TY - JOUR
T1 - Cardiovascular safety of second-generation antihistamines
AU - Barbey, Jean Thierry
AU - Anderson, Mark
AU - Ciprandi, Giorgio
AU - Frew, Anthony J.
AU - Morad, Martin
AU - Priori, Silvia G.
AU - Ongini, Ennio
AU - Affrime, Melton B.
PY - 1999
Y1 - 1999
N2 - Reports of serious cardiac arrhythmia associated with some second- generation antihistamines have prompted concern for their prescription. This article reviews the nature of the adverse events reported and concludes that the blockade of potassium channels, particularly the subtype responsible for the rapid component of the delayed rectifier current (I(Kr)), is largely responsible for such adverse cardiac events. Consequently, antihistamines with little or no interaction with these channels are expected to have the greatest safety margin. The main cardiac arrhythmia of concern is that of torsades de pointes, a potentially fatal phenomenon characterized by prolonged ventricular depolarization that manifest as a prolonged QT interval and polymorphic ventricular tachycardia, with twisting of the QRS complexes. Based on preclinical and clinical evidence, it appears that loratadine, cetirizine, and fexofenadine are safe from cardiac arrhythmia via the I(Kr) channel, whereas astemizole and terfenadine have a propensity to cause ventricular tachyarrhythmias.
AB - Reports of serious cardiac arrhythmia associated with some second- generation antihistamines have prompted concern for their prescription. This article reviews the nature of the adverse events reported and concludes that the blockade of potassium channels, particularly the subtype responsible for the rapid component of the delayed rectifier current (I(Kr)), is largely responsible for such adverse cardiac events. Consequently, antihistamines with little or no interaction with these channels are expected to have the greatest safety margin. The main cardiac arrhythmia of concern is that of torsades de pointes, a potentially fatal phenomenon characterized by prolonged ventricular depolarization that manifest as a prolonged QT interval and polymorphic ventricular tachycardia, with twisting of the QRS complexes. Based on preclinical and clinical evidence, it appears that loratadine, cetirizine, and fexofenadine are safe from cardiac arrhythmia via the I(Kr) channel, whereas astemizole and terfenadine have a propensity to cause ventricular tachyarrhythmias.
UR - http://www.scopus.com/inward/record.url?scp=0033005063&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0033005063&partnerID=8YFLogxK
U2 - 10.2500/105065899781389759
DO - 10.2500/105065899781389759
M3 - Article
C2 - 10392245
AN - SCOPUS:0033005063
SN - 1050-6586
VL - 13
SP - 235
EP - 243
JO - American Journal of Rhinology
JF - American Journal of Rhinology
IS - 3
ER -