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Chu Z, Cen L, Xu Q, Lin G, Mo J, Shao L, Zhao Y, Li J, Ye W, Fang T, Ren W, Zhu Q, He G, Xu Y. Discovery of the novel and potent histamine H1 receptor antagonists for treatment of allergic diseases. Eur J Med Chem 2024; 268:116197. [PMID: 38368709 DOI: 10.1016/j.ejmech.2024.116197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 01/27/2024] [Accepted: 01/28/2024] [Indexed: 02/20/2024]
Abstract
Desloratadine, a second-generation histamine H1 receptor antagonist, has established itself as a first-line drug for the treatment of allergic diseases. Despite its effectiveness, desloratadine exhibits an antagonistic effect on muscarinic M3 receptor, which can cause side effects such as dry mouth and urinary retention, ultimately limiting its clinical application. Herein, we describe the discovery of compound Ⅲ-4, a novel H1 receptor antagonist with significant H1 receptor antagonistic activity (IC50 = 24.12 nM) and enhanced selectivity towards peripheral H1 receptor. In particular, Ⅲ-4 exhibits reduced M3 receptor inhibitory potency (IC50 > 10,000 nM) and acceptable hERG inhibitory activity (17.6 ± 2.1 μM) compare with desloratadine. Additionally, Ⅲ-4 exhibits favorable pharmacokinetic properties, as well as in vivo efficacy and safety profiles. All of these reveal that Ⅲ-4 has potential to emerge as a novel H1 receptor antagonist for the treatment of allergic diseases. More importantly, the compound Ⅲ-4 (HY-078020) has recently been granted clinical approval.
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Affiliation(s)
- Zhaoxing Chu
- Jiangsu Key Laboratory of Drug Design and Optimization, Department of Medicinal Chemistry, China Pharmaceutical University, Nanjing, 210009, China; Hefei Institute of Pharmaceutical Industry Co., Ltd., Hefei, 230088, China
| | - Lifang Cen
- Jiangsu Key Laboratory of Drug Design and Optimization, Department of Medicinal Chemistry, China Pharmaceutical University, Nanjing, 210009, China
| | - Qinlong Xu
- Hefei Institute of Pharmaceutical Industry Co., Ltd., Hefei, 230088, China
| | - Gaofeng Lin
- Hefei Institute of Pharmaceutical Industry Co., Ltd., Hefei, 230088, China
| | - Jiajia Mo
- Hefei Institute of Pharmaceutical Industry Co., Ltd., Hefei, 230088, China
| | - Li Shao
- Hefei Institute of Pharmaceutical Industry Co., Ltd., Hefei, 230088, China
| | - Yan Zhao
- Hefei Institute of Pharmaceutical Industry Co., Ltd., Hefei, 230088, China
| | - Jiaming Li
- College of Pharmacy, Anhui University of Chinese Medicine, Hefei, 230012, China
| | - Wenfeng Ye
- Hefei Institute of Pharmaceutical Industry Co., Ltd., Hefei, 230088, China
| | - Tao Fang
- Hefei Institute of Pharmaceutical Industry Co., Ltd., Hefei, 230088, China
| | - Weijie Ren
- Jiangsu Key Laboratory of Drug Design and Optimization, Department of Medicinal Chemistry, China Pharmaceutical University, Nanjing, 210009, China
| | - Qihua Zhu
- Jiangsu Key Laboratory of Drug Design and Optimization, Department of Medicinal Chemistry, China Pharmaceutical University, Nanjing, 210009, China.
| | - Guangwei He
- Hefei Institute of Pharmaceutical Industry Co., Ltd., Hefei, 230088, China.
| | - Yungen Xu
- Jiangsu Key Laboratory of Drug Design and Optimization, Department of Medicinal Chemistry, China Pharmaceutical University, Nanjing, 210009, China.
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Sun MA, Yang R, Liu H, Wang W, Song X, Hu B, Reynolds N, Roso K, Chen LH, Greer PK, Keir ST, McLendon RE, Cheng SY, Bigner DD, Ashley DM, Pirozzi CJ, He Y. Repurposing Clemastine to Target Glioblastoma Cell Stemness. Cancers (Basel) 2023; 15:4619. [PMID: 37760589 PMCID: PMC10526458 DOI: 10.3390/cancers15184619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 09/08/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023] Open
Abstract
Brain tumor-initiating cells (BTICs) and tumor cell plasticity promote glioblastoma (GBM) progression. Here, we demonstrate that clemastine, an over-the-counter drug for treating hay fever and allergy symptoms, effectively attenuated the stemness and suppressed the propagation of primary BTIC cultures bearing PDGFRA amplification. These effects on BTICs were accompanied by altered gene expression profiling indicative of their more differentiated states, resonating with the activity of clemastine in promoting the differentiation of normal oligodendrocyte progenitor cells (OPCs) into mature oligodendrocytes. Functional assays for pharmacological targets of clemastine revealed that the Emopamil Binding Protein (EBP), an enzyme in the cholesterol biosynthesis pathway, is essential for BTIC propagation and a target that mediates the suppressive effects of clemastine. Finally, we showed that a neural stem cell-derived mouse glioma model displaying predominantly proneural features was similarly susceptible to clemastine treatment. Collectively, these results identify pathways essential for maintaining the stemness and progenitor features of GBMs, uncover BTIC dependency on EBP, and suggest that non-oncology, low-toxicity drugs with OPC differentiation-promoting activity can be repurposed to target GBM stemness and aid in their treatment.
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Affiliation(s)
- Michael A. Sun
- The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC 27710, USA; (M.A.S.); (R.Y.); (H.L.); (W.W.); (N.R.); (K.R.); (L.H.C.); (P.K.G.); (S.T.K.); (R.E.M.); (D.D.B.); (D.M.A.)
- Department of Pathology, Duke University Medical Center, Durham, NC 27710, USA
- Pathology Graduate Program, Duke University Medical Center, Durham, NC 27710, USA
| | - Rui Yang
- The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC 27710, USA; (M.A.S.); (R.Y.); (H.L.); (W.W.); (N.R.); (K.R.); (L.H.C.); (P.K.G.); (S.T.K.); (R.E.M.); (D.D.B.); (D.M.A.)
- Department of Pathology, Duke University Medical Center, Durham, NC 27710, USA
| | - Heng Liu
- The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC 27710, USA; (M.A.S.); (R.Y.); (H.L.); (W.W.); (N.R.); (K.R.); (L.H.C.); (P.K.G.); (S.T.K.); (R.E.M.); (D.D.B.); (D.M.A.)
- Department of Pathology, Duke University Medical Center, Durham, NC 27710, USA
- Pathology Graduate Program, Duke University Medical Center, Durham, NC 27710, USA
| | - Wenzhe Wang
- The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC 27710, USA; (M.A.S.); (R.Y.); (H.L.); (W.W.); (N.R.); (K.R.); (L.H.C.); (P.K.G.); (S.T.K.); (R.E.M.); (D.D.B.); (D.M.A.)
- Department of Pathology, Duke University Medical Center, Durham, NC 27710, USA
| | - Xiao Song
- The Ken & Ruth Davee Department of Neurology, Lou and Jean Malnati Brain Tumor Institute, The Robert H. Lurie Comprehensive Cancer Center, Simpson Querrey Institute for Epigenetics, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA; (X.S.); (B.H.); (S.-Y.C.)
| | - Bo Hu
- The Ken & Ruth Davee Department of Neurology, Lou and Jean Malnati Brain Tumor Institute, The Robert H. Lurie Comprehensive Cancer Center, Simpson Querrey Institute for Epigenetics, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA; (X.S.); (B.H.); (S.-Y.C.)
| | - Nathan Reynolds
- The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC 27710, USA; (M.A.S.); (R.Y.); (H.L.); (W.W.); (N.R.); (K.R.); (L.H.C.); (P.K.G.); (S.T.K.); (R.E.M.); (D.D.B.); (D.M.A.)
- Department of Pathology, Duke University Medical Center, Durham, NC 27710, USA
| | - Kristen Roso
- The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC 27710, USA; (M.A.S.); (R.Y.); (H.L.); (W.W.); (N.R.); (K.R.); (L.H.C.); (P.K.G.); (S.T.K.); (R.E.M.); (D.D.B.); (D.M.A.)
- Department of Pathology, Duke University Medical Center, Durham, NC 27710, USA
| | - Lee H. Chen
- The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC 27710, USA; (M.A.S.); (R.Y.); (H.L.); (W.W.); (N.R.); (K.R.); (L.H.C.); (P.K.G.); (S.T.K.); (R.E.M.); (D.D.B.); (D.M.A.)
- Department of Pathology, Duke University Medical Center, Durham, NC 27710, USA
| | - Paula K. Greer
- The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC 27710, USA; (M.A.S.); (R.Y.); (H.L.); (W.W.); (N.R.); (K.R.); (L.H.C.); (P.K.G.); (S.T.K.); (R.E.M.); (D.D.B.); (D.M.A.)
- Department of Pathology, Duke University Medical Center, Durham, NC 27710, USA
| | - Stephen T. Keir
- The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC 27710, USA; (M.A.S.); (R.Y.); (H.L.); (W.W.); (N.R.); (K.R.); (L.H.C.); (P.K.G.); (S.T.K.); (R.E.M.); (D.D.B.); (D.M.A.)
- Department of Neurosurgery, Duke University Medical Center, Durham, NC 27710, USA
| | - Roger E. McLendon
- The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC 27710, USA; (M.A.S.); (R.Y.); (H.L.); (W.W.); (N.R.); (K.R.); (L.H.C.); (P.K.G.); (S.T.K.); (R.E.M.); (D.D.B.); (D.M.A.)
- Department of Pathology, Duke University Medical Center, Durham, NC 27710, USA
- Department of Neurosurgery, Duke University Medical Center, Durham, NC 27710, USA
| | - Shi-Yuan Cheng
- The Ken & Ruth Davee Department of Neurology, Lou and Jean Malnati Brain Tumor Institute, The Robert H. Lurie Comprehensive Cancer Center, Simpson Querrey Institute for Epigenetics, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA; (X.S.); (B.H.); (S.-Y.C.)
| | - Darell D. Bigner
- The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC 27710, USA; (M.A.S.); (R.Y.); (H.L.); (W.W.); (N.R.); (K.R.); (L.H.C.); (P.K.G.); (S.T.K.); (R.E.M.); (D.D.B.); (D.M.A.)
