抗组胺药物除了用于过敏性疾病,其他“角色”知多少

2022-03-17 高丽丽 华医网

一起来看一看抗组胺药的那些鲜为人知的身份~

抗组胺药物即组胺受体拮抗剂是一类选择性地拮抗组胺H1受体的药物,可分为第一代抗组胺药物(镇静性抗组胺药物)、第二代抗组胺药物、第二代新型抗组胺药物,其有抗过敏作用,主要用于过敏性疾病如荨麻疹、过敏性鼻炎、湿疹等的治疗。除了抗过敏,其还有抗胆碱效应、抗炎效应、中枢抑制效应、拮抗5-羟色胺作用等,那么还可用于哪些疾病呢?

抗组胺药物的分类

图片

一、失眠

抗组胺药物有中枢抑制效应,其可透过血脑屏障,而引起中枢抑制如镇静、嗜睡等,可用于失眠的治疗。其中第一代抗组胺药物(镇静性抗组胺药物)常见,第二代抗组胺药物、第二代新型抗组胺药物较少见,西替利嗪、左西替利嗪、阿伐斯汀等可有轻度中枢抑制作用。

对慢性失眠者需坚持服药。失眠长期使用西药者,可适当配合使用抗组胺药物,如异丙嗪、氯苯那敏等。短期内服用3-7d左右,这样可利用抗组胺药物易致磕睡来改善睡眠,并减少安眠药物的剂量。

抗组胺药物(如苯海拉明)虽有催眠作用,但现有的临床研究证据有限,不宜作为治疗普通成人失眠的常规用药。抗组胺药物不宜用于慢性失眠的治疗。苯海拉明不推荐用于睡眠起始或者维持睡眠困难的治疗。

注意事项:抗组胺药物可引起头晕、颤抖、缺乏协调等,能减少快速动眼期睡眠,可能致学习能力下降。避免与对中枢有抑制作用的药物包括镇静催眠药物如地西泮、巴比妥类药物、抗精神失常药物如氯丙嗪、抗癫痫药物、阿片类药物、等合用。

二、功能性消化不良(FD

赛庚啶是5-羟色胺、H1受体和毒蕈碱受体的拮抗剂,有松弛胃底和促进食欲的作用,可用于儿童功能性消化不良(FD)的治疗,其能有效改善儿童FD者的临床症状,推荐剂量为0.25-0.5mg/kg·d)。

注意事项:约1 /3儿童可能引起不良反应,不良反应通常较轻微,仅限于嗜睡、食欲增加、体重增加。

三、止吐

第一代抗组胺药物如苯海拉明、羟嗪、多西拉敏等,有抗过敏、抗胆碱作用,且易透过血脑屏障,中枢抗胆碱作用能防晕与止吐,并有镇静作用,可用于晕动病呕吐等。

注意事项:抗组胺药物的抗胆碱能效应可引起口干、眼干、升高眼压、视力模糊、呼吸道分泌物黏稠、心律失常、尿潴留及排尿困难等。前列腺增生、尿潴留、闭角型青光眼、幽门十二指肠梗阻、前列腺肥大者慎用。

四、止咳

第一代抗组胺药物有抗过敏、抗胆碱作用,其有亲脂性,并易透过血脑屏障,可消除或减轻打喷嚏和流涕等症状,同时有助于减少分泌物、减轻咳嗽症状,且有一定的中枢镇咳作用,可用于普通感冒引起的咳嗽、感冒(染)后咳嗽(PIC)、过敏性(变应性)咳嗽(AC)。

第二代抗组胺药物、第二代新型抗组胺药物基本无抗胆碱作用,不易透过血脑屏障,不推荐用于普通感冒引起的咳嗽,其可抗过敏、抗炎,可用于上气道咳嗽综合征(UACS/鼻后滴流综合征(PNDS)引起的咳嗽、AC

注意事项:咳嗽可能需使用抗菌药物,《β内酰胺类抗菌药物皮肤试验指导原则(2021年版)》中指出,有些药物可抑制皮肤反应,致β-内酰胺类抗菌药物皮试假阴性结果,故皮试前应询问近期用药史,并在病情允许时停用可能干扰皮试结果的药物。全身应用第一代抗组胺药物停药至少2-3d,第二代抗组胺药物停药至少3-7d,对皮试的影响才能消除。

五、厌食(食欲减退)

