OTC allergy medication guide

For physicians whose patients will be traveling this spring, this product guide for over-the-counter allergy medications is another item travelers may want to pack for their trips. This is not intended to serve as a comprehensive guide, but includes the more commonly used products among children and adolescents.

Antihistamines

Antihistamines help relieve swelling, redness, itching, and watery eyes and nose.

Common adverse effects for antihistamines: drowsiness, dry nasal passages and mouth, dizziness, nausea and headache.

Pill and liquid

Cetirizine (Zyrtec, McNeil Consumer Healthcare)

• Drowsiness may occur. Caution should be used in children aged younger than 6 years and in patients with liver or kidney disease. May impair mental/physical abilities.
• The safety and effectiveness of cetirizine in pediatric patients aged younger than 6 months have not been established.

Chlorpheniramine (Chlor-Trimeton, Schering)

• Avoid use in patients with chronic bronchitis.

Clemastine (Tavist, Novartis)

• Dizziness is possible.
• Use with caution in patients with respiratory problems. May impair mental/physical abilities.

Diphenhydramine (Benadryl, McNeil Consumer Healthcare)

• The manufacturer warns against using this product to make a child sleepy, or with any other product containing diphenhydramine, even topical.
• Do not use in children aged younger than 2 years.

Loratadine (Claritin, Schering)

• Use with caution in patients with hepatic or renal impairment.

Decongestants

Decongestants help shrink swollen and congested nasal membranes and relieve runny nose and sinus pressure.

Common adverse effects: restlessness, sleeplessness and headache.

Pill and liquid

Pseudoephedrine (Sudafed, McNeil Laboratories)

• Do not use in patients who are taking a prescription monoamine oxidase inhibitor (MAOI) or for 2 weeks after stopping the MAOI drug.
• Advise against use in patients with heart disease, high blood pressure and diabetes.

Eye drops

Naphazoline (Visine, Johnson & Johnson)

• Overuse may cause more redness. Temporary enlargement of pupils may occur. Remove contact lenses before use. Discontinue use if eye pain or vision changes occur, if redness or irritation continues, or if condition worsens or persists for more than 72 hrs.

Nasal spray

Oxymetazoline (Sudafed OM Sinus Congestion Moisturizing Nasal Spray McNeil)

• Use with caution in patients with heart disease, diabetes and high BP. Use of container by more than one person may cause infection. Burning, stinging, sneezing or increased nasal discharge may occur. Frequent or prolonged use may cause nasal congestion to recur or worsen. Discontinue use if symptoms persist for more than 3 days.

Combination antihistamine and decongestant

These medications combine the benefits of antihistamines and decongestants to treat a multitude of allergy symptoms. Often, they will also include acetaminophen to treat minor pains that may accompany sinus pressure.

Common adverse effects: nervousness, sleeplessness and headache.

Pill and liquid

Acetaminophen, diphenhydramine, phenylephrine (Benadryl Allergy Cold, Benadryl Allergy Sinus Headache; Sudafed PE Severe Cold; Children’s Tylenol Plus Cold & Allergy; all products, McNeil Consumer Healthcare)

Acetaminophen should be used with caution if patients have:

• Advise patients not to take concomitantly two or more products that contain acetaminophen. Many prescription and nonprescription medications contain acetaminophen in combination with other medications.

Phenylephrine should be used with caution if patients have:

• Heart disease or diabetes;
• Marked drowsiness may occur and may impair mental/physical abilities. Excitability may occur in children. Discontinue use if nervousness, dizziness, and sleeplessness occur; if pain and nasal congestion gets worse or last more than 7 days; if redness or swelling is present; if fever worsens and lasts more than 3 days, or new symptoms develop.
• Do not use in children aged younger than 12 years.

Cetirizine, pseudoephedrine (Zyrtec-D, McNeil Consumer Healthcare)

(For contraindications and other side effects, see cetirizine and pseudoephedrine above.)

Acetaminophen, diphenhydramine, pseudoephedrine (Sudafed Sinus Nighttime Plus Pain Relief; Children’s Tylenol Allergy-D; all products, McNeil Consumer Healthcare)

(For contraindications and other side effects, see diphenhydramine and pseudoephedrine above.)

For more information:

• Physicians’ Desk Reference. 65th ed. Montvale, NJ: Thomson PDR; 2011.