Amy, a 26 year old woman, came into the pharmacy a few days ago. She had a red, itchy rash on her arms and belly since yesterday. She also had two little girls with her grabbing her arms and demanding their mama’s attention NOW!
When we were in pharmacy school, we were taught to spend 15 to 20 minutes asking questions to clarify the issue, explaining the options, reviewing side effects, etc. However, reality is, this mom had about 2 minutes before the kids went into melt down mode!
So, in short, if a patient is having a short-term bad allergic rash (like from food, poison ivy, dust) the best way to nip it in the bud is to take…
1. Benadryl(diphenhydramine) 25mg -1 to 2 tablets every 6 hours
2. Zantac(ranitidine) 150mg – 1 tablet every 12 hours
If she had more time, I would also mention that Benadryl can make her drowsy but works faster than Claritin (loratadine) and Zyrtec (cetirizine) and that she could use Pepcid (famotidine) instead of Zantac. If she was still itchy after a couple of days, I would tell her to ask her healthcare provider to ask about using doxepin.
Also, that oatmeal baths(home-made or from Aveeno) will help with the itchiness. And if she doesn’t see a big difference in 2 days or if it gets worst she should see her physician for some prescription drugs.
Oh yeah, if she really wanted to stick around, I would also explain that we have two different histamines in our bodies –H1 and H2- that can cause the rash. Usually Benadryl (works on H1) is enough but sometimes we need to add Zantac (work on H2).
But in truth, she said she would just take my word for it. She did call back today (I could hear the girls in the background) and said the Benadryl made her very drowsy but that the rash was gone!
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