Safety of antihistamines in the treatment of allergic rhinitis in elderly patients
J. D. McCue
University of Massachusetts Medical School, Berkshire Medical Center, Pittsfield, USA.
Elderly patients may be more susceptible than younger persons to the
sedating and anticholinergic effects of first-generation antihistamines.
Second-generation antihistamines, such as loratadine, astemizole, and
terfenadine, cause minimal sedation and little if any impairment in
cognitive and psychomotor activity in healthy nonelderly patients. Although
less extensively studied in elderly patients, it is probable that
second-generation antihistamines are also less likely to induce the adverse
central nervous system effects in older patients that are characteristic of
the first-generation antihistamines. Toxic effects to the cardiovascular
system, an issue of greater concern among elderly patients who may have
subclinical heart disease, has not been observed with first-generation
antihistamines. Among the second-generation antihistamines, however,
astemizole and terfenadine, but not loratadine, can cause serious
cardiovascular adverse effects, including death, when taken in high doses
or coadministered with ketoconazole, itraconazole, or macrolide
antibiotics.
