Does Benadryl raise blood pressure in hypertensive patients. Which allergy medications are safe for people with high blood pressure. How do antihistamines affect cardiovascular health. What are the risks of combining antihistamines with blood pressure medications.

Understanding Benadryl and Its Effects on Blood Pressure

Benadryl, a widely used oral antihistamine, is often the go-to medication for allergy symptoms, hives, and common cold relief. However, for those with hypertension, concerns about its impact on blood pressure may arise. Let’s explore the relationship between Benadryl and blood pressure to help you make informed decisions about your allergy treatment.

How Does Benadryl Work?

Benadryl, also known by its generic name diphenhydramine, is a first-generation antihistamine. It functions by blocking histamine receptors in the body. Histamine is a chemical that triggers allergic responses, and by inhibiting its action, Benadryl helps alleviate symptoms such as itchy eyes, sneezing, and runny nose.

Dr. Dung Trinh, an expert in preventive health and inflammation, explains, “Benadryl suppresses the effects of histamine by blocking its action on various target organs, including blood vessels, respiratory airways, and smooth muscles.” This mechanism of action is what makes Benadryl effective in treating allergic reactions and other related conditions.

Benadryl’s Impact on Blood Pressure

Does Benadryl directly affect blood pressure? According to Dr. Brandon Cometti, a dermatologist at Roswell Skin Center, “Most antihistamines, including Benadryl, do not have much effect on your blood pressure.” However, it’s essential to note that individual responses may vary, and certain factors can influence how Benadryl interacts with your cardiovascular system.

In some cases, Benadryl may cause a slight decrease in blood pressure. Dr. Trinh notes, “Research studies have shown that patients taking Benadryl may experience a decrease in their blood pressure readings, which may cause symptoms of dizziness and increase the risk of falls.” This effect is generally mild and not a significant concern for most users.

Potential Side Effects of Benadryl

While Benadryl is generally safe for most people, it can cause various side effects. Understanding these potential reactions is crucial for making informed decisions about its use, especially for those with pre-existing health conditions.

Common Side Effects

• Sleepiness or sedation
• Headache
• Constipation
• Dry mouth
• Dizziness
• Impaired coordination

Rare but Serious Side Effects

• Seizures
• Confusion
• Arrhythmias
• Anemia
• Heatstroke

It’s worth noting that in rare cases, Benadryl can raise your heart rate. However, research indicates that cardiac issues are unlikely unless you exceed the recommended dose.

Safe Allergy Medications for People with High Blood Pressure

If you have hypertension, you may be wondering which allergy medications are safe to use. Fortunately, there are several options available that don’t typically interfere with blood pressure control.

Antihistamines Safe for Hypertensive Patients

According to Dr. Cometti, it is generally safe to take Benadryl or other antihistamines if you have high blood pressure, as long as they do not contain decongestants. Single-ingredient antihistamine medications are not known to raise blood pressure significantly.

The following medications are considered safe for people with high blood pressure:

• Benadryl (diphenhydramine)
• Zyrtec (cetirizine)
• Claritin (loratadine)
• Allegra (fexofenadine)
• Nasal sprays such as Flonase (fluticasone) and Nasacort

Allergy Medications to Avoid with High Blood Pressure

While many antihistamines are safe for people with hypertension, certain allergy treatments should be approached with caution or avoided altogether. These include combination medications containing decongestants and some pain relievers.

Decongestants and Blood Pressure

Dr. Cometti explains, “The two main decongestant ingredients found in most allergy, cold, and sinus medications are phenylephrine or pseudoephedrine. These are known to raise blood pressure and heart rate.” If you have high blood pressure, it’s best to avoid these ingredients unless your doctor approves their use.

NSAIDs and Hypertension

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, which are found in some combination medications, may slightly increase blood pressure. It’s advisable to consult your healthcare provider before using these medications if you have hypertension.

Combination Medications to Avoid

The following combination medications are examples of drugs that may increase your blood pressure:

• Allegra-D (fexofenadine/pseudoephedrine)
• Zyrtec-D (cetirizine/pseudoephedrine)
• Claritin-D (loratadine/pseudoephedrine)
• Advil Allergy and Congestion Relief (chlorpheniramine/ibuprofen/phenylephrine)
• Sudafed (pseudoephedrine)
• Sudafed PE (phenylephrine)
• Benadryl Allergy Plus Congestion (diphenhydramine/phenylephrine)
• Tylenol Cold + Flu + Cough Night (acetaminophen/dextromethorphan/doxylamine/phenylephrine)

It’s important to note that this list is not exhaustive. Always consult with your healthcare provider or pharmacist before starting any new medication, especially if you have high blood pressure or other health concerns.

