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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  • MB

    Salt-found in the baking section of your grocery store is much cheaper than specially packaged saline rinses.

  • http://casadelogo.typepad.com eRobin

    MB: I agree. I do my own nasal irrigation with plain salt and it works great. My family gargles with it too. Also – nursing moms can use warm salt water compresses to relieve discomfort after nursing. I love salt water.

  • http://tjgmd99@blogspot.com doctor sabelotodo

    great post..a lot of good common sense..we should use these cost containing measures for all our pts. have you seen the cost of ACULAR (both brand and generic)..i compound drops for pts using toradol iv and sterile eye drops..costs about 5 bucks ..no charge to the pt..also i have pts. get up to year round relief with a single injectio of CELESTONE SOLUSPAN

  • Max

    Doctor Sabelotodo,

    Please tell me you’re not using Celestone yearly in your allergy patients. So you’re giving them a long acting steroid parenterally every single year. Well hopefully you’ll be long retired to florida when they step off that curb and fracture their ankle at age 55 from osteoporosis. At least cataracts aren’t that big a deal they are easily enough managed.

  • stargirl65

    I agree that these are great ideas for patients. Patients in America need to be more self directed. Many of these prescriptions can be purchased for a reasonable price without seeing a doctor. But most patients want FREE prescriptions from their health insurance company. They don’t want to buy them. They paid for health insurance and they want to use it.

    Also please don’t tell the patients to call me and ask for me to call in prescriptions for OTC meds to save THEM money. If I am responsible for the medicine then you will have to see me in my office.

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