Rumore MM 'Clinical pharmacokinetics of chlorpheniramine.' Drug Intell Clin Pharm 18 Paton DM, Webster DR 'Clinical pharmacokinetics of H1-receptor antagonists (the antihistamines).' Clin Pharmacokinet 10Р”В«lyden GT, Greenblatt DJ, Scavone JM, Shader RI 'Pharmacokinetics of diphenhydramine and a demethylated metabolite following intravenous and oral administration.' J Clin Pharmacol 26 Woosley RL 'Cardiac actions of antihistamines.' Annu Rev Pharmacol Toxicol 36 Smith SJ 'Cardiovascular toxicity of antihistamines.' Otolaryngol Head Neck Surg 111 Suppl Maddox DE, Reed CE 'Clinical pharmacodynamics of antihistamines.' Ann Allergy 59 Phenergan (promethazine).' Wyeth-Ayerst Laboratories, Philadelphia, PA. Watemberg NM, Roth KS, Alehan FK, Epstein CE 'Central anticholinergic syndrome on therapeutic doses of cyproheptadine.' Pediatrics 103 Semprex-D (acrivastine-pseudoephedrine).' Endo Laboratories LLC, Chadds Ford, PA. Antivert (meclizine).' Roerig Division, New York, NY. Tacaryl (methdilazine).' Westwood Squibb Pharmaceutical Corporation, Buffalo, NY. Chlortrimeton (chlorpheniramine).' Schering-Plough, Liberty Corner, NJ. Dimetane (brompheniramine).' Wyeth-Ayerst Laboratories, Philadelphia, PA. Louis, MO.Р”ВiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM 'Pharmacotherapy: A Pathophysiologic Approach 4th' Stamford, CT: Appleton & Lange Poly-Histine-D (pyrilamine).' Bock Pharmaceutical Company, St. Vistaril (hydroxyzine).' Pfizer US Pharmaceuticals, New York, NY. Schuller DE, Turkewitz D 'Adverse effects of antihistamines.' Postgrad Med 79 Dramamine (dimenhydrinate)' Pharmacia and Upjohn, Kalamazoo, MI. Zyrtec (cetirizine).' Pfizer US Pharmaceuticals, New York, NY. Marezine (cyclizine).' Glaxo Wellcome, Research Triangle Park, NC. Benadryl (diphenhydramine).' Parke-Davis, Morris Plains, NJ. Drixoral (dextromethorphan).' Schering-Plough, Liberty Corner, NJ. Temaril (trimeprazine)' Allergan Inc, Irvine, CA.

Optimine (azatadine).' Schering Laboratories, Kenilworth, NJ. Periactin (cyproheptadine).' Merck & Co, Inc, West Point, PA. Tavist (clemastine).' Sandoz Pharmaceuticals Corporation, East Hanover, NJ. In contrast, the newer, relatively nonsedating antihistamines (e.g., cetirizine, fexofenadine, loratadine) reportedly have low to minimal anticholinergic activity at normally recommended dosages and may be appropriate alternatives. Conventional, first-generation antihistamines such as the ethanolamines (bromodiphenhydramine, carbinoxamine, clemastine, dimenhydrinate, diphenhydramine, doxylamine, phenyltoloxamine) tend to exhibit substantial anticholinergic effects. Therapy with antihistamines should be administered cautiously, if at all, in patients with preexisting conditions that are likely to be exacerbated by anticholinergic activity, such as urinary retention or obstruction angle-closure glaucoma, untreated intraocular hypertension, or uncontrolled primary open-angle glaucoma and gastrointestinal obstructive disorders. Applicable conditions: Gastrointestinal Obstruction, Glaucoma/Intraocular Hypertension, Urinary RetentionР”Р„ntihistamines often have anticholinergic activity, to which elderly patients are particularly sensitive. Moderate Potential Hazard, High plausibility. Moderate Antihistamines (applies to Unisom SleepTabs) anticholinergic effects

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