Antihistamines and driving ability: evidence from on-the-road driving studies during normal traffic

Abstract

Background: All antihistamines are capable of crossing the blood-brain barrier and thus may cause sedation. Most antihistamine users are ambulatory patients and therefore presumably drive a car.Objective: To summarize the effects of antihistamine drugs on driving ability. Data Sources and Study Selection: A literature search (MEDLINE and cross-references) was performed using the keywords driving and antihistamine. Sixteen studies using the on-the-road driving test during normal traffic were included in the review. Studies were double-blind and placebo-controlled and included a positive control.Results: First-generation antihistamines (diphenhydramine, triprolidine, terfenadine, dexchlorpheniramine, clemastine) significantly impair driving performance after both one-time and repeated (daily) administration. Second-generation antihistamines (cetirizine, loratadine, ebastine, mizolastine, acrivastine, emedastine, mequitazine) may also impair driving performance, but the magnitude and extent of impairment depend on the administered dose, sex, and time between testing and treatment administration. Tolerance develops after 4 to 5 days of administration, but impairment is not absent. Third-generation antihistamines (fexofenadine and levocetirizine) have been shown to produce no driving impairment after both one-time and repeated administration.Conclusions: First-and second-generation antihistamines may significantly impair driving performance. In the context of driving safety but also taking into account the cardiotoxic properties of some of the second-generation antihistamines, we advise treating patients with third-generation antihistamines such as fexofenadine and levocetirizine.

H1-antihistamines suppress wheal-and-flare reaction and skin blood perfusion measured by Laser Dopppler flowmetry: randomized, double-blind, placebo-controlled, crossover design study

“…The magnitude and the extent of impairment depend on the administered dose, sex, and time between testing and treatment administration. Tolerance develops after 4 to 5 days of administration, but impairment is not fully absent (Verster et al, 2004).…”

The Benzodiazepine Stigma Persists

“…[3][4][5][6][7][8][9][10][11][12][13] Some of these medications have been associated with impairment in on-the-road driving tests and psychomotor tests in addition to being associated with motor vehicle accidents.…”

Effects of Seasonal Allergic Rhinitis on Driving Ability, Memory Functioning, Sustained Attention, and Quality of Life §

“…These studies were primarily set up to examine the effects of psychoactive drugs on driving ability. Dose-dependent increment of SDLP relative to placebo has been established for hypnotics, anxiolytics, antidepressants and antihistamines [13,[17][18][19]. As a historical reference for SDLP increments relative to placebo data with different dosages of alcohol is used [20].…”

“…Antihistamine drugs of *Address correspondence to this author at the Utrecht Institute for Pharmaceutical Sciences, Department of Psychopharmacology, Utrecht University, PO BOX 80082, 3508 TB, Utrecht, the Netherlands; Tel: +31 30 253 6909; Fax: +31 30 253 7900; E-mail: j.c.verster@uu.nl § The study is registered at www.clinicaltrials.gov (identifier NCT00223587). the first and second generation administered to healthy volunteers have shown to impair cognitive performance and behavioral skills and abilities, including driving a car [13]. In patients, antihistamines have shown to affect performance negatively [14], whereas others report performance improvement [15].…”