Allergy drug recommendations for patients on a budget

Ahhh spring.

The lovely blooms unfurling. The trees budding.

It’s enough to make a girl get tears in her eyes.

And sneezes in her nose.

And itching on her face.

Yes, it’s allergy season again — but what can you do to make yourself more comfortable without emptying your wallet?

1. Avoidance. Close the windows. Make someone else cut the grass. Stay inside. (Yes, I hate this one too- let’s move on.)

2. Neti pot or other nasal saline rinsing. LOVE this one. 85% of allergens get in through your nasal passages. The rest gets in through the eyes and mouth. Why not just rinse the stuff out of your nose before it gets a chance to stimulate your immune response and make you miserable? A neti pot with salt packets costs about $12-20 and lasts for months. My favorite brand: the Walgreens knock-off version of Sinucleanse.  If you don’t know what on earth I am talking about — you can watch this neti pot video.

3. Antihistamines. Helps with the sneezing and itching and eye-tearing. Claritin (loratadine) or Zyrtec (cetirizine) are both over the counter, available in generic and one tablet lasts all day. Some pharmacies will still dispense this as a prescription, too. For instance, Target sells 30 loratadine tabs on their $4 prescription plan. Costco (recall: you don’t need to be a member to use their pharmacy) sells 300 cetirizine tabs for $20! If neither of those meds works for you or makes you too sleepy –  there is also generic Allegra (fexofenadine) 180 mg tabs. This is only available by prescription and the price varies from $36- $90 for 30 tabs (Please see LesliesList.org price comparison: allergy meds). The other available over the counter antihistamines work just fine, but are so short-acting and sedating it is hard to recommend them as a daily allergy treatment strategy.

4. Decongestants. Sudafed (pseudoephedrine), for those of you that can tolerate it (makes some people feel speedy and light-headed) helps quite a bit with congestion. Fun fact: most medicines that end in a “D” (Allegra-D, Zyrtec-D, Claritin-D) simply an antohistamine with the addition of pseudoephedrine 120 mg. My advice is to purchase and use these medicines separately. This way you can take only as much as you need, and it is usually cheaper. For example: Allegra D 12-Hour (generic), 60 tabs, costs $130 at Walgreens. However, a 30 day rx for generic Allegra and 60 tabs of generic Sudafed is $59 + $24 = $84.

5. Nasal steroids and nasal antihistamine sprays. These can help with the nasal symptoms of allergy. Nice because they don’t really cause much in the way of systemic side effects, although they can cause irritation of the nose in 10-20% of users. All require a prescription from your doc. Nasal steroids prices vary from $15 (generic Flonase at Costco)- $136 (Rhinocort AQ at Walgreens- no generic available). Nasal antihistamines, such as generic Astelin, vary in price from $69 at Walmart – $131 at Walgreens.

6. Antihistamine eye drops. To treat itchy and watery eyes. These are available over the counter for about $7 (Visine-A). Since Visine A also has an ingredient that takes out redness, in addition to the antihistamine, this should be for occasional use only. You can also get prescription drops that are antihistamine only, such as generic Optivar (azelastine) for $77- 110, or Patanol (no generic available) for $95- 133 a bottle

5. Other. The leukotriene esterase inhibitors, such as Singulair, work like magic for some people but not at all for others. One thing for sure- they are very expensive ($122- 165 for a month’s supply) and require a prescription. My advice is, if you are looking to save money, buy as a last resort only.

Leslie Ramirez is an internal medicine physician and founder of Leslie’s List, which provides information that enables all patients, but especially the uninsured and underinsured, to find more affordable medications and health care services.

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