- Department of Neurosurgery, Duke University Medical Center, Durham, NC 27710, USA
| | - David M. Ashley
- The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC 27710, USA; (M.A.S.); (R.Y.); (H.L.); (W.W.); (N.R.); (K.R.); (L.H.C.); (P.K.G.); (S.T.K.); (R.E.M.); (D.D.B.); (D.M.A.)
- Department of Neurosurgery, Duke University Medical Center, Durham, NC 27710, USA
| | - Christopher J. Pirozzi
- The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC 27710, USA; (M.A.S.); (R.Y.); (H.L.); (W.W.); (N.R.); (K.R.); (L.H.C.); (P.K.G.); (S.T.K.); (R.E.M.); (D.D.B.); (D.M.A.)
- Department of Pathology, Duke University Medical Center, Durham, NC 27710, USA
| | - Yiping He
- The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC 27710, USA; (M.A.S.); (R.Y.); (H.L.); (W.W.); (N.R.); (K.R.); (L.H.C.); (P.K.G.); (S.T.K.); (R.E.M.); (D.D.B.); (D.M.A.)
- Department of Pathology, Duke University Medical Center, Durham, NC 27710, USA
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Church MK, Canonica GW, Kuna P, Maurer M, Mösges R, Novak Z, Papadopoulos NG, Del Rio PR. An international Delphi study on the burden of allergic rhinoconjunctivitis and urticaria and the role of bilastine among current treatment options. Expert Rev Clin Immunol 2023:1-8. [PMID: 37191185 DOI: 10.1080/1744666x.2023.2214729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
BACKGROUND allergic rhinoconjunctivitis and chronic urticaria are common histamine-driven diseases, exerting detrimental effects on cognitive functions, sleep, daily activities and quality of life. Non-sedating second-generation H1-antihistamines are the first line treatment of choice. Aim of the study was to define the role of bilastine among second-generation H1-antihistamines in the treatment of allergic rhinoconjunctivitis and urticaria in patients of different ages. METHODS an international Delphi study was carried out to assess consensus among experts from 17 European and extra-European countries on three main topics: 1) Burden of disease; 2) Current treatment options; 3) Specific characteristics of bilastine among second generation antihistamines. RESULTS here, we present the results obtained for a selection of 15 out of 27 consensus statements, focused on disease burden, role of second-generation antihistamines and bilastine profile. The rate of concordance was ≥ 98% for 4 statements, ≥ 96% for 6, ≥ 94% for 3, and ≥ 90% for 2. CONCLUSIONS the high degree of agreement obtained suggests a wide awareness of the burden of allergic rhinoconjunctivitis and chronic urticaria among experts from all over the world and reflect a broad consensus on the role of second generation antihistamines in general and of bilastine in particular for their management.
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Affiliation(s)
- M K Church
- Institute of Allergology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - G W Canonica
- Humanitas University, Via Rita Levi Montalcini 4 Pieve Emanuele,, 20090, Milan, Italy
- Personalized Medicine Asthma & Allergy IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - P Kuna
- Division of Internal Medicine, Asthma and Allergy, Medical University of Lodz, Poland
| | - M Maurer
- Institute of Allergology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - R Mösges
- IMSB, Medical Faculty, University at Cologne, and ClinCompetence Cologne GmbH, Cologne, Germany
| | - Z Novak
- Pediatric Department, University of Szeged, Hungary
| | - N G Papadopoulos
- Allergy Dpt, 2nd Pediatric Clinic, University of Athens, Athens, Greece
| | - P Rodriguez Del Rio
- Hospital Universitario Infantil Niño Jesus, Allergy Department. Madrid, Spain
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Wong TS, Li G, Li S, Gao W, Chen G, Gan S, Zhang M, Li H, Wu S, Du Y. G protein-coupled receptors in neurodegenerative diseases and psychiatric disorders. Signal Transduct Target Ther 2023; 8:177. [PMID: 37137892 PMCID: PMC10154768 DOI: 10.1038/s41392-023-01427-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 02/17/2023] [Accepted: 03/30/2023] [Indexed: 05/05/2023] Open
Abstract
Neuropsychiatric disorders are multifactorial disorders with diverse aetiological factors. Identifying treatment targets is challenging because the diseases are resulting from heterogeneous biological, genetic, and environmental factors. Nevertheless, the increasing understanding of G protein-coupled receptor (GPCR) opens a new possibility in drug discovery. Harnessing our knowledge of molecular mechanisms and structural information of GPCRs will be advantageous for developing effective drugs. This review provides an overview of the role of GPCRs in various neurodegenerative and psychiatric diseases. Besides, we highlight the emerging opportunities of novel GPCR targets and address recent progress in GPCR drug development.
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Affiliation(s)
- Thian-Sze Wong
- Kobilka Institute of Innovative Drug Discovery, Shenzhen Key Laboratory of Steroid Drug Discovery and Development, School of Medicine, The Chinese University of Hong Kong, 518172, Shenzhen, Guangdong, China
- School of Medicine, Tsinghua University, 100084, Beijing, China
| | - Guangzhi Li
- Institute of Urology, The Affiliated Luohu Hospital of Shenzhen University, Shenzhen University, 518000, Shenzhen, Guangdong, China
| | - Shiliang Li
- Shanghai Key Laboratory of New Drug Design, School of Pharmacy, East China University of Science and Technology, 200237, Shanghai, China
- Innovation Center for AI and Drug Discovery, East China Normal University, 200062, Shanghai, China
| | - Wei Gao
- Kobilka Institute of Innovative Drug Discovery, Shenzhen Key Laboratory of Steroid Drug Discovery and Development, School of Medicine, The Chinese University of Hong Kong, 518172, Shenzhen, Guangdong, China
- Innovation Center for AI and Drug Discovery, East China Normal University, 200062, Shanghai, China
| | - Geng Chen
- Kobilka Institute of Innovative Drug Discovery, Shenzhen Key Laboratory of Steroid Drug Discovery and Development, School of Medicine, The Chinese University of Hong Kong, 518172, Shenzhen, Guangdong, China
| | - Shiyi Gan
- Kobilka Institute of Innovative Drug Discovery, Shenzhen Key Laboratory of Steroid Drug Discovery and Development, School of Medicine, The Chinese University of Hong Kong, 518172, Shenzhen, Guangdong, China
| | - Manzhan Zhang
- Shanghai Key Laboratory of New Drug Design, School of Pharmacy, East China University of Science and Technology, 200237, Shanghai, China
- Innovation Center for AI and Drug Discovery, East China Normal University, 200062, Shanghai, China
| | - Honglin Li
- Shanghai Key Laboratory of New Drug Design, School of Pharmacy, East China University of Science and Technology, 200237, Shanghai, China.
- Innovation Center for AI and Drug Discovery, East China Normal University, 200062, Shanghai, China.
| | - Song Wu
- Institute of Urology, The Affiliated Luohu Hospital of Shenzhen University, Shenzhen University, 518000, Shenzhen, Guangdong, China.
- Department of Urology, South China Hospital, Health Science Center, Shenzhen University, 518116, Shenzhen, Guangdong, China.
| | - Yang Du
- Kobilka Institute of Innovative Drug Discovery, Shenzhen Key Laboratory of Steroid Drug Discovery and Development, School of Medicine, The Chinese University of Hong Kong, 518172, Shenzhen, Guangdong, China.
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Lopresti BJ, Royse SK, Mathis CA, Tollefson SA, Narendran R. Beyond monoamines: I. Novel targets and radiotracers for Positron emission tomography imaging in psychiatric disorders. J Neurochem 2023; 164:364-400. [PMID: 35536762 DOI: 10.1111/jnc.15615] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 10/18/2022]
Abstract
With the emergence of positron emission tomography (PET) in the late 1970s, psychiatry had access to a tool capable of non-invasive assessment of human brain function. Early applications in psychiatry focused on identifying characteristic brain blood flow and metabolic derangements using radiotracers such as [15 O]H2 O and [18 F]FDG. Despite the success of these techniques, it became apparent that more specific probes were needed to understand the neurochemical bases of psychiatric disorders. The first neurochemical PET imaging probes targeted sites of action of neuroleptic (dopamine D2 receptors) and psychoactive (serotonin receptors) drugs. Based on the centrality of monoamine dysfunction in psychiatric disorders and the measured success of monoamine-enhancing drugs in treating them, the next 30 years witnessed the development of an armamentarium of PET radiopharmaceuticals and imaging methodologies for studying monoamines. Continued development of monoamine-enhancing drugs over this time however was less successful, realizing only modest gains in efficacy and tolerability. As patent protection for many widely prescribed and profitable psychiatric drugs lapsed, drug development pipelines shifted away from monoamines in search of novel targets with the promises of improved efficacy, or abandoned altogether. Over this period, PET radiopharmaceutical development activities closely paralleled drug development priorities resulting in the development of new PET imaging agents for non-monoamine targets. Part one of this review will briefly survey novel PET imaging targets with relevance to the field of psychiatry, which include the metabotropic glutamate receptor type 5 (mGluR5), purinergic P2 X7 receptor, type 1 cannabinoid receptor (CB1 ), phosphodiesterase 10A (PDE10A), and describe radiotracers developed for these and other targets that have matured to human subject investigations. Current limitations of the targets and techniques will also be discussed.
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Affiliation(s)
- Brian J Lopresti
- Departments of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Sarah K Royse
- Departments of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Chester A Mathis
- Departments of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Savannah A Tollefson
- Departments of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Rajesh Narendran
- Departments of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,Departments of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Wolfson AR, Wong D, Abrams EM, Waserman S, Sussman GL. Diphenhydramine: Time to Move on? THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:3124-3130. [PMID: 35999169 DOI: 10.1016/j.jaip.2022.07.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/11/2022] [Accepted: 07/20/2022] [Indexed: 12/14/2022]
Abstract
Diphenhydramine is one of the most widely available, longest-used antihistamine medications but has many side effects including sedation and risk of toxicity in overdose including cardiac toxicity. It is frequently inappropriately used when newer, more favorable antihistamine medications are available. Second-generation antihistamines are also widely available and affordable, with many of the same desired effects as diphenhydramine and fewer, if any, of the undesirable side effects. Because of the negative side effects and wide availability of alternative antihistamine medications, it is definitively time to move on from diphenhydramine.
