The Best Antihistamines for Sneezing and Nasal Congestion
Photo Credit: Jon Lebkowsky
When we lived in Minnesota, I only had symptoms during the summer, especially when I cut grass or raked leaves, but after moving to southern Arizona, I now have perennial allergic rhinitis (PAR), since weeds release pollen into the air almost any time of the year. After I get a cold or after I am exposed to a high dose of allergens (such as using a line-trimmer to cut weeds), my allergic rhinitis often worsens to include sinusitis.
As a child, my mom gave me Benadryl or Chlor-Trimeton pills. They worked for a few hours to suppress my sneezing, stuffy nose, and itchy eyes, but made me drowsy -- probably a good side-effect from the viewpoint of my mother, considering my hyperactivity. In fact, these first generation antihistamines are also sold OTC (over-the-counter) as sleeping pills. I also got allergy shots and injections of my own urine (from a quack allergist), which "cured me" from complaining anymore about my allergies. I did avoid exposure to grass and weeds (also called secondary prevention) by not playing field sports (baseball, football, soccer) and by refusing to cut the grass.
I can't tell you "what 9 out of 10 doctors recommend for hay fever," but I can tell you what I've done, and tell you what's been published from research studies (controlled clinical trials) of antihistamines. For many years, I got prescriptions for a second-generation, once-a-day, non-sedating antihistamine. They cost about 3 dollars per pill and even with insurance, the co-pay was over $100 per year, so I took them only when I had symptoms. Many others must have done the same, since the U.S. market for prescription antihistamines was then over 4 billion dollars per year.
Everything changed around Christmas, 2002 when the patent for Claritin expired and Wellpoint successfully petitioned the FDA to switch non-sedating antihistamines to OTC. Since then, I've taken generic loratidine every morning; and it only costs $20 a year (for a small bottle of 300 little white pills). Despite the doom and gloom prophecies of allergists and big pharma in 2001, it became a win-win situation. The quality of my life and others improved because we rarely have allergy symptoms anymore, and the profits of the manufacturers of loratidine improved (with 30% market share and 1.4 billion dollars in annual sales).
Allergy sufferers got another Christmas present in 2007 when the patent on Zyrtec, another non-sedating antihistamine, expired. Zertec is now available OTC for about a dollar a pill for the brand name product, while the generic cetirizine costs only $15 to $45 for a bottle of 90 tablets -- enough to get through 3 months of the allergy season for those with seasonal allergic rhinitis. It's also available as a chewable tablet or liquid for children (at a lower dose) and combined with a Decongestant in a capsule.
As an allergy sufferer in the United States, your choices have now been expanded: You can buy generic Claritin OTC, generic Zyrtec OTC, or ask your doctor for a prescription for Clarinex, Allegra, or Xyzal. To determine which is best antihistamine, I read the most recent studies, which are summarized in an excellent review by Doctors Lehman and Blaiss from the University of Tennessee (in the journal Drugs 2006), and a similar review, written for physician assistants, which you can download without cost.
In summary, second-generation antihistamines are the first-line therapy for both seasonal and perennial allergic rhinitis (SAR and PAR). They are very effective, very safe, and last for more than 24 hours. They are much less likely to cause sedation (drowsiness or fatigue) when compared to the old first generation antihistamines. For any of these drugs, the higher the dose, the more likely sedation will be noticed. At the recommended doses for adults, Zyrtec and its twin brother Xyzal are more likely to cause sedation (5-10%) when compared to the others (1-2%).
A small advantage for Zyrtec and Xyzal is that their onset of action may be shorter (about an hour) when compared to the others (1-3 hours). However, a somewhat slower onset of action is not a problem when these drugs are taken every morning (when you brush your teeth) to PREVENT the release of histamine in your nose and eyes later in the day. Antihistamines are much less effective if you wait to take them until you have symptoms.
Allegra (fexofenadine, still by prescription only) is slightly more effective in relieving itchy, watery, red eyes, and less likely to cause sedation at higher (off-label) doses, when compared to Claritin and Clarinex. Blood levels of Allegra are increased by about 40% if you take it with grapefruit juice, erythromycin (an antibiotic), or ketoconazole (an antifungal), but these drug-drug interactions are unlikely to significantly increase the risk of sedation from Allegra.
