What is the safest antihistamine for older adults?

Antihistamines are medications that can help relieve allergy symptoms such as hives, hay fever, conjunctivitis, and insect bites. They’re typically available over the counter (OTC). Like with all medications, they can cause side effects like drowsiness, headaches, and nausea.

The chance of these side effects occurring may increase in older adults. Side effects like confusion and anxiety may be more likely in older adults, and they’re often more vulnerable to falls.

Antihistamines may interact with other medications. Antihistamines may also worsen conditions like high blood pressure or kidney damage that are common in older adults.

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What type of antihistamine is typically preferred for older adults?

Antihistamines are categorized into two main classes: first-generation and second-generation. They can also come in different forms.

Second-generation antihistamines

First-generation antihistamines can easily cross the blood-brain barrier, a protective layer surrounding the brain. They’re more likely to result in side effects in older adults, such as confusion, anxiety, and sedation. In contrast, second- and third-generation antihistamines cannot cross and are typically safer for older adults.

The American Academy of Allergy, Asthma, and Immunology (AAAAI) recommends second- and third-generation antihistamines as the safest option for older adults, as they cause fewer side effects. These antihistamines include loratadine (Claritin), cetirizine (Zyrtec), and fexofenadine (Allegra).

A common example of first-generation antihistamines is diphenhydramine (Benadryl).

Nasal sprays

Antihistamine prescription nasal sprays can also be good options. This is because nasal sprays typically aren’t absorbed as much as oral antihistamines and may have fewer side effects. Examples include azelastine (Astelin) and olopatadine (Patanase).

Olopatadine is also available in the form of eye drops, which can help manage itchy and watery eyes.

Other options

Several other options are available, such as intranasal corticosteroids, which are sprayed or inhaled into the nose to help with allergy symptoms. Examples include fluticasone (Flonase) and budesonide (Rhinocort). They’re effective and safe, especially for people with nasal congestion who don’t respond well to oral antihistamines.

The most common side effect of nasal sprays is minor nosebleeds. If you blow your nose, you might see a little bit of blood. There are some rare reports that long-term use may lead to glaucoma.

If you’re concerned that you may have glaucoma after using nasal sprays for a period of time, consider speaking with a doctor. They can decide whether you’d benefit from a lower dose.

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Which antihistamines carry the highest risk for older adults?

First-generation oral antihistamines tend to carry the highest chance of complications for older adults, and it’s recommended to avoid them. Common examples include diphenhydramine (Benadryl) and chlorpheniramine (Chlor-Trimeton).

The complications of first-generation antihistamines could be severe for older adults. This is because these can cause anticholinergic effects, which block the action of chemical messengers (neurotransmitters) in the brain. Symptoms can include:

• blurred vision
• dry eyes
• confusion
• dry mouth
• increased risk of falls

However, many of these side effects are unlikely to occur when using diphenhydramine as a topical cream. This is because the cream acts locally, which means any side effects that do occur would not be widespread.

Which other allergy relief medications should be avoided?

All drugs can carry side effects. But older adults may be more susceptible to these effects because of the natural changes that happen in the body with aging. Your liver and kidneys may not flush out medications as well, so drugs stay in the system longer.

Alongside first-generation antihistamines, other allergy relief medications, like decongestants, can raise the risk of complications in older adults.

Decongestants, such as pseudoephedrine (Sudafed), may carry a high risk for older adults, especially those with high blood pressure.

Sudafed can increase your heart rate, narrow your blood vessels, and raise your blood pressure. If you have hypertension, which is more common in older adults, Sudafed is not recommended.

Some OTC allergy medications come combined with decongestants like pseudoephedrine, which is why it’s always important to read the label of your medication before taking it. If you have any concerns, you can reach out to a healthcare professional.

Which medications don’t mix well with allergy medications?

Some medications can have similar side effects to antihistamines and are not recommended to be taken together. This is because they can increase complications and may lead to heavy sedation. These medications include:

• tricyclic antidepressants
• seizure medications
• sleeping pills
• pain relievers
• tranquilizers and other sedatives
• antidepressants, such as monoamine oxidase inhibitors (MAOIs)

Medications for an overactive bladder (OAB) also do not mix well. If you’re taking allergy relief medications on top of your OAB medication, it could cause too much urinary retention and may lead to urinary tract infections (UTIs).

This is why it’s always important to let a healthcare professional know what medications you’re taking, whether it’s prescription, OTC, or herbal treatments. They’ll be able to check for any drug interactions.

Summary

As there are so many allergy relief options available OTC, it can be hard to keep track of what’s old and what’s new. Speaking with a healthcare professional can help.

They can take into account your medical history and any other medications you take. This will help them identify the allergy treatment options that are the safest and most effective option for your individual needs.

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