赛庚啶有较强的抗组胺作用,也是5-羟色胺和激肽的拮抗剂,对神经中枢有一定抑制作用,其有刺激食欲、改善症状的作用,可用于肿瘤性厌食治疗。

注意事项:与吩噻嗪类药物如氯丙嗪等合用,可增加室性心律失常的风险,严重者可致尖端扭转型心律失常。幽门梗阻者禁用。

参考文献

1.抗组胺药在皮肤科应用专家共识[J].中华皮肤科杂志,2017,50(6):393-395

2.抗组胺H1受体药在儿童常见过敏性疾病中应用的专家共识[J].中国实用儿科杂志,2018,33(3):161-168

3.口服H1抗组胺药治疗变应性鼻炎2018广州共识[J].中国眼耳鼻喉科杂志,2018,18(3):149-156

4.失眠症中医临床实践指南WHO/WPO[J].世界睡眠医学杂志,2016,3(1):8-24

5.儿童功能性消化不良中西医结合诊治专家共识[J].中国实用儿科杂志,2022,37(1):7-10

6.钱之玉.药理学[M].北京:中国医药科技出版社,2009:562-563

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    学习

    0

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  5. [GetPortalCommentsPageByObjectIdResponse(id=1742171, encodeId=e4c81e42171c0, content=<a href='/topic/show?id=a830e7734a0' target=_blank style='color:#2F92EE;'>#组胺#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=77734, encryptionId=a830e7734a0, topicName=组胺)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7e6235043235, createdName=bluefate133, createdTime=Sat Oct 29 22:06:05 CST 2022, time=2022-10-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2047465, encodeId=4ffb204e46591, content=<a href='/topic/show?id=6f5294036b1' target=_blank style='color:#2F92EE;'>#过敏性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=94036, encryptionId=6f5294036b1, topicName=过敏性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0a8e213, createdName=hongbochen, createdTime=Tue May 17 00:06:05 CST 2022, time=2022-05-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1203982, encodeId=2458120398276, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220625/6f4f075937de4c5d9fc7ab3a1bc6d8c2/13a8a29e67044698af1fb74276589093.jpg, createdBy=b5c55099112, createdName=D-House, createdTime=Sat Mar 19 10:03:42 CST 2022, time=2022-03-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1311581, encodeId=a55d13115811e, content=<a href='/topic/show?id=b53e5560953' target=_blank style='color:#2F92EE;'>#抗组胺药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=55609, encryptionId=b53e5560953, topicName=抗组胺药)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=62a7397, createdName=charl1234567, createdTime=Sat Mar 19 05:06:05 CST 2022, time=2022-03-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1546071, encodeId=7e8415460e136, content=<a href='/topic/show?id=a6b655610ca' target=_blank style='color:#2F92EE;'>#抗组胺药物#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=55610, encryptionId=a6b655610ca, topicName=抗组胺药物)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8cec13863916, createdName=siiner, createdTime=Sat Mar 19 05:06:05 CST 2022, time=2022-03-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1203673, encodeId=ea9312036e3e6, content=学习了,以前只是用过失眠和止咳,不知道还有助消化和助消化科作用,可以尝试, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220218/da36c69a14324d4abc87a4849571ea94/4e8eb4cd909647ae8988d5cd1e7bdeed.jpg, createdBy=b2501806815, createdName=ms3035926579531214, createdTime=Fri Mar 18 07:37:01 CST 2022, time=2022-03-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1203517, encodeId=e1cc120351efb, content=学习。, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210703/9c448fe1b3b54fd7bc9477662f4861bb/4bdadad22bfd46f2921aabb4c40265d3.jpg, createdBy=a8d81938466, createdName=weigq, createdTime=Thu Mar 17 17:38:18 CST 2022, time=2022-03-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1203511, encodeId=37431203511ed, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=162b5598790, createdName=ms3000000874455998, createdTime=Thu Mar 17 17:19:10 CST 2022, time=2022-03-17, status=1, ipAttribution=)]
  6. [GetPortalCommentsPageByObjectIdResponse(id=1742171, encodeId=e4c81e42171c0, content=<a href='/topic/show?id=a830e7734a0' target=_blank style='color:#2F92EE;'>#组胺#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=77734, encryptionId=a830e7734a0, topicName=组胺)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7e6235043235, createdName=bluefate133, createdTime=Sat Oct 29 22:06:05 CST 2022, time=2022-10-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2047465, encodeId=4ffb204e46591, content=<a href='/topic/show?id=6f5294036b1' target=_blank style='color:#2F92EE;'>#过敏性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=94036, encryptionId=6f5294036b1, topicName=过敏性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0a8e213, createdName=hongbochen, createdTime=Tue May 17 00:06:05 CST 2022, time=2022-05-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1203982, encodeId=2458120398276, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220625/6f4f075937de4c5d9fc7ab3a1bc6d8c2/13a8a29e67044698af1fb74276589093.jpg, createdBy=b5c55099112, createdName=D-House, createdTime=Sat Mar 19 10:03:42 CST 2022, time=2022-03-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1311581, encodeId=a55d13115811e, content=<a href='/topic/show?id=b53e5560953' target=_blank style='color:#2F92EE;'>#抗组胺药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=55609, encryptionId=b53e5560953, topicName=抗组胺药)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=62a7397, createdName=charl1234567, createdTime=Sat Mar 19 05:06:05 CST 2022, time=2022-03-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1546071, encodeId=7e8415460e136, content=<a href='/topic/show?id=a6b655610ca' target=_blank style='color:#2F92EE;'>#抗组胺药物#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=55610, encryptionId=a6b655610ca, topicName=抗组胺药物)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8cec13863916, createdName=siiner, createdTime=Sat Mar 19 05:06:05 CST 2022, time=2022-03-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1203673, encodeId=ea9312036e3e6, content=学习了,以前只是用过失眠和止咳,不知道还有助消化和助消化科作用,可以尝试, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220218/da36c69a14324d4abc87a4849571ea94/4e8eb4cd909647ae8988d5cd1e7bdeed.jpg, createdBy=b2501806815, createdName=ms3035926579531214, createdTime=Fri Mar 18 07:37:01 CST 2022, time=2022-03-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1203517, encodeId=e1cc120351efb, content=学习。, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210703/9c448fe1b3b54fd7bc9477662f4861bb/4bdadad22bfd46f2921aabb4c40265d3.jpg, createdBy=a8d81938466, createdName=weigq, createdTime=Thu Mar 17 17:38:18 CST 2022, time=2022-03-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1203511, encodeId=37431203511ed, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=162b5598790, createdName=ms3000000874455998, createdTime=Thu Mar 17 17:19:10 CST 2022, time=2022-03-17, status=1, ipAttribution=)]
    2022-03-18 ms3035926579531214

