Rangkuman Book Reading
Rangkuman Book Reading
Rangkuman Book Reading
Formulation/Presentation
The following are available in solution or syrup form: cetirizine, chlorpheniramine,
clemastine, cyproheptadine, diphenhydramine, desloratadine and promethazine. Some
can be given parenterally, but this frequently causes local irritation. Some topical
antihistamines are available but prolonged use should be avoided because of a
relatively high risk of contact sensitization.
Generic names and dosages and suggested regimens of antihistamines used in
dermatology in the UK.
Dossages and suggested regimen
Antihistamines are usually given orally. If standard dosing is not effective in chronic
urticaria, increasing the dosage up to fourfold is recommended. For patients who do
not respond to a fourfold increase in dosage second-line therapies should be added to
the antihistamine. Treatment options include montelukast 10 mg daily, omalizumab
300 mg by s/c injection every 4 weeks or immunosupressant drugs, e.g. ciclosporin.
H2 ANTIHISTAMINES
There is controversy about the use of H2 antagonists in urticaria. H1 and H2 receptor
activation can cause vasodilation and increased vascular permeability, while H1
receptors mediate itch and flare. Theoretically therefore, H2 receptor antagonists may
reduce whealing. Their dermatological use is unlicensed and they should not be used
as monotherapy. Ranitidine can be given at doses of 150 mg twice daily and is
usually choenrather than cimetidine, as it does not inhibit CYP450.
Doxepin
Doxepin is a tricyclic antidepressant with potent H1 and H2 antihistamine effects, it
is a useful drug in the treatment of adult urticaria and pruritus night-time sedation is
required. initial dose of 25 mg/d at night is usually sufficient, and may be adjusted to
response. An alternative low-dose regimen is 10 mg two or three times a day. A
topical formulation of doxepin is licensed for use as an antipruritic.