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Antihistamines, Decongestants, and Expectorants during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Pseudoephedrine hydrochloride is the most commonly used agent for pregnant women who require a decongestant (Hornby and Abrahams, 1996; Stanley et al., 2019). It is also the most frequently used sympathomimetic in pregnant and non-pregnant individuals, and is typically used as a decongestant. Pseudoephedrine is also part of a combination therapy and combined with different antihistamines in “common cold” or “sinus” medications. Epidemiological studies of more than 1,000 first-trimester human pregnancies exposed to pseudoephedrine indicate no association with congenital anomalies (Aselton et al., 1985; Heinonen et al., 1977; Jick et al., 1981; Rosa, unpublished, Briggs et al., 2021). Among 12,734 malformed newborns, the frequency of birth defects was not increased among 531 infants whose mothers used pseudoephedrine during organogenesis (Yau et al., 2013).
Pulmonary diseases in pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Leah Lande, Abraham Sanders, Dana Zappetti
Much like asthma, allergic rhinitis that is present prior to pregnancy may remain stable, worsen, or improve (64). Skin testing to identify an allergen is avoided during pregnancy given the possibility of a severe systemic allergic response during testing. Intranasal cromolyn sodium is safe and efficacious, and unlike in non-allergic rhinitis of pregnancy, intranasal glucocorticoids are effective and considered safe (65). Antihistamines are generally less effective and the intranasal formulations should be avoided. Second-generation antihistamines such as loratadine and cetirizine are the formulations of choice if more than topical therapy is needed. Decongestants have the added benefit of having vasoconstrictive properties, but because of this effect, they should be avoided in the first trimester. Nasal oxymetolazone, as in nonpregnant patients, should be used only for a short duration of 2 to 3 days to avoid rebound symptoms. If necessary, pseudoephedrine can be used after the first trimester and if there is no maternal hypertension (65,66). Allergen immunotherapy is often successful in controlling symptoms of allergy—both rhinitis and asthma. While it is not recommended to start immunotherapy during pregnancy, for fear of systemic allergic reaction, patients who are tolerating a stable dose and who are benefiting from the therapy prior to pregnancy should continue their injections throughout pregnancy (67).
Rhinitis
Published in Pudupakkam K Vedanthan, Harold S Nelson, Shripad N Agashe, PA Mahesh, Rohit Katial, Textbook of Allergy for the Clinician, 2021
Vinay Mehta, Srinivasan Ramanuja, Pramod S Kelkar
Oral decongestants such as pseudoephedrine and phenylephrine can reduce nasal congestion caused by both allergic and nonallergic rhinitis. However, they do not possess anti-inflammatory properties and are generally not effective in the treatment of other symptoms. Furthermore, decongestants can have a variety of adverse effects, including hypertension, insomnia, irritability and headache. They are relatively contraindicated in patients with hypertension, and should be used with caution in patients with closed angle glaucoma, cardiovascular or cerebrovascular disease, hyperthyroidism or bladder neck obstruction.
Current and emerging treatment modalities for bacterial rhinosinusitis in adults: a comprehensive review
Published in Expert Opinion on Pharmacotherapy, 2022
Maria Gabriella Matera, Barbara Rinaldi, Vito de Novellis, Paola Rogliani, Mario Cazzola
A systemic decongestant (such as pseudoephedrine or phenylephrine) or topical nasal decongestant (such as xylometazoline) are commonly used in patients with ABRS to minimize nasal congestion and improve patient symptoms [27]. Still, there are side effects to be aware of, including the possibility of developing rhinitis medicamentosa with prolonged topical use and hypertension with oral decongestants, as well as irritability, palpitations, and insomnia [3]. Nasal decongestants should not be taken for more than ten days precisely because of the risk of rebound rhinitis [27]. Canadian guidelines recommend not using them for more than three days [4]. However, not enough data are available for a recommendation based on evidence. The EPOS 2020 steering group did not recommend using decongestants, at least in post-viral ARS, due to the lack of clinically relevant data [14]. However, due to the effectiveness of oral decongestants in reducing nasal congestion, Canadian guidelines advise patients without contraindications to consider these medications a treatment option [4].
Pharmacokinetics and pharmacodynamics of dextromethorphan: clinical and forensic aspects
Published in Drug Metabolism Reviews, 2020
Ana Rita Silva, Ricardo Jorge Dinis-Oliveira
DXM abuse can cause several other serious health complications not directly related to DXM itself, but due to other drugs found in OTC medications (Woo and Hanley 2013). Indeed, when abuse occurs using the formulations containing antihistamines (chlorpheniramine, brompheniramine, pheniramine), analgesics (paracetamol, acetyl salicylic acid), decongestants (phenylephrine, pseudoephedrine), and/or expectorant mucolytic agents; additional toxicity of these compounds is a concern and predisposes to fatal overdoses (Karch 2008; Karch and Drummer 2016). Some liquid DXM preparations also contain ethanol concentrations up to approximately 25% (Bisaga and Popik 2000). Thus, a high level of suspicion is needed when detected an increase in blood pressure possibly due to pseudoephedrine, a delayed liver damage related to high doses of paracetamol or central nervous system depression, cardiovascular and anticholinergic toxicity from antihistamines (Gunn et al. 2001; Banken and Foster 2008; Woo and Hanley 2013).
Methamphetamine exposures reported to United States poison control centers, 2000–2019
Published in Clinical Toxicology, 2021
Tiffany Chen, Henry A. Spiller, Jaahnavi Badeti, Alexandra R. Funk, Motao Zhu, Gary A. Smith
The rates of exposure to methamphetamine demonstrated an initial increase from the beginning of the study period through 2005 before rapidly decreasing until 2007, followed by an increase through the end of the study in 2019. These trends reflect the history of methamphetamine production and policy in the US and neighboring countries. By the mid-1990s, Mexican drug trafficking organizations were supplying the bulk of the US methamphetamine supply, supplemented by increasing numbers of clandestine domestic laboratories [5]. Methamphetamine was predominantly made from precursors like ephedrine and pseudoephedrine, which were readily available in large quantities without a prescription [13]. The Combat Methamphetamine Epidemic Act of 2005 went into effect in March 2006 [18] and restricted access to ephedrine, pseudoephedrine, and phenylpropanolamine. Canada, the main supplier of pseudoephedrine to Mexico, passed similar legislation in 2005 that limited the distribution of pseudoephedrine [19], and in 2008, Mexico placed a domestic ban on pseudoephedrine and ephedrine products [20]. Together, these efforts resulted in a decline in methamphetamine use in the US. However, Mexican drug trafficking organizations soon switched to using phenyl-2-propanone as a precursor [13,21], reigniting an increase in methamphetamine availability and use in the US. The observed decrease in methamphetamine cases in this study demonstrates the effectiveness of coordinated public policy. However, the impact was transient, and additional efforts are now needed to reverse the current upward trend in methamphetamine availability and use driven by international drug trafficking organizations.