Drug Treatment
Symptoms: Sneezing, itchy nose/eyes/throat, watery eyes, rhinorrhea (runny nose), nasal congestion, post-nasal drip
| CATEGORY | GENERIC | BRAND | USE / MOA | ADRs | BBW / WARNINGS | CONTRAINDICATIONS | NOTES |
|---|---|---|---|---|---|---|---|
| NON-PHARM TX | Avoid exposure to allergens IgE – mediated or blood test Nasal irrigation – saline, propylene/polyethylene glycol Neti Pot Boiled/Distilled H₂O |
NEVER use faucet water | |||||
| DRUG TX | Chronic moderate–severe rhinitis | 1st LINE = Intranasal Corticosteroid | Decongestants/other agents may be used for itchy eyes | ||||
| Mild symptoms | Oral Antihistamine | ||||||
| INTRANASAL CORTICOSTEROIDS (1st line for mod–severe) | Beclomethasone | Beconase, Qnasl | ↓ inflammation (most effective class) | HA, dry nose, bad taste, epistaxis, local infection | Adrenal suppression w/ long-term use; delayed wound healing; avoid nasal ulcers/trauma; stunted growth in children; ↑ IOP, open-angle glaucoma, cataracts | May take 1 week to get relief | |
| Budesonide | Rhinocort Aqua | Pregnancy – use Budesonide | |||||
| Fluticasone | Flonase | Get nasal exams for long-term use | |||||
| Mometasone | Nasonex | Avoid contagious people | |||||
| Triamcinolone | Nasacort | Shake well before use | |||||
| Ciclesonide | Omnaris, Zetonna | ||||||
| Flunisolide | Flonase & Nasacort counseling: Shake bottle; Prime 7 days no use; Prime 14 days if unused; Point away from septum; Tilt head forward & inhale while spraying | ||||||
| ORAL ANTIHISTAMINES – 1st GEN | Diphenhydramine HCl | Benadryl | Itching, sneezing, rhinorrhea | Somnolence, cognitive impairment, strong anticholinergic effects | Avoid elderly; caution CVD; prostate enlargement; glaucoma; asthma; excessive sedation | Infants, lactating women, narrow-angle glaucoma, asthma, MAOI use | Do NOT use <6 yo; Adults 25–50 mg PO q4–6h |
| Clemastine | Tavist, Dayhist | ||||||
| Chlorpheniramine | Chlor-Trimeton, Chlorphen | ||||||
| Carbinoxamine | Arbinoxa, Karbinal | Lactating women use 2nd gen; All should d/c before allergy skin testing; ↑ photosensitivity | |||||
| ORAL ANTIHISTAMINES – 2nd GEN (PREFERRED) | Cetirizine | Zyrtec | Less sedation, better cognition | Somnolence (occasional) | CNS depression; sedation w/ other sedating meds | Avoid Al⁺/Mg⁺ products | |
| Levocetirizine | Xyzal | ESRD | |||||
| Fexofenadine | Allegra | Take with water | |||||
| Loratadine | Claritin | Pregnancy – Loratadine/Cetirizine best | |||||
| Desloratadine | Clarinex | ||||||
| INTRANASAL ANTIHISTAMINES | Azelastine | Astelin, Astepro | Helps with nasal congestion | Somnolence, bitter taste | |||
| Olopatadine | Patanase | HA, nosebleed | |||||
| ORAL DECONGESTANTS (α-Adrenergic Agonists) | Phenylephrine HCl | Sudafed PE | Vasoconstriction | CV + CNS stimulation | Avoid <2 yo | 14 days w/ MAOI | Phenylephrine low BA; onset 15–60 min |
| Pseudoephedrine | Sudafed, Nexafed, Zephrex-D | Phenylephrine: HTN, tachycardia | PSE more effective | ||||
| TOPICAL (INTRANASAL) DECONGESTANTS | Oxymetazoline | Afrin | Stinging, burning, sneezing, dryness, rebound congestion after 3 days | Avoid <2 yo | MAOI use | Effective in 5–10 min; limit <3 days | |
| Naphazoline | Privine | ||||||
| Tetrahydrozoline | Tyzine | ||||||
| OTHER | Intranasal Cromolyn | Nasalcrom | Mast-cell stabilizer | Can be used as Tx + Px | |||
| Ipratropium Bromide | Atrovent | Anticholinergic | Good for rhinitis by drying the nose | ||||
| Montelukast | Singulair | Leukotriene antagonist | 10 mg PO QD; adjunctive | ||||
| Sublingual Immunotherapy | Immune tolerance | Allergy shots: 1st dose in office; monitor 30 min | Pt should get Rx for Epinephrine pen | ||||