What is the best over the counter antihistamine?

Do you know the best over the counter antihistamines?

If not, you may be wasting hundreds or thousands of dollars on medications that are less effective or have more side effects.  Commercials and advertising are great at getting you to buy their brand of medication.  But they don’t tell you everything… and I want to help fix that today.

Zyrtec(cetirizine) vs Allegra(fexofenadine) vs Claritin(loratadine) as the best antihistamine
What is the best over the counter antihistamine?

Question:  What is the best over the counter antihistamine?

– Heather C

 

Answer:

Heather,

I get this question a lot and it’s no surprise it was one of the first questions asked in my blog.  Luckily, there is a very clear answer that is helpful to just about everyone.

Best Over the Counter Antihistamine:  The Options

Benadryl (diphenhydramine) – probably the worst

  • Benadryl (diphenhydramine) is often considered and marketed as the best choice. It’s not.
  • Benadryl (diphenhydramine) takes about 2-3 hours to reach maximum concentration.
  • Benadryl (diphenhydramine) only lasts about 6-8 hours and then it wears off
  • Benadryl (diphenhydramine) has significant side effects (these are just a few of the top ones): agitation or drowsiness (different for different people), excessive dryness (mouth, eyes), and possibly confusion, dizziness, and irritability.

 

Claritin (loratadine) – probably the second worst

  • Claritin (loratadine) is marketed as a once a day medication. But it only lasts an average of 8 hours!
  • Claritin (loratadine) takes about 1-3 hours to stat to work
  • For kids, there are dissolvable tablets and liquid dosing
  • It doesn’t have many side effects, though, which is nice. It generally doesn’t cause drowsiness and is considered non-sedating.  It just doesn’t last all day for a once a day medication.

 

Allegra (fexofenadine) – close to the best

  • Allegra (fexofenadine) is a once a day medication (for some doses) and lasts about 16-17 hours with studies showing benefit for a full day
  • Allegra (fexofenadine) takes about 1-2 hours to start to work
  • For adults, Allegra (fexofenadine) is a very good choice.
  • For kids, there are liquid forms but those become a twice a day dosing. Twice a day dosing is harder to remember than once a day dozing, and this is the only reason it is not my favorite.
  • It doesn’t have many side effects. It tends to have a larger pill but it’s not a horse pill.  It generally doesn’t cause drowsiness and is considered non-sedating.

 

Zyrtec (cetirizine)  – the best!

  • Zyrtec (cetirizine) is a once a day medication for all doses with a half-life of about 8 hours treats symptoms for about 21 hours.
  • Zyrtec (cetirizine) takes about 30 minutes to 1 hour to start to work
  • For adults and kids, it is usually a once a day medication
  • For kids, there are liquid forms as well as dissolvable tablets.
  • It doesn’t have many side effects. It is a smaller tablet with multiple dosing options.  For some people, it is mildly sedating
    • I usually say it’s a 1/10 for sedation whereas Benadryl (diphenhydramine) is a 6/10.
    • For most people, I tell them to take it at night.
    • If it IS sedating, then it’ll be gone before you wake up and the tablet does last a full day so it doesn’t matter when you take the tablet.

 

So that is my personal preference for the best over the counter antihistamines, and I try hard to base mine not just on experience but on medical studies and pharmacodynamics as well.

Best Over the Counter Antihistamine:  The Winner is:  Zyrtec (cetirizine)!

 

Is there a difference between generic vs name brand antihistamines?

This is usually a follow up question that most people have so I thought I’d answer it here as well.  As a general rule, the generic variety is JUST AS GOOD as the name brand.  That is why I listed the names above as having both the name brand and the generic names.

For my patients, I tend to recommend they get the cheapest version available at the time they purchase the medication.

  • Sometimes name brand Zyrtec (cetirizine) has coupons that make it the cheapest option.  Always check for coupons online before you shop.
  • Sometimes the store brand cetirizine is the best option.  Especially if you have a store rewards card.
  • As a general rule, stores that sell in bulk (Costco, Sam’s Club) tend to have the lowest per-tablet price but it’s all the same medication so shop around!

 

Does that answer the question?  If you have more questions on this topic, let me know or ask them in the comments below (if you’re wondering it, chances are someone else is too)!

NOTE:  I am not an affiliate of any product, have no disclosures, and am not getting paid in any way by any product.  My recommendations are my own and based on how I practice allergy/immunology.

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  • Susan kaler says:

    Have prickly feeling started on arms,reddnes,.started 6 mo.ago.seems to be all over body now. Have a cat,that I have had for 8 yrs.dr. has prescribed citrizine? Does not seem to help.

    • There is a lot here, and it will be easier to email me more details and I can help.

      But in general, I would refer you to this article on common causes of hives and read it first. It is possible this is due to the cat or possibly due to more of an idiopathic hive trigger. Either way, finding the cause is the first step and then increasing medication would be step #2. So start with the cause and go from there.

  • Renee Duplechain says:

    I just read two of your articles and I was so impressed! I will definitely be following you on Facebook, not only for me, but for my grandchildren also. I love the way you speak in plain English! lol Thank you for informing us on so many topics.

    • Thank you for your kind words. If there is anything I can do for you, your grandchildren or anyone else please Email me and I’ll try to help.

  • Grace muncie says:

    Does Zyrtec work for eye allergies as well

    • Grace,

      Yes, Zyrtec (cetirizine) does work for eye allergies. Nose sprays often work better.

      Think of it this way: the nose is the gateway to the eyes. So better control of the nose will cause better control of the eyes.

      If that doesn’t help, an over the counter medicine specific for eyes called Zatidor is usually a good next step.

  • What is the best remedy for itchy skin? like hives i don’t know if it’s hives but it so itchy, it start on a small red dot spot then it worsen it look likes a hives now.

    • As a general rule, antihistamines are great for hives and Zyrtec (cetirizine) has the best response to the wheal and flare model (which might mean it works the best for itchy skin). For itch and for chronic hives, I usually start with twice a day instead of the usual once a day (for severe hives, you can take it up to 4 times a day!)

      That’s the quick answer.

      But for a slight detour: it is also important to find the cause. Hives can happen and are common, but you also want to make sure there isn’t a more dangerous cause of hives. If you get a chance, look through this article on the cause of hives. It will at least give you an overview of where to go next. And you can always email me if you want more help.

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