Which antihistamines to use in chronic kidney disease and hemodialysis?

The general agreement is that some first generation antihistamines are safe, e.g. diphenhydramine, hydroxizine, chlorpheniramine.

Some studies in the recent years confirmed that the second generation antihistamines are also safe but the dose may need modification.



Oral Antihistamines (click to enlarge the image).

Evidence from the multiple-dose study supports the clinical use of cetirizine for ESRF patients on HD. Thus, it is concluded that a prescription of 5 mg cetirizine three times a week during the predialysis period will be the effective and safety renal dosage for ESRD patients on HD.

No significant relationship was observed between the terminal elimination half-life of loratadine or descarboethoxyloratadine and creatinine clearance. Hemodialysis augmented endogenous clearance by less than 1%. The disposition of loratadine is not significantly altered in patients with severe renal insufficiency nor is hemodialysis an effective means of removing loratadine or descarboethoxyloratadine from the body.

The use of H1-receptor antagonists may even help prevent left ventricular remodeling in patients on chronic hemodialysis. A 2010 study suggested a suppressive role of second-generation antihistamines on LV remodeling.

References:

Comparative pharmacology of the H1 antihistamines. J Investig Allergol Clin Immunol 2006; Vol. 16, Supplement 1:3-12. Full text PDF.

Pharmacokinetics of cetirizine in chronic hemodialysis patients: multiple-dose study.
Noiri E, Ozawa H, Fujita T, Nakao A. Nephron. 2001 Sep;89(1):101-4.

Pharmacokinetics of loratadine in patients with renal insufficiency. Matzke GR, Halstenson CE, Opsahl JA, Hilbert J, Perentesis G, Radwanski E, Zampaglione N. J Clin Pharmacol. 1990 Apr;30(4):364-71.

The use of H1-receptor antagonists and left ventricular remodeling in patients on chronic hemodialysis. Omae K, Ogawa T, Yoshikawa M, Nitta K. Heart Vessels. 2010 Mar;25(2):163-9. Epub 2010 Mar 26.