Top 200: Antihistamines & Cough

Highly prevalent allergen-induced upper airway inflammatory disease

Seasonal

Perennial (year-round)

Most common atopic (susceptible to developing allergies) disease in the US

• Increased age
• Early food exposure
• Heavy maternal smoking
• Indoor allergen exposure
• Parental Allergic Disorder

• A cure does not exist
• The goal is to lessen symptoms & increase the patient's quality of life
• Implement lifestyle changes
• Pharmacologic Therapy

• H-1 antagonists, also called inverse agonists:
• -bind to and stabilize the H-1 receptor
• -Inhibit mast cell and basophil mediator release
• -Reduces sneezing, itching, ocular irritation

Reduces or eliminates the effects of Histamine (recall Histamine released during an allergic reaction)

Anti-cholinergic effects

First generation drugs (more adverse effects)

• Second-generation drugs (less adverse effects)

• Diphenhydramine
• Meclizine
• Hydroxyzine
• Promethazine
• Brompheniramine
• Chlorpheniramine

• short half-life (dosed q 4-6 hours)
• Crosses the blood brain barrier
• CNS adverse effects:
• dry mouth
• dry eyes
• constipation
• urinary retention

• Fexofenadine
• Loratadine
• Desloratadine

• Non-sedating
• Poor penetration of blood brain barrier
• Decreased CNS effects
• Some OTC products

allergic rhinitis

allergic conjunctivitis

allergic dermatological conditions (contact dermatitis)

urticaria (hives)

angioedema

pruritus (atopic dermatitis, insect bites)

anaphylactic or anaphylactoid reactions

nausea and vomiting

sedation (first-generation H1-antihistamines)

Recall the dose is 5 mg/kg/DAY for Benadryl, and it is dosed every 4 to 6 hours.

• Keeps airways clear
• Dry vs. productive cough
• Acute
• Chronic
• Only a symptom...NOT a disease

Allergies and asthma

Lung infections (pneumonia or acute bronchitis)

Chronic obstructive pulmonary disease (COPD)

Sinusitis leading to post-nasal drip

Lung disease

Gastroesophageal reflux disease (GERD)

Cigarette smoking

Exposure to secondhand smoke

Exposure to air pollutants

ACE inhibitors

Croup

Mucolytics (breaks down mucus)

• Expectorants (helps bring up mucus and other
• material from the lungs, bronchi, and trachea)

Suppressants

Decongestants

Antihistamines

Pain relievers

Others

FDA Recommendation: OTC Cough and Cold Medications Should Not Be Used in Infants and Children < 2 Years of Age -January, 2008

FDA Recommendation: do not use in children <4 years of age UNLESS under guidance of health care professional -October 2008

CDC: ~ 7,000 children under age 11 go to the ER each year after taking cough and cold medicines

Codeine (and derivatives)

Narcotic, Opioid

• Affects of Codeine:
• binds to opiate receptors in the CNS
• causes cough suppression by direct central action in the medulla
• produces generalized CNS depression

Brand name(s): Benadryl

Drug Class: Antihistamine (first generation)

Indications for use: relief of allergic symptoms; for moderate or severe allergic reaction

Adverse Effects: drowsiness, dizziness, dry mouth

• Patient Education:
• -Enters breast milk
• -May cause drowsiness, fatigue, diarrhea

Children's Dosing: 5 mg/kg/day (divided doses q 6-8 hrs

Brand name(s):

Drug Class: Antihistmaine (first generation)

Indications for use:

Adverse Effects:

Patient Education:

Brand name(s):

Drug Class: Antihistamine (first generation)

Indications for use:

Adverse Effects:

Patient Education:

Brand name(s): Phenergan (also available with Codeine)

Drug Class: Antihistamine (first generation), Antiemetic, Sedative

Available Formulations: Table, syrup, suppository, injection

Indications for use: allergic reactions, sedative, motion sickness, post-operative pain

Adverse Effects: drowsiness, dizziness, dry mouth

• Patient Education:
• -Enters breast milk
• -May cause drowsiness, fatigue, diarrhea

• Other information:
• -Refrigerate suppositories
• -onset of action for suppositories: 15-30 mins
• -not for children < 2 years

Brand name(s):

Drug Class: Antihistamine (second generation)

Available formulations:

Indications for use:

Adverse Effects:

Patient Education:

Brand name(s):

Drug Class: Antihistamine (second generation)

Available formulations:

Indications for use:

Adverse Effects:

Patient Education:

Brand name(s):

Drug Class: Expectorant

Indications for use: loosens phlegm, increases lubrication of lungs, allow for a productive cough and decreased chest congestion

Adverse Effects:

• Patient Education:
• -Drink water!
• Other Information:
• -comes in many dosage forms

Brand name(s): Tussionex

Drug Class: Antitussive

Indications for use: relief of cough

Adverse Effects: drowsiness, constipation

• Patient Education:
• -SHAKE WELL!
• -Avoid alcohol
• -could be habit forming
• -not for children < 6 years old
• -not for asthmatics

Brand name(s): Tessalon or Tessalon Perles

Drug Class: Antitussive

Indications for use: relief of cough

Adverse Effects: headache, constipation, nausea

• Patient Education:
• -*LIFE THREATENING RXN with patients allergic to tetracaine or procaine
• -Do not crush, chew or dissolve
• -not for children < 10 years old

Brand name(s):

Drug Class: Narcotic; Opiod

Indications for use: found in many cough products

Adverse Effects:

Patient Education:

• Other Information:
• -Binds to opiate receptors in the CNS
• -causes cough suppression by direct central action in the medulla
• -produces generalized CNS depression