Dr Haydon has done an excellent job of presenting the pros and cons of the use of nonsedating antihistamines. Actually, other than economic reasons, it is difficult to make a convincing argument against using the newer antihistamines, which have been formulated to avoid the CNS adverse effects of conventional preparations. The health and economic consequences of impaired cognition and performance associated with the use of first-generation antihistamines are exemplified in a study on work-related injuries and medication use in which antihistamines had the highest odds ratio of such injuries compared with 8 other classes of drugs, including hypnotic agents.1 Third-party payers frequently suggest the use of a sedating (ie, less expensive) antihistamine at night, arguing that "the patient is going to sleep, anyway." This argument has been convincingly refuted in an editorial by Simons,2 who discusses the risk-benefit-cost "eternal triangle," citing evidence that, although H1 blockage may not always persist until the next morning, the adverse CNS effects often do.3
Mabry RL. Antihistamines: Is There Really a Cost-Benefit Controversy? Arch Otolaryngol Head Neck Surg. 2001;127(12):1514. doi:10.1001/archotol.127.12.1514
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