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Educating older patients and their caregivers is especially important because of the widespread OTC availability of these antihistamines.
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First-generation antihistamines are widely available without a prescription and commonly used to treat allergic symptoms, including rhinitis, conjunctivitis, pruritus, eczema, urticaria, and anaphylactic reactions.
These sedating antihistamines often are used alone or in combination with other ingredients in cold and cough medications, and over-the-counter (OTC) sleep aid products.
These antihistamines are more selective on peripheral H1 receptors and have a lower affinity for cholinergic and alpha-adrenergic receptor sites, which reduces the risk of anticholinergic and central nervous system side effects.
Older adults are especially sensitive to the central nervous system- and anticholinergic-related side effects of sedating antihistamines because of decreased cholinergic neurons or receptors in the brain, reduced hepatic and renal function, and increased blood-brain permeability.
H2 blockers (eg, ranitidine, famotidine) commonly are used for the treatment of heartburn and gastroesophageal reflux disease.
These medications decrease gastric acid secretion in the stomach by antagonizing the effects of histamine at H2 receptors found in gastrointestinal parietal cells.
Diphenhydramine (Benadryl) is the most common first-generation antihistamine found in OTC sleep aids, whether used alone or in combination with pain relievers, including acetaminophen (eg, Tylenol PM), ibuprofen (eg, Advil PM), and aspirin.
Other sleep aids often contain the antihistamine doxylamine (eg, Unisom).
The diseases antihistamines are used for include: Older antihistamines, such as Benadryl and Atarax, have a significant amount of anticholinergic side effects, including dry mouth, drowsiness, constipation, headache, and urinary retention.
Because of the side effects of these medications, they are generally considered to be too sedating for routine daytime use.
These antihistamines also are potent muscarinic receptor antagonists that can lead to serious anticholinergic side effects, such as sinus tachycardia, dry skin, dry mucous membranes, dilated pupils, constipation, ileus, urinary retention, and agitated delirium.3 The mnemonic “blind as a bat, dry as a bone, red as a beet, mad as a hatter, and hot as a hare” often is used to help describe and identify patients suffering from anticholinergic syndrome (see Table 2 below).Tags: Adult Dating, affair dating, sex dating