    学习了,以前只是用过失眠和止咳,不知道还有助消化和助消化科作用,可以尝试

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=1742171, encodeId=e4c81e42171c0, content=<a href='/topic/show?id=a830e7734a0' target=_blank style='color:#2F92EE;'>#组胺#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=77734, encryptionId=a830e7734a0, topicName=组胺)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7e6235043235, createdName=bluefate133, createdTime=Sat Oct 29 22:06:05 CST 2022, time=2022-10-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2047465, encodeId=4ffb204e46591, content=<a href='/topic/show?id=6f5294036b1' target=_blank style='color:#2F92EE;'>#过敏性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=94036, encryptionId=6f5294036b1, topicName=过敏性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0a8e213, createdName=hongbochen, createdTime=Tue May 17 00:06:05 CST 2022, time=2022-05-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1203982, encodeId=2458120398276, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220625/6f4f075937de4c5d9fc7ab3a1bc6d8c2/13a8a29e67044698af1fb74276589093.jpg, createdBy=b5c55099112, createdName=D-House, createdTime=Sat Mar 19 10:03:42 CST 2022, time=2022-03-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1311581, encodeId=a55d13115811e, content=<a href='/topic/show?id=b53e5560953' target=_blank style='color:#2F92EE;'>#抗组胺药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=55609, encryptionId=b53e5560953, topicName=抗组胺药)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=62a7397, createdName=charl1234567, createdTime=Sat Mar 19 05:06:05 CST 2022, time=2022-03-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1546071, encodeId=7e8415460e136, content=<a href='/topic/show?id=a6b655610ca' target=_blank style='color:#2F92EE;'>#抗组胺药物#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=55610, encryptionId=a6b655610ca, topicName=抗组胺药物)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8cec13863916, createdName=siiner, createdTime=Sat Mar 19 05:06:05 CST 2022, time=2022-03-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1203673, encodeId=ea9312036e3e6, content=学习了,以前只是用过失眠和止咳,不知道还有助消化和助消化科作用,可以尝试, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220218/da36c69a14324d4abc87a4849571ea94/4e8eb4cd909647ae8988d5cd1e7bdeed.jpg, createdBy=b2501806815, createdName=ms3035926579531214, createdTime=Fri Mar 18 07:37:01 CST 2022, time=2022-03-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1203517, encodeId=e1cc120351efb, content=学习。, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210703/9c448fe1b3b54fd7bc9477662f4861bb/4bdadad22bfd46f2921aabb4c40265d3.jpg, createdBy=a8d81938466, createdName=weigq, createdTime=Thu Mar 17 17:38:18 CST 2022, time=2022-03-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1203511, encodeId=37431203511ed, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=162b5598790, createdName=ms3000000874455998, createdTime=Thu Mar 17 17:19:10 CST 2022, time=2022-03-17, status=1, ipAttribution=)]
    2022-03-17 weigq

    学习。

    0

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    2022-03-17 ms3000000874455998

    学习了

    0

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