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Affiliation(s)
- Anna R Wolfson
- Harvard Medical School, Boston, Mass; Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass.
| | - Dennis Wong
- Division of Clinical Immunology and Allergy, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Elissa M Abrams
- University of Manitoba, Department of Pediatrics, Section of Allergy and Clinical Immunology, Winnipeg, MB, Canada; University of British Columbia, Department of Pediatrics, Division of Allergy and Immunology, Vancouver, BC, Canada
| | - Susan Waserman
- Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Gordon L Sussman
- Division of Clinical Immunology and Allergy, Department of Medicine, University of Toronto, Toronto, ON, Canada
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Van Gastel A. Drug-Induced Insomnia and Excessive Sleepiness. Sleep Med Clin 2022; 17:471-484. [PMID: 36150808 DOI: 10.1016/j.jsmc.2022.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Undesirable side effects of insomnia and/or sleepiness may occur with many prescribed drugs, psychotropics as well as non-psychotropics. These central nervous system effects can be explained by the interactions of the drug with any of the numerous neurotransmitters and receptors that are involved in sleep and wakefulness. Also a close - sometimes bidirectional - relationship between disease and (disturbed) sleep/wakefulness is often present e.g. in chronic pain; drug effects may lead this vicious circle in both ways. Besides the importance for health and quality of life, effects on sleep or waking function can be a potential source of non-compliance.
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Affiliation(s)
- Ann Van Gastel
- Multidisciplinary Sleep Disorders Centre and University Department of Psychiatry, Antwerp University Hospital, Drie Eikenstraat 655, 2650 Edegem, Antwerp, Belgium; Faculty of Medicine and Health Sciences, Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp (UA), Campus Drie Eiken, Universiteitsplein 1, 2610 Wilrijk, Antwerp, Belgium.
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Abstract
PURPOSE OF REVIEW This article presents an update on the clinical pharmacology, mechanisms of action, and safety of second generation antihistamines (SGAHs). RECENT FINDINGS Recent research has shown the efficacy and good tolerance of SGAHs supporting its indication as first line medications for the treatment of allergic rhinoconjunctivitis and urticaria. SUMMARY The information contained in this review is relevant for the correct utilization of SGAHs by practicing physicians who take care of these highly prevalent clinical disorders.
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Nakamura T, Hiraoka K, Harada R, Matsuzawa T, Ishikawa Y, Funaki Y, Yoshikawa T, Tashiro M, Yanai K, Okamura N. Brain histamine H 1 receptor occupancy after oral administration of desloratadine and loratadine. Pharmacol Res Perspect 2019; 7:e00499. [PMID: 31338198 PMCID: PMC6624455 DOI: 10.1002/prp2.499] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/30/2019] [Accepted: 06/10/2019] [Indexed: 01/27/2023] Open
Abstract
Some histamine H1 receptor (H1R) antagonists induce adverse sedative reactions caused by blockade of histamine transmission in the brain. Desloratadine is a second-generation antihistamine for treatment of allergic disorders. Its binding to brain H1Rs, which is the basis of sedative property of antihistamines, has not been examined previously in the human brain by positron emission tomography (PET). We examined brain H1R binding potential ratio (BPR), H1R occupancy (H1RO), and subjective sleepiness after oral desloratadine administration in comparison to loratadine. Eight healthy male volunteers underwent PET imaging with [11C]-doxepin, a PET tracer for H1Rs, after a single oral administration of desloratadine (5 mg), loratadine (10 mg), or placebo in a double-blind crossover study. BPR and H1RO in the cerebral cortex were calculated, and plasma concentrations of loratadine and desloratadine were measured. Subjective sleepiness was quantified by the Line Analogue Rating Scale (LARS) and the Stanford Sleepiness Scale (SSS). BPR was significantly lower after loratadine administration than after placebo (0.504 ± 0.074 vs 0.584 ± 0.059 [mean ± SD], P < 0.05), but BPR after desloratadine administration was not significantly different from BPR after placebo (0.546 ± 0.084 vs 0.584 ± 0.059, P = 0.250). The plasma concentration of loratadine was negatively correlated with BPR in subjects receiving loratadine, but that of desloratadine was not correlated with BPR. Brain H1ROs after desloratadine and loratadine administration were 6.47 ± 10.5% and 13.8 ± 7.00%, respectively (P = 0.103). Subjective sleepiness did not significantly differ among subjects receiving the two antihistamines and placebo. At therapeutic doses, desloratadine did not bind significantly to brain H1Rs and did not induce any significant sedation.
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Affiliation(s)
- Tadaho Nakamura
- Division of Pharmacology, Faculty of MedicineTohoku Medical and Pharmaceutical UniversitySendaiJapan
- Department of PharmacologyTohoku University Graduate School of MedicineSendaiJapan
| | - Kotaro Hiraoka
- Cyclotron and Radioisotope CenterTohoku UniversitySendaiJapan
| | - Ryuichi Harada
- Department of PharmacologyTohoku University Graduate School of MedicineSendaiJapan
| | - Takuro Matsuzawa
- Department of PharmacologyTohoku University Graduate School of MedicineSendaiJapan
| | - Yoichi Ishikawa
- Cyclotron and Radioisotope CenterTohoku UniversitySendaiJapan
| | | | - Takeo Yoshikawa
- Department of PharmacologyTohoku University Graduate School of MedicineSendaiJapan
| | - Manabu Tashiro
- Cyclotron and Radioisotope CenterTohoku UniversitySendaiJapan
| | - Kazuhiko Yanai
- Department of PharmacologyTohoku University Graduate School of MedicineSendaiJapan
| | - Nobuyuki Okamura
- Division of Pharmacology, Faculty of MedicineTohoku Medical and Pharmaceutical UniversitySendaiJapan
- Department of PharmacologyTohoku University Graduate School of MedicineSendaiJapan
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Antihistamines for Allergic Rhinitis Treatment from the Viewpoint of Nonsedative Properties. Int J Mol Sci 2019; 20:ijms20010213. [PMID: 30626077 PMCID: PMC6337346 DOI: 10.3390/ijms20010213] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 12/26/2018] [Accepted: 12/29/2018] [Indexed: 12/21/2022] Open
Abstract
Antihistamines targeting the histamine H1 receptor play an important role in improving and maintaining the quality of life of patients with allergic rhinitis. For more effective and safer use of second-generation drugs, which are recommended by various guidelines, a classification based on their detailed characteristics is necessary. Antihistamines for first-line therapy should not have central depressant/sedative activities. Sedative properties (drowsiness and impaired performance) are associated with the inhibition of central histamine neurons. Brain H1 receptor occupancy (H1RO) is a useful index shown to be correlated with indices based on clinical findings. Antihistamines are classified into non-sedating (<20%), less-sedating (20–50%), and sedating (≥50%) groups based on H1RO. Among the non-sedating group, fexofenadine and bilastine are classified into “non-brain-penetrating antihistamines” based on the H1RO. These two drugs have many common chemical properties. However, bilastine has more potent binding affinity to the H1 receptor, and its action tends to last longer. In well-controlled studies using objective indices, bilastine does not affect psychomotor or driving performance even at twice the usual dose (20 mg). Upon selecting antihistamines for allergic rhinitis, various situations should be taken into our consideration. This review summarizes that the non-brain-penetrating antihistamines should be chosen for the first-line therapy of mild allergic rhinitis.
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Garg A, Cranwell A, Chan D. Cetirizine - how much is too much? JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2018. [DOI: 10.1002/jppr.1358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Alka Garg
- Women's and Children's Hospital Adelaide; North Adelaide Australia
| | | | - Damien Chan
- Women's and Children's Hospital Adelaide; North Adelaide Australia
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Yanai K, Yoshikawa T, Yanai A, Nakamura T, Iida T, Leurs R, Tashiro M. The clinical pharmacology of non-sedating antihistamines. Pharmacol Ther 2017; 178:148-156. [PMID: 28457804 DOI: 10.1016/j.pharmthera.2017.04.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
We previously reported on brain H1 receptor occupancy measurements of antihistamines in human brain using [11C]doxepin and positron emission tomography (PET). We proposed the use of brain H1 receptor occupancy to classify antihistamines objectively into three categories of sedating, less-sedating, and non-sedating antihistamines according to their sedative effects. Non-sedating antihistamines are recommended for the treatment of allergies such as pollinosis and atopic dermatitis because of their low penetration into the central nervous system. Physicians and pharmacists are responsible for fully educating patients about the risks of sedating antihistamines from pharmacological points of view. If a sedating antihistamine must be prescribed, its sedative effects should be thoroughly considered before choosing the drug. Non-sedating antihistamines should be preferentially used whenever possible as most antihistamines are equally efficacious, while adverse effects of sedating antihistamines can be serious. This review summarizes the pharmacological properties of clinically useful non-sedating antihistamines from the perspective of histamine function in the CNS.
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Affiliation(s)
- Kazuhiko Yanai
- Department of Pharmacology, Tohoku University School of Medicine, Sendai 980-8575, Japan; Cyclotron and Radioisotope Center, Tohoku University, Sendai 980-8578, Japan
| | - Takeo Yoshikawa
- Department of Pharmacology, Tohoku University School of Medicine, Sendai 980-8575, Japan.
| | - Ai Yanai
- Department of Pharmacology, Tohoku University School of Medicine, Sendai 980-8575, Japan
| | - Tadaho Nakamura
- Department of Pharmacology, Tohoku Medical and Pharmaceutical University, Sendai 981-8558, Japan
| | - Tomomitsu Iida
- Department of Pharmacology, Tohoku University School of Medicine, Sendai 980-8575, Japan
| | - Rob Leurs
- Amsterdam Institute of Molecules, Medicines and Systems, Department of Medicinal Chemistry, Vrije Universiteit Amsterdam, The Netherlands
| | - Manabu Tashiro
- Cyclotron and Radioisotope Center, Tohoku University, Sendai 980-8578, Japan
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Togawa M, Yamaya H, Rodríguez M, Nagashima H. Pharmacokinetics, Pharmacodynamics and Population Pharmacokinetic/Pharmacodynamic Modelling of Bilastine, a Second-Generation Antihistamine, in Healthy Japanese Subjects. Clin Drug Investig 2017; 36:1011-1021. [PMID: 27498100 PMCID: PMC5107204 DOI: 10.1007/s40261-016-0447-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVES Bilastine is a novel second-generation antihistamine for the symptomatic treatment of allergic rhinitis and urticaria. The objective of this study was to evaluate the pharmacokinetics, pharmacodynamics, and tolerability of bilastine following single and multiple oral doses in healthy Japanese subjects. The pharmacokinetic and pharmacodynamic profiles were compared with those reported in Caucasian subjects. METHODS In a single-blind, randomized, placebo-controlled, parallel-group, single- and multiple-ascending dose study, bilastine tablets were administered at single doses of 10, 20, and 50 mg (Part I), and once daily for 14 days at 20 and 50 mg (Part II). RESULTS After single oral doses, maximum plasma concentrations (C max) were reached at 1.0-1.5 h postdose. Plasma exposure [C max and area under the plasma concentration-time curve (AUC)] increased dose-proportionally at single doses of 10-50 mg. In repeated-dose administration, no remarkable differences were observed between Day 1 and Day 14 for C max or AUC. For inhibitory effects on wheal and flare response, bilastine 20 and 50 mg showed significant inhibition from 1.5 h after administration as compared with placebo, and the significant effect persisted for 24 h after administration. The rates of adverse events (AEs) were comparable between bilastine and placebo in both Part I and Part II. In addition, no dose- or administration period-dependent tendency of increase in rate of AEs or worsening of severity was observed. CONCLUSION Bilastine exhibits similar single- and multiple-dose pharmacokinetic and pharmacodynamic characteristics in healthy Japanese subjects compared with those observed in Caucasian subjects in previous studies.
