Antihistamine Use in Liver Impairment

Safe Antihistamine Options

• Loratadine and desloratadine are the preferred non-sedating antihistamines for patients with hepatic impairment as they have no specific contraindications in liver disease 1, 2
• Fexofenadine has minimal hepatic metabolism and can be considered as an alternative option 1, 2

Antihistamines to Avoid

• Mizolastine is contraindicated in significant hepatic impairment 1, 2, 3
• Alimemazine (trimeprazine) should be avoided in hepatic impairment as it is hepatotoxic and may precipitate coma in severe liver disease 1, 2, 3
• Chlorphenamine (chlorpheniramine) should be avoided in severe liver disease due to inappropriate sedating effects 1, 2, 3
• Hydroxyzine should be avoided in severe liver disease due to its sedating effects 1, 2, 3

General Recommendations

• Non-sedating antihistamines are generally preferred over sedating ones due to the risk of hepatic encephalopathy with sedating agents in severe liver disease 1, 2, 3
• Patients should be offered a choice of at least two non-sedating H1 antihistamines as responses and tolerance vary between individuals 1, 2
• Avoid combining antihistamines with other hepatotoxic medications or those that inhibit hepatic metabolism via cytochrome P450 1, 2