  • Vaccination with live-virus vaccines is not recommended

Disclaimer

All dosage recommendations are for non-pregnant and non-breastfeeding women, and non-elderly adults with normal renal and hepatic function unless otherwise stated.  
Not all products are available or approved for above use in all countries.  
Products listed in the Drug Summary are based on indications stated in the locally approved product monographs.   
Please refer to local product monographs in Related MIMS Drugs for country-specific prescribing information.