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Affiliation(s)
- Michinori Togawa
- Project Management Department, TAIHO Pharmaceutical Co., Ltd., 1-2-4, Uchikanda, Chiyoda-ku, Tokyo, 101-0047, Japan.
| | - Hidetoshi Yamaya
- Tsukuba Research Center, TAIHO Pharmaceutical Co., Ltd., 3 Okubo, Tsukuba, Ibaraki, 300-2611, Japan
| | - Mónica Rodríguez
- Drug Modeling and Consulting, DynaKin, S.L. Bizkaia Technology Park, 48160, Derio, Vizcaya, Spain
| | - Hirotaka Nagashima
- Shinjuku Research Park Clinic, 1-22-17, Hyakunin-cho, Shinjuku-ku, Tokyo, 169-0073, Japan
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Kanamitsu K, Nozaki Y, Nagaya Y, Sugiyama Y, Kusuhara H. Quantitative prediction of histamine H1 receptor occupancy by the sedative and non-sedative antagonists in the human central nervous system based on systemic exposure and preclinical data. Drug Metab Pharmacokinet 2016; 32:135-144. [PMID: 28190755 DOI: 10.1016/j.dmpk.2016.11.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 10/28/2016] [Accepted: 11/07/2016] [Indexed: 12/15/2022]
Abstract
Significant histamine H1 receptor occupation in the central nervous system (CNS) is associated with sedation. Here we examined the time profiles of the H1 receptor occupancy (RO) in the CNS using sedative (diphenhydramine and ketotifen) and non-sedative (bepotastine and olopatadine) antagonists at their therapeutic doses by integrating in vitro and animal data. A pharmacokinetic model was constructed to associate plasma concentrations and receptor binding in the brain. Dissociation and association rate constants with the H1 receptor and plasma and brain unbound fractions were determined in vitro. Passive and active clearances across the blood-brain barrier (BBB) were estimated based on physicochemical properties and microdialysis studies in mice and monkeys. The estimated RO values were comparable with the reported values determined at time to maximum concentration (Tmax) of plasma by positron-emission tomography in humans. The simulation suggested that the predicted maximum ROs by bepotastine and olopatadine were greater than the reported values. Sensitivity analysis showed that active transport across BBB had a significant impact on the RO duration of the H1 antagonists examined. The present study demonstrated that modeling and simulation permits a reasonable RO estimation in the human CNS. Our findings will facilitate the development of CNS-acting drugs.
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Affiliation(s)
- Kayoko Kanamitsu
- Laboratory of Molecular Pharmacokinetics, Graduate School of Pharmaceutical Sciences, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan; Tokushima Research Institute, Otsuka Pharmaceutical Co., Ltd., 463-10 Kagasuno, Kawauchi-cho, Tokushima-shi, Tokushima, 771-0192, Japan
| | - Yoshitane Nozaki
- Drug Metabolism and Pharmacokinetics Tsukuba, Tsukuba Research Laboratories, Eisai Co., Ltd., 5-1-3 Tokodai, Tsukuba-shi, Ibaraki, 300-2635, Japan
| | - Yoko Nagaya
- Drug Metabolism and Pharmacokinetics Tsukuba, Tsukuba Research Laboratories, Eisai Co., Ltd., 5-1-3 Tokodai, Tsukuba-shi, Ibaraki, 300-2635, Japan
| | - Yuichi Sugiyama
- Sugiyama Laboratory, RIKEN Innovation Center, Research Cluster for Innovation, RIKEN, 1-7-22 Suehiro-cho, Tsurumi-ku, Yokohama-shi, Kanagawa, 230-0045, Japan
| | - Hiroyuki Kusuhara
- Laboratory of Molecular Pharmacokinetics, Graduate School of Pharmaceutical Sciences, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
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Inami A, Matsuda R, Grobosch T, Komamura H, Takeda K, Yamada Y, Miyake M, Hiraoka K, Maurer M, Yanai K, Tashiro M. A simulated car-driving study on the effects of acute administration of levocetirizine, fexofenadine, and diphenhydramine in healthy Japanese volunteers. Hum Psychopharmacol 2016; 31:167-77. [PMID: 26999510 DOI: 10.1002/hup.2524] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Accepted: 01/18/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Antihistamines are often used for treating allergic rhinitis. However, many older antihistamines cause sedative side effects. The sedative effects of antihistamines on car-driving have been investigated. This has not been investigated for levocetirizine, a new-generation antihistamine, in Asian populations, and so we evaluated its sedative effects in healthy Japanese subjects. METHODS In this double-blind, placebo-controlled, four-way crossover study, healthy volunteers received single doses of levocetirizine 5 mg, fexofenadine 60 mg, diphenhydramine 50 mg, and placebo at intervals of at least 6 days. Simple brake reaction time and choice brake reaction time task (CBRT), a lateral tracking (LT) task, and a multiple task, a mixture of CBRT and LT task, were used to compare driving performance between the four drugs. Subjective sedation was also assessed. RESULTS The simple brake reaction time and CBRT, and the CBRT component of the multiple task, did not show any significant differences between the drugs. In contrast, the LT, both as a single parameter and as a component of the multiple task, showed significant differences between diphenhydramine and the newer-generation antihistamines in a manner that corresponds with subjective sedation. CONCLUSIONS Levocetirizine and fexofenadine did not impair psychomotor performance in subjects performing simulated car-driving tasks, while diphenhydramine did impair psychomotor performance in the subjects. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Akie Inami
- Division of Cyclotron Nuclear Medicine, Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan
| | - Rin Matsuda
- Division of Cyclotron Nuclear Medicine, Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan
| | - Thomas Grobosch
- Department of Dermatology and Allergy, Allergie-Centrum-Charité/ECARF, Charité - Universitätsmedizin, Berlin, Germany
| | - Hiroshi Komamura
- Division of Cyclotron Nuclear Medicine, Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan
| | - Kazuko Takeda
- Division of Cyclotron Nuclear Medicine, Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan
| | - Yusuke Yamada
- Division of Cyclotron Nuclear Medicine, Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan
| | - Masayasu Miyake
- Division of Cyclotron Nuclear Medicine, Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan
| | - Kotaro Hiraoka
- Division of Cyclotron Nuclear Medicine, Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan
| | - Marcus Maurer
- Department of Dermatology and Allergy, Allergie-Centrum-Charité/ECARF, Charité - Universitätsmedizin, Berlin, Germany
| | - Kazuhiko Yanai
- Division of Cyclotron Nuclear Medicine, Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan.,Department of Pharmacology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Manabu Tashiro
- Division of Cyclotron Nuclear Medicine, Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan
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Wang XY, Lim-Jurado M, Prepageran N, Tantilipikorn P, Wang DY. Treatment of allergic rhinitis and urticaria: a review of the newest antihistamine drug bilastine. Ther Clin Risk Manag 2016; 12:585-97. [PMID: 27110120 PMCID: PMC4835134 DOI: 10.2147/tcrm.s105189] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Allergic rhinitis and urticaria are common allergic diseases that may have a major negative impact on patients' quality of life. Bilastine, a novel new-generation antihistamine that is highly selective for the H1 histamine receptor, has a rapid onset and prolonged duration of action. This agent does not interact with the cytochrome P450 system and does not undergo significant metabolism in humans, suggesting that it has very low potential for drug-drug interactions, and does not require dose adjustment in renal impairment. As bilastine is not metabolized and is excreted largely unchanged, hepatic impairment is not expected to increase systemic exposure above the drug's safety margin. Bilastine has demonstrated similar efficacy to cetirizine and desloratadine in patients with seasonal allergic rhinitis and, in a Vienna Chamber study, a potentially longer duration of action than fexofenadine in patients with asymptomatic seasonal allergic rhinitis. It has also shown significant efficacy (similar to that of cetirizine) and safety in the long-term treatment of perennial allergic rhinitis. Bilastine showed similar efficacy to levocetirizine in patients with chronic spontaneous urticaria and can be safely used at doses of up to fourfold higher than standard dosage (80 mg once daily). The fourfold higher than standard dose is specified as an acceptable second-line treatment option for urticaria in international guidelines. Bilastine is generally well tolerated, both at standard and at supratherapeutic doses, appears to have less sedative potential than other second-generation antihistamines, and has no cardiotoxicity. Based on its pharmacokinetic properties, efficacy, and tolerability profile, bilastine will be valuable in the management of allergic rhinitis and urticaria.
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Affiliation(s)
- Xue Yan Wang
- Department of Allergy, Beijing Shijitan Hospital, Capital Medical University, Beijing, People's Republic of China
| | | | - Narayanan Prepageran
- Department of Otorhinolaryngology, Head & Neck Surgery, University Malaya Faculty of Medicine, Kuala Lumpur, Malaysia
| | - Pongsakorn Tantilipikorn
- Rhinology and Allergy Division, Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - De Yun Wang
- Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Kim D, Lee J, Lee S, Park J, Lee D. Predicting unintended effects of drugs based on off-target tissue effects. Biochem Biophys Res Commun 2015; 469:399-404. [PMID: 26626077 DOI: 10.1016/j.bbrc.2015.11.095] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 11/22/2015] [Indexed: 11/16/2022]
Abstract
Unintended effects of drugs can be caused by various mechanisms. Conventional analysis of unintended effects has focused on the target proteins of drugs. However, an interaction with off-target tissues of a drug might be one of the unintended effect-related mechanisms. We propose two processes to predict a drug's unintended effects by off-target tissue effects: 1) identification of a drug's off-target tissue and; 2) tissue protein - symptom relation identification (tissue protein - symptom matrix). Using this method, we predicted that 1,177 (10.7%) side-effects were related to off-target tissue effects in 11,041 known side-effects. Off-target tissues and unintended effects of successful repositioning drugs were also predicted. The effectiveness of relations of the proposed tissue protein - symptom matrix were evaluated by using the literature mining method. We predicted unintended effects of drugs as well as those effect-related off-target tissues. By using our prediction, we are able to reduce drug side-effects on off-target tissues and provide a chance to identify new indications of drugs of interest.
