I feel blessed to have a large number of friends and acquaintances. Most of them of course know that in my working hours I am an Ear, Nose and Throat doctor. A typical question I get is, “Hey doc, what do you recommend as an over-the-counter medication for my allergies?” (Stopped up nose, sinus headache, postnasal drip, sneezing, coughing, sore throat, etc.)
Many of these type problems can certainly be solved without a trip to a doctor’s office. There are a wide variety of over-the-counter medications that are effective and helpful to get over these various maladies. I thought it might be helpful to write down some of my more common recommendations. Please note that when I list any specific medication, they are ones that I have found helpful for patients. I am in no way financially tied to any of these medicines and of course I know often there are alternatives.
As far as the treatment of seasonal allergies goes, my first recommendation is usually an antihistamine tablet, and my choice is based on whether traditional antihistamines make you sleepy or not. If this type of medicine tends to make you drowsy I generally recommend you take Allegra (fexofenadine). This is a fairly potent well-tolerated antihistamine with good effectiveness for drying up runny nose and taking care of sneezing or other allergy symptoms. Because it does not cross into the brain it will not make you sleepy. If you do not get drowsy from taking antihistamines then I recommend either Zyrtec (cetirizine) or a medication related to it called Xyzal (levocetirizine). I believe Zyrtec is the most potent of the over-the-counter antihistamines but often makes people sleepy.
For a stopped up nose or ears with pressure for the short term use I strongly recommend decongestant nasal spray like Afrin (oxymetazoline). There are many brands of this available. It is an excellent medication to use as a nasal spray twice a day for up to 4 days. It works quickly with minimal side effects but cannot be used longer than 4 days. Additionally, Afrin spray can be used to open up stopped ears or before airplane flights to prevent ear pressure.
Oral tablet decongestants such as Sudafed (pseudoephedrine) are also effective. They however can raise a person’s blood pressure or make their heart race. Also Sudafed type medicine requires your driver’s license to obtain from the pharmacy but it is over-the-counter. There is no problem with taking this type of decongestant long-term.
For long-term allergy symptoms or congestion the steroid-based nasal sprays are effective. They do not start working very quickly, sometimes taking 2-3 days of daily use before they are effective. The over-the-counter brand that I recommend most is Nasacort (triamcinolone spray). It seems to have the least amount of stinging, burning or nasal bleeding.
Along the lines of nasal sprays I cannot strongly enough recommend the use of a salt water nasal wash. Many people have heard of a Netti pot which looks like a small teapot. I usually do not recommend it because it is awkward to use and often goes into your ears. I do recommend a squeeze bottle of salt water nasal spray that you make on your own with the dispenser tip on top-like the Neilmed brand. These types of washes get rid of pollens, molds, bacteria and viruses before they get a foothold on your nasal passages and cause problems. Nasal washes are good for both allergies and sinus infections.
For control of cough I usually recommend a mucous thinning agent or expectorant. The most common one is Mucinex (guaifenesin). Interestingly iodine was available for many years as a cough syrup as it is a very good expectorant. You can safely buy iodine in the form of kelp capsules which you can get from a health food store.
To suppress cough the over-the-counter medication dextromethorphan (DM in Robitussin-DM or also in Delsym syrup) is generally what I recommend.
Obviously all of these medications have to be taken in the dosage recommended on the labels.
Hopefully this little bit of insight that I give to my friends is helpful to everyone reading this.