Pharmacists Help Patients Decide on OTC Allergy Medications

Amanda Blevins, PharmD, pharmacy manager of Food City Stores, breaks down how pharmacists can tailor OTC allergy recommendations to specific patient symptoms, emphasizing both efficacy and safety. For nasal congestion, she highlights intranasal corticosteroids such as fluticasone (Flonase) and triamcinolone (Nasacort) as first-line options due to their strong, targeted relief.

For patients who prefer oral treatments, she explains that pseudoephedrine is generally more effective than phenylephrine, though it requires more careful consideration of contraindications. She also notes that oxymetazoline (Afrin) nasal spray can be a useful short-term option, particularly for certain populations like pregnant patients, provided it is not used beyond the recommended duration to avoid rebound congestion.

When managing runny nose, itching, and sneezing, Blevins recommends prioritizing second-generation oral antihistamines because they are less sedating, have a longer duration of action, and carry a lower risk of anticholinergic side effects such as dry mouth and blurred vision. She contrasts options like cetirizine (Zyrtec), which has a faster onset, with loratadine (Claritin), which offers 24-hour coverage with a slower onset. Fexofenadine (Allegra) is singled out as an excellent choice for patients especially concerned about drowsiness.

She also covers ophthalmic options for itchy, watery eyes, including antihistamine eye drops such as olopatadine and ketotifen (eg, Zaditor), along with more cost-effective generics that can help keep patient expenses down.

Beyond medications, Blevins underscores the importance of lifestyle modifications and patient education. She advises counseling patients on avoiding triggers like pollen, dust, mold, and smoke; washing bedding weekly; using allergen-proof covers; maintaining indoor humidity below 50%; and adding HEPA-filter air purifiers. Combining evidence-based OTC therapies with practical environmental controls, she explains, offers patients the best chance at sustained allergy relief.

“With regard to OTC allergy options, really, we're going to be making those recommendations based on the symptoms that the patients are presenting to the pharmacy with,” Blevins said. "There’s a lot of different choices out there when patients have some of the common symptoms they're going to be presenting with.”