What to do now?   There are no other OTC inhaler options.  All other options are prescription only.  Most likely, an albuterol inhaler (by prescription) will be the most appropriate alternative.  Here are some options to help with paying for the inhalers: Proair assitance program, Proventil coupon,  Xopenex coupon and Ventolin assistance program.

HFA inhaler switch: HFA inhalers feel quite different then the old inhalers.  The old (CFC) inhalers had a propellent in them so people could “feel” the drug when using it.  The new HFA inhalers have a finer mist so often patients complain they can’t taste/feel the medicine going in….be assured, the medicine is still being delivered! 

If you think your HFA inhaler is broken -please see the article My HFA Inhaler is Broken

How do you feel about Primatene Mist inhalers being taken off the market?  How do you feel about the new HFA inhalers? We would love to hear from you –please leave a comment!

The li'l allergy sufferer

The first time we realized Tater had allergies was because she was scratching her head so hard, her hair started falling out in clumps!  Poor Tater Tot!  She didn’t look a hot mess because she has so much hair you couldn’t even see the bald spots but she was clearly in distress.  We took her to the vet and we walked away with this magical liquid that would treat her allergy symptoms and it only cost $25 for a week’s supply -yikes!  

When we got home and it was time for Tater’s medicine -I pulled out the container and what did I see on the label?  Diphenhydramine (Benadryl’s generic)…my first thought was what?  I just paid $25 for something that would have cost ~$3 in the store!  And now I have a liquid to give to Tater -which is messy and close to impossible!  Frustrating!!  So, I thought why not pass on a little information so others don’t go down this path!

Now, before we go on…the first time this happens it is best to visit the dog’s vet because we don’t want to get allergies confused with more serious issues like kennel cough, ring worm or fleas.  And the vet will okay use of Benadryl, some dogs should NOT receive Benadryl, such as young puppies, dogs with glaucoma or thyroid issues or taking certain medications that may interact.   At this point, if your vet says that Benadryl (diphenhydramine) is okay to use, go ahead and speak up and tell them you will get it at your local pharmacy.  Most vets know that it is much cheaper in the “human” pharmacy and will happily let you save some money by getting it there instead of their office. 

How do we treat allergy symptoms in dogs?  Benadryl (diphenhydramine) works well, is inexpensive and super easy!  It works in dogs just like it does in humans to stop allergy symptoms. 

How do we determine proper dose?  Typically it is dosed at 1mg/lb (so Tater weighs ~12 lbs, I give her 1/2 of a diphenhydramine 25mg tablet).  Most dogs will receive dose every 8 or 12 hours.   

How do I choose which Benadryl (diphenhydramine?)  At the pharmacy, get the Benadryl 25mg (or generic -works just as well and is way cheaper .  You want to pick out the pink tablets that ONLY has diphenhydramine in them.  Make sure to NOT get the other ones like Benadryl Cold & Sinus and such -those other medications are NOT safe for your pup!

How do I give it to my dog?  The tough part   There are those expensive Pill Pockets out there that seem to work well for most.  For Tater Tot and Toshia, we just smear a teeny amount of peanut butter on the tablet and put it on a human finger and they gladly lick and eat the peanut butter and tablet!  Be warned, this will lead to the dogs getting uber excited everytime you open a jar of peanut butter (or actually any sound that may possibly be you opening a jar of peanut butter!)

What are the side effects? Number one side effect is lethargy -your dog may just seem tired and out of it (usually this will go away after a few doses).  Your pup may also have, dry mouth (be sure to keep fresh water out for her), urinate less and possibly (but rare) diarrhea and vomiting.

I hope this helps your doggie fell better and you save some money.  Just so you know, there are other medicines that are available at the “human” pharmacy instead of at the vet’s office -like Flagyl (metronidazole) and Pepcid (famotidine) and amoxicillin.  If you talk with your vet, they can just give you a script for your dog to take to the “human” pharmacy -ie Walgreens, Target, CVS…  Most vets are glad to do this for you.  And yes the script will read for “Tater Tot”

In the past, there have always been two different concentrations of liquid Tylenol on the market -one for children and one for infants.  Now, with the transition in place, there will be only one concentration (160mg/5ml) for all OTC pediatric single-ingredient liquid Tylenol products.

