• Medications for Allergic Rhinitis

    The information provided here is meant to give you a general idea about each of the medicines listed below. Only the most common side effects are included, so ask your doctor if you need to take any special precautions. Use each of these medicines as recommended by your doctor, or according to the instructions provided. If you have further questions about usage or side effects, contact your doctor.
    There are many types of medicines—both over-the-counter and prescription—that can be used to treat symptoms of allergic rhinitis, and each class of medicines works differently in the body. However, once a definite diagnosis of allergic rhinitis is made, the first-line treatment of choice is nasal corticosteroid spray, as it is has been shown to be the most effective with the fewest side effects. Ask your doctor which medicines may offer the best prevention against allergic rhinitis symptoms.

    Prescription Medications

    Antihistamines
    • Desloratadine (Clarinex)
    • Levocetirizine dihydrochloride (Xyzal)
    Oral Decongestants and Antihistamine Combinations
    • Fexofenadine and pseudoephedrine (Allegra-D)
    • Acrivastine and pseudoephedrine (Semprex-D)
    • Azatadine and pseudoephedrine (Trinalin)
    Nasal Corticosteroid Spray
    • Beclomethasone (Beconase)
    • Budesonide nasal (Rhinocort)
    • Fluticasone (Flonase)
    • Triamcinolone (Nasacort)
    • Mometasone (Nasonex)
    • Flunisolide (Nasalide)
    Nasal Mast Cell Stabilizer
    • Cromolyn sodium (Intal)
    Leukotriene Inhibitor
    • Montelukast (Singulair)

    Over-the-Counter Medications

    Antihistamines
    • Diphenhydramine (Benadryl)
    • Fexofenadine (Allegra)
    • Loratadine, prescription strength (Claritin)
    • Cetirizine hydrochloride (Zyrtec)
    • Chlorpheniramine (Chlor-Trimeton)
    • Brompheniramine (Dimetane)
    • Dexbrompheniramine and pseudoephedrine (Drixoral)
    • Clemastine (Tavist)
    • Chlorpheniramine and pseudoephedrine (Triaminic Cold and Allergy)
    Oral Decongestants
    • Loratadine and pseudoephedrine (Claritin-D)
    • Pseudoephedrine (Sudafed)
    • Triprolidine and pseudoephedrine (Actifed Allergy Daytime)
    • Naphazoline (Allerest)
    Nasal Decongestants
    • Oxymetazoline (Afrin)
    • Phenylephrine (Neo-Synephrine)

    Prescription Medications

    Antihistamines
    Common names include:
    • Desloratadine (Clarinex)
    • Levocetirizine (Xyzal)
    Antihistamines block or reduce the action of histamine, a chemical that is released when the immune system reacts to an allergen. The release of histamine leads to the symptoms of allergic rhinitis.
    Possible side effects include:
    • Drowsiness
    • Lightheadedness
    • Blurry vision
    • Change in ability to think clearly
    • Dry mouth, nose, or throat
    • Gastrointestinal upset, stomach pain, or nausea
    • Increased appetite and weight gain
    • Thickening of mucus
    • Increased effects in people with kidney disease due to slower removal from the body
    Nasal antihistamine sprays are also available, such as azelastine (Astelin).
    Oral Decongestants and Antihistamine Combinations
    Common names include:
    • Fexofenadine and pseudoephedrine (Allegra-D)
    • Acrivastine and pseudoephedrine (Semprex-D)
    • Azatadine and pseudoephedrine (Trinalin)
    Decongestants help to narrow the blood vessels, which results in a clearing of nasal congestion. Antihistamines help stop or reduce the production of histamine, a chemical that is released when the immune system reacts to an allergen.
    Possible side effects of the oral decongestant/antihistamine combinations include:
    • Drowsiness
    • Cough
    • Increase in blood pressure
    • Headache
    • Nervousness, difficulty sleeping
    • Nausea
    • Rapid heart rate
    Nasal Corticosteroid Spray
    Common names include:
    • Beclomethasone (Beconase)
    • Budesonide nasal (Rhinocort)
    • Fluticasone (Flonase)
    • Triamcinolone (Nasacort)
    • Mometasone (Nasonex)
    • Budesonide (Rhinocort)
    Nasal corticosteroids are sprayed or inhaled into the nose to help relieve the stuffy nose and discomfort of allergies.
    Possible side effects include:
    • Burning, dryness, or other irritation inside the nose (mild, lasting only a short time)
    • Increase in sneezing
    • Irritation of the throat
    Nasal Mast Cell Stabilizer
    Common name: Cromolyn sodium (Intal)
    Cromolyn is unique in that it is preventative. It changes the body's immunological response to allergens. It is most effective when used before coming into contact with substances that cause allergies or before allergy season. Cromolyn may be used alone or with other medicines.
    Possible side effects include:
    • Burning, stinging, or irritation inside of nose
    • Flushing
    • Increase in sneezing
    Leukotriene Inhibitor
    Common name: Montelukast (Singulair)
    This medication is also used to prevent allergy symptoms. It works by decreasing how many leukotrienes (chemicals) the body creates in response to an allergen.
    Possible side effects include:
    • Flu-like symptoms
    • Nervousness
    • Headache and stomach ache
    • Nausea and vomiting
    • Nasal congestion
    The US Food and Drug Administration (FDA) recommends that this medicine have a label that warns that there may be a link between taking this medicine and having suicidal thoughts. Talk to your doctor if you have any suicidal thoughts. If you are taking Singulair, do not stop right way. Talk to your doctor first.

