This article evaluates and summarizes the results of studies investigating the central nervous system effects of second-generation antihistamines, with particular emphasis on psychomotor and cognitive effects. The data sources were computer-assisted MEDLINE searches using the search terms histamine H1antagonists, psychomotor performance, sleep, and specific drug names, including astemizole, cetirizine, loratadine, and terfenadine; the searches were limited to studies in humans. Only controlled studies (placebo or active control or both) using standardized or quantitative methods for defining drug-induced effects on sedation, psychomotor performance, or cognition were reviewed. Additional published studies were identified within the references of the first group of studies. Finally, representative studies were selected for summarization. Objective and subjective measures of sedation show that loratadine and terfenadine produce sedation at a rate comparable with placebo. Moreover, these agents, when used at standard therapeutic doses, do not produce detrimental effects on objective measures of psychomotor or cognitive function. Cetirizine is associated with sedation or psychomotor impairment in some studies but not in others. The data on central nervous system effects of astemizole are limited and were not evaluated. The absence of sedation and psychomotor or cognitive impairment in patients receiving loratadine or terfenadine justifies the cost of these agents, particularly for patients who drive, pilot aircraft, or operate machinery. Whether the potential for rare but serious cardiovascular events (associated with astemizole and terfenadine) is justifiable must be decided on a case-by-case basis.
Arch Intern Med. 1997;157:494-500
Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more
Subscribe for full-text access to content from 1998 forward and a host of useful features
Activate your current subscription (AMA members and current subscribers)
Purchase Online Access to this article for 24 hours
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
Instructions
Thank you for submitting a comment on this article. It will be reviewed by JAMA Internal Medicine editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest* Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 34
Customize your page view by dragging & repositioning the boxes below.
More Listings atJAMACareerCenter.com >
and access these and other features:
Register Now
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Need assistance?
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.