Interactions Between Antihistamines and Blood Pressure Medications

Understanding potential drug interactions is crucial for anyone taking multiple medications. This is especially true for individuals managing both allergies and hypertension.

Potential Risks of Combining Medications

When taken alongside blood pressure medications such as propranolol or metoprolol, Benadryl may cause your blood pressure to drop too low. This interaction can lead to symptoms like dizziness, fainting, or increased risk of falls.

It’s essential to discuss any pre-existing medical conditions and current medications with a healthcare professional to rule out potential drug interactions. They can provide personalized advice based on your specific health profile and medication regimen.

Alternative Allergy Management Strategies for Hypertensive Patients

For individuals with high blood pressure who are concerned about using antihistamines, there are several alternative strategies to manage allergy symptoms effectively.

Non-Pharmacological Approaches

• Allergen avoidance: Identify and minimize exposure to your specific allergens.
• Nasal irrigation: Use saline nasal sprays or neti pots to flush out allergens and clear nasal passages.
• Air purifiers: Use HEPA filters to reduce airborne allergens in your home.
• Immunotherapy: Consider allergy shots or sublingual tablets to build tolerance to specific allergens over time.

Natural Remedies

Some natural remedies may help alleviate allergy symptoms without affecting blood pressure. These include:

• Quercetin: A natural antihistamine found in foods like onions, apples, and berries.
• Butterbur: An herb that may help reduce nasal allergy symptoms.
• Probiotics: May help modulate the immune system and reduce allergic responses.
• Local honey: Some believe consuming local honey can help build tolerance to local pollen allergens.

Always consult with a healthcare professional before trying any new supplement or natural remedy, especially if you have high blood pressure or other health conditions.

Monitoring Blood Pressure While Using Antihistamines

If you have hypertension and need to use antihistamines, it’s important to monitor your blood pressure regularly. This can help you and your healthcare provider identify any potential issues early on.

Tips for Effective Blood Pressure Monitoring

• Use a reliable home blood pressure monitor.
• Take readings at the same time each day.
• Record your readings and share them with your healthcare provider.
• Be aware of any symptoms that might indicate changes in your blood pressure, such as dizziness or headaches.

If you notice any significant changes in your blood pressure readings after starting an antihistamine, contact your healthcare provider promptly.

Personalized Allergy Treatment Plans for Hypertensive Patients

Managing allergies while dealing with high blood pressure requires a personalized approach. Your healthcare provider can help develop a treatment plan that addresses your allergy symptoms without compromising your cardiovascular health.

Factors to Consider in Treatment Planning

• Severity of allergy symptoms
• Current blood pressure levels and stability
• Other medications you’re taking
• Overall health status and any other medical conditions
• Personal preferences and lifestyle factors

By taking these factors into account, your healthcare provider can recommend the most appropriate allergy treatments that are safe and effective for your specific situation.

In conclusion, while Benadryl and many other antihistamines are generally safe for people with high blood pressure, it’s crucial to approach allergy treatment with caution and under medical guidance. By understanding the potential effects of different medications, exploring alternative treatments, and maintaining open communication with your healthcare provider, you can effectively manage your allergies while keeping your blood pressure under control.

Does Benadryl raise blood pressure?

Here is what you should know about the oral antihistamine if you have hypertension

If you’ve had allergies, hives, hay fever, or the common cold then it’s likely you’ve considered Benadryl to treat your symptoms. It’s an oral antihistamine that is very effective to help alleviate symptoms like itchy, watery eyes, sneezing, and runny nose. However, it’s an older medication that can come with some unpleasant side effects—like major drowsiness or dry mouth. But, if you have hypertension, does Benadryl raise your blood pressure? Experts offer advice.

How does Benadryl work

Benadryl (diphenhydramine) is a first-generation antihistamine sold over the counter. Like other antihistamines, it works by blocking histamine receptors. Histamine is a chemical in your body that responds to allergens. 

