antihistamines


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Antihistamines

 

Definition

Antihistamines are drugs that block the action of histamine (a compound released in allergic inflammatory reactions) at the H1 receptor sites, responsible for immediate hypersensitivity reactions such as sneezing and itching. Members of this class of drugs may also be used for their side effects, including sedation and antiemesis (prevention of nausea and vomiting).

Purpose

Antihistamines provide their primary action by blocking histamine H1 at the receptor site. They have no effect on rate of histamine release, nor do they inactivate histamine. By inhibiting the activity of histamine, they can reduce capillary fragility, which produces the erythema, or redness, associated with allergic reactions. They will also reduce histamineinduced secretions, including excessive tears and salivation. Additional effects vary with the individual drug used. Several of the older drugs, called first-generation antihistamines, bind non-selectively to H1 receptors in the central nervous system as well as to peripheral receptors, and can produce sedation, inhibition of nausea and vomiting, and reduction of motion sickness. The second-generation antihistamines bind only to peripheral H1 receptors, and reduce allergic response with little or no sedation.
The first-generation antihistamines may be divided into several chemical classes. The side effect profile, which also determines the uses of the drugs, will vary by chemical class. The alkylamines include brompheniramine (Dimetapp) and chlorpheniramine (Chlor-Trimeton.) These agents cause relatively little sedation, and are used primarily for treatment of allergic reactions. Promethazine (Phenergan), in contrast, is a phenothiazine, chemically related to the major tranquilizers, and while it is used for treatment of allergies, may also be used as a sedative, the relieve anxiety prior to surgery, as an anti-nauseant, and for control of motion sickness. Diphenhydramine (Benadryl) is chemically an ethanolamine, and in addition to its role in reducing allergic reactions, may be used as a nighttime sedative, for control of drug-induced Parkinsonism, and, in liquid form, for control of coughs. Consult more detailed references for further information.
ANTIHISTAMINES
Brand Name (Generic Name) Possible Common Side Effects
Include:
∗Also used in the treatment of
anxiety
∗Atarax (hydroxyzine
hydrochloride)
Drowsiness, dry mouth
Benadryl (diphenhydramine
hydrochloride)
Dizziness, sleepiness, upset stomach,
decreased coordination
Hismanal (astemiozole) Drowsiness, dry mouth, fatigue, weight
gain
PBZ-SR (tripelennamine
hydrochloride)
Dizziness, drowsiness, dry mouth and
throat, chest congestion, decreased
coordination, upset stomach
Periactin (cyproheptadine
hydrochloride)
Chest congestion, dizziness, fluttery
heartbeat, loss of appetite, hives, slee-
piness, vision problems
Phenergan (promethazine
hydrochloride)
Changes in blood pressure, dizziness,
blurred vision, nausea, rash
Polaramine (dexchlorphenira-
mine maleate)
Drowiness
Seldane, Seldane-D
(terfenadine)
Upset stomach, nausea, drowiness,
headache, fatigue
Tavist (clemastine fumarate) Decreased coordination, dizziness,
upset stomach
Trinalin Repetabs (azatadine
maleate, pseudoephedrine
sulfate)
Abdominal cramps, chest pain, dry
mouth, headache
The second generation antihistamines have no central action, and are used only for treatment of allergic reactions. These are divided into two chemical classes. Cetirizine (Zyrtec) is a piperazine derivative, and has a slight sedative effect. Loratidine (Claritin) and fexofenadine (Allegra) are members of the piperadine class and are essentially non-sedating.

Recommended dosage

Dosage varies with drug, patient and intended use. Consult more detailed references for further information.
When used for control of allergic reactions, antihistamines should be taken on a regular schedule, rather than on an as-needed basis, since they have no effect on histamine itself, nor on histamine already bound to the receptor site.
Efficacy is highly variable from patient to patient. If an antihistamine fails to provide adequate relief, switch to a drug from a different chemical class. Individual drugs may be effective in no more than 40% of patients, and provide 50% relief of allergic symptoms.

Side effects

The frequency and severity of adverse effects will vary between drugs. Not all adverse reactions will apply to every member of this class.
Central nervous system reactions include drowsiness, sedation, dizziness, faintness, disturbed coordination, lassitude, confusion, restlessness, excitation, tremor, seizures, headache, insomnia, euphoria, blurred vision, hallucinations, disorientation, disturbing dreams/nightmares, schizophrenic-like reactions, weakness, vertigo, hysteria, nerve pain, and convulsions. Overdoses may cause involuntary movements. Other problems have been reported.
Gastrointestinal problems include increased appetite, decreased appetite, nausea, vomiting, diarrhea, and constipation.
Hematologic reactions are rare, but may be severe. These include anemia, or breakdown of red blood cells; reduced platelets; reduced white cells; and bone marrow failure.
A large number of additional reactions have been reported. Not all apply to every drug, and some reactions may not be drug related. Some of the other adverse effects are chest tightness; wheezing; nasal stuffiness; dry mouth, nose and throat; sore throat; respiratory depression; sneezing; and a burning sensation in the nose.
When taking antihistamines during pregnancy, Chlorpheniramine (Chlor-Trimeton), dexchlorpheniramine (Polaramine), diphenhydramine (Benadryl), brompheniramine (Dimetapp), cetirizine (Zyrtec), cyproheptadine (Periactin), clemastine (Tavist), azatadine (Optimine), loratadine (Claritin) are all listed as category B. Azelastine (Astelin), hydroxyzine (Atarax), promethazine (Phenergan) are category C.
Regardless of chemical class of the drug, it is recommended that mothers not breast feed while taking antihistamines.

