Torsade de Points is unique polymorphic ventricular tachycardia associated with QT interval prolongation. The mechanism of Torsade de Points was not defined exactly but triggered activity associated with afterdepolarization and/or dispersion of repolarization were known possible explanation. Torsade de points is most often induced by various drugs such as antiarrythmic agents, antipsychotic agents, antibiotis, and antihistamines. Astemizole(Hismanal(R)) and Terfenadine among antihistamines are reported that cause leading to a Torsade de Points. We experienced the case of Torsade de Points which was induced with Piprinhydrinate(Diphenylpyraline, Plokon(R)), antihistamine of ethanolamine derivatives, expressed recurrent syncope and dizziness in a young lady.
Antipsychotic Agents ; Dizziness ; Ethanolamine ; Histamine Antagonists ; Syncope ; Tachycardia, Ventricular* ; Terfenadine

Fexofenadine (Allegra(R) 180) is a second-generation antihistamine. It is widely used as anti-allergic drug, which suppresses various allergic reactions mediated by histamines. A few cases of H1-antihistamine-induced urticaria have been reported. Herein, we report a rare case of fexofenadine-induced urticaria which was confirmed by a prick test, oral provocation test, and flow cytometry assisted-basophil activation test.
Basophil Degranulation Test ; Flow Cytometry ; Hypersensitivity ; Terfenadine ; Urticaria

OBJECTIVETo establish a precolumn chiral derivatization method for determination of fexofenadine enantiomers, a chiral substrate of OATP1B1, in cellular model.

METHODSR-(+)-phenylethyl isocyanate was selected as chiral derivatization reagent, which was reacted with fexofenadine to form carbamate derivatives. Enantiomers were identified by LC/MS and separated by RP-HPLC.

RESULTSUnder the experimental conditions, the fexofenadine enantiomers were separated completely. The standard curve was linear over the concentration range of 25-100 ng/ml (R(2)=0.9992, 0.9989). Accuracy was 101.1% and 98.3%, intra-precision was 2.4% and 3.1%, inter-precision was 3.1% and 4.0% for D1 and D2, respectively.

CONCLUSIONThe method established is sensitive and accurate for determination of fexofenadine enantiomers in cells.

BACKGROUND: Eosinophilia in the nasal secretion and mucosal tissues is the characteristic finding of allergic rhinitis. We compared the effects of nasal budesonide dipropionate and oral terfenadine on the symptom score and nasal secretion eosinophils in perennial allergic rhinitics. MATERIALS AND METHOD: Study subjects consisted of 81 patients with perennial allergic rhinitis and nasal eosinophilia. Fifty-seven patients were treated with nasal budesonide and 24 patients were treated with oral terfenadine for two weeks respectively. Nasal secretion eosinophils were measured as the percentage of total leukocytes under microscope. Symptom scores for sneezing, rhinorrhea, obstruction and itching were graded from 0 (no symptom) to 3 (severe symptom). RESULTS: In budesonide treatment group, symptom score reduction (total symptom score before treatment-total symptom score after treatment) was 5.1, while it was 2.3 in the terfenadine treatment group, which revealed a statistically significant difference (p<0.01). Reduction of eosinophils was 50% in the budesonide treatment group and 28% in terfenadine treatment group (p=0.045). There was statistically significant correlation between total symptom score and % eosinophils (r= 0.668 , p<0.01 ) CONCLUSION: Although both the nasal budesonide and oral terfenadine substantially reduced the proportion of eosinophils in the nasal secretion as well as symptoms in allergic rhinitics with eosinophilia, budesonide was superior to terfendine. Nasal eosinophils correlated with reduction of allergic symptoms in a statisticaly significant manner.
Budesonide* ; Eosinophilia ; Eosinophils* ; Humans ; Leukocytes ; Mucous Membrane ; Pruritus ; Rhinitis ; Sneezing ; Terfenadine*