    Over-the-Counter Medications

    Antihistamines
    The following medicines are available without a prescription. Many of these are older or first-generation antihistamines. First-generation antihistamines can cause drowsiness. However, both loratadine and cetirizine are nonsedating second-generation antihistamines.
    • Diphenhydramine (Benadryl)
    • Chlorpheniramine (Chlor-Trimeton)
    • Brompheniramine (Dimetane)
    • Dexbrompheniramine and pseudoephedrine (Drixoral)
    • Clemastine (Tavist)
    • Chlorpheniramine and phenylpropanolamine (Triaminic Allergy)
    Several second-generation antihistamines are also available over the counter. Second-generation antihistamines are nonsedating.
    • Loratadine (Claritin)
    • Cetirizine hydrochloride (Zyrtec)
    • Fexofenadine (Allegra)
    Antihistamines help reduce or block the action of histamine, a chemical that is released when the immune system reacts to an allergen. The release of histamine leads to the symptoms of allergic rhinitis.
    Possible side effects include:
    • Drowsiness (Claritin, Zyrtec, and Allegra are nonsedating.)
    • Slowed reaction time
    • Dry mouth
    Oral Decongestants
    Common names include:
    • Pseudoephedrine-containing products (eg, Sudafed, Actifed, Drixoral)
    Decongestants help to narrow the blood vessels, which results in a clearing of nasal congestion. One possible side effect is an increase in blood pressure.
    Nasal Decongestants
    Common names include:
    • Afrin
    • Neo-Synephrine
    Nasal sprays help relieve the stuffy nose and discomfort of allergies.
    Possible side effects include:
    • Burning, stinging, or irritation inside of nose
    • Flushing
    • Increase in sneezing
    • Rebound (increased nasal congestion) if nasal decongestant sprays are used for more than three days
    Saline Nasal Spray
    Salinex is a nasal spray that contains a saltwater solution to rinse your nose and help relieve mild congestion, loosen mucus, and prevent crusting. Though it can be useful for relieving symptoms of a stuffy nose and has no side effects, saline cannot prevent allergy symptoms from occurring, as some other allergy treatments can.

    Special Considerations

    Whenever you are taking a prescription medicine, take the following precautions:
    • Take them as directed—not more, not less, not at a different time.
    • Do not stop taking them without consulting your doctor.
    • Do not share them with anyone else.
    • Know what effects and side effects to expect, and report them to your doctor.
    • If you are taking more than one drug, even if it is over-the-counter, be sure to check with a physician or pharmacist about drug interactions.
    • Plan ahead for refills so you do not run out.

    References

    Advice from your allergist: rhinitis. American College of Allergy, Asthma, & Immunology website. Available at: http://www.acaai.org/public/advice/rhin.htm . Accessed September 15, 2008.

    Leukotriene inhibitors: montelukast (marketed as Singulair), zafirlukast (marketed as Accolate), and zileuton (marketed as Zyflo and Zyflo CR). US Food and Drug Administration website. Avialable at: http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm166246.htm . Updated August 2009. Accessed August 8, 2011.

    Levocetirizine. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary/ . Updated December 2009. Accessed February 10, 2010.

    Montelukast. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated August 2008. Accessed September 15, 2008.

    United States Pharmacopeial Convention. USP DI . 21st ed. Englewood, CO: Micromedex; 2001.

    5/6/2010 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Segall N, Gawchik S, Georges G, Haeusler JM. Efficacy and safety of levocetirizine in improving symptoms and health-related quality of life in US adults with seasonal allergic rhinitis: a randomized, placebo-controlled study. Ann Allergy Asthma Immunol. 2010;104(3):259-267.

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