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Affiliation(s)
- Docyong Kim
- Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Jaehyun Lee
- Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Sunjae Lee
- Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Junseok Park
- Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Doheon Lee
- Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea; Bio-Synergy Research Center, Daejeon, Republic of Korea.
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Farré M, Pérez-Mañá C, Papaseit E, Menoyo E, Pérez M, Martin S, Bullich S, Rojas S, Herance JR, Trampal C, Labeaga L, Valiente R. Bilastine vs. hydroxyzine: occupation of brain histamine H1 -receptors evaluated by positron emission tomography in healthy volunteers. Br J Clin Pharmacol 2015; 78:970-80. [PMID: 24833043 PMCID: PMC4243871 DOI: 10.1111/bcp.12421] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 05/08/2014] [Indexed: 12/16/2022] Open
Abstract
AIM A close correlation exists between positron emission tomography (PET)-determined histamine H1 -receptor occupancy (H1 RO) and the incidence of sedation. Antihistamines with H1 RO <20% are classified as non-sedating. The objective was to compare the H1 RO of bilastine, a second generation antihistamine, with that of hydroxyzine. METHODS This randomized, double-blind, crossover study used PET imaging with [(11) C]-doxepin to evaluate H1 RO in 12 healthy males (mean age 26.2 years), after single oral administration of bilastine (20 mg), hydroxyzine (25 mg) or placebo. Binding potentials and H1 ROs were calculated in five cerebral cortex regions of interest: frontal, occipital, parietal, temporal, insula. Plasma bilastine concentrations, subjective sedation (visual analogue scale), objective psychomotor performance (digital symbol substitution test), physiological variables and safety (adverse events, AEs), were also evaluated. RESULTS The mean binding potential of all five regions of interest (total binding potential) was significantly greater with bilastine than hydroxyzine (mean value 0.26 vs. 0.13, P < 0.01; mean difference and 95% CI -0.130 [-0.155, 0.105]). There was no significant difference between bilastine and placebo. Overall H1 RO by bilastine was significantly lower than that by hydroxyzine (mean value -3.92% vs. 53.95%, P < 0.01; mean difference and 95% CI 57.870% [42.664%, 73.075%]). There was no significant linear relationship between individual bilastine plasma concentrations and total binding potential values. No significant between-treatment differences were observed for sedation and psychomotor performance. Twenty-six non-serious AEs were reported. Sleepiness or sedation was not reported with bilastine but appeared in some subjects with hydroxyzine. CONCLUSIONS A single oral dose of bilastine 20 mg had minimal H1 RO, was not associated with subjective sedation or objective impairment of psychomotor performance and was devoid of treatment-related sedative AEs, thus satisfying relevant subjective, objective and PET criteria as a non-sedating antihistamine.
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Affiliation(s)
- Magí Farré
- Human Pharmacology and Neuroscience Research Unit, Hospital del Mar Medical Research Institute-IMIM, and Universidad Autónoma de Barcelona-UAB, Barcelona, Spain
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Anoush M, Mohammad Khani MR. Evaluating the Anti-nociceptive and Anti-inflammatory Effects of Ketotifen and Fexofenadine in Rats. Adv Pharm Bull 2015; 5:217-22. [PMID: 26236660 DOI: 10.15171/apb.2015.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 07/20/2014] [Accepted: 07/21/2014] [Indexed: 11/09/2022] Open
Abstract
PURPOSE As H1 and H3 receptors' roles has been defined in peripheral pains in some papers and because histamine is known for its role in inflammatory responses; this study investigated the possible analgesic and anti-inflammatory effects of ketotifen and fexofenadine as relatively safe long acting anti histamines in both chronic chemical pain and acute inflammation in rats. METHODS In this study, male Sprague-Dawley rats weighing 225-250 grams were used. In order to evaluate the chemical chronic pain, sub-plantar injection of formalin applied and the pain scores were recorded every 15 seconds during 60 minutes. Carrageenan injection to the right hind paw was used for induction of acute inflammation and the paw edema was measured every 60 minutes for 4 hours. RESULTS Based on the results, both ketotifen and fexofenadine were able to significantly diminish chemical acute and chronic pain as well as inflammation in comparison with the control group and the effects were acceptable according to the standard treatment. Both effects for fexofenadine started later than those of ketotifen. CONCLUSION According to the outcomes of the study, ketotifen and fexofenadine demonstrated significant analgesic and anti-inflammatory characteristics in both models of chemical pain and acute inflammation in laboratory animals.
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Affiliation(s)
- Mahdieh Anoush
- Department of Pharmacology& Toxicology, School of Pharmacy, Zanjan University of Medical Sciences, Znjan, Iran. ; Applied Drug Research Center, Zanjan University of Medical Sciences, Znjan, Iran
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Central nervous system effects of the second-generation antihistamines marketed in Japan--review of inter-drug differences using the proportional impairment ratio (PIR)-. PLoS One 2014; 9:e114336. [PMID: 25501360 PMCID: PMC4264760 DOI: 10.1371/journal.pone.0114336] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Accepted: 11/08/2014] [Indexed: 11/19/2022] Open
Abstract
Background Second-generation antihistamines (AHs) have, in general, fewer sedative effects than the first-generation. However, important inter-drug differences remain in the degree of cognitive and/or psychomotor impairment. The extent to which a particular compound causes disruption can be conveniently compared, to all other AHs, using the Proportional Impairment Ratio (PIR). Although the PIR can differentiate the relative impairment caused by individual drugs, there is no indication of the reliability of the ratios obtained. Objective To calculate the PIRs –together with 95% confidence intervals (CIs), as an index of reliability– and compare AHs currently, or soon to be, available in Japan, with respect to their intrinsic capacity to cause impairment. Methods Results from studies of cetirizine, desloratadine, ebastine, fexofenadine, levocetirizine, loratadine, mequitazine, and olopatadine were included in the PIR calculations. All data utilised came from crossover studies in healthy volunteers which were randomised and placebo and positive-internal controlled. Existing databases from studies reporting the sedative effects of AHs on objective (speed, accuracy, memory) and subjective (feeling) psychometrics were augmented, via results from suitable studies published after the previous reviews. The null value for a PIR was one. Results A total of 45 studies were finally included for this review. Of the AHs assessed, fexofenadine, ebastine, and levocetirizine showed a PIR for objective tests of 0. However, only fexofenadine (PIR = 0.49) had an upper limit of the 95% CI of less than 1. Fexofenadine, levocetirizine, desloratadine, olopatadine, loratadine, and mequitazine all had a PIR for subjective ratings of 0, but the upper limits of the 95% CIs were all in excess of 1, although fexofenadine (PIR = 2.57) was the lowest. Conclusions The results show that there are differences between second-generation AHs in the extent of sedation produced. However, subjective ratings indicate that patients may not necessarily be aware of this.
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Hiraoka K, Tashiro M, Grobosch T, Maurer M, Oda K, Toyohara J, Ishii K, Ishiwata K, Yanai K. Brain histamine H1 receptor occupancy measured by PET after oral administration of levocetirizine, a non-sedating antihistamine. Expert Opin Drug Saf 2014; 14:199-206. [PMID: 25466429 DOI: 10.1517/14740338.2015.989831] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Histamine H1 receptor (H1R) antagonists often have sedative side effects, which are caused by the blockade of the neural transmission of the histaminergic neurons. We examined the brain H1R occupancy (H1RO) and the subjective sleepiness of levocetirizine, a new second-generation antihistamine, comparing fexofenadine, another non-sedating antihistamine, as a negative active control. METHODS Eight healthy volunteers underwent positron emission tomography (PET) imaging with [(11)C]doxepin, a PET tracer that specifically binds to H1Rs, after a single oral administration of levocetirizine (5 mg), fexofenadine (60 mg) or placebo in a double-blind crossover study. Binding potential ratios and H1ROs in the cerebral cortices regions were calculated using placebo. Subjective sleepiness was assessed with the Line Analogue Rating Scale and the Stanford Sleepiness Scale. RESULTS There was no significant difference between the mean brain H1RO after levocetirizine administration (8.1%; 95% CI: -9.8 to 26.0%) and fexofenadine administration (-8.0%; 95% CI: -26.7 to 10.6%). Similarly, subjective sleepiness was not significantly different between the two antihistamines and placebo. Neither subjective sleepiness nor plasma concentrations was significantly correlated with the brain H1RO of the two antihistamines. CONCLUSION At therapeutic dose, levocetirizine does not bind significantly to the brain H1Rs and does not induce significant sedation.
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Affiliation(s)
- Kotaro Hiraoka
- Tohoku University, Cyclotron and Radioisotope Center, Division of Cyclotron Nuclear Medicine , 6-3, Aoba, Aramaki, Aoba-ku, Sendai, 980-8578 , Japan
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Ozdemir PG, Karadag AS, Selvi Y, Boysan M, Bilgili SG, Aydin A, Onder S. Assessment of the effects of antihistamine drugs on mood, sleep quality, sleepiness, and dream anxiety. Int J Psychiatry Clin Pract 2014; 18:161-8. [PMID: 24673474 DOI: 10.3109/13651501.2014.907919] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE There are limited comparative studies on classic and new-generation antihistamines that affect sleep quality and mood. The purpose of this study was to determine and compare the effects of classic and new-generation antihistamines on sleep quality, daytime sleepiness, dream anxiety, and mood. METHODS Ninety-two patients with chronic pruritus completed study in the dermatology outpatient clinic. Treatments with regular recommended therapeutic doses were administered. The effects of antihistaminic drugs on mood, daytime sleepiness, dream anxiety, and sleep quality were assessed on the first day and 1 month after. RESULTS Outpatients who received cetirizine and hydroxyzine treatments reported higher scores on the depression, anxiety, and fatigue sub-scales than those who received desloratadine, levocetirizine, and rupatadine. Pheniramine and rupatadine were found to be associated with daytime sleepiness and better sleep quality. UKU side effects scale scores were significantly elevated among outpatients receiving pheniramine. Classic antihistamines increased daytime sleepiness and decreased the sleep quality scores. New-generation antihistamines reduced sleep latency and dream anxiety, and increased daytime sleepiness and sleep quality. CONCLUSION Both antihistamines, significantly increased daytime sleepiness and nocturnal sleep quality. Daytime sleepiness was significantly predicted by rupadatine and pheniramine treatment. Cetirizine and hydroxyzine, seem to have negative influences on mood states. Given the extensive use of antihistamines in clinical settings, these results should be more elaborately examined in further studies.