Contraindications

The following are absolute or relative contraindications to use of antihistamines. The significance of the contraindication will vary with the drug and dose.
  • glaucoma
  • hyperthyroidism (overactive thyroid)
  • high blood pressure
  • enlarged prostate
  • heart disease
  • ulcers or other stomach problems
  • stomach or intestinal blockage
  • liver disease
  • kidney disease
  • bladder obstruction
  • diabetes

Interactions

Monoamine oxidase inhibitor antidepressants (phenelzine [Nardil], tranylcypromine [Parnate]) may prolong and increase the effects of some antihistamines. When used with promethazine (Phenergan) this may cause reduced blood pressure and involuntary movements.

Resources

Organizations

Allergy and Asthma Network. 3554 Chain Bridge Road, Suite 200. (800) 878-4403.
American Academy of Allergy, Asthma, and Immunology. 611 East Wells St, Milwaukee, WI 53202. (800) 822-2762. http://www.aaaai.org.
Asthma and Allergy Foundation of America. 1125 15th Street NW, Suite 502, Washington, DC 20005. (800)727-8462.

an·ti·his·ta·mines

(an'tē-his'tă-mēnz),
Drugs having an action antagonistic to that of histamine on either H1 or H2 receptors.

an·ti·his·ta·mines

(an'tē-his'tă-mēnz)
Drugs with an action antagonistic to that of histamine; used to treat allergic symptoms.

antihistamines

systemic, topical or inhaled drugs that antagonize histamine and control allergies, e.g. hayfever (seasonal rhinitis), drug allergies, urticaria (induced by insect bites); injected antihistamine (chlorphenamine) is used as an adjunct to adrenaline in the treatment of anaphylaxis and angioedema; modern antihistamines (e.g. acrivastine, cetirizine) tend not to cause sedation

an·ti·his·ta·mines

(an'tē-his'tă-mēnz)
Drugshaving an action antagonistic to that of histamine on either H1 or H2 receptors.
References in periodicals archive ?
These studies showed that although montelukast was better than placebo in controlling the symptoms of allergic rhinitis, antihistamines were significantly more effective than montelukast.
They can also access the dual acting drugs, ie, ketotifen and olopatadine, as well as selective antihistamines (eg, azelastine and emedastine), all of which can be used in a similar manner to a mast cell stabilizer with certain caveats.
First- and second-generation oral antihistamines have not been adequately compared for allergic rhinitis, but the task force generally preferred second-generation oral antihistamines because they are associated with fewer adverse effects, such as sedation, performance impairment, and anticholinergic effects.
And while such impairment may be less evident with many of the second-generation antihistamines when prescribed at the doses approved for seasonal allergic rhinitis, these agents are often used at far higher, even heroic doses in treating a variety of pruritic dermatologic diseases, Dr.
Newer-generation antihistamines, such as loratadine (Claritin), which recently moved from prescription-only to OTC status, desloratadine (Clarinex), cetirizine (Zyrtec) and fexofenadine (Allegra), were developed to minimize the adverse events observed with the earlier agents while maintaining efficacy.
Take preventative action by taking antihistamines two to three weeks prior to the onset of hay fever season
However, antihistamines are once again great for treating the problem.
Second generation--second-generation antihistamines are a good choice to manage allergy symptoms and allow you to function normally.
Once the participants' core body temperatures reached about 100[degrees]F, they were dermally dosed with either the antihistamine pyrilamine, which acts through the H1 receptor; the antihistamine cimetidine, which acts through the H2 receptor; or nitro-L-arginine-methyl ester (L-NAME), which blocks nitric oxide.
Drugs & Clients: What Every Psychotherapist Needs To Know by Patma Catell (Associate Professor of Psychology, California Institute of Integral Studies) is a straightforward reference informing psychotherapists and lay readers alike of the basic facts concerning common pscyhoactive medications as well as non-prescription pscyhoactive drugs such as alcohol, antihistamines, nicotine, caffeine, cocaine, marijuana and more.
The standard medical treatment for these ailments has been based on the use of nasal steroid sprays, oral steroids, and antihistamines.
Parents should think twice before administering antihistamines to relieve their child's symptoms during their next ear infection.