ABSTRACT
Background: Allergic rhinitis (AR) is associated with disturbed sleep and subsequent functioning, and an impaired quality of life (QoL). The symptoms of AR exhibit prominent circadian variations, with symptoms being more common at the night-time or early morning. Addressing these allergy-related sleep issues, impaired QoL, and circadian variation in symptoms is important from the patient perspective and should be considered in the management of AR. Objective: To review the efficacy of cetirizine, a second-generation antihistamine and selective H1-receptor antagonist, in relation to improvement in the QoL of the patients, addressing the sleep disturbances and circadian variations in the symptoms of AR in clinical practice, and establishing its role as a contemporary antihistamine for the management of AR compared to newer antihistamines. Methods: Systematic literature review of the databases such as PubMed/MEDLINE, Google Scholar, and the Cochrane Central Register of Controlled Trials from 1990 to 2020. Results: The symptoms of AR exhibited a circadian variation, with symptoms being worse during the night and early morning. The patients with AR encountered several sleep-related symptoms, including poor sleep quality, daytime somnolence, fatigue, and impaired productivity and QoL. Impaired QoL in AR was related to the disease severity. Administration of cetirizine at bedtime provides effective control of sleep impairment and symptoms of AR, besides improving the QoL. The efficacy of cetirizine has been demonstrated to be superior or comparable to the newer second-generation antihistamines. Cetirizine exhibits a tolerability profile comparable to the newer antihistamines. Conclusion: With long years of clinical experience and a good tolerability profile, cetirizine represents a valuable therapeutic option for the management of AR, even 30 years after its introduction. Cetirizine is included in the National List of Essential Medicines of India for the management of allergic disorders in view of its established efficacy and safety profile as well as being a cost-effective option.
ABSTRACT
Context: To study the role of statins (Atorvastatin, Simvastatin, and Pravastatin) as novel pharmacological option in treatment of depression. Aim: To evaluate antidepressant activity of statins (HMG-CoA reductase inhibitor) in combination with Fluoxetine in acute and chronic forced swim test in rats. Design: An experimental animal study. Materials and methods : Male albino wistar rats of either sex with weight range 150-250 grams were used. Part 1 is Dose finding study in acute forced swim test with three doses of Atorvastatin (2.5 mg/kg, 5 mg/ kg, 10 mg/kg), Simvastatin (2.5 mg/kg, 5 mg/kg, 10 mg/kg), and Pravastatin (10 mg/kg, 20 mg/kg, 40 mg/ kg) each were done. Part 2 was conducted to study the effects of statins (Atorvastatin, Simvastatin, and Pravastatin) and Fluoxetine (10 mg/kg) per se and in combination, on immobility of rats in acute forced swim test were compared. In part 3 effects of statins (Atorvastatin, Simvastatin, and Pravastatin) and Fluoxetine per se and in combination on immobility of rats in chronic forced swim test were compared. Open field test was performed to discriminate between the general behavioural stimulation (false positives) and antidepressant effect of study drugs. All study drugs were given orally. In Part 2 & 3 maximum effective dose of statin from part 1 was utilised. Statistics: ANOVA with post-hoc Tukeys test, significant effects were analyzed further using post hoc Newman-Keuls tests. Results: In part 1 of dose finding study most effective doses for Atorvastatin, Simvastatin and Pravastatin were 10 mg/kg, 10 mg/kg and 40 mg/kg respectively. In this part acute forced swim test showed, no statistically significant reduction in duration of immobility by any of the statins (Atorvastatin, Simvastatin, and Pravastatin) as compared to control. In Part 2 acute forced swim test, When combined with Fluoxetine, Atorvastatin (157.83 ± 10.51) and Simvastatin (167.66 ± 7.71) showed significant reduction in duration of