“Benadryl suppresses the effects of histamine by blocking its action on a variety of target organs including blood vessels, respiratory airways, and smooth muscles,” says Dung Trinh, MD, an expert in preventive health and inflammation and founder of Healthy Brain Clinic.  

Because Benadryl can make you feel sleepier than newer allergy treatments, it is more often used to treat an allergic reaction, hives, or viral symptoms whereas second- and third-generation medications like Zyrtec (cetirizine), Claritin (loratadine), and Allegra (fexofenadine) are generally used to treat or prevent daily allergy symptoms. Benadryl is also sometimes used to prevent motion sickness or to help with nausea.

Does Benadryl affect blood pressure?

“Most antihistamines, including Benadryl, do not have much effect on your blood pressure,” says Brandon Cometti, MD, a dermatologist at Roswell Skin Center in New Mexico. “An antihistamine might react with other medications or other underlying health issues and lead to lower blood pressure, but this is usually not the case.” When taken along with blood pressure medications (such as propranolol or metoprolol), Benadryl may cause your blood pressure to dip too low. Be sure to discuss any pre-existing medical conditions and current medications with a healthcare professional to rule out any potential drug interactions.  

“Research studies have shown that patients taking Benadryl may experience a decrease in their blood pressure readings, which may cause symptoms of dizziness and increase the risk of falls,” Dr. Trinh says. 

Benadryl side effects

In addition to dizziness and impaired coordination, other common side effects of Benadryl include:

• Sleepiness or sedation 
• Headache 
• Constipation 
• Dry mouth

Possible serious side effects include:

• Seizures
• Confusion
• Arrhythmias
• Anemia
• Heatstroke

In rare cases, Benadryl can raise your heart rate—but research shows that cardiac issues are unlikely unless you use more than the recommended dose.

RELATED: Can you overdose on Benadryl?

What allergy medicine can I take with high blood pressure?

It is generally safe to take Benadryl or another antihistamine if you have high blood pressure—as long as they do not contain decongestants, according to Dr. Cometti. Single-ingredient antihistamine medications are not known to raise blood pressure.

The following meds for seasonal allergies are considered safe for people with high blood pressure:

• Benadryl (diphenhydramine)
• Zyrtec (cetirizine)
• Claritin (loratadine)
• Allegra (fexofenadine)
• Nasal sprays including Flonase (fluticasone) and Nasacort

What allergy medication should I

not take with high blood pressure?

Not all allergy treatments are safe for people with hypertension—particularly combination medications that contain decongestants and certain pain relievers. 

• Decongestants: “The two main decongestant ingredients found in most allergy, cold, and sinus medications are phenylephrine or pseudoephedrine,” Dr. Cometti explains. “These are known to raise blood pressure and heart rate.” Both of these ingredients should be avoided if you have high blood pressure, unless your doctor approves their use.
• Nonsteroidal anti-inflammatory drugs (NSAIDs): These drugs, which include ibuprofen, which is found in some combination medications, may raise blood pressure slightly. Ask your healthcare provider before using. 

The following combination medications are examples of drugs that may increase your blood pressure:

• Allegra-D (fexofenadine/pseudoephedrine) 
• Zyrtec-D (cetirizine/pseudoephedrine)
• Claritin-D (loratadine/pseudoephedrine) 
• Advil Allergy and Congestion Relief (chlorpheniramine/ibuprofen/phenylephrine)
• Sudafed (pseudoephedrine)
• Sudafed PE (phenylephrine)
• Benadryl Allergy Plus Congestion (diphenhydramine/phenylephrine)
• Tylenol Cold + Flu + Cough Night (acetaminophen/dextromethorphan/doxylamine/phenylephrine)

The list above does not contain all medications that may affect your blood pressure. Before you take any medication, you should carefully read the ingredients list and seek medical advice from your healthcare provider or pharmacist. 

It’s allergy season! What that might mean for you: Premier Cardiology Consultants: Cardiologists

It’s allergy season! What that might mean for you: Premier Cardiology Consultants: Cardiologists

From Springtime on into the summer months, millions of people struggle with allergies related to pollen and other environmental factors. Because they are so widely available, the common perception of over-the-counter allergy medications is that they are safe.

This Isn’t Necessarily A Given.