What’s the reason for the change? Simply to decrease the chances for medication errors as parents were at times getting confused between the two infants’ and childrens’ acetaminophen products.

The recommended dose of Tylenol will remain the same at 10-15mg/kg.  The difference is the approriate Tylenol dose is being given in a larger volume of liquid.  Definitely read the label on the box to get the correct amount of Tylenol needed to dose your child!

Be very aware there may be a point in time where both the old and new concentrations of infants’ Tylenol liquid products will be available on store shelves.  Either product is fine to use, just make sure you know which one you have so you can dose your child correctly!

There will be no changes made to childrens’ Tylenol dosing.

Do not hesitate to stop in at your local pharmacy if you’re concerned about dosing issues related to infants’ tylenol products.  Better safe than sorry, right?!

 We received this question in our Submit Your Question page:
Question: I am taking xanax it is really messing with my stomach and am having trouble sleeping and looking for the purest form of benedryl liquid to aid me in sleeping?

Thank you for contacting us!  Xanax can be rough on the belly.  Benadryl is available in multiple forms, including liquid and tablet form.  The actual drug is diphenhydramine.  If you are interested in the liquid form -the “purest” from what is available commercially, would be Children’s Benadryl Dye Free Allergy Liquid.  Although, all liquids It still contains additives and flavoring but is at least free of dye.  It may be “more pure” to take the Dye Free Benadryl gelcaps -they are flavor and color free.

As you probably know, Benadryl (diphenhydramine) is an antihistamine and is used for allergies.  So, it comes along with some side effects, such as dry mouth, dry eyes, possible “hangover” in the morning…  Having said that, up to 90% of Benadryl is used by people to help fall asleep!  If you are new to Benadryl, I would recommend using 12.5mg -25mg 15-30 minutes before bedtime.  You can build from there up to 50mg before bedtime.  Benadryl is not physically addicting.  Take care about the possible “hangover” feeling the next morning and drink lots of extra water!

Can I take Prozac with Coricidin?

Yes and no.  Prozac is okay to take with Coricidin Cold and Flu only.  The rest of the Coricidins contain dextromethorphan which can  interact with Prozac and cause serotonin syndrome.

I ate my Chia Pet’s sprouts on a dare -is that bad?

Not at all!  Actually Chia sprouts and chia seeds are edible and good for your health!  If you want to learn more -please read Chia for Your Health.

Is there a substitute for Xyzal 5mg?

Currently, there is not a generic available for Xyzal 5mg but there are some alternatives.  Xyzal works similarly to Allegra (fexofenadine) which is a prescription antihistamine (available in generic).  OTC generics include Claritin (loratadine) or Zyrtec (cetirizine).  There are also some antihistamine eye drops and nose spray that often are used along with an oral antihistamine.  

A woman asked via email, “I read your article on the Neti Pot.  I’ve always had low blood pressure but just found I am now borderline (140/80). Only change in life is using the Neti Pot daily for 1 year -could that cause it?”

No, there is no known link between use of the Neti Pot and high blood pressure.  Your question does make me wonder what led you to use the Neti Pot daily for the last year -perhaps it is related to the bump in blood pressure…?

Sometimes people are concerned with the “salt water” used in the Neti Pot being able to  raise blood pressure.  This is a false concern because 1.  Very little of the irrigation solution is absorbed into the body and 2. The salt level in the irrigation solution is equal to the body’s salt level so the salt can not pass into the body due to osmotic pressure.

A mom wrote in a recent email, “Can I give my daughter Mucinex for Kids and Children’s Motrin at the same time?”

Yes -it is okay to give the Mucinex and Motrin at the same time.  There are different medications in each.  It is good to ask and be cautious, especially with combination products.

A patient came into the pharmacy this morning and asked, “My doctor told me once I take Nexium for a few weeks, I no longer need to take it on an empty stomach…is that right?”

First, a little background info -Nexium along with Prilosec (omprazole), Aciphex and Prevacid (lansoprazole) -and a couple others- are in a class of drugs called proton pump inhibitor (PPI).  PPIs are used to treat issues related to acid in the stomach (like GERD or heartburn). 

