Does benadryl cause dry eyes

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Fifty million Americans are affected by allergy each year, and 30 million of these individuals suffer from seasonal allergies.1 Meanwhile, ocular surface disease (OSD) affects approximately 20.7 million people in the U.S. every year.2 Of these, nearly 4.25 million individuals have chronic ocular surface disease.3 While many clinicians still ascribe to the general notion that “allergy affects the young and dry eye affects the old,” international epidemiology data suggests that allergic disease is on the rise across all age groups.4 The prevalence of allergic rhinitis (AR) has increased during the last three decades and is now estimated to affect 20% of the adult population in the U.S.4 AR is actually considered the most common chronic condition in both adults and children.6 And, 75% of those diagnosed with AR actually have allergic rhinoconjunctivitis.5

It can be challenging to differentiate ocular surface disease from allergic conjunctivitis, as seen in this patient.
Courtesy: Jason R. Miller, O.D.

It can be a challenge to distinguish allergic symptoms from dry eye symptoms. Treating a patient who presents with concurrent allergy and dry eye symptoms, however, can be an even greater challenge. Whether you are considering a true type I IgE-mediated allergic reaction or a type IV delayed cell-mediated reaction, the likelihood of allergy colliding with ocular surface disease in patients of advanced age is significant.

In the following case, the patient presents with concurrent allergy and OSD. What risk factors does she face? How should she best be treated? And, what general management tips and strategies can you recommend to her?

A Case of Concurrent Allergy and Ocular Surface Disease

History. A 49-year-old postoperative LASIK patient presented to our Lexington, Ky., office on a warm April morning with complaints of watery, itchy eyes. She had been doing well since we inserted silicone punctal plugs one week after undergoing LASIK three months earlier.

At first, the patient was miserable because she did not want to rub her eyes and disturb her corneal flap. She reported some relief after taking Claritin (loratadine, Schering Corporation) and using Refresh Liquigel (Allergan) q.i.d. O.U., but noted that her eyes still bothered her noticeably.

Her medical history was unremarkable. Her ocular history was positive for preoperative spectacle correction and wavefront-guided LASIK for compound myopic astigmatism (spherical equivalent of -7.25D O.U.). Interestingly, she reported no history of allergies on her pre-LASIK questionnaire.

Diagnostic data. Her best-uncorrected visual acuity measured 20/20 O.U. A slit lamp examination confirmed conjunctival papillae and palpebral conjunctival injection, with mild bulbar conjunctival chemosis O.U. Also, there was mild thickening and hyperemia of the lid margins. There was adequate lid and punctal apposition O.U., and her silicone punctal plugs were in place. Despite intermittent reflex tearing, her tear prism was poor, and there was mild lissamine green staining involving both the nasal and temporal conjunctiva O.U.

Upon further questioning, the patient indicated that she had suffered from seasonal allergies in the past, but that they had not bothered her since she moved to Lexington from Chicago nearly a year ago. She noticed that her symptoms were worse in the morning, especially while jogging outside. When asked if she had a family history of allergies, she revealed that both of her children used nebulizers for mild asthma when they were young, but no longer require treatment. The patient also mentioned that her father had hired a lawn service to mow his grass several years ago because of his allergies.

Discussion. Our patient demonstrates several risk factors for seasonal allergic conjunctivitis (SAC):

1. Springtime in the southeastern U.S. In general, cities in the southeast tend to have high levels of tree pollen in the springtime. Most importantly, a 2008 report from the Asthma and Allergy Foundation of America suggested that Lexington is the worst city for springtime allergies in the U.S.7

2. History of SAC. Our patient has a personal history of SAC, and her recent move from Chicago explains her brief sabbatical from allergic symptoms. Additionally, the patient has a family history of both allergy and asthma. If a patients family history is negative for SAC, then he or she has just a 10% to 15% chance of developing SAC. If one parent has a history of allergic disease, the patients risk increases to 30%. Finally, if both parents have a history of allergy, the patient has a 45% to 50% chance of developing SAC.8 Additionally, if both parents have the same type of allergic disease, the risk increases to 72%.8