Allergy drugs, both prescription and commercial, can effectively reduce the symptoms of hay fever and other allergies. This is a big plus. On the other hand, allergy medications could interact with certain drugs prescribed for the heart and blood pressure or with an existing heart condition. For example, allergy medications with pseudoephedrine may increase blood pressure or heart rate, which could agitate some cardiac conditions. For this reason, any person who is considering an over-the-counter allergy medicine is encouraged to speak with the on-site pharmacist or their physician for recommendations based on other medications they may be taking or on their general heart health.

Are All Allergy Meds Potentially Bad For Your Heart?

Allergy drugs generally fit into one of three classes:

• Antihistamine
• Anti-inflammatory
• Decongestant

Antihistamines are generally viewed as safe, even for people with heart disease or high blood pressure. However, the FDA does state that antihistamines could elevate heart rate and blood pressure temporarily. Additionally, some antihistamine drugs also contain decongestant ingredients. This is typically notated with a “D” after the medication name. Some experts warn that people with high blood pressure or other cardiac problems should avoid decongestants altogether due to this elevation and its potential to create disturbance in heart rhythm such as atrial fibrillation. The reason why decongestants do this is that they constrict the blood vessels.

Anti-inflammatory allergy medications like intranasal sprays are generally safe for all people provided that usage instructions are followed. Overuse of an intranasal spray could affect the efficacy of blood pressure medications and may also lead to water and salt retention.

Staying Heart-Healthy Through The Allergy Season

It is possible for people taking heart medications or managing a heart or blood pressure situation to make it through allergy season. Prescription allergy medications have been developed for use alongside heart medications. Your primary care doctor or cardiologist can assist you in finding the right allergy medication for your needs. Even after consulting with your doctor, it is beneficial to also speak with the pharmacist who fills all of your prescriptions to confirm that there is no risk of drug interactions.

Premier Cardiology Consultants proudly serves the areas of Lake Success, Forest Hills, and Richmond Hill, NY. To schedule a consultation with us, call 516-437-5600.

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Chinese scientists explain how allergies and high blood pressure are related

• Health

Why should allergy sufferers be more attentive to their heart health, regularly measure blood pressure and visit a cardiologist? The answer was given by scientists from China in the latest study.

April 12, 2022

Source:

Getty Images

The risk of developing hypertension and cardiovascular disease may be higher in patients with certain conditions, according to a study from Shenzhen University in China.

It turned out that the highest risk of developing hypertension and heart disease is in people with allergies, writes CNN.

Highest risk

Previous studies have also found a link between allergic diseases and heart disease, but according to Korean scientists, it was controversial. In the same work, the hypothesis was tested on the basis of data from a larger number of participants – 10 thousand people aged 18 to 57 years. Each of them had at least one type of allergy – respiratory, food or skin.

It turned out that allergy sufferers are not only at risk of becoming hypertensive, but are also more likely to develop coronary heart disease. Moreover, at risk are patients with allergies over the age of 39 years.

Ischemic heart disease is an acute or chronic disease associated with a decrease or complete cessation of blood supply to the muscle tissue of the heart.

Scientists believe that based on their findings, when examining patients with allergies, as well as those with asthma, doctors should also evaluate cardiovascular risks.

“Blood pressure should be monitored and coronary heart disease screened to ensure early effective treatment of patients,” said study lead author Yang Guo.

Read also

“We can’t give a precise causal relationship, but it’s most likely due to pro-inflammatory mediators that cause inflammation in the body,” said pulmonologist Dr. Raj Dasgupta, assistant professor of clinical medicine at the Keck School of Medicine at the University of Southern California.

Inflammation is the body’s way of fighting pathogens, but an overactive or prolonged response is a major factor in many chronic diseases, including diabetes, high blood pressure, and heart disease.

– Antihistamines and other medications taken by allergy sufferers constrict blood vessels, which can cause high blood pressure and heart palpitations, says Raj Dasgupta. – A number of drugs that are prescribed for allergies can also have a negative effect on the cardiovascular system – for example, steroids.

Text author:Anna Maiskaya

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Antihistamines in the treatment of comorbid patients | #04/13

Antihistamines are drugs that completely or partially inhibit the action of histamine. Histamine is the most important mediator of various physiological and pathological processes in the body. An increase in its concentration causes a spasm of smooth muscles and bronchi, dilation of blood vessels, a decrease in blood pressure, an increase in capillary permeability, an increase in the secretion of gastric juice, etc.

