The Second-Generation (Peripherally-Selective) Antihistamines in Children

Marcia L. Buck, Pharm.D., FCCP


Pediatr Pharm. 2001;7(4) 

In This Article

Adverse Effects

In general, the second generation antihistamines are well tolerated. Despite their relative selectivity for peripheral receptors, some patients may still experience drowsiness and fatigue. Sedation appears to occur most frequently with cetirizine (14%), occasionally with loratadine (8%), and rarely with fexofenadine (1%). Other adverse effects reported with this class include: headache (1-12%), dry mouth (3-5%), sore throat (1-2%), and nausea, vomiting, or stomach pain (1-2%).[1,2]

Overdoses have been reported with the second generation antihistamines in both adults and children. Symptoms of overdose commonly include central nervous system (CNS) depression, arrhythmias, and cardiovascular collapse. In children, paradoxical CNS stimulation may be present, with hallucinations, psychosis, delirium, ataxia, and seizures.[1,14] Management of an overdose should begin with gut decontamination, followed by supportive care. Hemoperfusion may be used in extreme cases; none of the second generation antihistamines are removed by dialysis.[1]


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