Antihistamines:  non-drowsy

Non-sedating antihistamines offer a big advantage over older antihistamines.  They are less likely to make you feel tired.  The non-sedating antihistamines also interfere less with thinking and movement than the older antihistamines because they penetrate the brain only in small amounts.


Although drowsiness is rare, patients should be advised that it can occur and may affect performance of skilled tasks (driving).  Excess alcohol should be avoided.


CLARITIN
Generic Name: loratadine
Brand Names: Claritin, Alavert, Claritin Hives Relief, Clear-Atadine, Claritin Reditab, Clear-Atadine Children's, Dimetapp ND, Tavist ND, Wal-itin
This is a non-sedating antihistamine that can be bought without a prescription or, in other words, over-the-counter (OTC).  Loratadine is available as tablets, oral suspension and syrup, and also in combination with pseudoephedrine (Claritin-D).  When loratadine is combined with pseudoephedrine, a decongestant, this medicine is somewhat useful for colds as well as allergies, but adds potential side-effects of insomnia, nervousness and anxiety.
Loratadine should be used with caution in liver, kidney disease and epilepsy.  Children and the elderly are more susceptible to side-effects.  Do not give Claritin to a child younger than 6 years old.  Loratadine can be used with reasonable safety during breast-feeding and pregnancy.


Common side-effects
Drowsiness, headache, thought and movement impairment, difficulty urinating, dry mouth, blurred vision, and gastrointestinal disturbances. 

Loratadine disintegrating tablets (Claritin Reditab) may contain phenylalanine. Talk to your doctor before using Claritin Reditabs if you have phenylketonuria (PKU). 

Rare side-effects
Hypotension, extrapyramidal effects, dizziness, confusion, depression, sleep disturbances, tremor, convulsions, palpitation, arrhythmias, hypersensitivity reactions (including bronchospasm, angioedema, and anaphylaxis, rashes, and photosensitivity reactions), blood disorders, liver dysfunction, and angle-closure glaucoma

CLARINEX (Desloratadine) is a metabolized form of Loratadine.  It is a very similar medication, but requires a prescription.
ALLEGRA®
(fexofenadine) Tablets, ODT (orally disintegrating tablets) and Oral Suspension
This is a metabolite of Terfenadine (Seldane) which duplicates its helpful anti-allergic properties, but without the potential serious side effects of its predecessor.
Common side effects of Allegra include nausea, vomiting, weakness, drowsiness, diarrhea and unusual bowel movements.  Uncommonly Allegra does cause headaches or backaches. For more information, go to www.allegra.com.
No drug interactions.
ALLEGRA Tablets: available in 30 mg, 60 mg, and 180 mg strengths.
Adults and Children 12 Years and Older.  60 mg twice daily or 180 mg once daily with water.
Children 6 to 11 Years. 30 mg twice daily with water.

 

ALLEGRA ODT: available as a 30 mg orally disintegrating tablet and is intended for use only in children 6 to 11 years of age. The recommended dose is 30 mg twice daily.  ALLEGRA ODT is designed to disintegrate on the tongue, followed by swallowing with or without water and is not intended to be chewed and  should be taken on an empty stomach. 


ALLEGRA oral suspension:  Children 2 to 11 Years: The recommended dose of ALLEGRA oral suspension is 30 mg twice daily.  Shake bottle well,  before each use.


ZYRTEC®  (cetirizine) Tablets, Chewable Tablets and Syrup
Now available Over-The-Counter (OTC).  No prescription needed.
Zyrtec has a higher occurrence of sleepiness than other nonsedating antihistamines.  This medication can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert. Avoid drinking alcohol. It can increase some of the side effects of Zyrtec.


For seasonal allergies the recommended dose for adults and children 12 years or older is 60 mg twice daily or 180 mg once daily. Children 2-11 years of age should be given 30 mg twice daily.

You may take Zyrtec with or without food. Take Fexofenadine with water (not fruit juice).
 

ZYRTEC chewable tablets are available in 5 and 10 mg strengths.  The chewable tablet must be chewed before you swallow it.
Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop using Zyrtec and call your doctor at once if you have any of these serious side effects:

  • fast, pounding, or uneven heartbeat
  • weakness, tremors (uncontrolled shaking), or sleep problems (insomnia)
  • severe restless feeling, hyperactivity
  • confusion
  • problems with vision
  • urinating less than usual or not at all

 Less serious side effects may include:

  • dizziness, drowsiness
  • tired feeling
  • dry mouth
  • sore throat, cough
  • nausea, constipation or headache

XYZAL (levocetirizine): developed from the second generation antihistamine cetirizine (Zyrtec).  Used for allergic rhinitis and chronic skin rash.  For adults- 5 mg daily in evening. For children older than 5.  Do not use if you have poor kidney function.  Advantage: less sleepiness.

Generic
Name
Trade
Name
Reduce Dosage in Special
Populations
Pregnancy Category
Cetirizine
Zyrtec®
(no prescription - OTC)
patients >76 years;
liver or kidney disease
B
Desloratadine
Clarinex®
(prescription)
liver or kidney disease
C
Fexofenadine
Allegra®
(prescription)
kidney disease only
C
Levocetirizine
Xyzal®
(prescription)
liver or kidney disease
B
Loratadine
Claritin®
(no prescription - OTC)
liver or kidney disease
B

Category A: Studies have shown no increased risk of fetal abnormalities
Category B: Studies have not been able to prove an increased risk of fetal abnormalities
Category C: Studies in animals have shown an adverse effect but no studies have been done on pregnant women or no animal studies have been done and there are no adequate studies in pregnant women.
Category D: Studies have shown that there is a risk to the fetus
Category X: Studies clearly show a risk of abnormalities to the fetus

Olopatadine (Patanase)

Olopatadine 0.6% is a new antihistamine and mast cell stablizer product which promises to be as effective as Astelin. It also works within 30 minutes, reduces most allergy symptoms, including nasal congestion and itchy, watery eyes. It has minimal side effects. Its side effects may include headaches (7% of occurrence), throat irritation and taste change.

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