In my last post I briefly went over allergic rhinitis. In response I received several requests for advise on how to choose an antihistamine or which one is best.
I usually don’t endorse any specific drug, as medical decisions are usually individualized to the patient by the treating physician. I will, however, briefly discuss the salient features of my favorites, and why I might consider one over the other. One thing I don’t make any bones about is that I am not a fan of any previous generation antihistamines. These include
- diphenhydramine
- chlorpheniramine
These are usually quite sedative and are often combined with stimulating decongestants to keep your eyes, I mean nose, open. Furthermore, they need to be administered every 6-8 hours for true 24 hour effect. The three antihistamines that I am most likely to recommend to my patients are all “one a day” and although not perfect, are far better tolerated:
- loratadine
- cetirizine
- fexofenadine
The four factors to consider are:
- Cost and availability
- Potency
- Sedation
Loratadine
Of the three, loratadine was the first to lose patent prior to which it was marketed as Claritin. As a result, it was the preferred agent of insurance companies for years, primarily due to its low cost. It remains the cheapest of the three, and is available at almost all pharmacies, grocery stores, and supermarkets. Although not the strongest, loratadine is sufficiently potent for most patients. It is marketed as “non-sedating”, but can cause some minor sedation – negligible in most patients.
Cetirizine
Cetirizine lost patent a few years ago. Previously only available as brand Zyrtec, cetirizine has been rapidly becoming as ubiquitous as loratadine. Its price has been gradually been coming down, to almost that of loratadine. Lately, there are very few retailers that do not carry cetirizine. Most patients find cetirizine more potent than loratadine. Cetirizine has also been shown in studies to have an anti-inflammatory affect on the airways and nasal passages in colds, as well as with rashes in certain skin conditions related to sensitive skin. Although it is described as minimally sedative, it is the most sedative of the three. Most patients, however tolerate it quite well but caution is advised.
Fexofenadine
Fexofenadine, is commonly known by the brand name Allegra, and is the most recent to found as an over the counter store brand. You can find it at some supermarkets such as Walmart, as well as some pharmacies. It is not nearly as frequented upon, although I suspect it is just a matter of time before it swallows a chunk of the market share. Fexofenadine is reputed to be as potent an antihistamine as cetirizine, although I am not aware of any anti-inflammatory properties. Unlike loratadine and cetirizine, fexofenadine is supposedly completely non sedating, although I have a few patients who would most certainly differ.
There you have it guys. Above is my take on the three popular once daily antihistamines which are available without a prescription, and as generic store brands.
Loratadine, the least potent, but dirt cheap. Cetirizine, almost as cheap, more potent, also good in colds etc., but more sedative. Fexofenadine, potent, least sedative, but the most expensive (for now).
My typical use:
Mild allergies: loratadine.
Need, sniff, help, sniff, fast: cetirizine.
Pilot of my plane: fexofenadine.
“Poetry is thoughts that breath, and words that burn.” – Thomas Gray.
Have some antihistamines worked better than other for you? Some of them knock you out? Please shoot of in the comments below, As always, I would love to hear your experiences.
Disclosure: Any information in this blog is for informative purposes only, and is not intended to establish a physician patient relationship. The writer of this blog believes in sharing his experiences for none other than educational purposes. Please discuss individual management of your symptoms with your doctor.