Objective: Antihistaminics are mainly used to threat chronic pruritus or to affect sleep quality and mood. However, there are limited prospective and comprehensive comparative studies about both classic and new-generation antihistaminics. The purpose of this study was to determine and compare the effects of classical and new-generation antihistaminics on sleep quality, daytime sleepiness, dream anxiety and mood states.
Method: 92 patients with chronic pruritus participated in the study, who were consecutively admitted to the dermatology outpatient clinic of Dursun Odabas Research Hospital. Treatments with regular recommended therapeutic doses were as follows: 15 patients were given pheniramine maleate three times a day, 16 patients were given hydroxyzine 25 mg/day, 15 patients were given cetirizine 10 mg/day, 15 patients were given desloratadine 5 mg/day, 15 patients were given levocetirizine 5 mg/day, and 16 patients were given rupatadin 10 mg/day. Inşuences of antihistaminic drugs on mood, daytime sleepiness, dream anxiety and sleep quality in the first day and 1 month after the treatment were evaluated. Participants completed the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Van Dream Anxiety Scale (VDAS), Profile of Mood States (POMS), and UKU (Udvalg für Kliniske Undersogelser) before the treatment. We evaluated with ESS, POMS and psychological side effects with UKU on day 1 and ESS, PSQI, VDAS, POMS and UKU were filled and compared again one month after treatment.
Results: The six drugs were separately compared with each other and it was found that outpatients who received cetirizine treatment reported higher scores on depression, anxiety and fatigue subscales of the POMS than outpatients, who received desloratadine, levocetirizine and rupatadin treatment. Hydroxyzine and cetirizine did not differ from each other. Sleep latency was significantly improved among patients medicated with levocetirizine. Daytime sleepiness was predicted by rupadatin and pheniramine treatments. The UKU scores significantly increased among outpatients receiving pheniramine treatment. Antihistaminics regardless of being a first or second generation increased daytime sleepiness and decreased the scores of subjective sleep quality, showed no significant inşuence on mood. Antihistaminic drugs reduced sleep latency, increased daytime sleepiness and subjective sleep quality. There were no differences in sleep and affective characteristics between classic and new generation antihistaminic drugs before the treatment, on the first day and one month after the treatment. The global PSQI scores significantly decreased after one month in both groups that means improvement in subjective sleep quality. However, the dream anxiety scores of outpatients, who were medicated with new generation drugs as compared to outpatients, who were medicated with first generation drugs were significantly lower after one month.
Conclusion: According to the results of the study; either classical or new generation antihistaminics significantly increased daytime sleepiness as well as nocturnal sleep quality. As far as the remarkable differences between drugs are concerned, cetirizine and hydroxyzine seem to have negative inşuences on mood states; pheniramine and rupatadin appear to be related to more daytime sleepiness and better nocturnal sleep quality. Since the small sample size of each drug group, the current results should be confirmed in further studies with larger patient groups.