Introduction

Antihistamines (AHs) are prescribed by physicians for management of allergic diseases and by the dermatologists for the long-term management of chronic urticaria, tinea infections, psoriasis, and atopic dermatitis. The cognitive function and psychomotor performance are impaired due to the AHs that cross the blood brain barrier and bind to H₁ receptors in brain. Long term effects of AHs on cognitive function and psychomotor performance in patients with dermatological conditions have not been studied.

Aim

This study evaluated the effects of long-term administration of AHs on memory, mood, attention, sleep and executive function and psychomotor performance in patients suffering from dermatological conditions.

Method

Study Design

• Prospective observational study

  Patient Profile

• Patients who were newly prescribed chlorpheniramine, levocetirizine, fexofenadine or bepotastine for at least 28 days

Treatment Strategy

• Adults (18-65 years) with dermatological condition were newly prescribed either chlorpheniramine (4 mg, BD), levocetirizine (10 mg, OD), fexofenadine (180 mg, OD) or bepotastine (10 mg, BD) for at least 28 days
• Cohort underwent detailed assessment of memory, sleep and psychomotor performance at baseline, 1 week and 4 weeks
• A post hoc analysis was conducted

Endpoints

• Memory using the PGI memory scale (PGIMS)
• Psychomotor functions
• Mood using Brief Mood Introspection Scale
• Sleep using Epworth Sleepiness Scale
• Safety

Results

• Final cohort comprised 83 patients of which 22 were in chlorpheniramine group, 23 in levocetirizine group, 20 in fexofenadine group and 18 in bepotastine group
• Tinea cruris was the most common clinical condition followed by eczema, tinea corporis and scabies
• Mental balance, attention and concentration, delayed recall and total PGIMS scores significantly decreased in chlorpheniramine group at 4 weeks as compared to baseline
• A remarkable reduction in mental balance, delayed recall, visual retention and total PGIMS scores was demonstrated with levocetirizine at 4 weeks
• Fexofenadine had a significant favorable effect on attention and concentration, immediate and delayed recall, verbal retention of similar and dissimilar pairs, visual retention, recognition and total PGIMS scores at 4 weeks
• Bepotastine notably increased remote memory score, verbal retention of dissimilar pairs, recognition score and total PGIMS scores at 4 weeks
• Drowsiness was reported by 12 and 9 patients in chlorpheniramine and levocetirizine groups respectively
• No effect on sleep was observed with bepotastine
• There was no significant difference in mood scores between chlorpheniramine, levocetirizine and fexofenadine groups
• Arousal calm and positive tired scores increased at 4 weeks with bepotastine 

Conclusion

• Chlorpheniramine and levocetirizine had increased sleepiness and deteriorating effects on cognition and psychomotor performance whereas fexofenadine and bepotastine exhibited positive effects.
• Patients involved in tasks that require alertness should be prescribed either bepotastine or fexofenadine.
• Cognitive and psychological functions should be periodically assessed in patients with dermatological illnesses.

J Family Med Prim Care. 2022 Oct; 11(10): 5909–5917.