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Affiliation(s)
- Pinar Guzel Ozdemir
- Department of Psychiatry, Yuzuncu Yil University Medicine Faculty , Van , Turkey
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Pellecchia MT, Esposito M, Cozzolino A, Squillante M, Penza P, Barone P. Drug induced oromandibular dystonia: A case related to prolonged use of cetirizine. Parkinsonism Relat Disord 2014; 20:566-7. [DOI: 10.1016/j.parkreldis.2014.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 12/23/2013] [Accepted: 02/06/2014] [Indexed: 11/24/2022]
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Histamine H₁ receptor occupancy by the new-generation antidepressants fluvoxamine and mirtazapine: a positron emission tomography study in healthy volunteers. Psychopharmacology (Berl) 2013; 230:227-34. [PMID: 23728612 DOI: 10.1007/s00213-013-3146-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 05/08/2013] [Indexed: 10/26/2022]
Abstract
RATIONALE Histamine H₁ antagonists have hypnotic, appetite-promoting, and sedative effects. The affinities of various antidepressants for histamine receptors have only been partially determined in vitro and animal study. Positron emission tomography (PET) can clarify the in vivo dynamics of antidepressants at histamine receptors. OBJECTIVES We performed human PET imaging with [¹¹C]doxepin, a selective PET ligand of the histamine H₁ receptor (H₁R), to study the in vivo affinities of fluvoxamine and mirtazapine for the H₁R. METHODS The subjects were five male healthy Japanese volunteers. We performed cross-randomized PET imaging after single oral administration of fluvoxamine (25mg), mirtazapine (15 mg), or placebo. PET data were analyzed by region-of-interest and voxel-by-voxel analysis. We concurrently measured plasma drug concentrations, using liquid chromatography/tandem mass spectrometry and subjective sleepiness. RESULTS The binding potential ratio of mirtazapine in brain cortex was significantly lower than that of fluvoxamine or placebo. Fluvoxamine did not occupy the H₁R, whereas H₁R occupancy (H₁RO) of mirtazapine reached 80-90 % in the cerebral neocortex. In the voxel-by-voxel analysis, the binding potential of mirtazapine was significantly lower than placebo in the dorsolateral prefrontal cortex, lateral temporal cortex, anterior cingulate gyrus, and posterior cingulate gyrus. The H₁RO of mirtazapine depended on the plasma drug concentration (AUC(0-180 min)) and was related to subjective sleepiness. CONCLUSIONS Our results demonstrate a low affinity of fluvoxamine and a very high affinity of mirtazapine for the human brain H₁R in vivo. This study provides a basis for investigating the efficacy of new-generation antidepressants in central histamine systems.
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Abstract
H1-antihistamines, the mainstay of treatment for urticaria, were developed from anticholinergic drugs more than 70 years ago. They act as inverse agonists rather than antagonists of histamine H1-receptors which are members of the G-protein family. The older first generation H1-antihistamines penetrate readily into the brain to cause sedation, drowsiness, fatigue and impaired concentration and memory causing detrimental effects on learning and examination performance in children and on impairment of the ability of adults to work and drive. Their use should be discouraged. The newer second-generation H1-antihistamines are safer, cause less sedation and are more efficacious. Three drugs widely used for symptomatic relief in urticaria, desloratadine, levocetirizine and fexofenadine are highlighted in this review. Of these levocetirizine and fexofenadine are the most potent in humans in vivo. However, levocetirizine may cause somnolence in susceptible individuals, whereas fexofenadine has a relatively short duration of action and may be required to be given twice daily for all round daily protection. Although desloratadine is less potent, it has the advantages of rarely causing somnolence and having a long duration of action.
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Affiliation(s)
- Martin K Church
- Allergie-Centrum-Charité/ECARF, Charité-Universitätsmedizin Berlin, Germany
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Funke U, Vugts DJ, Janssen B, Spaans A, Kruijer PS, Lammertsma AA, Perk LR, Windhorst AD. 11C-labeled and18F-labeled PET ligands for subtype-specific imaging of histamine receptors in the brain. J Labelled Comp Radiopharm 2013; 56:120-9. [DOI: 10.1002/jlcr.3038] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 01/18/2013] [Accepted: 01/29/2013] [Indexed: 12/13/2022]
Affiliation(s)
| | - Danielle J. Vugts
- VU University Medical Center, Department of Radiology & Nuclear Medicine; Location Radionuclide Center; De Boelelaan 1085c; 1081; HV; Amsterdam; The Netherlands
| | - Bieneke Janssen
- VU University Medical Center, Department of Radiology & Nuclear Medicine; Location Radionuclide Center; De Boelelaan 1085c; 1081; HV; Amsterdam; The Netherlands
| | | | - Perry S. Kruijer
- BV Cyclotron VU; De Boelelaan 1081; 1081; HV; Amsterdam; The Netherlands
| | - Adriaan A. Lammertsma
- VU University Medical Center, Department of Radiology & Nuclear Medicine; Location Radionuclide Center; De Boelelaan 1085c; 1081; HV; Amsterdam; The Netherlands
| | - Lars R. Perk
- BV Cyclotron VU; De Boelelaan 1081; 1081; HV; Amsterdam; The Netherlands
| | - Albert D. Windhorst
- VU University Medical Center, Department of Radiology & Nuclear Medicine; Location Radionuclide Center; De Boelelaan 1085c; 1081; HV; Amsterdam; The Netherlands
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Abstract
This article reviews the molecular biology of the interaction of histamine with its H1-receptor and describes the concept that H1-antihistamines are not receptor antagonists but are inverse agonists i.e. they produce the opposite effect on the receptor to histamine. It then discourages the use of first-generation H1-antihistamines in clinical practice today for two main reasons. First, they are less effective than second generation H1-antihistamines. Second, they have unwanted side effects, particularly central nervous system and anti-cholinergic effects, and have the potential for causing severe toxic reactions which are not shared by second-generation H1-antihistamines. There are many efficacious and safe second-generation H1-antihistamines on the market for the treatment of allergic disease. Of the three drugs highlighted in this review, levocetirizine and fexofenadine are the most efficacious in humans in vivo. However, levocetirizine may cause somnolence in susceptible individuals while fexofenadine has a relatively short duration of action requiring twice daily administration for full all round daily protection. While desloratadine is less efficacious, it has the advantages of rarely causing somnolence and having a long duration of action. Lastly, all H1-antihistamines have anti-inflammatory effects but it requires regular daily dosing rather than dosing 'on-demand' for this effect to be clinically demonstrable.
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Abstract
This article reviews the molecular biology of the interaction of histamine with
its H1-receptor and describes the concept that
H1-antihistamines are not receptor antagonists but are inverse
agonists i.e. they produce the opposite effect on the receptor to histamine. It
then discourages the use of first-generation H1-antihistamines in
clinical practice today for two main reasons. First, they are less effective
than second generation H1-antihistamines. Second, they have unwanted
side effects, particularly central nervous system and anti-cholinergic effects,
and have the potential for causing severe toxic reactions which are not shared
by second-generation H1-antihistamines. There are many efficacious
and safe second-generation H1-antihistamines on the market for the
treatment of allergic disease. Of the three drugs highlighted in this review,
levocetirizine and fexofenadine are the most efficacious in humans in
vivo. However, levocetirizine may cause somnolence in susceptible
individuals while fexofenadine has a relatively short duration of action
requiring twice daily administration for full all round daily protection. While
desloratadine is less efficacious, it has the advantages of rarely causing
somnolence and having a long duration of action. Lastly, all
H1-antihistamines have anti-inflammatory effects but it requires
regular daily dosing rather than dosing 'on-demand' for this effect to be
clinically demonstrable.
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Yamada K, Takizawa F, Tamura T, Kanda T. The effect of antihistamines on seizures induced by increasing-current electroshocks: ketotifen, but not olopatadine, promotes the seizures in infant rats. Biol Pharm Bull 2012; 35:693-7. [PMID: 22687403 DOI: 10.1248/bpb.35.693] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Clinical reports have shown that some antihistamines, such as ketotifen, occasionally produced seizures, especially in pre-school age children or young patients with epilepsy. The purpose of this study was to investigate whether olopatadine, one of the most efficacious antihistamines, promotes seizures induced by electroshocks in young rats. We investigated the seizures induced by electroshock using increasing-current delivery in 3- or 4-week-old rats, and found that the threshold-current of tonic extensor seizures was elevated with age in weeks in the vehicle-treatment groups. While caffeine decreased the threshold-current in every age group of rats, pentylenetetrazole, a γ-aminobutyric acid (GABA)(A) receptor antagonist, significantly decreased them only in 4-week-old rats. On the other hand, ketotifen decreased them only in 3-weeks-old rats. In the 3-week-old rats, neither olopatadine nor fexofenadine had any effect on the threshold-currents of tonic extensor seizures. These results showed that histaminergic neuro-transmission in the brain plays a crucial role in inhibiting seizures in rats soon after weaning, but is no longer effective in rats as they approach sexual maturation. In addition, unlike ketotifen, olopatadine, as well as fexofenadine, do not promote the occurrence of seizures in infant rats.
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Affiliation(s)
- Koji Yamada
- Pharmacological Research Laboratories, Research Division, Kyowa Hakko Kirin Co., Ltd., Shizuoka, Japan.
