DON'T PAY THROUGH THE NOSE FOR ALLERGY DRUGS YOU DON'T NEED
(MONEY Magazine) – If you're among the 35 million Americans who suffer from hay fever, here's news that will really make you reach for the tissues. Those expensive prescription drugs you may be taking are likely to be no more effective than some over-the-counter pills costing a twelfth as much. Worse, some of the most frequently prescribed medications can actually be harmful. In January, the Food and Drug Administration announced it intends to pull the popular prescription allergy drug Seldane off the market because it can cause potentially fatal cardiac problems when taken with some other common medications. (Seldane manufacturer Hoechst Marion Roussel is fighting the decision, so Seldane is likely to remain on the market for at least a year.) Nor is Seldane the only allergy drug that some medical studies have linked to health ills.
The good news: Many people are better off with cheaper allergy medications. You pay more for prescription antihistamines than for the over-the-counter variety simply because the prescription versions don't make you drowsy. Allergists say, however, that one or two doses of the over-the-counter antihistamine chlorpheniramine maleate afford many people the same relief as prescription drugs with no or little drowsiness--and it does so for as little as 16[cents] a day. Plus, it's safer than some of its prescription-only counterparts.
Here's our cost-effective survival guide to the hay-fever season.
--When you feel that first sneeze coming on, try low doses of chlorpheniramine maleate, the active ingredient in the over-the-counter brand Chlortrimeton (about 23[cents] a tablet; 16[cents] for the generic version). Antihistamines block histamine, a substance produced by the allergy-prone that is designed to flush out irritating pollen or mold by causing sneezing, watery eyes and a runny nose. "For many people, one 4mg tablet at bedtime is enough to take care of their symptoms for 24 hours without drowsiness," says Jay Portnoy, chief of the allergy/immunology department at Children's Mercy Hospital in Kansas City, Mo. If that dosage is not effective after three days, he recommends adding another 4mg tablet in the morning and, if necessary, a third tablet in the afternoon--although the more pills you take, the greater the chance you'll feel drowsy.
--If you have a stuffy nose along with other allergy symptoms, also take the over-the-counter decongestant pseudoephedrine, the active ingredient in the brand Sudafed (about 18[cents] per 30mg tablet in generic form). Decongestants clear stuffiness by narrowing blood vessels in the nose. Unfortunately, they also elevate blood pressure and can make it hard to fall asleep. Allergists say that pseudoephedrine probably poses the smallest risk of elevated blood pressure of any decongestant. Start with a low dose--one tablet in the morning--and add to it gradually as needed to relieve symptoms, advises Portnoy.
--Avoid products that combine a decongestant and antihistamine, such as Tylenol Allergy Sinus. They can pack a rapid one-two punch: The sedative effect of the antihistamine kicks in first, followed by the stimulant in the decongestant. (By contrast, ingesting the ingredients separately lets you take the sedating one at night and the stimulating one in the morning.) The recommended dose of Tylenol Allergy Sinus gives you a whopping 16mg of chlorpheniramine and 240mg of pseudoephedrine, plus 4,000mg of acetaminophen. You don't even need that last ingredient unless you have a headache or fever too.
--Don't use decongestant nasal sprays, such as Afrin, to combat chronic hay fever. Such sprays clear nasal congestion by shrinking blood vessels in the nose. But if you use them for more than three days, they tend to dilate those blood vessels, making your stuffiness even worse.
--If an over-the-counter antihistamine proves too weak to do the trick in doses small enough not to make you drowsy, only then should you consult an allergist about prescription medications. Two worth considering: Allegra and Claritin. Allegra (about $1.80 for the recommended two tablets a day), introduced last summer by Hoechst Marion Roussel, is similar to Seldane but does not appear to pose cardiac risks. Schering-Plough's Claritin (about $2.03 for the recommended one tablet a day) is equally effective.
--Avoid Hismanal, another big-selling prescription antihistamine, says Larry Sasich, a research analyst at Public Citizen, a consumer group in Washington, D.C. According to the package insert, the drug can cause fatal cardiac problems when taken with certain other medications. However, in part because an FDA spokesman says that some people get better relief with Hismanal than with other allergy drugs, the FDA hasn't banned its sale.
--If your allergies are severe enough to require daily treatment for weeks or months, use a prescription corticosteriod-based intranasal spray, advises Michael Schatz, a San Diego allergist. These sprays work differently from the over-the-counter kind and are sold under brand names such as Flonase (about $1.45 a day), Nasacort (about $1.61) and Vancenase (about $1.30). They provide relief from stuffiness, sneezing, itching and other histamine-induced woes without dangerous side effects. The downside: It can take from two days to two weeks of regular use before you feel full relief. So you may have to take an antihistamine in the meantime until the spray's effects kick in.
If your allergies don't respond to any of these steps, turn to immunotherapy, which involves getting a series of injections from an allergist over a three- to five-year period. It is effective in about 80% of cases. Sure, the shots are uncomfortable--but then, hay fever is no fun either.