Antihistamines: Understanding Your OTC Options

What types of OTC antihistamines are available?

Over-the-counter (OTC) drugs are medicines you can buy without a prescription from your doctor. Antihistamines help relieve or prevent allergy symptoms. Two types of OTC antihistamines are available: first-generation and second-generation antihistamines. Both types can be useful for allergies. First-generation antihistamines are also sometimes used in OTC cold medicines.

How do antihistamines work?

When your body is exposed to allergens, it releases histamines. Histamines attach to the cells in your body and cause them to swell and leak fluid. This can cause itching, sneezing, runny nose and watery eyes. Antihistamines prevent histamines from attaching to your cells and causing symptoms.

First-generation antihistamines also work in the part of the brain that controls nausea and vomiting. This is why they can help prevent motion sickness. Because one of the most common side effects of first-generation antihistamines is feeling sleepy, they are sometimes used to help people who have trouble sleeping (insomnia).

First-Generation OTC Antihistamines

Brompheniramine (one brand name: Dimetapp Cold and Allergy Elixir)
Chlorpheniramine (one brand name: Chlor-Trimeton)
Dimenhydrinate (one brand name: Dramamine)
Diphenhydramine (two brand names: Benadryl Allergy, Nytol, Sominex)
Doxylamine (two brand names: Vicks NyQuil, Alka-Seltzer Plus Night-Time Cold Medicine)

Second-Generation OTC Antihistamines

Loratadine (some brand names: Alavert, Claritin)
Cetirizine (one brand name: Zyrtec)
Fexofenadine (one brand name: Allegra)

Note: Both types of antihistamines often are mixed with other drugs, such as pain relievers or decongestants. Many of the brand names above are for these combination medicines, which are meant to treat many symptoms at once. In general, it’s a good idea to treat just the symptoms that you have. For example, if you have only a runny nose, don’t choose a medicine that also treats headache and fever.

What are some common side effects of OTC antihistamines?

Healthy adults don’t usually experience side effects from antihistamines. However, side effects can be a concern for older adults or people who have health problems.

First-generation antihistamines can make you feel very sleepy. This can affect your ability to drive or operate machines. It can also make it hard for you to think clearly. Antihistamines can cause your mouth and eyes to feel dry. They can also cause abdominal pain and headaches. Second-generation antihistamines are much less likely to cause these side effects.

Could OTC antihistamines cause problems with any other medicines I take?

Antihistamines can interact with other drugs you take. If you take any of the following drugs, talk to your doctor before taking a first-generation antihistamine:

Sleeping pills
Sedatives
Muscle relaxants

Antihistamines are often combined with decongestants and/or pain relievers. If you take one of these combination medicines, it’s important to understand each of the active ingredients and the interactions they may have with other medicines you’re taking.

Be sure not to take too much antihistamine. Many OTC cold and allergy medicines contain antihistamines, as do some prescription drugs. If you take more than one of these products, you may get much more antihistamine than you intend.

Second-generation antihistamines are less likely to interact with other medicines you are taking.

Who shouldn’t take antihistamines?

Talk to your doctor before using a first-generation antihistamine if you have any of the following health problems:

Glaucoma
Trouble urinating (from an enlarged prostate gland)
Breathing problems, such as asthma, emphysema or chronic bronchitis
Thyroid disease
Heart disease
High blood pressure

If you have kidney or liver disease, you should talk to your doctor before taking a second-generation antihistamine.

Drug Recall Information

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Funding and support for this material have been provided by the Consumer Healthcare Products Association.

Written by familydoctor.org editorial staff

Reviewed/Updated: 02/12
Created: 09/05