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Fully Automated Production of 11C-Doxepin for PET Imaging Histamine H1 Receptor. Mol Imaging Biol 2012; 14:546-52. [DOI: 10.1007/s11307-011-0535-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kamei H, Isaji A, Noda Y, Ishikawa K, Senzaki K, Yamada K, Sugiura K, Tomita Y, Nabeshima T. Effects of single therapeutic doses of promethazine, fexofenadine and olopatadine on psychomotor function and histamine-induced wheal- and flare-responses: a randomized double-blind, placebo-controlled study in healthy volunteers. Arch Dermatol Res 2011; 304:263-72. [PMID: 22130869 PMCID: PMC3332365 DOI: 10.1007/s00403-011-1192-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2011] [Revised: 11/09/2011] [Accepted: 11/14/2011] [Indexed: 11/30/2022]
Abstract
Since most first-generation antihistamines have undesirable sedative effects on the central nervous systems (CNS), newer (second-generation) antihistamines have been developed to improve patients’ quality of life. However, there are few reports that directly compare the antihistaminic efficacy and impairment of psychomotor functions. We designed a double-blind, placebo controlled, crossover study to concurrently compare the clinical effectiveness of promethazine, a first-generation antihistamine, and fexofenadine and olopatadine, second-generation antihistamines, by measuring their potency as peripheral inhibitors of histamine-induced wheal and flare. Further, we investigated their sedative effects on the CNS using a battery of psychomotor tests. When single therapeutic doses of fexofenadine (60 mg), olopatadine (5 mg) and promethazine (25 mg) were given in a double-blind manner to 24 healthy volunteers, all antihistamines produced a significant reduction in the wheal and flare responses induced by histamine. In the comparison among antihistamines, olopatadine showed a rapid inhibitory effect compared with fexofenadine and promethazine, and had a potent effect compared with promethazine. In a battery of psychomotor assessments using critical flicker fusion, choice reaction time, compensatory tracking, rapid visual information processing and a line analogue rating scale as a subjective assessment of sedation, promethazine significantly impaired psychomotor function. Fexofenadine and olopatadine had no significant effect in any of the psychomotor tests. Promethazine, fexofenadine and olopatadine did not affect behavioral activity, as measured by wrist actigraphy. These results suggest that olopatadine at a therapeutic dose has greater antihistaminergic activity than promethazine, and olopatadine and fexofenadine did not cause cognitive or psychomotor impairment.
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Affiliation(s)
- Hiroyuki Kamei
- Department of Clinical Pharmacy Practice and Health Care Management, Meijo University, Nagoya, Japan
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Abstract
INTRODUCTION Chronic urticaria is characterized by recurring episodes of spontaneous transient dermal wheals and pruritus, with or without angioedema, which can persist for ≥ 6 weeks. Chronic urticaria impairs quality of life, emphasizing the need for effective treatments. Professional societies and clinical experts have issued evidence-based recommendations for the management of chronic urticaria, including recommending the use of second-generation antihistamines as a first-line therapy. AREAS COVERED A Medline search was conducted from 2000 to 2011 using the following terms, alone or in combination: 'chronic urticaria', 'management guidelines', 'consensus guidelines' and 'expert opinions'. Ten management guidelines/expert opinions met the inclusion criteria. EXPERT OPINION There was a universal agreement among the articles reviewed, that low-sedating, second-generation antihistamines should be prescribed as a first-line treatment of chronic urticaria. For refractory urticaria, however, recommendations varied and included dose escalation of second-generation antihistamines and adjunctive treatments with other agents of the same class, such as sedating antihistamines or leukotriene receptor antagonists. More research into effective second-line treatments and consistent implementation of current guidelines is needed, to ensure that treatment is based on clinical evidence.
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Affiliation(s)
- Jean-Paul Ortonne
- Service de Dermatologie, Hôpital de l'Archet, 151, route de Saint-Antoine-de-Ginèstre, F-06202, Nice cedex 03, France.
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Cole S, Bagal S, El-Kattan A, Fenner K, Hay T, Kempshall S, Lunn G, Varma M, Stupple P, Speed W. Full efficacy with no CNS side-effects: unachievable panacea or reality? DMPK considerations in design of drugs with limited brain penetration. Xenobiotica 2011; 42:11-27. [DOI: 10.3109/00498254.2011.617847] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Church MK. Safety and efficacy of bilastine: a new H(1)-antihistamine for the treatment of allergic rhinoconjunctivitis and urticaria. Expert Opin Drug Saf 2011; 10:779-93. [PMID: 21831011 DOI: 10.1517/14740338.2011.604029] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION New H(1)-antihistamines should be effective in relieving the symptoms of allergic disease, should have a rapid onset and long duration of action and should neither cause sedation nor interact with cytochrome P450. A review of bilastine was undertaken to determine whether this newer H(1)-antihistamine meets these requirements. AREAS COVERED A Medline search was conducted to identify preclinical and clinical studies of bilastine. This was supplemented with additional articles or abstracts cited in reference lists and/or obtained from online sources and internal reports supplied by Faes Farma. Review of these data indicated that bilastine has high selectivity for H(1)-receptors, is rapidly and effectively absorbed, undergoes negligible metabolism and is a substrate for P-glycoprotein, which limits its passage across the blood-brain barrier. At the recommended dose of 20 mg, bilastine is non-sedative, does not enhance the effects of alcohol or CNS sedatives, does not impair actual driving tests, shows no cardiotoxicity and has a similar efficacy to other second-generation H(1)-antihistamines in the treatment of allergic rhinoconjunctivitis and urticaria. EXPERT OPINION In view of its favorable pharmacological and clinical characteristics, bilastine is likely to have particular benefit in urticaria for which guidelines recommend increasing the dosage of H(1)-antihistamines up to fourfold if standard dosing is ineffective.
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Affiliation(s)
- Martin K Church
- Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Charitéplatz 1, D-10117, Berlin, Germany.
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Zuberbier T. Pharmacological rationale for the treatment of chronic urticaria with second-generation non-sedating antihistamines at higher-than-standard doses. J Eur Acad Dermatol Venereol 2011; 26:9-18. [DOI: 10.1111/j.1468-3083.2011.04185.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Allergic rhinitis: an update on disease, present treatments and future prospects. Int Immunopharmacol 2011; 11:1646-62. [PMID: 21784174 DOI: 10.1016/j.intimp.2011.07.005] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Revised: 06/21/2011] [Accepted: 07/06/2011] [Indexed: 11/20/2022]
Abstract
Allergic rhinitis (AR) is an inflammation of nasal mucosa mediated by IgE-associated processes occurring independently, or concurrently with asthma. AR is characterized by sensitization-formation and expression of antigen specific IgE, followed by inflammation in two phases. The early phase response involves cross linking of IgE molecules leading to degranulation of mast cells and release of preformed mediators such as histamine and tryptase, or newly synthesized mediators such as prostaglandins and leukotrienes. The late phase response is predominated by the presence of eosinophils, lymphocytes, cytokines, and adhesion molecules. Newer insights reveal that the whole phenomenon of immunological inflammation is intricately knit with neural pathways, which strongly influence the process. Furthermore, AR can impact psychological health and vice versa. Classical pharmacotherapy of AR includes use of oral or topical antihistamines, oral antileukotrienes, topical corticosteroids, mast cell stabilizers, decongestants, and an anticholinergic agent. Among immunomodulatory treatments, immunotherapy is gaining widespread use, while antibody treatment is restricted mainly to resistant cases. Several small molecules with improved safety profile, or targeting novel mechanisms are in the clinical research. Newer antihistamines and corticosteroids with improved safety profile and antagonists of the prostaglandin D(2) (CRTH2) receptors are likely to be available for clinical use in the near future. Lack of properly validated animal models and complexities associated with clinical evaluation are some of the challenges facing the researchers in AR. Comprehensive understanding of immunological and neurological processes in AR would facilitate the future quest for more effective and safer management of this disease.
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Yanai K, Zhang D, Tashiro M, Yoshikawa T, Naganuma F, Harada R, Nakamura T, Shibuya K, Okamura N. Positron emission tomography evaluation of sedative properties of antihistamines. Expert Opin Drug Saf 2011; 10:613-22. [DOI: 10.1517/14740338.2011.562889] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Kubo N, Senda M, Ohsumi Y, Sakamoto S, Matsumoto K, Tashiro M, Okamura N, Yanai K. Brain histamine H1 receptor occupancy of loratadine measured by positron emission topography: comparison of H1 receptor occupancy and proportional impairment ratio. Hum Psychopharmacol 2011; 26:133-9. [PMID: 21433074 DOI: 10.1002/hup.1184] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
AIMS We have evaluated the sedative properties of H1-antihistamines by using positron emission tomography (PET) and ¹¹C-doxepin. The purpose of the present study was to measure histamine H1 receptor occupancy (H1RO) of loratadine 10 mg in patients with allergic rhinitis and to compare this occupancy with that of d-chlorpheniramine 2 mg, a first-generation antihistamine. We also compared our PET findings with the proportional impairment ratio reported by McDonald et al. METHODS The H1RO of loratadine 10 mg and d-chlorpheniramine 2 mg were evaluated in human brains in a double-blind and crossover design using ¹¹C-doxepin PET. Eleven young male patients with allergic rhinitis were examined by PET following oral single administration of loratadine 10 mg and d-chlorpheniramine 2 mg. RESULTS Loratadine 10 mg occupied 11.7 ± 19.5% of histamine H1 receptors in the cortex, whereas d-chlorpheniramine 2 mg occupied 53.0 ± 33.2% in the same area, suggesting a non-sedating property of loratadine at a dose of 10 mg. The H1RO values of loratadine and d-chlorpheniramine as well as those of previous studies were found to be significantly proportional to the proportional impairment ratio (r = 0.899). CONCLUSION Measurement of H1RO is a sensitive and absolute method to characterize the non-sedating property of drugs with H1 antagonistic activity.
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Affiliation(s)
- Nobuo Kubo
- Department of Otolaryngology, Kansai Medical University, Osaka, Japan
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van Ruitenbeek P, Vermeeren A, Riedel WJ. Histamine H1 receptor antagonist cetirizine impairs working memory processing speed, but not episodic memory. Br J Pharmacol 2011; 161:456-66. [PMID: 20735428 DOI: 10.1111/j.1476-5381.2010.00907.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND PURPOSE The histaminergic neurotransmitter system is currently under investigation as a target for drug treatment of cognitive deficits in clinical disorders. The therapeutic potential of new drugs may initially be screened using a model of histaminergic dysfunction, for example, as associated with the use of centrally active antihistamines. Of the selective second generation antihistamines, cetirizine has been found to have central nervous system effects. The aim of the present study was to determine whether cetirizine can be used as a tool to model cognitive deficits associated with histaminergic hypofunction. EXPERIMENTAL APPROACH The study was conducted according to a three-way, double-blind, cross-over design. Treatments were single oral doses of cetirizine 10 and 20 mg and placebo. Effects on cognition were assessed using tests of word learning, memory scanning, vigilance, divided attention, tracking and visual information processing speed. KEY RESULTS Cetirizine 10 mg impaired tracking performance and both doses impaired memory scanning speed. None of the other measures indicated impaired performance. CONCLUSION AND IMPLICATIONS Cetirizine affects information processing speed, but these effects were not sufficient to serve as a model for cognitive deficits in clinical disorders.
