As far as what you can take, I'd say, first, if you haven't tried any of the newer antihistamines... do try them. These are less likely to cause sedation or to cause cumulative effects with your meds. Failing that, there are a couple of the older ones you could try. You have options.

Here are my suggestions in order of preference:

1. Zyrtec (cetirizine). Used for allergic rhinitis and asthma. Side effects unlikely, relatively interaction-free, once-daily dosing. A lot of people do well with this. Some studies show it yields better responses than other second-generation antihistamines.

2. Allegra (fexofenadine). Side-effects unlikely. Has an interaction with grapefruit juice and some meds but should not affect other meds.

3. Benadryl (diphenhydramine). This is a very effective first generation antihistamine and can treat moderate to severe reactions. Although it is a different chemical class than chlorpheniramine, it too has SSRI-like activity, and it can produce paradoxical agiation. However, it is a more potent anticholinergic, and most find it to be sedating.

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The first two choices are the newer (second-generation) antihistamines. These have the best side-effect profile, but you should always check with the pharmacist about adding anything to your med regimen.

The drugs I listed are from distinct drug classes. If a drug fails, the best strategy is to try one from a different class. However, sometimes, a different drug in the same class does work. There are many more second-generation antihistamines that you can try.

Benadryl is kind of like a catch-all. There is even one past that, but you'd have to talk to the doc about it, and I wouldn't recommend it unless you are really desperate so I haven't listed it.

waves

Waves,

That is helpful.

Mari

O.K. I understand.

My father has allergies.
My sister has for years taken allergy meds for years but I have not used or studied them.

Mari

Oh Steve, I do apologize. I somehow missed this earlier.

Durahist-D is dexchlorpheniramine. It is the "active" isomer of chlorpheniramine. Molecularly, Durahist has the interaction potential you were concerned about chlorpheniramine.

If you didn't see a panic problem with the Durahist-D, I'd have to suggest that the worsening you saw in the panic disorder was more than likely coincidence. I'd say, if the Durahist worked for you, then try the chlorpheniramine again.

Another possibility is how often did you take the Durahist? Every four hours? You should get a formulation of chlorpheniramine that is to be taken at the same intervals... dosages affect peak drug levels. An extended release version could produce different side effects than an immediate release, and vice versa.

Chlorpheniramine used to be available in immediate release,(4-hour dosing, intermedieate (8-hour) and extended (12-hour) dosing. For the 8- and 12-hour release versions, you might have to get a hold of Chlor-Trimeton brand and I don't know if that's available still. The 4-hour version is standard and is available in all generics.

All the pheniramine drugs are second generation and have some drowiness and other CNS effects. They can affect the brain because histamine is a signaling neurotransmitter in the brain, to release other neurotransmitters. Also some antihistamines like Benadryl have actions on motor neurons...and are used sometimes for side effects of movement disorders caused by other drugs.

The newer one like Allegra (a metabolite of the old Seldane which was taken off the market), have much less CNS effects if any. Claritin is a poor antihistamine all around so I don't recommend it. Zyrtec has retained some of the characteristics of
its chemical parent Atarax, and has some CNS effects, but not as many as the Atarax has. Both Allegra and Zyrtec are OTC now.

The new allergy nose ointments, block the pollen before it gets into your nose at all...
example:
http://www.amazon.com/Chloraseptic-A.../dp/B001BNQVC6
This is drug free and works well for most.

Typo, right? You meant first generation, here, I think.

Sorry, I just didn't want people to be confused if paying attention to the generation info.

waves

I always thought that Dramamine was first generation, and Benadryl. Chlorpheniramine and Dex, and bromo were 2nd, and
the new ones like Claritin, Allegra 3rd. Back when the pheniramines were advertised and promoted, they were suggested as "less drowsy" than Benadryl and Atarax tended to be.

But some places list them differently.

The distinction is that only a few have little or no CNS effects and are the most recent. Things like Zyrtec contain some drowsiness factors and really aren't 3rd generation, IMO.

Allegra is the metabolite of Seldane, and works pretty well with little or no CNS effects. Claritin is overused, and useless IMO.
We used to get RXs from doctors using it themselves, taking 2 or 3 a day to try and get some effects!

Here is one example:
http://www.ncbi.nlm.nih.gov/pubmed/15992014

I've always seen the pheniramines listed as first-generation, the distinction being that they do cross the BBB significantly and also have some, albeit less, anticholinergic activity.

The delineation between second and third is imho hazier. Most of the "third-generation ones are refinements of second-generation ones but do not exhibit significant differences (eg. 2nd-cetirizine/3rd-levocetirizine) other than with terfenadine/fexofenadine, in which case the first had toxic interactions while its metabolite does not. Now, I *have* seen the so-called third generation ones sometimes lumped together with second generation, which makes sense to me because their behavior is not significantly different.

Not terrribly surprised though that you have seen the classifications listed differently for the pheniramines. It sounds like they might have been proposed as a newer generation when they first came out. Interesting. These "delineations" and what falls under each umbreall probably changes somewhat over time.

For Steve's purposes, I stand by my previous recommendations to him, including the notes to retry chlorpheniramine since dexchlorpheniramine was getting the job done for him.


waves

I think he should try the drug free nasal gel.... It really works, and won't interfere with his other medications. This is a new way to deal with pollen allergies.


It is so simple...you can do it even with Aquaphor ointment if you have some around (use a very very little bit around the opening to the nose, but not INSIDE the nose.

Thanks for all the great information.

Derrick, takes both Claritin and zyrtek. But we need to
make a decision if they are both needed.



Otherwise it will be Zyrtek, because of drowsiness.

But I take Claritin right now. My allergist got the wrong
prescription. But its working so we will see.

I use a nose spray that is wonderful. So I am staying with
it. I can't remember its name right now.

Donna