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Effect of H1 antihistamines upon the central nervous system


J Montoro 1, J Sastre 2, J Bartra 3, A del Cuvillo 4, I Dávila 5, I Jáuregui 6,J Mullol 7, AL Valero 3

1 Unidad de Alergia. Hospital La Plana. Villarreal (Castellón), Spain;
2 Servicio de Alergia. Fundación Jiménez Díaz. Madrid, Spain;
3 Unitat d.Al·lèrgia. Servei de Pneumologia i Al·lèrgia Respiratòria. Hospital Clínic (ICT). Barcelona, Spain;
4 Clínica Dr. Lobatón. Cádiz, Spain;
5 Servicio de Alergia. Hospital Clínico. Salamanca, Spain;
6 Unidad de Alergología. Hospital de Basurto. Bilbao, Spain;
7 Unitat de Rinologia, Servei d’Otorinolaringologia (ICEMEQ). Hospital Clínic. Barcelona, Spain

J Investig Allergol Clin Immunol 2006; Vol. 16, Supplement 1: 24-28



The antihistamines have been divided into fi rst and second generation drugs, according to their pharmacokinetic properties, structural characteristics and adverse effects. The effects exerted by these substances upon the central nervous system (CNS) are fundamentally determined by their capacity to cross the blood-brain barrier (BBB) and bind to the central H1 receptors (RH1). The capacity to cross the BBB is dependent upon the lipophilicity of the drug molecule and on its affi nity for P glycoprotein (GpP) – the active transporter of the BBB – which “actively extracts xenobiotic substances from the CNS”. GpP is located on the luminal surface of the endothelial cells of the brain blood vessels [1]. The cerebral capillaries present tightly sealing intercellular junctions with a relative lack of transendothelial conduits for the passive diffusion of soluble molecules.
The first generation antihistamines are liposoluble, with scant affi nity for GpP – unlike the second generation molecules which are lipophobic and are regarded as GpP substrates. The distinction based on differences in molecular weight (the smaller the molecule, the easier it is to cross the BBB, at least in theory) is becoming increasingly less important. As an example, desloratadine has a molecular weight (mw = 338.9) similar to that of hydrazine (347.9), but permanence of the two drugs in brain tissue differs after administration. .../... more at PDF full text