The use of antihistamines (AHs) has been associated with cognitive and psychomotor impairments, largely caused by the sedative properties of many of these drugs. Due to the ambulant nature of the population using AHs, it is important to evaluate these effects using standardised methodology and psychometric tests. A previous extensive review of the literature collated the results of studies of H₁ receptor antagonists to determine the extent to which a particular AH produced impairments on a battery of psychometric tests by calculating a proportional impairment ratio for each AH.

In light of a number of major studies published following the previous review, and the development of the second and new‐generation AHs, the present review aims to add to the database and update the review, using the same methodology.

The newer generation AHs appear to be the least impairing, and the first generation, as expected, appear to be the most impairing. There are also differences within the AH drug generations. The review highlights the necessity to consider the sedating potential of AHs, along with other factors such as efficacy, when prescribing AHs to ambulant patients. Copyright © 2008 John Wiley & Sons, Ltd.