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Sedative Effects of Levocetirizine: A Systematic Review and Meta-Analysis of Randomized Controlled Studies

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Abstract

Introduction

As a substrate of P-glycoprotein, levocetirizine should not cause sedative effects. However, while cetirizine, a mixture of levocetirizine and dextrocetirizine, can slightly penetrate the blood brain barrier, the sedative effects of levocetirizine are still under study.

Objectives

The aim of this study was to investigate the sedative effects of levocetirizine.

Methods

An electronic literature search was performed using Medline and EMBASE from January 01, 2001 through August 6, 2015. Randomized controlled trials (RCTs) comparing levocetirizine with other antihistamines or placebo for patients with allergy and healthy subjects were selected. Primary outcome was risk ratio between levocetirizine and comparators. Secondary outcome was change in psychomotor speed. Data were pooled for meta-analysis using a fixed-effect model.

Results

Forty-eight studies of 18,014 patients met the inclusion criteria. When compared to placebo, levocetirizine produced modest sedative effects (RR: 1.67; 95% CI 1.17, 2.38). However, when compared to other second-generation antihistamines, sedative effects of levocetirizine did not differ (RR: 1.23; 95% CI 0.96, 1.58). In subgroup analysis, there was no difference between the sedative effects of levocetirizine and fexofenadine (RR: 1.7; 95% CI 0.59, 4.88), desloratadine (RR: 1.58; 95% CI 0.9, 2.77), loratadine (RR: 1.56; 95% CI 0.28, 8.56), bilastine (RR: 1.17; 95% CI 0.48, 2.84), olopatadine (RR: 1.09; 95% CI 0.81, 1.47), azelastine (RR: 0.19; 95% CI 0.01, 3.68) and rupatadine (RR: 1.47; 95% CI 0.14, 15.72). When compared to first-generation antihistamines, levocetirizine had less sedative effects and less change of reaction time (mean difference: −250.76 s; 95% CI −338.53, −162.98).

Conclusion

Levocetirizine has modest sedative effects with a risk ratio of 1.67 when compared with placebo. The sedative effects observed for levocetirizine are not different from other second-generation antihistamines.

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Authors contributions

Kornkiat Snidvongs: conception, development of protocol, study selection, data extraction, assessment of risk of bias, data analysis and interpretation, manuscript preparation. Kachorn Seresirikachorn: search strategy, study selection. Likhit Khattiyawittayakun: data extraction, assessment of risk of bias. Wirach Chitsuthipakorn: conception, development of protocol, critical review, final approval.

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Authors and Affiliations

  1. Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, 1873 Rama 4 Road, Pathumwan, Bangkok, 10330, Thailand

    Kornkiat Snidvongs, Kachorn Seresirikachorn & Likhit Khattiyawittayakun

  2. Department of Otolaryngology, Sawan Pracharak Hospital, Atthakawi Road, Tambon Paknam Pho, Amphoe Mueang Nakhon Sawan, Nakhon Sawan, 60000, Thailand

    Wirach Chitsuthipakorn

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  1. Kornkiat Snidvongs
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Correspondence to Kornkiat Snidvongs.

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This was an unfunded study.

Authors’ financial disclosures

Kornkiat Snidvongs received honoraria for speaking at symposia for Merck Sharp & Dohme, GlaxoSmithKline, Takeda, Sanofi Aventis.

Kachorn Seresirikachorn, Likhit Khattiyawittayakun, and Wirach Chitsuthipakorn have no conflict of interest.

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Snidvongs, K., Seresirikachorn, K., Khattiyawittayakun, L. et al. Sedative Effects of Levocetirizine: A Systematic Review and Meta-Analysis of Randomized Controlled Studies. Drugs 77, 175–186 (2017). https://doi.org/10.1007/s40265-016-0682-0

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