Ever hear the myth that older folks are less prone to allergies? Don’t believe it. Mold, pollen and pet dander are equal-opportunity villains, and allergy remedies are medicine-cabinet staples for many older adults. That’s especially true for people dealing with chronic obstructive pulmonary disease (COPD) and asthma.

But once you hit age 65, you have to be more careful about the medications you choose to relieve those itchy eyes and runny nose. Some over-the-counter and prescription medications don’t mix well with other drugs you may be taking. Other allergy medications can aggravate such conditions as high blood pressure or kidney damage. Plus, certain medications can increase confusion and leave you more vulnerable to falls.

We asked Alyssa Wozniak, PharmD, a clinical assistant professor at D’Youville School of Pharmacy in Buffalo, New York, for her thoughts on allergy medications. Which ones are safe for older adults to take, and which ones should they skip? Here’s what she had to say.

What are the riskiest allergy medications for older adults?

Wozniak: Be wary of medications such as Benadryl® (diphenhydramine) and Chlor-Trimeton® (chlorpheniramine). These are first-generation antihistamines available over the counter. They’re especially risky for older adults because they have a group of side effects known as “anticholinergic” effects. The symptoms can include:

  • Blurred vision
  • Dry eyes
  • Constipation
  • Dry mouth
  • Urinary retention (you’re unable to fully empty your bladder)

They can also be very sedating. These medications have the potential to cause a lot of drowsiness, which can lead to confusion for some older adults.

Men with an enlarged prostate shouldn’t take Benadryl® because of the urinary side effects. People who have glaucoma or are at higher risk for it should also likely steer clear, because of the potential for blurred vision and dry eyes.

What about decongestants? Are they safer for people 65 and older?

Wozniak: These are medications such as Sudafed® (pseudoephedrine) and Sudafed PE® (phenylephrine). They can also be risky for older adults, especially those with high blood pressure. Both medications can raise blood pressure if someone already has high blood pressure or if it’s not controlled well.

We also worry that blood pressure medications won’t work as well if Sudafed® is taken at the same time. Plus, decongestants can cause issues with urination and keep people up at night.

Another thing to watch for: Sometimes allergy medications can be combined with decongestants such as pseudoephedrine or phenylephrine, so you should always read the label.

What are the risks of decongestants for people with other types of conditions?

Wozniak: Sudafed® can affect your heart rate. That’s why it’s not recommended for people with heart disease or abnormal heart rhythm. People with overactive thyroid should also avoid it, because this condition can make your heart beat faster.

Similarly, you might also want to avoid Sudafed® if you have glaucoma or diabetes. And because it can cause urinary retention like those older antihistamines, men with an enlarged prostate should also stay away from this medication.

Are these seasonal sniffles and sneezes a new thing for you? You could be hay fever first-timer — even now! Get the scoop on adult-onset allergies.

Are there other ingredients in combination allergy medications that can affect older adults?

Wozniak: Sometimes there is acetaminophen or ibuprofen. Some people take Tylenol (acetaminophen) or Motrin (ibuprofen) separately, and we don’t want them to unknowingly take too much. Again, it’s important to read the label.

What about other types of antihistamines? Do they have side effects, and are older adults more susceptible? 

Wozniak: All drugs can carry side effects. Unfortunately, older adults can be more susceptible to them because of some of the natural changes that happen in the body with aging and how medications break down. Their liver and kidneys can’t flush out medications as well, so they stay in the system longer. They might weigh less and need lower doses.

So what can older adults safely take for allergy relief?

Wozniak: Newer antihistamines such as Claritin® (loratadine) and Allegra® (fexofenadine) tend to be safer and better tolerated. They’re effective for symptoms such as itching, sneezing and runny nose, and they minimize those sedating side effects more so than Benadryl®.

But we want to make sure your doctor or pharmacist is helping you choose. You may need a lower starting dose or close monitoring. While these newer medications are safer, there are differences. For example, Zyrtec® can sometimes be a bit more sedating than Claritin®.

Some antihistamines are also available in prescription nasal sprays, such as Astepro® (azelastine) or Patanase® (olopatadine). These can be good options, too. The thought is that the nasal sprays typically aren’t absorbed as much as the oral antihistamines and may have fewer side effects.

Olopatadine comes in eye drop form as well, which can really help with itchy, watery eyes. If you prefer an over-the-counter option, there’s Zaditor® (ketotifen).

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What about steroid nasal sprays like Flonase? Are those safer to take?

Wozniak: There are a bunch of options for nasal sprays, including Flonase® (fluticasone) and Rhinocort® (budesonide). They’re really effective and safe, especially for people with nasal congestion that didn’t respond to oral antihistamines. They’re also helpful if you have more moderate to severe persistent symptoms.

The most common side effects are minor nosebleeds. If you blow your nose, you might see a little bit of blood. There are some reports that long-term use can cause glaucoma and cataracts. An eye doctor can monitor that, but you can also take a lower dose once your symptoms are under control so you’re less at risk.

What if you have cognitive issues, such as mild dementia or Alzheimer’s, on top of allergies?

Wozniak: You’ll want to stay away from those first-generation antihistamines for sure. We would worry about worsening that situation. In this case, try to choose remedies that have local and not body-wide effects. For example, choose eye drops and nasal sprays over pills.

Which common drugs don’t mix well with allergy medicines?

Wozniak: For the antihistamines, it’s the medications that have similar side effects or are also very sedating. These include:

  • Tricyclic antidepressants
  • Seizure medications
  • Sleeping pills
  • Painkillers
  • Tranquilizers and other sedatives

Medications for overactive bladder (OAB) also don’t mix well. If you’re taking Benadryl® on top of your OAB medicine, it could cause too much urine retention and may lead to urinary tract infections.

People who take medication for high blood pressure need to avoid Sudafed® because it can reduce the effectiveness of those blood pressure medications. And it can raise blood pressure on its own. There can also be severe drug interactions with older antidepressants called MAOIs (monoamine oxidase inhibitors).

But it’s just 1 reason why it’s important to tell your provider and pharmacist about everything you’re on, whether it’s prescription, over-the-counter or herbal. Because they will check for those rare interactions.

Are there other things older adults should consider when taking allergy medications?

Wozniak: In general, since there’s so much available over the counter and it’s hard to keep track of what’s older or what’s newer, talking with your pharmacist, doctor and health care team is pretty important. That way we can consider those other conditions, the other medications you’re on and the individual factors of the medication to make sure it’s safe and effective for you.