A popular false rumor was started that once a PPI is taken for a few weeks, timing doesn’t matter. 

Untrue!  Just remember,  PPIs are most effective if taken on an empty stomach 30 to 6o minutes before eating.

A dad wrote, “I’ve been surfing (and surfing), looking for an answer to (what I thought) was a simple question, so I’m hoping you can advise: My daughter had an upset stomach (vomiting), so I gave her some Pepto. I then discovered it had expired by about a year. Is there any danger in this? I’ve since thrown it out once I realised, but just wanted some reassurance that there was no serious danger.”

Taking expired Pepto is not known to cause any issues -so I would not worry.  However, Pepto is not good to give to kids under 12 years of age.  Pepto contains bismuth salicylate which is like aspirin.  Aspirin (and Pepto) can cause Reye’s Syndrome in children -it is a very small but serious risk.  There is Children’s Pepto that contains calcium carbonate (like Tums) -and does not have any risk of causing Reye’s.  

If you want some more info on expired meds please read Expired Medications.

To see more random questions and answers, please visit the Question of the Day page.  If you want to ask a random question -please visit our Submit Your Question page.

Don’t get me wrong, I think Allegra and its counterparts, Claritin and Zyrtec are great options to treat allergies, but the intranasal corticosteroids are the most effective monotherapy (single-drug therapy) for allergic rhinitis (aka allergy symptoms).

Intranasal means you take the medication through your nose, and corticosteroids are a class of drugs that decrease inflammation and are similar to the natural corticosteroid hormones produced by the body.

Examples are generic fluticasone (Flonase), Nasonex, Rhinocort, Nasacort, and Beconase. 

These nasal sprays are more effective than antihistamines (i.e. Allegra) in relieving sneezing, itchy nose, nasal blockage, runny nose, and post nasal drip.

There appear to be no significant differences in efficacy among the various nasal sprays, but I’m strong on the fluticasone (see title!) because it is the only one that comes in generic (cheaper) and it’s the one I use to control my seasonal allegies!

The intranasal corticosteroids are especially helpful in patients with severe, persistent allergy symptoms and nasal blockage.

Just a little blurb on fluticasone and the other nasal sprays of its kind.  Stay tuned for more info on these nasal sprays!

Don’t forget, we still have our free course on how to save money on prescription meds available…here it is.  Tell us what you think!

Nova put up a great post last week, “Juice and Allegra.”  It answers the many different questions and comments we received in response to my “Orange Juice with Allegra” piece.  Check it out!

Here’s some extra details on Allegra and its buddies Claritin and Zyrtec. 

Congestion -which OTC allergy medication is the best for this problem? 

Well, studies have shown that Allegra  may have some anti-inflammatory properties (decreases swelling) that may help to relieve nasal congestion.

Apparently Allegra can block the release of  mast cell and basophil inflammatory mediators, resulting in the whole decrease in nasal swelling and congestion.  Neat, huh?

Claritin and Zyrtec do not appear to have these same anti-inflammatory properties, making them not a great choice to help with stuffy nose/sinuses due to allergies. 

Just thought this would be interesting and helpful to those who’s major symptom is nasal congestion! 

In case you’re curious, I suffer from some serious allergies (I think!) here in Charlotte just during the Spring season (end of March to mid-May).  I believe I have found the most effective treatment regimen for myself!  I take Allegra at night (pretty much at bedtime) and fluticasone nasal spray (Flonase) in the morning. 

My very irritating itchy nose, constant sneezing, and nasal/sinus congestion are under control. 

I still notice some post-nasal drip and my eyes are still crazy itchy if I put my contacts in, but I’m at the point where I’m not miserable.  I’m not a fan of wearing my glasses (mostly because I don’t see as well out of them and they make me sleepy), but my eyes seem to hardly itch when I’m not wearing my contacts. 

I’m not sure which medication is doing the best job, and I’m not really up for doing a trial run without one of them to figure it out.  I do know that my symptoms were not well controlled with just Allegra and Sudafed.  When I added fluticasone nasal spray and took off the Sudafed, my quality of life increased dramatically! 

No need to worry, I’ll be posting about my new friend fluticasone nasal spray next. :)

**This is Cate from the future…check out this bit of info about fluticasone nasal spray by clicking here**

Please keep leaving your comments and questions below…it’s fun! 

