Here are some tips to help you choose the best OTC antihistamine for you.
What is an antihistamine?
Antihistamines are commonly found in OTC allergy, sleep, and cold or flu medications. They work by blocking the effects of histamine, a natural chemical that your body makes when an inflammatory reaction takes place—like when you have an allergic reaction or are fighting an infection. Histamine causes symptoms like itching, sneezing, and congestion.
Different types of antihistamines are often grouped by when they were made. Older antihistamines are considered first-generation, while the newer ones are considered second- and third-generation antihistamines.
Older, first-generation antihistamines have been around for more than 60 years and are notorious for being very sedating. The most well-known brand is Benadryl. Diphenhydramine, and generic form of Benadryl, is now often found in OTC sleep aids, cough and cold preparations, and in combination with pain relievers (as in Advil PM or Tylenol PM).
Chlorpheniramine (Chlor-Trimeton), doxylamine (Unisom), clemastine (Tavist), and triprolidine (Histex) are other examples of first-generation antihistamines.
Second- and third-generation antihistamines
Newer second- and third-generation antihistamines cause less drowsiness and only need to be taken 1 to 2 times daily compared to first-generation antihistamines, which may be need to be taken 4 to 6 times daily. Second-generation antihistamines include Zyrtec (cetirizine) and Claritin (loratadine). Allegra (fexofenadine) is currently the only third-generation antihistamine available without a prescription.
Some of the newer antihistamines come in combination with pseudoephedrine, found in Sudafed. Some examples include: Allegra-D, Claritin-D, and Zyrtec-D. Pseudoephedrine is an ingredient that can help with nasal congestion, but be aware—you will need to pick up these medications from your pharmacy’s counter, just like when you purchase alone.
If you suffer from seasonal allergies, OTC antihistamines like Claritin, Zyrtec, and Allegra can give you relief without a visit to your doctor. You can—and should—still ask your doctor or pharmacist if you aren’t sure what to take.
Risks if you’re over 65 years old
First-generation antihistamines should be taken with caution—and ideally, after consulting a doctor—if you are over the age of 65 due to increased risks for falling and having trouble urinating.
An increased risk of falls
Older antihistamines can cause falls, especially in the elderly. Antihistamines, even ones that claim to be non-drowsy, can have many side effects that may lead to falls, including sedation, drowsiness, and dizziness. Antihistamine drugs should be used with caution in anyone 65 years of age or older because of this risk.
An increased risk of problems urinating
Older antihistamines can also cause urination problems. Again, it’s more likely in older people. Antihistamines basically work by “drying you up”, so anything involving fluid in your body will decrease—including urine. The inability to urinate can be a problem for many older patients on antihistamines, specifically those who already have other related issues like benign prostatic hyperplasia (BPH) or incontinence. The inability to completely urinate can also increase the risk for urinary tract infections, especially in women.
Which antihistamines should you avoid if you’re over 65?
A good guideline is the “Beers list,” created in 1991 by Dr. Mark Beers, which identifies potentially inappropriate medications for nursing home residents. This list is continually updated as new medications come along. These first-generation antihistamines are currently on the list:
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