A randomized, double‐blind, crossover comparison among cetirizine, levocetirizine, and ucb 28557 on histamine‐induced cutaneous responses in healthy adult volunteers

Background: Cetirizine is a highly efficacious and long‐acting second‐generation H1‐receptor antagonist for the treatment of allergic diseases, such as allergic rhinitis and chronic idiopathic urticaria, in adults and children. Pharmacologic studies have demonstrated that cetirizine, a racemate mixt...

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Published inAllergy (Copenhagen) Vol. 56; no. 1; pp. 50 - 57
Main Authors Devalia, J. L., Hanotte, F., Baltes, E., De Vos, C.
Format Journal Article
LanguageEnglish
Published Copenhagen Munksgaard International Publishers 01.01.2001
Blackwell
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Abstract Background: Cetirizine is a highly efficacious and long‐acting second‐generation H1‐receptor antagonist for the treatment of allergic diseases, such as allergic rhinitis and chronic idiopathic urticaria, in adults and children. Pharmacologic studies have demonstrated that cetirizine, a racemate mixture composed of equal amounts of two enantiomers, does not undergo hepatic metabolism to any significant level. The enantiomers are excreted mainly unchanged, predominantly in the urine and to a lesser extent in the faeces. Methods: The pharmacologic activity and potency of the two enantiomers of cetirizine in the management of allergic skin conditions were investigated by studying the effect of treatment with 5.0 mg cetirizine; 2.5 mg levocetirizine, the (R)‐enantiomer; and 2.5 mg ucb 28557, the (S)‐enantiomer, on histamine‐induced wheal and flare response in 18 healthy volunteers. Each treatment was administered as a single oral dose in randomized, double‐blind, and crossover manner, and the efficacy of treatment was assessed over a period of 32 h, as per cent inhibition of the histamine‐induced wheal and flare areas before treatment. Blood and urine samples were collected in a time‐dependent manner and analyzed for the total amounts of each study drug, to elucidate their pharmacokinetic profiles. Results: Both cetirizine and levocetirizine caused a marked inhibition of histamine‐induced wheal and flare, whereas ucb 28557 was inactive in this model. Inhibition of the wheal response observed for cetirizine and levocetirizine was apparent by 1 h after dosage and lasted for mean durations of 24.4 and 28.4 h, respectively. In addition, the response for cetirizine and levocetirizine became maximal by 6 h after treatment, rising to 79.5% and 83.8%. Similarly, cetirizine and levocetirizine also markedly inhibited the histamine‐induced flare response. This effect was evident for both drugs by 1 h after dosage and lasted over a mean period of 28.4 and 26.0 h, respectively, for cetirizine and levocetirizine. The inhibitory effect of these compounds on histamine‐induced flare response was also maximal by approximately 6 h after dosage, peaking at 88.5% and 83.6%, respectively. Statistical evaluation showed that cetirizine and levocetirizine were equivalent for maximum inhibition of histamine‐induced wheal and flare. However, levocetirizine was found to be superior to cetirizine when area under the curve was compared. In contrast, ucb 28557 was not found to inhibit histamine‐induced wheal and flare responses at any time during the study period. Plasma concentrations of levocetirizine were found to be approximately double those of ucb 28557 at 4 and 8 h after dosing, and 50–60% of the drugs were excreted unchanged in urine over a period of 32 h. Conclusions: The finding that, in this model, levocetirizine 2.5 mg has comparable antihistaminic activity to cetirizine 5 mg, whereas its other enantiomer ucb 28557 has no pharmacodynamic effect, suggests that the antihistaminic properties of cetirizine observed in the management of allergic skin conditions are likely to be attributable to levocetirizine.