You can also e-mail me at Cate@getpharmacyadvice.com.

Have a great Sunday!

I LOVE juice -what do I do?  Take the Allegra at night!  It is actually best to take the daily antihistamines (Allegra, Zyrtec, Claritin) at night.  This is because it is best to take the antihistamine 2-5 hours before being exposed to allergens.  And guess when pollen levels are at their worse?  Usually between 5-10 AM!  So, if Allegra is taken at night, you wake up ready to fight off allergens and free to drink as much juice as you want!

Does it hurt me to drink juice and take Allegra at the same time?  No, nothing bad will happen to you if you drink juice and take Allegra at the same time.  However, drinking juice and taking Allegra at same time can actually decrease the amount of Allegra that is absorbed (up to 50% in one study) -this means the Allegra doesn’t work as well.

What about orange juice, cranberry juice, grapefruit juice, grape juice….? Most of the stuidies have been with grapefruit juice, however what causes the interaction is in all fruit juices -so no juice is “safe”.

How long must I separate drinking juice and taking Allegra?  It is best to separate drinking juice and taking Allegra by at least 4 hours.  It is time dependent -so, if you take it together up to 50% won’t be absorbed, if you wait 2 hours 25% won’t be absorbed, if you wait 4 hours mostly all of it will be absorbed.

Can I just take twice the prescribed dose in order to overcome the loss caused by the orange juice? Not a great choice for a couple of reasons.  First, because it is not an exact science of how much Allegra is absorbed so most likely too much Allegra will get into the body.  This increases the risk of side effects.  And because doubling the dose is not very cost effective!

Is it the vitamin C in the juice that causes the interaction? No it is not the vitamin C that causes the interaction.  It is most likely caused by fruit juices inhibiting an organic anion transporting peptide (OATP1A2).  By inhibiting OATP1A2, the absorption of Allegra is reduced.

Why would Zyrtec advertise for Allegra? I really don’t know…

Which is better -Zyrtec, Allegra or Claritin? All three -Zyrtec (cetirizine), Claritin (loratadine) and Allegra (fexofenadine) are now available OTC and all work well.   Studies show that Zyrtec and Claritin are more likely to cause drowsiness then Allegra.  I must admit I am slightly biased because I heart me some Allegra  but others claim Zyrtec or Claritin works better for them.  I would think about cost and what works best with the least side effects for you personally.

If you decide OTC Allegra is for you -go visit their website and get a coupon! 

I hope this clears some questions up!  Thank you for all your comments and questions -please keep them coming!

I was taking a rare moment to relax last night (usually I’m running around with my head cut off!), and while I was watching TV (American Idol to be more specific) a Zyrtec commercial came on. 

I think it was a Zyrtec commercial!  All I know is the producers of said commercial were clearly putting Allegra down because somewhere on the Allegra labeling it says you shouldn’t drink orange juice while taking this medication (or something along those lines!). 

The reason why this statement about Allegra is true is because fruit juices like apple, orange, and grapefruit juice can decrease the amount of Allegra that is absorbed by about 36%!

This doesn’t mean you have to avoid the fruit juices for the whole day.  Just give the Allegra enough time to get into your system and you can drink all the orange juice you want!  

How much time does that take?  To be on the super safe side, I’d say wait 4 hours before drinking your fruit juice after taking Allegra. 

So, this article led to a ton of comments and questions -thanks for all the feedback.  Please read the follow up article Juice and Allegra.  Have more questions/comments?  Keep ‘em coming!

Any questions?  E-mail me at Cate@getpharmacyadvice.com or leave a comment below. 

Happy Spring!

Allergy symptoms are starting to run rampant here in North Carolina.  Much to do with the fantastic weather we’ve been having as of late!  And with the full-blown allergy season fast-approaching, this OTC Allegra news comes just in time (covenient, right?) to help fight the slew of nasty allergy symptoms that will be affecting tons of people. 

According to the representative I talked to at Sanofi Aventis (the maker of this medication, but marketed by a company call Chattem), all strengths (30mg, 60mg, and 180mg) and forms (tablets, orally disentegrating tablets, oral suspension, and Allegra-D)  will be over-the-counter.  Yes, even the children’s orally disintegrating tablets and children’s oral suspension are going OTC!

