• Medications for Allergic Rhinitis

    The information provided here is meant to give you a general idea about each of the medications 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 medications 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 medications—both over the counter and prescription—that can be used to treat symptoms of allergic rhinitis. Each class of medications 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 medications may offer the best prevention against allergic rhinitis symptoms.

    Prescription Medications

    • Desloratadine
    • Levocetirizine dihydrochloride
    • Fexofenadine and pseudoephedrine
    • Acrivastine and pseudoephedrine
    • Azatadine and pseudoephedrine
    • Beclomethasone
    • Budesonide nasal
    • Fluticasone
    • Triamcinolone
    • Mometasone
    • Flunisolide
    • Cromolyn sodium
    • Montelukast

    Over the Counter Medications

    • Diphenhydramine
    • Fexofenadine
    • Loratadine, prescription strength
    • Cetirizine hydrochloride
    • Chlorpheniramine
    • Brompheniramine
    • Dexbrompheniramine and pseudoephedrine
    • Clemastine
    • Chlorpheniramine and pseudoephedrine
    • Loratadine and pseudoephedrine
    • Pseudoephedrine
    • Triprolidine and pseudoephedrine
    • Naphazoline
    • Oxymetazoline
    • Phenylephrine
    • Salinex

    Prescription Medications

    Antihistamines
    Common names include:
    • Desloratadine
    • Levocetirizine dihydrochloride
    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.
    Oral Decongestants and Antihistamine Combinations
    Common names include:
    • Fexofenadine and pseudoephedrine
    • Acrivastine and pseudoephedrine
    • Azatadine and pseudoephedrine
    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
    • Budesonide nasal
    • Fluticasone
    • Triamcinolone
    • Mometasone
    • Flunisolide
    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 medications.
    Possible side effects include:
    • Burning, stinging, or irritation inside of nose
    • Flushing
    • Increase in sneezing
    Leukotriene Inhibitor
    Common name: Montelukast
    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 medication have a label that warns that there may be a link between taking this medication and having suicidal thoughts. Talk to your doctor if you have any suicidal thoughts. If you are taking montelukast, do not stop right way. Talk to your doctor first.

    Over the Counter Medications

    Antihistamines
    The following medications 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
    • Fexofenadine
    • Loratadine, prescription strength
    • Cetirizine hydrochloride
    • Chlorpheniramine
    • Brompheniramine
    • Dexbrompheniramine and pseudoephedrine
    • Clemastine
    • Chlorpheniramine and pseudoephedrine
    Several second-generation antihistamines are also available over the counter. Second-generation antihistamines are non-sedating.
    • Loratadine
    • Cetirizine hydrochloride
    • Fexofenadine
    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 (some brands are non-sedating.)
    • Slowed reaction time
    • Dry mouth
    Oral Decongestants
    Common names include:
    • Pseudoephedrine-containing products
    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
    • Neosynephrine
    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 3 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

    If you are taking medications, follow these general guidelines:
    • Take the medication as directed. Do not change the amount or the schedule.
    • Ask what side effects could occur. Report them to your doctor.
    • Talk to your doctor before you stop taking any prescription medication.
    • Plan ahead for refills if you need them.
    • Do not share your prescription medication with anyone.
    • Drugs can be dangerous when mixed. Talk to your doctor if you are taking more than one drug, including over-the-counter products and supplements.

    References

    Allergic rhinitis. American College of Allergy, Asthma, & Immunology website. Available at: http://acaai.org/allergies/types/hay-fever-rhinitis. Accessed September 15, 2016.

    Allergic rhinitis. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T116217/Allergic-rhinitis. Updated July 22, 2016. Accessed September 15, 2016.

    Leukotriene inhibitors: montelukast (marketed as Singulair), zafirlukast (marketed as Accolate), and zileuton (marketed as Zyflo and Zyflo CR). US Food and Drug Administration website. Available at: http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm166246.htm. Updated August 29, 2013. Accessed Septemgber 15, 2016.

    5/6/2010 DynaMed Plus Systematic Literature Surveillance. http://www.dynamed.com/topics/dmp~AN~T116217/Allergic-rhinitis. 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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