AbstractList Cetirizine is a highly efficacious and long-acting second-generation H sub(1)-receptor antagonist for the treatment of allergic diseases, such as allergic rhinitis and chronic idiopathic urticaria, in adults and children. Pharmacologic studies have demonstrated that cetirizine, a racemate mixture composed of equal amounts of two enantiomers, does not undergo hepatic metabolism to any significant level. The enantiomers are excreted mainly unchanged, predominantly in the urine and to a lesser extent in the faeces. The pharmacologic activity and potency of the two enantiomers of cetirizine in the management of allergic skin conditions were investigated by studying the effect of treatment with 5.0 mg cetirizine; 2.5 mg levocetirizine, the (R)-enantiomer; and 2.5 mg ucb 28557, the (S)-enantiomer, on histamine-induced wheal and flare response in 18 healthy volunteers. Each treatment was administered as a single oral dose in randomized, double-blind, and crossover manner, and the efficacy of treatment was assessed over a period of 32 h, as per cent inhibition of the histamine-induced wheal and flare areas before treatment. Blood and urine samples were collected in a time-dependent manner and analyzed for the total amounts of each study drug, to elucidate their pharmacokinetic profiles. Both cetirizine and levocetirizine caused a marked inhibition of histamine-induced wheal and flare, whereas ucb 28557 was inactive in this model. Inhibition of the wheal response observed for cetirizine and levocetirizine was apparent by 1 h after dosage and lasted for mean durations of 24.4 and 28.4 h, respectively. In addition, the response for cetirizine and levocetirizine became maximal by 6 h after treatment, rising to 79.5% and 83.8%. Similarly, cetirizine and levocetirizine also markedly inhibited the histamine-induced flare response. This effect was evident for both drugs by 1 h after dosage and lasted over a mean period of 28.4 and 26.0 h, respectively, for cetirizine and levocetirizine. The inhibitory effect of these compounds on histamine-induced flare response was also maximal by approximately 6 h after dosage, peaking at 88.5% and 83.6%, respectively. Statistical evaluation showed that cetirizine and levocetirizine were equivalent for maximum inhibition of histamine-induced wheal and flare. However, levocetirizine was found to be superior to cetirizine when area under the curve was compared. In contrast, ucb 28557 was not found to inhibit histamine-induced wheal and flare responses at any time during the study period. Plasma concentrations of levocetirizine were found to be approximately double those of ucb 28557 at 4 and 8 h after dosing, and 50-60% of the drugs were excreted unchanged in urine over a period of 32 h. The finding that, in this model, levocetirizine 2.5 mg has comparable antihistaminic activity to cetirizine 5 mg, whereas its other enantiomer ucb 28557 has no pharmacodynamic effect, suggests that the antihistaminic properties of cetirizine observed in the management of allergic skin conditions are likely to be attributable to levocetirizine.
Cetirizine is a highly efficacious and long-acting second-generation H1-receptor antagonist for the treatment of allergic diseases, such as allergic rhinitis and chronic idiopathic urticaria, in adults and children. Pharmacologic studies have demonstrated that cetirizine, a racemate mixture composed of equal amounts of two enantiomers, does not undergo hepatic metabolism to any significant level. The enantiomers are excreted mainly unchanged, predominantly in the urine and to a lesser extent in the faeces. The pharmacologic activity and potency of the two enantiomers of cetirizine in the management of allergic skin conditions were investigated by studying the effect of treatment with 5.0 mg cetirizine; 2.5 mg levocetirizine, the (R)-enantiomer; and 2.5 mg ucb 28557, the (S)-enantiomer, on histamine-induced wheal and flare response in 18 healthy volunteers. Each treatment was administered as a single oral dose in randomized, double-blind, and crossover manner, and the efficacy of treatment was assessed over a period of 32 h, as per cent inhibition of the histamine-induced wheal and flare areas before treatment. Blood and urine samples were collected in a time-dependent manner and analyzed for the total amounts of each study drug, to elucidate their pharmacokinetic profiles. Both cetirizine and levocetirizine caused a marked inhibition of histamine-induced wheal and flare, whereas ucb 28557 was inactive in this model. Inhibition of the wheal response observed for cetirizine and levocetirizine was apparent by 1 h after dosage and lasted for mean durations of 24.4 and 28.4 h, respectively. In addition, the response for cetirizine and levocetirizine became maximal by 6 h after treatment, rising to 79.5% and 83.8%. Similarly, cetirizine and levocetirizine also markedly inhibited the histamine-induced flare response. This effect was evident for both drugs by 1 h after dosage and lasted over a mean period of 28.4 and 26.0 h, respectively, for cetirizine and levocetirizine. The inhibitory effect of these compounds on histamine-induced flare response was also maximal by approximately 6 h after dosage, peaking at 88.5%) and 83.6%, respectively. Statistical evaluation showed that cetirizine and levocetirizine were equivalent for maximum inhibition of histamine-induced wheal and flare. However, levocetirizine was found to be superior to cetirizine when area under the curve was compared. In contrast, ucb 28557 was not found to inhibit histamine-induced wheal and flare responses at any time during the study period. Plasma concentrations of levocetirizine were found to be approximately double those of ucb 28557 at 4 and 8 h after dosing, and 50-60% of the drugs were excreted unchanged in urine over a period of 32 h. The finding that, in this model, levocetirizine 2.5 mg has comparable antihistaminic activity to cetirizine 5 mg, whereas its other enantiomer ucb 28557 has no pharmacodynamic effect, suggests that the antihistaminic properties of cetirizine observed in the management of allergic skin conditions are likely to be attributable to levocetirizine.