The expediency of using antihistamines is due to the increase in recent years in the number of patients with allergic reactions: urticaria, atopic dermatitis, allergic rhinitis and conjunctivitis (hay fever). These conditions are generally not life-threatening, but require active therapeutic intervention that must be effective, safe, and well tolerated by patients.

This group of drugs prevents or eliminates the excessive physiological effects of endogenous histamine in the body by reducing its concentration in tissues, as well as by blocking histamine receptors. Most of the antihistamines used have a number of specific pharmacological properties that characterize them as a separate group. These include antipruritic, decongestant, antispastic, anticholinergic, antiserotonin, sedative and local anesthetic effects, as well as prevention of histamine-induced bronchospasm.

The first substances with antihistamine activity were synthesized in the 1920s. In the 1960s Three subtypes of histamine receptors have been identified: H ₁ , H ₂ and H ₃ , which differ in structure, localization, and physiological effects arising from their activation and blockade [1].

The antihistamine effect that develops with the blockade of type 1 histamine receptors is used mainly in allergology, as well as to achieve a sedative, hypnotic or antiemetic effect.

The antihistamine effect that develops with blockade of type 2 histamine receptors is used in gastroenterology to suppress histamine-dependent secretion of hydrochloric acid by parietal cells of the fundic glands of the stomach.

There are several classifications of antihistamines. The most popular classification of H ₁ -histamine blockers was based on their sedative effect [2].

According to the degree of sedative activity, three groups, or “generations”, of antihistamines are distinguished: H ₁ – 1st generation antagonists with a noticeable sedative effect; H ₁ – 2nd generation antagonists that do not give a sedative effect at the recommended therapeutic dose, however, when the dose is increased, they exhibit a sedative effect; and H ₁ – 3rd generation antagonists that do not cause signs of sedation even when the therapeutic dose is exceeded. In addition, H ₁ -3rd generation antagonists, in addition to the highest antihistamine activity, do not cause cardiotoxic effects characteristic of 2nd generation drugs.

H

₁ 1st generation antagonists

All antihistamines of the 1st generation are well soluble in fats and, in addition to H ₁ -histamine, also block cholinergic, muscarinic and serotonin receptors. Solubility in lipids determines their sedative effect. As a result of lipophilicity, H ₁ -histamine blockers penetrate the blood-brain barrier well and block H ₁ receptors in the brain. The degree of manifestation of the sedative effect of the 1st generation drugs varies from moderate to severe, intensifying when they are taken together with alcohol or psychotropic drugs. In this regard, some of the H ₁ -histamine blockers are even used as sleeping pills (doxylamine). However, instead of sedation, sometimes (against the background of taking large doses), the opposite occurs – an exciting effect, the so-called psychomotor agitation. Due to the sedative effect, most 1st generation drugs cannot be used during work that requires increased attention.

Another psychotropic effect inherent in individual representatives (hydroxyzine) H ₁ -histamine blockers of the first generation is an anxiolytic effect due to the suppression of the activity of the central nervous system in certain areas of the subcortical region.

Atropine-like reactions are most characteristic of ethanolamines and ethylenediamines. These effects are manifested by dry mouth and nasopharynx, urinary retention, constipation, tachycardia and visual disturbances.

This property of H ₁ -histamine blockers can increase bronchial obstruction in bronchial asthma (due to an increase in sputum viscosity), exacerbate glaucoma and lead to infravesical obstruction in prostate adenoma, and therefore their use in comorbid patients should be as limited as possible. . Antiemetic and antiswaying effects of 1st generation antihistamines are also associated with their central anticholinergic action. Diphenhydramine, promethazine, cyclizine, meclizine reduce the stimulation of vestibular receptors and inhibit the function of the labyrinth, and therefore can be used for motion sickness. Row H ₁ -histamine blockers, inhibiting the central effects of acetylcholine, reduce the symptoms of parkinsonism.

Antitussive action, which is realized through a direct action on the cough center in the medulla oblongata, is most characteristic of diphenhydramine. The antiserotonin effect, which is primarily characteristic of cyproheptadine, determines its use in migraine.

