Delgado L F, Pferferman A, Solé D, Naspitz C K
Department of Pediatrics, Paulista School of Medicine, Federal University of São Paulo, SP, Brazil.
Ann Allergy Asthma Immunol. 1998 Apr;80(4):333-7. doi: 10.1016/S1081-1206(10)62979-1.
Adverse cardiac effects have been related to the use of H1-receptor antagonists terfenadine and astemizole.
We have investigated the cardiac effects of the H1-receptor antagonists terfenadine, astemizole, loratadine and cetirizine, used in recommended doses, concomitantly or not with the antibiotic erythromycin.
A group of 80 children aged 5 to 12 years was studied. All children had been diagnosed with perennial allergic rhinitis based on symptoms, clinical signs and a positive immediate skin test to Dermatophagoides pteronyssinus. The children had no personal history of cardiac disease or hepatic dysfunction, and they had a normal electrocardiogram (ECG) at the beginning of the study. Forty children had allergic rhinitis and sinusitis, and were assigned to subgroups of ten children who received terfenadine, astemizole, loratadine, or cetirizine, concomitantly with erythromycin, for 14 days. Erythromycin was started to treat presumed bacterial infection in children with complete radiologic opacification of the maxillary sinus(es). The remaining 40 children had no sinusitis, and were assigned to subgroups of 10 children who received terfenadine, astemizole, loratadine, or cetirizine for 14 days.
No significant changes in the QT interval and QTc (QT corrected by Bazzett's equation) were observed among children who received astemizole, loratadine or cetirizine, with or without erythromycin. Children who have received terfenadine and erythromycin showed significantly prolonged QT interval (mean pretreatment and posttreatment values 0.32s and 0.34s, respectively). Analysis of the QTc interval, however, showed no significant differences in the group treated with terfenadine and erythromycin (mean values 0.39s and 0.39s, respectively).
Our results show that H1-receptor antagonists terfenadine, astemizole, loratadine and cetirizine, administered with or without erythromycin, to atopic children in recommended doses, do not induce adverse cardiac effects. Although the association between terfenadine and erythromycin has caused a statistically significant increase in QT interval measurements, the magnitude of these changes was below levels considered cardiotoxic or clinically relevant.
心脏不良反应与使用H1受体拮抗剂特非那定和阿司咪唑有关。
我们研究了推荐剂量使用H1受体拮抗剂特非那定、阿司咪唑、氯雷他定和西替利嗪，无论是否同时使用抗生素红霉素时的心脏效应。
对一组80名5至12岁的儿童进行了研究。所有儿童根据症状、临床体征以及对尘螨的阳性速发型皮肤试验被诊断为常年性变应性鼻炎。这些儿童无心脏病或肝功能障碍个人史，且在研究开始时心电图（ECG）正常。40名患有变应性鼻炎和鼻窦炎的儿童被分配到10名儿童的亚组中，分别接受特非那定、阿司咪唑、氯雷他定或西替利嗪，并同时服用红霉素，为期14天。红霉素用于治疗上颌窦完全影像学混浊的儿童的疑似细菌感染。其余40名儿童无鼻窦炎，被分配到10名儿童的亚组中，分别接受特非那定、阿司咪唑、氯雷他定或西替利嗪治疗14天。
在接受阿司咪唑、氯雷他定或西替利嗪治疗的儿童中，无论是否使用红霉素，QT间期和QTc（根据Bazzett公式校正的QT）均未观察到显著变化。接受特非那定和红霉素治疗的儿童QT间期显著延长（治疗前和治疗后平均值分别为0.32秒和0.34秒）。然而，对QTc间期的分析显示，接受特非那定和红霉素治疗的组无显著差异（平均值分别为0.39秒和0.39秒）。
我们的结果表明，以推荐剂量给特应性儿童使用H1受体拮抗剂特非那定、阿司咪唑、氯雷他定和西替利嗪，无论是否同时使用红霉素，均不会诱发心脏不良反应。尽管特非那定和红霉素的联合使用导致QT间期测量值在统计学上显著增加，但这些变化的幅度低于被认为具有心脏毒性或临床相关性的水平。