You’ll still have to go to the pharmacy to purchase the Allegra-D 12 Hour or 24 Hour Allergy and Congestion products…just like you have to for any other Sudafed products!

If you’re getting Allegra by prescription, you’re probably used to getting the generic, fexofenadine.  As of right now, there does not appear to be a generic OTC Allegra hitting the market, but it probably won’t take long for that to happen. 

The only part of  Allegra that is not going OTC is the children’s oral suspension indicated to treat hives in children 6 months to 6 years of age.  So, the oral suspension itself is going OTC, but not for the aforementioned indication!  

That part may be confusing so feel free to send me an e-mail at Cate@getpharmacyadvice.com or comment below if you have any questions.

Happy March!

            The urushiol oil contained in the resin released from the poison ivy, oak, or sumac plant creates an allergic contact dermatitis in about 50% of people who are exposed to the oil.  The reaction almost always involves red, inflamed, circular lesions, which will start “weeping” within a few days, along with the out of control itching mentioned above. 

            So, what can you do about these symptoms? Not much!  I know, that’s a terrible, no good answer, but it’s the truth. 

           Your first step after exposure is to wash the affected area with soap and water, which should help rid your skin of the urushiol oil.  Actually, not only should you wash the affected area, you should also wash underneath your fingernails, as this area becomes a safe haven for the oil, which can then be spread to other parts of your body. To assist in the washing procedure, you can use an OTC chemical inactivator, like Tecnu or an oil-removing compound, such as Goop, but just plain soap is a fine option too! 

            According to studies, there seems to be no significant difference in effectiveness when it comes to comparing the aforementioned options, so instead of spending the extra money for Tecnu or Goop, go grab the Dove (or whatever you’re soap of choice happens to be!).  Oh yeah, dishwashing detergent works wonders as well…I’d say find the sale and stick with that!

           I guess I should mention a product called Zanfel –an OTC wash that works similar to soap, but for about 5 times the price!  Apparently, Zanfel is thought to work a little better at improving the lesions but doesn’t do anything more for the itch when compared to your everyday soap.  With this info in mind, I do not recommend Zanfel!

           Next step: dry the weeping lesions.  To do this you can use an OTC product called Burow’s solution.  Also, using calamine lotion, soaking in an oatmeal bath, or applying cool compresses may also help dry up the rashes and reduce the itching.

            I wouldn’t waste my money on over-the-counter hydrocortisone cream because it’s probably not strong enough to help out.   However, the prescription steroid creams can do some good if they are started before the lesions breakout and if less than 10% of your body is affected.

            I do not recommend using topical antihistamines like Benadryl cream or antibiotic ointments like Neosporin because they don’t help with the itching and they can worsen the rash.  It is possible that oral antihistamines would help, but probably more for their sedative effect rather than their ability to calm the itch or rashes! 

            If lesions cover greater than 25% of your body or if you have lesions on your face or genitals, it’s probably best that you see a physician.  At this point, it’s likely that you need an oral corticosteroid (aka oral steroid) to calm the rash down! 

            If your physician gives the nod on the steroid pill and they prescribe a Medrol Dosepak, have them change it to prednisone because the starting dose on the Medrol Dosepak is too low and the duration of therapy is too short for poison ivy.

Prednisone 60mg/day for 4 days, then decreasing that by 10mg every 2 days would be a decent regimen for most adults (14 days of treatment).

For children, a good suggestion for a prednisone regimen would be 1 to 2mg/kg once daily for 7 to 10 days, then taper down for another 7 to 10 days (14 to 20 days of treatment).

It is important to taper down when it comes to the steroid treatment because otherwise the lesions may flare back up.  

           There you have it…not much you can do, right?  You pretty much have to wait it out.  The irritating and extremely itchy rash will actually go away on its own within 1 to 4 weeks, but you can certainly use the recommendations above to help control the symptoms.

Let us know if you have other tips on how to control the symptoms of poison ivy, oak or sumac by leaving a comment below!

 Looking to save money on your prescription medications?  Fabulous!  Check out our FREE video course on how to do just that.