Allergy Medicines Without a Prescription

Which Allergy Medications Are Available Over the Counter (OTC)?

Man sneezing into tissue
Many allergy medicines can be purchased without a doctor's prescription. Image Source/Photodisc/Getty Images

Over the past 10 years or so, numerous allergy medicines, once available only with a doctor’s prescription, are now available over-the-counter (OTC) without a prescription. Some medicines, like oral decongestants (Sudafed/pseudoephedrine) and sedating antihistamines (Benadryl/diphenhydramine), have been available without a prescription for years. Other medicines, including low sedating antihistamines (such as Allegra) and intranasal corticosteroid sprays (such as Nasacort 24 Hour Allergy), have only recently become available OTC without a prescription.

Given the wide variety of allergy medicines available without a prescription, it is now possible for people to treat most symptoms or nasal (allergic rhinitis) and eye (allergic conjunctivitis) without seeing a doctor – assuming that the person knows which medicine to choose for their symptoms. The symptom-based approach to the treatment of allergy symptoms is very important, since not all medicines treat all the symptoms of allergies.

Learn more about the symptom-based approach to the treatment of nasal allergies.

Antihistamines

Sedating antihistamines, including Benadryl and Chlor-Trimeton (chlorphenirimine), are considered too sedating for routine use. These medicines can result mental and physical impairment, even if you don’t feel sleepy after taking them.  You could even be charged with a DUI (driving under the influence) in many states if you drive an automobile after taking these medications.

There are three newer antihistamines, Claritin (loratadine), Zyrtec (cetirizine), and Allegra (fexofenadine), available OTC without a prescription. These medications cause much less sedation, and no have not been shown to result in impairment of mental or physical tasks. All of these medicines are also available in generic form and under other brand names: Alavert is another brand of loratadine; Mucinex Allergy is another brand of fexofenadine.

Learn more about antihistamines for the treatment of allergies.

Decongestants

Decongestants are available OTC without a prescription in oral (Sudafed/pseudoephrine) and nasal forms (Afrin/oxymetazoline). Both do a fairly good job at treating nasal congestion. While some people use Sudafed on a regular basis, side effects are common. Side effects of oral decongestants include insomnia, high blood pressure, anxiety and headaches. People with these symptoms should check with their doctor prior to using oral decongestants. In my opinion, oral decongestants are fine for most people for a short period of time, but I generally don’t recommend depending on oral decongestants over the long run for the control of allergy symptoms.

Nasal decongestant sprays, such as Afrin (oxymetazoline), should only be used for short periods of time, usually for no more than 3 days. Overuse of Afrin can lead to a medical condition called rhinitis medicamentosa, characterized by symptoms of worsening nasal congestion that are less responsive or unresponsive to additional Afrin use.

This condition requires evaluation and treatment by a physician.

Antihistamine/Decongestant Combinations

The combination of antihistamines and decongestants is nothing new. These medications, such as Actifed (chlorpheniramine/phenylephrine) and Dimetapp (brompheniramine/phenylephrine), have been on the market for years. In recent years, the combination of a newer antihistamine along with a decongestant has become available by prescription, and more recently OTC. These include Claritin-D (loratadine/pseudoephedrine), Zyrtec-D (cetirizine/pseudoephedrine) and Allegra-D (fexofenadine/pseudoephedrine). These medicines are often kept behind the pharmacy counter, but do not require a doctor's prescription to purchase.

Allergy Nasal Sprays

There are two types of nasal sprays that can be used for an indefinite period of time for the treatment of nasal allergy symptoms (unlike Afrin, which should only be used for a brief period of time as described above).

Nasalcrom is a relatively good medication for preventing allergic rhinitis symptoms, but must be used on a regular basis in order to work. This medicine works by preventing the release of allergic chemicals such as histamine from mast cells, but does nothing to block the effects of the allergic chemicals once released (unlike an antihistamine). NasalCrom is relatively safe, can be used for long periods of time and is OK for adults and children as young as 2 years of age.

Nasacort 24 Hour Allergy is the first nasal corticosteroid spray available OTC without a prescription, and became available in the spring of 2014. There are a number of other nasal corticosteroid sprays only available by prescription at the current time. Flonase (fluticasone) is projected to be available OTC starting sometime in 2015. Studies show that nasal corticosteroid sprays are the single most effective medications at treating all symptoms of allergic rhinitis, and are even helpful at treating the symptoms of allergic conjunctivitis.

Learn more about the use of intranasal corticosteroid sprays.

Allergy Eye Drops

There are a number of different eye drops available OTC for the treatment of eye allergy. Many OTC allergy eye drops contain topical decongestants, like those found in Visine (naphazoline), which should only be used for a few days at a time. When topical decongestants are used long-term, a medical condition called conjunctivitis medicamentosa can develop. Symptoms may include an increase in eye redness and irritation, with more dependence on the eye drop for relief. Zaditor/Alaway (ketotifen), a topical antihistamine and mast cell stabilizer eye drop, is now available over-the-counter for the treatment of eye allergies. It is also available in generic forms. This medication can be used long-term without the potential side effect of conjunctivitis medicamentosa.

Find out more about medications for the treatment of allergic rhinitis.

Source:

Dykewicz MS, Fineman S, editors. Diagnosis and Management of Rhinitis: Complete Guidelines of the Joint Task Force on Practice Parameters in Allergy, Asthma and Immunology.

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