BACKGROUND: Fexofenadine (Allegra(R)) is a H1-receptor selective antihistamine which exhibits consistent efficacy and safety in the treatment of allergic diseases. We thought that fexofenadine may be useful in treatment of the pruritus associated with eczema. OBJECTIVE: The purpose of this study was to evaluate the efficacy and safety of fexofenadine in the treatment of pruritus associated with eczema. METHODS: In this study, patients with atopic and allergic contact dermatitis were divided into a group given fexofenadine 180 mg once daily with topical prednicarbate treatment group or a topical prednicarbate treatment only group, for 1 week. The primary efficacy parameter was the mean change from baseline in pruritus score, and the secondary parameters were the mean change in the incidence of scratching, the mean change in visual analogue scale (0~100 mm) of pruritus, and a comparison of patient satisfaction. RESULTS: 435 patients were included and the mean age was 32.9 years old. The mean pruritus score at baseline was 3.55 point in fexofenadine group and 3.51 point in the control group. Regarding the mean change in pruritus score, fexofenadine significantly decreased the severity of pruritus compared with the control group (p<0.05). There were no significant differences in the decrease in the incidence of scratching between the two groups. A decrease in pruritus levels utilizing visual analogue scale was significant in the fexofenadine group (p<0.05) and patient satisfaction was significantly higher in the fexofenadine group (p=0.0192). There was no significant difference in the incidence of adverse events between two groups (p=0.6237). CONCLUSION: Fexofenadine administered 180 mg once daily in combination with topical prednicarbate treatment was effective and well tolerated in this study.
Dermatitis, Allergic Contact ; Dermatitis, Atopic ; Eczema ; Humans ; Incidence ; Patient Satisfaction ; Prednisolone ; Pruritus ; Terfenadine

Terfenadine is widely used because of nonsedating effect. But It could rarely provoke a potentially lethal ventricular tachyarrhythmia. Recently, we experienced two cases of torsades de pointes(TDP) of occurred after combined use of terfenadine and ketoconazole in usual dose. In one case, 31-yr-old female presented palpitation and recurrent syncope of sudden onset after ingestion of terfenadine 60mg and ketoconzole 200mg 5 times. On attack, ECG showed a polymorphic ventricular tachycardia, and after attack, showed prolongation of QT interval and TU wave changes. Her laboratory findings were not contributory. TDP was controlled with MgSO4 and isoproterenol infusion. Then, QT interval was normalized and no further episode occurred. In the other case, 32-yr-old female presented palpitation and recurrent syncope of sudden onset after ingestion of terfenadine 60mg and ketoconzole 200mg 5 times. ECG showed prolongation of QT interval and TU wave changes. Her laboratory findings were not contributory. TDP was controlled with MgSO4 and isoproterenol infusion. Then, QT interval was normalized and no further episode occurred.
Eating ; Electrocardiography ; Female ; Humans ; Isoproterenol ; Ketoconazole* ; Syncope ; Tachycardia ; Tachycardia, Ventricular ; Terfenadine* ; Torsades de Pointes*

Torsades de pointes is a polymorphic ventricular tachycardia associated with prolonged QT interval and increased U wave amplitude. It has been found to be induced by various drugs, electrolyte imbalances, and so on, but the mechanism of torsades de pointes has not been completely documented. Two hypotheses, early afterdepolarization and dispersion of repolarization have been known to be the possible mechanism. Terfenadine and astemizole are the antihistamines, known to be one of the etiologic agents of torsades de pointes, and factors associated with increased risk are significant liver disease, drug overdose, and concomitant administration of imidazole and macrolide antimicrobial drugs. There has been only one case reported that torsades de pointes had been induced by first-generation antihistamine, piprinhydrinate. We experienced a case of 43 year old male patient with torsades de pointes induced by first-generation antihistamine, hydroxyzine and treated successfully with drug cessation, MgSO
Adult ; Astemizole ; Drug Overdose ; Histamine Antagonists ; Humans ; Hydroxyzine* ; Isoproterenol ; Liver Diseases ; Male ; Tachycardia, Ventricular ; Terfenadine ; Torsades de Pointes*