The alpha-1 blocking effect with peripheral vasodilation, especially with phenothiazine antihistamines, can lead to a transient decrease in blood pressure. Also, for most antihistamines of the 1st generation, a local anesthetic effect is characteristic, which occurs due to a decrease in the permeability of membranes for sodium ions. Diphenhydramine and promethazine are stronger local anesthetics than novocaine. However, they have systemic quinidine-like effects, manifested by prolongation of the refractory phase and the development of ventricular tachycardia.

All of the above qualities have allowed 1st generation antihistamines to occupy a clinical niche in the treatment of non-allergic diseases such as migraine, sleep disorders, extrapyramidal disorders, anxiety and motion sickness. Some 1st generation antihistamines are used in combination preparations for colds to provide a sedative and hypnotic effect (Fig. ).

Antihistamines of the 1st generation differ from the 2nd generation in the short duration of exposure with a relatively rapid onset of the clinical effect, so many of them are available in parenteral forms.

H

₁ 2nd generation antagonists

The emergence of a new generation of antihistamines has significantly expanded the possibilities of their use in clinical practice for the treatment of allergic diseases. All 2nd generation antihistamines are characterized by high specificity and high affinity for H1 receptors in the absence of an effect on choline and serotonin receptors, therefore, unlike the previous generation, 2nd generation drugs have practically no sedative and anticholinergic effects. The rapid onset of the effect and its prolongation can be achieved due to the high binding of drugs to carrier proteins, their accumulation in the body, as well as delayed excretion. The minimum sedative effect when using drugs in therapeutic doses is due to the weak passage of the blood-brain barrier due to the peculiarities of the structure of these drugs. Some particularly sensitive individuals may experience moderate drowsiness, which is rarely the reason for discontinuing the drug. It should be noted that with long-term use of this group of drugs, there are no phenomena of addiction, resistance and tachyphylaxis [3].

However, there is also a “reverse side of the coin”. 2nd generation antihistamine blockers have the ability to block the potassium channels of the heart muscle, which is associated with prolongation of the QT interval, cardiac arrhythmias, and an increased risk of sudden death. The likelihood of these side effects increases in patients with severe liver dysfunction, as well as when antihistamines are combined with antifungal drugs (ketoconazole, itraconazole), macrolides (erythromycin, clarithromycin) and antidepressants (fluoxetine, sertraline, paroxetine).

In addition, it should be borne in mind that some 2nd generation drugs (terfenadine, astemizole) are characterized by a cardiotoxic effect that is not associated with their antihistamine activity and, therefore, is specific for certain drugs, and not for the entire class H ₁ 2nd generation histamine blockers. In confirmation of this fact, no cardiotoxic effect was registered in clinical studies of acrivastine, cetirizine, ebastine, fexofenadine, norastemizole and descarboethoxyloratadine [4].

Thus, the advantages of 2nd generation antihistamines include a wider range of indications for use (bronchial asthma, atopic dermatitis, hay fever, allergic rhinitis) and the presence of additional antiallergic effects: the ability to stabilize mast cell membranes, suppress the accumulation of eosinophils in the airways.

H

₁ 3rd generation antagonists

H ₁ -3rd generation antagonists are currently represented by two drugs – cetirizine and fexofenadine. This class of drugs is fundamentally different from its predecessors in that the drugs in this group are active metabolites of antihistamines of the previous generation. Their most important advantage is the lack of influence on the QT interval. In therapeutic doses, 3rd generation antihistamines rarely cause sedation, it is not so pronounced as to cause discontinuation of the drug. In addition, another obvious advantage of the representatives of this group is the absence of the phenomenon of tachyphylaxis, which makes it possible to conduct long courses of antiallergic treatment.

H ₁ -3rd generation antagonists are close to ideal antiallergic drugs, and their improvement is aimed at eliminating even the minimal sedative effect, accelerating the absorption of oral drugs and their distribution in target organs, as well as increasing bioavailability and the duration of the half-life. Moreover, the developers of 3rd generation antihistamines pursue the possibility of taking drugs once a day and maintaining its clinical effect for 24 hours without the need to adjust the dosage regimen in patients with impaired liver and kidney function [5]. The absence of clinically significant interactions with other drugs under conditions of forced polypharmacy, an increase in anti-inflammatory activity and the ability of drugs to modify the activation of epithelial cells can make this generation of antihistamines almost flawless.