Chronic chlorpheniramine therapy: subsensitivity, drug metabolism, and compliance.
To investigate whether patients develop true subsensitivity to antihistamines during chronic therapy, we studied 14 adult subjects who received chlorpheniramine for 3-day and 3-week trials of therapy. Titrated skin tests to histamine and compound 48/80, chlorpheniramine blood levels (by HPLC), compliance, and side effects were monitored and compared during the two courses of therapy and their respective 72-hour washout periods. We found a significant correlation between chlorpheniramine blood levels and skin test suppression during both the 3-day and 3-week therapies. The 3-day chlorpheniramine therapy was more clinically effective (measured by skin test suppression corrected for serum chlorpheniramine concentration) than the 3-week therapy (P less than .01). Chlorpheniramine serum half-lives and 2-hour chlorpheniramine blood levels were not significantly different after the 3-day and 3-week trials. Compliance was significantly worse (P less than .01) during 3-week therapy. Medication side effects (particularly drowsiness) were frequently reported during both courses of therapy. We conclude that subsensitivity to chlorpheniramine does develop in adult patients receiving 3 weeks of therapy. This subsensitivity is not explained by changes in drug metabolism. In addition to subsensitivity, poor compliance may contribute to sub-therapeutic results during chronic antihistamine therapy. Side effects from antihistamines may also require individualization of therapy for certain patients.
Bantz
E W
EW
Allergy-Immunology Service, Fitzsimons Army Medical Center, Aurora, CO 80045-5001.
Dolen
W K
WK
Chadwick
E W
EW
Nelson
H S
HS
D000328:Adult; D002744:Chlorpheniramine / Q000009:adverse effects* / Q000097:blood; D002851:Chromatography, High Pressure Liquid; D004341:Drug Evaluation; D004342:Drug Hypersensitivity / Q000097:blood / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D012882:Skin Tests / Q000379:methods; D013997:Time Factors
D002744:Chlorpheniramine