How to Choose the Right OTC Antihistamine

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There are many different antihistamines now available over-the-counter(OTC). Each has different qualities, so it's important to pick the correct drug for your situation. The OTC antihistamines fall into two categories, first generation and second generation. First generation antihistamines are the older OTC products such as diphenhydramine (Benadryl) and chlorpheniramine (Chlor-Trimeton). These products tend to cause drowsiness and have a drying effect. They also tend to be the most effective. The second generation OTC antihistamines are loratadine (Claritin, Alavert) and cetirizine (Zyrtec). They tend to have much less side effects and last longer (24hrs vs 4-6 hrs), but not be as effective in certain situations. How do you choose which one to take?

Things You'll Need

  • A nearby pharmacy.
  • $5 to $25 depending on which product you require.
  • For most peoples seasonal allergies, loratadine or cetirizine are good choices. They both last 24 hours and are non-sedating. Cetirizine can cause drowsiness in some people. By taking it at bedtime, you can minimize that effect. These are also available for small children.

  • If your seasonal allergies tend to include significant eye itching, you can take an antihistamine OTC eye drop like ketotifen (Zaditor) in addition to loratadine or cetirizine.

  • If your seasonal allergies involve sinus pressure, loratadine and cetirizine are available along with a decongestant (Claritin-D or Zyrtec-D). The most effective decongestant is pseudoephedrine. Make sure you buy the decongestant containing product at the pharmacy counter, because this is the only place you can still get it in the US. You will need to show a State ID/Driver's License and sign for it. The other popular decongestant, phenylephrine, is much more widely available, but doesn't work nearly as well.

  • For a nose that will not stop running try an older antihistamine like chlorpheniramine (Chlor-Trimeton). This antihistamine is not as sedating as diphenhydramine (Benadryl) and is short acting (about 4 hours). Since its short acting, you can take it just when you need it and can skip a dose if you get too dried out or need to be fully alert.

  • For more serious allergic reactions, the most effective OTC antihistamine is diphenhydramine (Benadryl). This is a good choice for reactions to bug bites, hives, allergy related rashes, mild food allergies, etc. It tends to be really sedating so be really careful while on it. However for any allergic reaction, see a doctor if the reaction is severe or the antihistamine doesn't improve it. Some reactions can be life-threatening, so it's always better to be safe than sorry.

  • If you're still itchy after taking the antihistamine, there are to more things you can take in addition to it. The first is an H2 Blocker. Normally this kind of medication is used to reduce stomach acid, but it can also block additional histamine receptors in the skin not blocked by the traditional antihistamines. Examples of this drug are ranitidine (Zantac), famotidine (Pepcid), and cimetidine (Tagamet). Caution should be used with cimetidine since it has many drug interactions. The second thing is hydrocortisone 1% cream. It can also be applied to itchy rashes and bug bites to help with itchiness, but it should be used for short term use only (5-7 days). The ointment version may work better in areas that tend to get sweaty, because it stays put.

Tips & Warnings

  • Store brand versions of the these products tend to be just as effective but much less expensive.
  • Check with your doctor if you have glaucoma or prostate problems as antihistamines may worsen them (esp.. the first generation).
  • Since they thicken mucus, they are bad choices for some people with Asthma or if you have chest congestion.
  • Decongestants can raise blood pressure (but antihistamines do not). Check with your doctor before taking something with a decongestant in it if you have high blood pressure or a heart condition.
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