Thursday, June 12, 2014

Seasonal Allergies--a Guide to Over-the-Counter Antihistamines

Are these spring flowers making you sneeze?
When I first moved from the desert to a green city Provo, Utah where I went to college, the first spring was incredibly miserable. After weeks I finally bought Claritin, a gentle, 24-hour antihistamine. After a few days, I no longer felt like I was in a fog. My nose no longer ran like crazy, and I didn't sneeze much.
I thought I had discovered the greatest miracle pill ever! Yes, I had occasional flare ups, but for several months all I had to do was take these pills and I functioned well.
And then fall happened. My symptoms were back and not leaving, despite taking pills. I finally consulted a pharmacist. Here's what I learned:

  • When you take an antihistamine long term, it may stop being effective, so you should rotate it with other antihistamines.
  • There are 2 kinds of antihistamines: first generation, which were developed first, and second generation. The famous first generation antihistamine, Benadryl, only lasts 4-6 hours because although it works the best, it can have severe side effects, like making you tired and loopy. The second generation ones were developed more recently and have fewer side effects. 

Generic Zyrtec from Dollar Tree and Generic Benadryl from Walmart.

First Generation Antihistamines

  • Last 4-6 hours.
  • Help relieve itching, rash, congestion, watery eyes, and sneezing.
  • Side effects include sleepiness, feeling goofy, and not being able to operate heavy machinery (like driving). They will also make you thirsty.
  1. Diphenhydramine (Benadryl)--the most common pink pills
  2. Chlorpheniramine Maleate
I only use these right before going to bed at night, or if I've had a really bad reaction and can cancel any plans to drive or make coherent sentences. I sometimes take 1/2 the recommended adult dose. If that isn't working, I'll take the other half. I do not take this while taking other antihistamines and I drink extra water.
This is not an all-inclusive list of first generation antihistamines, but the most common ones.

Second Generation Antihistamines

  • Last 24 hours.
  • Help relieve itching, rash, congestion, watery eyes, and sneezing.
  • Side effects are a lot less common or severe, but can include feeling sleepy and dry.
  • Listed from the weakest to the strongest.
  1. Loratadine (Claritin)--the gentlest.
  2. Fexofenadine (Allegra)--stronger than Claritin. You can buy 5 doses for $1 at Dollar Tree of the generic brand. 
  3. Cetirizine (Zyrtec)--the strongest and most likely to make you sleepy. I often take it only once every 2-3 days.  You can buy 14 doses for $1 at Dollar Tree of the generic brand. 

Antihistamine Hack: 

Even after antihistamines have "worn off," they will stay in your system for 3-7 days. This means that if you take Benadryl at night, the next day you will be able to reap some residual benefits even though you probably won't have any of the ill side effects of taking Benadryl. 

A warning about using second generation antihistamines:

If you take a 24 hour antihistamine and it doesn't work (like if you actually have a nasty cold that is beyond the scope of the drug), you have to wait 24 hours before you can take a stronger one.

Don't misunderstand me: I love the second generation antihistamines and they are my allergy medicine of choice. I simply avoid them when I am having a very bad reaction or when I have a virus.

Interactions

I am not a pharmacist, but I have been told the following by pharmacists and doctors. You should check with a pharmacist or doctor as well just to make sure. Since it's a bit complicated, I feel better asking to see a pharmacist when I buy new medications to be taken with other ones. Pharmacists are always happy to answer questions about even over-the-counter drugs and interactions.
  1. Do not take antihistamines with each other. 
  2. Benadryl, Claritin, Allegra, and Zyrtec can be taken with regular Tylenol (with acetaminophen as the only active ingredient). 
  3. Benadryl, Claritin, Allegra, and Zyrtec can be taken with pseudoephedrine (Sudafed)--a decongestant. Note: antihistamines with a D after it already have pseudoephedrine in it. Example: Allegra D has pseudoephedrine and Fexofenadine in it. Do not take additional pseudoephedrine.
  4. Benadryl, Claritin, Allegra, and Zyrtec can be taken with Nasacort, which is an over-the-counter nasal steroid.
What medications do you take for your seasonal allergies? What works for you, and what has not worked at all?

Note: This post is to help familiarize you with some information on over-the-counter drugs. This is not full information. See medication packaging for full directions and warnings. Also, if allergy problems persist, consult a doctor.

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