It’s Allergy Season, Which Medication is Right for You
Spring is a wonderful time of year with its longer days and warmer weather, but for many of us, it also brings the scourge of allergies. Fortunately, there are several treatments options for those awful allergy symptoms. So many, in fact, it can be overwhelming to decide which one to use.
In the next few posts, I’ll give you the lowdown on the over-the-counter medications available so that you can make in an informed choice. I also encourage you to talk to a healthcare professional if you have any questions not covered here. Better yet, drop by Wellcome Pharmacy if you live or work near Saratoga, West San Jose, or Cupertino. I’ll be happy to chat with you in person.
For this 1st post, I’ll be focusing on oral antihistamines, these are the most common treatment options for allergies. There are actually 2 generations of antihistamines, with the second generation generally viewed as safer with fewer side effects. The following table should give you a quick overview of the differences between the OTC medications available in the US today.
As you can see, there are so many options that the drug manufacturers had to use different colors for their packaging to avoid confusion. So, it’s not surprising that people have questions. Here are some of the most common questions I’ve been asked:
What are the differences between the two generations of antihistamines?
Compared with the 1st generation of oral antihistamines, systematic reviews of randomized controlled trials have found 2nd generation antihistamines to be safer and longer lasting. In this case, safer means that they have fewer drug interactions and less adverse side effects such as making you drowsy or sleep. In terms of longer lasting, all 2nd generation antihistamines come in a once-a-day dosing meaning that you can just pop one in the morning and have it last all day. The 2nd generation antihistamines also kick in faster with some able to bring relief in less than an hour.
Why do some of the allergy medications have a “-D” at the end?
The “-D” means that the manufacturer has added a nasal decongestant to the medication. It is almost always pseudoephedrine, or more commonly known as Sudafed. For many, the addition of a decongestant provides more relief because the medication includes two mechanisms of action. The downside is that pseudoephedrine is a stimulant (as fans of Breaking Bad would know) and folks often have a hard time sleeping after taking it.
What are the differences between the 12-hour and 24-hour versions of the same medication?
Only the 2nd generation antihistamines come in formulations that last up to 24 hours on a single dose. Among them, Claritin (loratadine), Zyrtec (cetirizine), and Allegra (fexofenadine) have a 12-hour formulation. The primary difference, if we exclude the versions that include a decongestant, is the amount of drug in each dose. This doesn’t mean that the 24-hour dose is always double the 12-hour. For example, Allegra’s 24-hour dosage is actually triple that of the 12-hour.
Another related question I often get is whether it is better to take a single 24-hour dose or two 12-hour dose, and from the research I can find, there’s little additional benefit to taking two separate doses if you are looking for 24 hours of relief. Studies have generally shown that there isn’t an increase in side effects or a decrease in efficacy of the 24-hour versions.
What is the difference between the extended-release vs normal versions?
“Extended-release” generally refers to medications that have special formulation that allows for the drug to be available for a longer period inside your body. For oral antihistamines, extended-release versions are really only needed for the 2nd generation formulations that include pseudoephedrine. The pseudoephedrine doesn’t last as long as the newer antihistamines in your body, so extended-release technology is used to help the pseudoephedrine keep up.
Which one should you choose?
There’s really no “one size fits all” answer for this question because everyone is so different.
My first advice is that if you have already found something that works well for you, then stick with that. My next recommendation is to use 2nd generation antihistamines unless you are looking to sleep or nap after taking the medication. Beyond that, the best option really depends the individual. Nonetheless, here are some suggestions that may help:
If you tend to take allergy meds as needed after you already start experiencing symptoms, you may want to look into Xyzal (levocetirizine) or Zyrtec (cetirizine). Tests have consistently show that they can alleviate symptoms the fastest with levocetirizine just slightly faster than cetirizine in some studies
If price is a concern, Claritin (loratadine) is an oldie but goodie that is often available at a lower cost than its peers and comes in pretty much every imaginable form such as liquid, chewable, dissolving tablets, etc
If you hate the feeling of being drowsy or being out of it, studies have shown that Claritin (loratadine) and Allegra (fexofenadine) are “non-sedating” antihistamines and least likely to have any neurological effect because they don’t cross the blood-brain barrier