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Affiliation(s)
- P van Ruitenbeek
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, the Netherlands.
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Next-day residual sedative effect after nighttime administration of an over-the-counter antihistamine sleep aid, diphenhydramine, measured by positron emission tomography. J Clin Psychopharmacol 2010; 30:694-701. [PMID: 21105284 DOI: 10.1097/jcp.0b013e3181fa8526] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Antihistamines often are self-administered at night as over-the-counter (OTC) sleep aids, but their next-day residual sedative effect has never been evaluated using a reliable quantitative method such as positron emission tomography (PET). We performed a double-blind, placebo-controlled, crossover study in which we evaluated the residual effect the next day after nighttime administration of diphenhydramine, a commonly used OTC sleep aid, in terms of brain H₁ receptor occupancy (H₁RO) measured using ¹¹C-doxepin-PET. We also compared the results of diphenhydramine with those of bepotastine, a second-generation antihistamine. Eight healthy adult male subjects underwent PET measurement the morning (11:00) after random oral administration of diphenhydramine (50 mg), bepotastine (10 mg), or placebo the night before (23:00). Binding potential ratios and H₁ROs were calculated in different brain regions of interest such as the cingulate gyrus, frontotemporal cortex, and cerebellum. Subjective sleepiness and plasma drug concentration also were measured. Calculation of binding potential ratios revealed significantly lower values for diphenhydramine than for bepotastine or placebo in all regions of interest (P < 0.01). Cortical mean H₁RO after diphenhydramine treatment was 44.7% compared with 16.6% for bepotastine treatment (P < 0.01). Subjective sleepiness was not significantly different among the subjects treated with each test drug or the placebo. In conclusion, the next-day residual sedative effect after nighttime administration of the OTC sleep aid diphenhydramine was verified for the first time by direct PET measurement of H₁RO. Taking into account the possible hangover effect of OTC antihistamine sleep aids, care needs to be taken during their administration.
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Histamine, histamine receptors and antihistamines: new concepts. An Bras Dermatol 2010; 85:195-210. [PMID: 20520935 DOI: 10.1590/s0365-05962010000200010] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2009] [Accepted: 02/12/2009] [Indexed: 11/21/2022] Open
Abstract
Drugs with antihistamine action are the most commonly prescribed medication in daily dermatologic practice, both to adults and children. This article addresses new concepts of the role of histamine receptors (H1 receptors) and discusses the anti-inflammatory effects of these drugs. Second generation antihistamines differs from first generation because of their high specificity and affinity for peripheral H1-receptors. Second generation antihistamines are also less likely to produce sedation because they have less effect on the central nervous system. Although the efficacy of the various H1-antihistamines in the treatment of allergic patients is similar, even when comparing first- and second-generation drugs, these drugs are still very different in terms of their chemical structure, pharmacology and toxic properties. Consequently, knowledge of their pharmacokinetic and pharmacodynamic characteristics is essential for a better medical care, especially that offered to pregnant women, children, the elderly, and patients with comorbidities.
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Van Ruitenbeek P, Vermeeren A, Riedel WJ. Cognitive domains affected by histamine H(1)-antagonism in humans: a literature review. ACTA ACUST UNITED AC 2010; 64:263-82. [PMID: 20685608 DOI: 10.1016/j.brainresrev.2010.04.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2009] [Revised: 04/23/2010] [Accepted: 04/24/2010] [Indexed: 11/18/2022]
Abstract
The neurotransmitter histamine has been suggested to be involved in cognitive functioning. Generally, studies in animals have shown a decrease in performance after decreasing histamine neurotransmission and improved performance after increasing histamine neurotransmission. It is unclear, however, what role histamine plays in cognition in humans. Up until now, most data are derived from studies and reviews that aimed to assess the sedative potential of H(1)-antagonists and not the effects on cognition in particular. The objective of this paper is specifically to review which cognitive domains are affected by H(1)-antagonists. Taken together, 90 experimental studies on the performance effects of sedative H(1)-antagonists published between 1973 and 2009 were reviewed. Results showed that psychomotor skills and attention are most frequently impaired and memory the least. Tasks assessing memory that were affected usually required rapid responses. It was concluded that both the complexity of the task as well as the demand for information processing speed determines the sensitivity to the effects of central H(1)-antagonism. The importance of the sensitive cognitive domains to histaminergic dysfunction, as well as the relation between histamine related decrease in arousal and task performance deserve further research.
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Affiliation(s)
- P Van Ruitenbeek
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, The Netherlands, Maastricht, The Netherlands.
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Tsujii T, Yamamoto E, Ohira T, Takahashi T, Watanabe S. Antihistamine effects on prefrontal cortex activity during working memory process in preschool children: A near-infrared spectroscopy (NIRS) study. Neurosci Res 2010; 67:80-5. [DOI: 10.1016/j.neures.2010.01.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2009] [Revised: 01/27/2010] [Accepted: 01/27/2010] [Indexed: 11/24/2022]
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Smith SM, Gums JG. Fexofenadine: biochemical, pharmacokinetic and pharmacodynamic properties and its unique role in allergic disorders. Expert Opin Drug Metab Toxicol 2010; 5:813-22. [PMID: 19545214 DOI: 10.1517/17425250903044967] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Fexofenadine is one of several second-generation H(1)-antihistamines approved for the treatment of various allergic disorders; however, it shows numerous unique properties that make it an optimal choice for many patients. OBJECTIVE To review the pharmacology, efficacy and safety of fexofenadine and the attributes differentiating it from other H(1)-antihistamines. METHODS We performed a literature search in PubMed/MEDLINE (1966 - March 2009) using the keywords fexofenadine, antihistamine, allergic rhinitis and chronic urticaria. We also reviewed data provided by the manufacturer in addition to reports from various governmental agencies. RESULTS/CONCLUSIONS Fexofenadine is devoid of sedative and anticholinergic effects and may offer equivalent or greater efficacy in treating allergic disorders compared with other currently available second-generation H(1)-antihistamines. In addition, fexofenadine may offer cost savings over other selected H(1)-antihistamines owing to its recent availability in generic form in the US.
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Affiliation(s)
- Steven M Smith
- University of Florida, Colleges of Pharmacy and Medicine, Departments of Pharmacotherapy & Translational Research and Community Health & Family Medicine, Gainesville, FL 32610-0486, USA.
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Benedetti MS, Whomsley R, Poggesi I, Cawello W, Mathy FX, Delporte ML, Papeleu P, Watelet JB. Drug metabolism and pharmacokinetics. Drug Metab Rev 2009; 41:344-90. [PMID: 19601718 DOI: 10.1080/10837450902891295] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
In this article, aspects of absorption, distribution, metabolism, and excretion have been described bearing in mind the pathogenesis of allergic diseases and their possible therapeutic opportunities. The importance of the routes of administration of the different therapeutic groups has been emphasized. The classical aspects of drug metabolism and disposition related to oral administration have been reviewed, but special emphasis has been given to intranasal, cutaneous, transdermal, and ocular administration as well as to the absorption and the subsequent bioavailability of drugs. Drug-metabolizing enzymes and transporters present in extrahepatic tissues, such as nasal mucosa and the respiratory tract, have been particularly discussed. As marketed antiallergic drugs include both racemates and enantiomers, aspects of stereoselective absorption, distribution, metabolism, and excretion have been discussed. Finally, a new and promising methodology, microdosing, has been presented, although it has not yet been applied to drugs used in the treatment of allergic diseases.
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Tramadol-induced seizurogenic effect: a possible role of opioid-dependent histamine H1 receptor activation-linked mechanism. Naunyn Schmiedebergs Arch Pharmacol 2009; 381:11-9. [PMID: 20012267 DOI: 10.1007/s00210-009-0476-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2009] [Accepted: 11/13/2009] [Indexed: 12/17/2022]
Abstract
The present study has been designed to investigate the role of opioid receptors, mast cells, and histamine receptors (H(1) subtype) in the seizurogenic effect of tramadol on pentylenetetrazole-treated mice. A single injection of pentylenetetrazole (80 mg kg(-1)) was used to elicit seizure activity in mice. Seizures were assessed in terms of the time latency of the onset of Straub-like tail, onset of jerky movements of whole body, convulsions, and death. Tramadol administration (50 mg kg (-1)) caused a marked increase in seizurogenic activity of pentylenetetrazole as measured in terms of a significant decrease in the time latency of the onset of Straub-like tail, jerky movements of whole body, convulsions, and death. Moreover, prior administration of naloxone (2 mg kg(-1)), fexofenadine (100 mg kg(-1)), cetrizine, sodium cromoglycate, and ketotifen (10 mg kg(-1)), respectively, attenuated the seizurogenic activity that tramadol exerted on pentylenetetrazole-treated mice. Therefore, it may be suggested that tramadol exerts a seizurogenic effect on mice via an H(1) receptor activation-linked pathway possibly through an opioid receptor-dependent release of histamine from the mast cells.
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Tsujii T, Masuda S, Yamamoto E, Ohira T, Akiyama T, Takahashi T, Watanabe S. Effects of sedative and nonsedative antihistamines on prefrontal activity during verbal fluency task in young children: a near-infrared spectroscopy (NIRS) study. Psychopharmacology (Berl) 2009; 207:127-32. [PMID: 19705105 DOI: 10.1007/s00213-009-1640-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2009] [Accepted: 08/03/2009] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Antagonists of histamine H(1) receptors (antihistamines) are widely used for the treatment of allergic disorders in children. These drugs' sedative effect on brain function, however, has been mostly examined in adults. OBJECTIVE The objective of this study was to examine the effects of anitihistamines on prefrontal cortex activity in young children using near-infrared spectroscopy (NIRS), a novel brain-imaging method. MATERIALS AND METHODS In 15 healthy children (mean age, 7.7 years), we examined changes of oxygenated hemoglobin concentration in the prefrontal cortex while they performed a verbal fluency task 3 h after taking a sedating antihistamine (ketotifen), nonsedating antihistamine (epinastine), or placebo. RESULTS Ketotifen significantly impaired behavioral performance and cortical activation at the lateral prefrontal cortex compared with placebo. There were no sedative effects on neural response or behavioral performance after epinastine administration. CONCLUSIONS NIRS revealed that sedating and nonsedating antihistamines exert differential effects on brain hemodynamic response in young children.
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Affiliation(s)
- Takeo Tsujii
- Center for Advanced Research on Logic and Sensibility, Keio University, Mita 3-1-7, Minato-ku, Tokyo, 108-0073, Japan.
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