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

Generalized Maculopapular Eruption Induced by Minocycline: A Case Report.

Brahmbhatt Shruti S, Shah Arpit M AM

Ventilator-associated pneumonia is a frequent cause of infection that is responsible for high morbidity and mortality, particularly when caused by multidrug-resistant gram-negative organisms. Minocycline is useful for its broad antimicrobial spectrum. Minocycline may cause gastrointestinal upset, dizziness, pruritus, photosensitivity, drug-induced lupus, intracranial hypertension, and drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome, including rare adverse reactions such as cutaneous manifestations. Here, we report an uncommon case of a 51-year-old male patient admitted to the medical intensive care unit (MICU) due to ventilator-associated pneumonia caused by multidrug-resistant Klebsiella pneumoniae. The patient developed a generalized maculopapular rash within 12 hours of receiving a single dose of 200 mg of minocycline through the intravenous route. The medication was stopped the next day. The patient received supportive treatment with levocetirizine, and the rash disappeared completely within 48 hours. Causality assessment using the Naranjo Adverse Drug Reaction Probability Scale yielded a score of 6, and the World Health Organization-Uppsala Monitoring Centre (WHO-UMC) scale categorized the event as "probable." This case underlines the need for close monitoring of patients for cutaneous adverse drug reactions during minocycline therapy. Early identification and immediate withdrawal of the drug are essential for rapid recovery.

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.