Background: Cetirizine is a highly efficacious and long‐acting second‐generation H1‐receptor antagonist for the treatment of allergic diseases, such as allergic rhinitis and chronic idiopathic urticaria, in adults and children. Pharmacologic studies have demonstrated that cetirizine, a racemate mixture composed of equal amounts of two enantiomers, does not undergo hepatic metabolism to any significant level. The enantiomers are excreted mainly unchanged, predominantly in the urine and to a lesser extent in the faeces. Methods: The pharmacologic activity and potency of the two enantiomers of cetirizine in the management of allergic skin conditions were investigated by studying the effect of treatment with 5.0 mg cetirizine; 2.5 mg levocetirizine, the (R)‐enantiomer; and 2.5 mg ucb 28557, the (S)‐enantiomer, on histamine‐induced wheal and flare response in 18 healthy volunteers. Each treatment was administered as a single oral dose in randomized, double‐blind, and crossover manner, and the efficacy of treatment was assessed over a period of 32 h, as per cent inhibition of the histamine‐induced wheal and flare areas before treatment. Blood and urine samples were collected in a time‐dependent manner and analyzed for the total amounts of each study drug, to elucidate their pharmacokinetic profiles. Results: Both cetirizine and levocetirizine caused a marked inhibition of histamine‐induced wheal and flare, whereas ucb 28557 was inactive in this model. Inhibition of the wheal response observed for cetirizine and levocetirizine was apparent by 1 h after dosage and lasted for mean durations of 24.4 and 28.4 h, respectively. In addition, the response for cetirizine and levocetirizine became maximal by 6 h after treatment, rising to 79.5% and 83.8%. Similarly, cetirizine and levocetirizine also markedly inhibited the histamine‐induced flare response. This effect was evident for both drugs by 1 h after dosage and lasted over a mean period of 28.4 and 26.0 h, respectively, for cetirizine and levocetirizine. The inhibitory effect of these compounds on histamine‐induced flare response was also maximal by approximately 6 h after dosage, peaking at 88.5% and 83.6%, respectively. Statistical evaluation showed that cetirizine and levocetirizine were equivalent for maximum inhibition of histamine‐induced wheal and flare. However, levocetirizine was found to be superior to cetirizine when area under the curve was compared. In contrast, ucb 28557 was not found to inhibit histamine‐induced wheal and flare responses at any time during the study period. Plasma concentrations of levocetirizine were found to be approximately double those of ucb 28557 at 4 and 8 h after dosing, and 50–60% of the drugs were excreted unchanged in urine over a period of 32 h. Conclusions: The finding that, in this model, levocetirizine 2.5 mg has comparable antihistaminic activity to cetirizine 5 mg, whereas its other enantiomer ucb 28557 has no pharmacodynamic effect, suggests that the antihistaminic properties of cetirizine observed in the management of allergic skin conditions are likely to be attributable to levocetirizine.
Background: Cetirizine is a highly efficacious and long‐acting second‐generation H 1 ‐receptor antagonist for the treatment of allergic diseases, such as allergic rhinitis and chronic idiopathic urticaria, in adults and children. Pharmacologic studies have demonstrated that cetirizine, a racemate mixture composed of equal amounts of two enantiomers, does not undergo hepatic metabolism to any significant level. The enantiomers are excreted mainly unchanged, predominantly in the urine and to a lesser extent in the faeces. Methods: The pharmacologic activity and potency of the two enantiomers of cetirizine in the management of allergic skin conditions were investigated by studying the effect of treatment with 5.0 mg cetirizine; 2.5 mg levocetirizine, the ( R )‐enantiomer; and 2.5 mg ucb 28557, the ( S )‐enantiomer, on histamine‐induced wheal and flare response in 18 healthy volunteers. Each treatment was administered as a single oral dose in randomized, double‐blind, and crossover manner, and the efficacy of treatment was assessed over a period of 32 h, as per cent inhibition of the histamine‐induced wheal and flare areas before treatment. Blood and urine samples were collected in a time‐dependent manner and analyzed for the total amounts of each study drug, to elucidate their pharmacokinetic profiles. Results: Both cetirizine and levocetirizine caused a marked inhibition of histamine‐induced wheal and flare, whereas ucb 28557 was inactive in this model. Inhibition of the wheal response observed for cetirizine and levocetirizine was apparent by 1 h after dosage and lasted for mean durations of 24.4 and 28.4 h, respectively. In addition, the response for cetirizine and levocetirizine became maximal by 6 h after treatment, rising to 79.5% and 83.8%. Similarly, cetirizine and levocetirizine also markedly inhibited the histamine‐induced flare response. This effect was evident for both drugs by 1 h after dosage and lasted over a mean period of 28.4 and 26.0 h, respectively, for cetirizine and levocetirizine. The inhibitory effect of these compounds on histamine‐induced flare response was also maximal by approximately 6 h after dosage, peaking at 88.5% and 83.6%, respectively. Statistical evaluation showed that cetirizine and levocetirizine were equivalent for maximum inhibition of histamine‐induced wheal and flare. However, levocetirizine was found to be superior to cetirizine when area under the curve was compared. In contrast, ucb 28557 was not found to inhibit histamine‐induced wheal and flare responses at any time during the study period. Plasma concentrations of levocetirizine were found to be approximately double those of ucb 28557 at 4 and 8 h after dosing, and 50–60% of the drugs were excreted unchanged in urine over a period of 32 h. Conclusions: The finding that, in this model, levocetirizine 2.5 mg has comparable antihistaminic activity to cetirizine 5 mg, whereas its other enantiomer ucb 28557 has no pharmacodynamic effect, suggests that the antihistaminic properties of cetirizine observed in the management of allergic skin conditions are likely to be attributable to levocetirizine.