Bottom line, I will continue to take generic Claritin every morning, because it's effective, doesn't cause sedation at the recommended dose, and cheap. I may try generic Zyrtec when the cost drops towards that of generic Claritin. I will still keep a bottle of generic Benedryl for insect stings and severe allergic reactions, realizing that after taking it I will feel like a space cadet or sleepy. Despite heavy advertising, I personally see no reason to ask my doctor for a prescription for Clarinex, Allergra, or Xyzal, but I am sure that a few patients will feel that these expensive antihistamines are more effective.
Related Topics: Technorati Tags: hay fever, pollen, allergic rhinitis, sinusitis, Benedryl, Chlor-Trimeton, antihistamines, Claritin, Zyrtec, Clarinex, Allegra, Xyzal, allergies
12 Comments:
Where do you find the loratadine for that cheap??? I've never seen it that cheap.
I'm currently taking Nasacort AQ (expensive even with an insurance copay) and loratadine (an ok price, but not as cheap as you find it)
I've found that my allergies are still not controlled, especially problems with my eyes, so what you said about the allergra was interesting. Though I think ultimately I just want to try the allergy shots because my allergies seem to be getting worse and worse every year.
Good post I'd be interested in hearing what you have to say about the nasal sprays
Clariton, coupled with Singulair have allowed me to actually enjoy spring. I did not know Clariton worked better if taken daily. I will heed this advice and report my findings. Another great post.
drytears,try Sams Club,even though there's an annual membership fee,their prices for a lot of generic drugs are very cheap.
Costco is another good source for very inexpensive generic loratadine and also generic Zyrtec (cetirizine)...I have seen the generic loratadine at Costco and my partners tell me generic cetirizine is available for about a nickel a tablet there now too. If nasal passage airflow blockage is a problem, the nasal steroids are a better choice than the antihistamines.
I have been taking generic Claritin daily for 2 years. It does not help me as much as Allegra does. I don't have insurance and when Claritin went generic they changed from carrying Allegra to loratadine. I wish I could have my Allegra back. It stopped the nasal congestion, itchiness and post nasal drainage down my throat. You have to find the antihistamine that works best for you.
iam a 57 year old woman with a history of copd in my family i have now my self have it yes i have been a smoker since the age of 11, whole family smoked iam wondering now that i have applied for ssd what kind of test to they put you threw dose any one have an ans?
When Claritin first became available OTC, my son and I tried it for our alleriges. We found that it made us very drowsy and only provided relief for 6 hours.
I have yet to figure out how Claritin can say it is the only non-drowsy allergy medicine in its advertising.
Currently my son takes Zytrec-D 2x a day and I take Allegra 2x a day to control allergies. We will stick with this until we find something else that works for us.
Allegra 60 mg every 12 hours works best for me. Not that sedating and does not dry me out that badly. Unfortunately, with the availability of OTC, my HMO won't cover this anymore. I have to fight to get a scrip.
Generic Claritin was quite sedating and really didn't work. Taking Benedryl was cheaper but just as sedating. Not helpful when I need to work.
My son usually takes Clarinex, but our insurance company wanted him to try OTC Loratadine instead. It is cheap ($4/30 tablets at Walmart),but it raised his heartrate to 114bpm, made him anxious and extremely nervous.
That's what you get when the insurance companies play doctor!
I have severe allergies to everything and I also have asthma. My doctors and I have tried every medication on the market..Nothing helps.Nasal douches,allergy shots, Ive tried them all..I took allergy shots for five years--no help--Anyone with suggestions?
I find that I feel my best when I avoid medications entirely. I wash my nasal passages rather than medicate them. Cleaning the pollen out makes me feel energized and refreshed and my symptoms go away. I use a Neti pot or in a pinch I use Simply Saline for on the road. That's a lot more expensive than just making your own, though.
To overcome asthma or allergies u hv to concern abt weather for all time and maintain some strict rules.Not to eat those foods which higher the risk and take bath with a clean and soft warm water.U can use ayurvedic item for consumption bcoz those items can help u to cure properly.
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