Aquagenic urticaria is a rare form of physical urticaria, in which contact with water evokes wheals. A 19-year-old man and a 4-year-old boy complained of recurrent episodes of urticaria. Urticaria appeared while taking a bath or a shower, in the rain, or in a swimming pool. Well-defined pin head to small pea-sized wheals surrounded by variable sized erythema were provoked by contact with water on the face, neck, and trunk, regardless of its temperature or source. Results from a physical examination and a baseline laboratory evaluation were within normal limits. Treatment of the 19-year-old man with 180 mg fexofenadine daily was successful to prevent the wheals and erythema. Treatment with 5 ml ketotifen syrup bid per day resulted in improvement of symptoms in the 4-year-old boy.
Baths ; Erythema ; Head ; Humans ; Ketotifen ; Neck ; Physical Examination ; Preschool Child ; Rain ; Swimming Pools ; Terfenadine ; Urticaria ; Water ; Young Adult

Torsade de pointes (TdP) is a form of polymorphic ventricular tachycardia that is associated with prolongation of the QT interval. Although it occurs in many clinical settings, torsade de pointes is most commonly caused by drugs. The second generation antihistamines, including terfenadine and astemizole, have little sedation or other adverse effects on the CNS. They have been used widely to treat various allergic diseases, but it has been reported that overdoses or combinations with antifungal agents or macrolide antibiotics may lead to TdP. We report a case of TdP that occured during com-bination therapy of terfenadine and ketoconazole.
Anti-Bacterial Agents ; Antifungal Agents ; Astemizole ; Histamine H1 Antagonists, Non-Sedating ; Ketoconazole* ; Tachycardia, Ventricular ; Terfenadine* ; Torsades de Pointes*

PURPOSE: To estimate the prevalence of co-prescribing contraindicated drugs for elderly patients in Busan. METHODS: We used the Health Insurance Review Agency (HIRA) claims database. Study population consisted of elderly patients who visited clinics or hospitals in Busan metropolitan city from January 1, 2000 to December 31, 2001. Contraindicated drugs were defined as 162 combinations of contraindicated drugs announced by the Korea Ministry of Health and Welfare in 2004. The co-prescription of contraindicated drugs was defined as prescribing two or more contraindicated drugs in combination in the same prescription. The prevalence of co-prescribing contraindicated drugswas estimated as proportion of co-prescribed patients out of the study patients. We estimated and age-adjusted prevalence and its 95% confidence interval of co-prescription of contraindicated drugs among the elderly patients in Korean population in 2001. RESULTS: The study elderly patients were 262,952 with 2,483,227 prescriptions. Among the study patients 1,208 (4.6%) were prescribed contraindicated drugs in combination. A total of 16,255 patients were estimated as the number of co-prescribed patients among the Korean elderly in 2001. Age-standardized prevalence of co-prescription to the Korean elderly was estimated to be 45 per 10,000 persons. The most frequently prescribed combinations were cisapride & amitriptyline, roxithromycin & ergoloid mesylate, and terfenadine & erythromycin, and the frequency were 325 (16.8%), 149 (7.7%), and 132 (6.8%),respectively. CONCLUSIONS: The contraindicated drugs were co-prescribed to the elderly patients in Korea. Many of these co-prescriptions should be avoided if unnecessary. The patients should be carefully monitored if they were inevitably prescribed the contraindicated drugs.
Aged ; Amitriptyline ; Cisapride ; Drug Combinations ; Drug Utilization Review ; Ergoloid Mesylates ; Erythromycin ; Humans ; Insurance, Health ; Korea ; Prescriptions ; Prevalence ; Roxithromycin ; Terfenadine