Author De Vos, C.
Baltes, E.
Devalia, J. L.
Hanotte, F.
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  surname: Devalia
  fullname: Devalia, J. L.
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  surname: Hanotte
  fullname: Hanotte, F.
– sequence: 3
  givenname: E.
  surname: Baltes
  fullname: Baltes, E.
– sequence: 4
  givenname: C.
  surname: De Vos
  fullname: De Vos, C.
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Issue 1
Keywords Human
Immunopathology
Skin disease
Urticaria
Antiasthma agent
Cetirizine
Antihistaminic
Biological activity
Chemotherapy
Randomization
Treatment
Enantiomer
Double blind study
Antagonist
H1 Histamine receptor
Levocetirizine
Comparative study
Language English
License CC BY 4.0
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PublicationCentury 2000
PublicationDate January 2001
2001
2001-Jan
2001-01-00
20010101
PublicationDateYYYYMMDD 2001-01-01
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  year: 2001
  text: January 2001
PublicationDecade 2000
PublicationPlace Copenhagen
PublicationPlace_xml – name: Copenhagen
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PublicationTitle Allergy (Copenhagen)
PublicationTitleAlternate Allergy
PublicationYear 2001
Publisher Munksgaard International Publishers
Blackwell
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References 1990; 40
1990; 86
1993; 46
1991; 19
1987; 135
1990; 20S
1990; 28
1997; 52
1999; 29 Suppl 3
1998; 316
1995
1999; 54
1993
1989; 26
1998; 5
1996; 76
1987; 59
1987; 15
1992; 5
Snyder SH (e_1_2_6_16_2) 1987; 59
e_1_2_6_18_2
e_1_2_6_12_2
e_1_2_6_13_2
e_1_2_6_11_2
e_1_2_6_17_2
e_1_2_6_14_2
e_1_2_6_15_2
e_1_2_6_20_2
White MV (e_1_2_6_10_2) 1987; 135
Bousquet J (e_1_2_6_7_2) 1992; 5
e_1_2_6_8_2
e_1_2_6_9_2
e_1_2_6_4_2
e_1_2_6_3_2
e_1_2_6_6_2
e_1_2_6_5_2
e_1_2_6_24_2
e_1_2_6_23_2
e_1_2_6_2_2
Steinijans VW (e_1_2_6_19_2) 1990; 28
e_1_2_6_22_2
e_1_2_6_21_2
e_1_2_6_26_2
e_1_2_6_25_2
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Snippet Background: Cetirizine is a highly efficacious and long‐acting second‐generation H1‐receptor antagonist for the treatment of allergic diseases, such as...
Cetirizine is a highly efficacious and long-acting second-generation H1-receptor antagonist for the treatment of allergic diseases, such as allergic rhinitis...
Background: Cetirizine is a highly efficacious and long‐acting second‐generation H 1 ‐receptor antagonist for the treatment of allergic diseases, such as...
Cetirizine is a highly efficacious and long-acting second-generation H sub(1)-receptor antagonist for the treatment of allergic diseases, such as allergic...
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SubjectTerms Adolescent
Adult
Anti-Allergic Agents - adverse effects
Anti-Allergic Agents - pharmacokinetics
Anti-Allergic Agents - pharmacology
antihistamines
Biological and medical sciences
cetirizine
Cetirizine - adverse effects
Cetirizine - pharmacokinetics
Cetirizine - pharmacology
Cross-Over Studies
Double-Blind Method
equivalence
histamine
Histamine - pharmacology
Histamine and antagonists. Allergy
Histamine H1 Antagonists - adverse effects
Histamine H1 Antagonists - pharmacokinetics
Histamine H1 Antagonists - pharmacology
Humans
levocetirizine
Male
Medical sciences
Pharmacology. Drug treatments
Skin Tests
Stereoisomerism
ucb 28557
urinary excretion
urticaria
Title A randomized, double‐blind, crossover comparison among cetirizine, levocetirizine, and ucb 28557 on histamine‐induced cutaneous responses in healthy adult volunteers
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