3. Morning symptoms. Our patient’s allergic symptoms are worse during the morning hours when pollen counts are highest (usually between 5:00 a.m. and 10:00 a.m.).
Additionally, our patient demonstrates several risk factors for ocular surface disease:

1. Post-menopausal female. According to the Women’s Health Study, 3.2 million women age 50 or older suffer from clinically significant dry eye.9 In this demographic, ocular surface disease tends to affect females at a rate of 3:1 vs. males.9 Additionally, the risk of dry eye increases both during and after menopause. Advancing age and varying hormonal changes are also associated with ocular surface disease.10

2. History of refractive surgery. The creation of a corneal flap disrupts normal corneal innervation and results in hypoesthesia that may persist for six months or longer.11 Hypoesthesia, or decreased corneal sensitivity, contributes to the disruption of the normal neuronal-feedback loop, causing decreased tear production, tear film instability, decreased tear clearance, increased tear osmolarity and epitheliopathy.12

Superior hinge flaps decrease innervation to an even greater degree; the main branches of the long posterior corneal nerves enter the eye at both a 3 o’clock and 9 o’clock position. When a nasal hinge flap is created, the nasal arm is preserved.13 Femtosecond flap technology (e.g., IntraLase, Abbott Medical Optics) provides more flexibility with respect to flap size, hinge location and flap thickness–all of which can be adjusted to improve post-LASIK dry eye symptoms and recovery time.14 Some clinicians have also proposed that the greater the refractive error (thus, the greater ablation depth in laser vision correction), the greater the decrease in corneal sensitivity and the longer the recovery time.8,15

3. Oral antihistamine use. According to a 2008 survey conducted by Pharmacy Times, U.S. pharmacists make more than 2.3 million recommendations per month for oral over-the-counter antihistamine drugs.16 Almost half of these recommendations were for Claritin (see The Top Five Most Frequently Recommended Oral OTC Antihistamines, below).

Also, oral histamine H1-receptor antagonists are the most frequently prescribed class of agents used for allergic rhinitis management.17 Unlike first-generation antihistamines, second-generation agents are highly selective peripheral histamine blockers that demonstrate little or no side effects upon the central or autonomic nervous systems.18 While second-generation agents are actually “minimally-sedating,” they still exhibit a tendency to reduce tear volume and may exacerbate symptoms of ocular irritation, itching and dryness.19

After considering these factors extensively, I suggested that our patient modify a few of her lifestyle activities, including jogging in the evening instead of the morning. Also, I started her on a regimen of Elestat (epinastine HCL 0.05%, Allergan) b.i.d. O.U. and Refresh Plus (Allergan) q2h; I instructed her to refrigerate both products. Finally, if our patient’s ocular symptoms improve but her nasal congestion persists, I will remove her silicone punctal plugs.

Five Tips for Allergy Sufferers

1. Avoid the avoidable. Allergy testing is a critical first step in determining precisely what is causing your patient’s allergic reaction. Narrowing the list of potentially offending allergens through skin-prick or blood testing allows for more targeted avoidance techniques and treatments, including immunization therapy.

Also, patients with seasonal allergies should pay attention to local weather and pollen counts on a daily basis to avoid acute allergic reactions. Instruct your patients to remain indoors in the air conditioning as much as possible when pollen counts are high. When spring arrives, most people have a natural tendency to want to open all of the windows and let fresh air in. Despite this natural impulse, seasonal allergy sufferers need to remember that this could incite or worsen allergy symptoms.

Instruct your patients with allergic conjunctivitis to remain indoors when local pollen counts are elevated.
Courtesy: Jason R. Miller, O.D.
Remind patients to avoid prolonged rubbing of itchy eyes. Intense itching is the classic sign of an IgE-dependent hypersensitivity response. In susceptible individuals, initial exposure of an allergen to the ocular surface stimulates the production of specific immunologic antibodies, which bind to and degranulate mast cells that contain several preformed mediators, including histamine. Histamine, once released, binds to H1 and H2 receptors located on the conjunctiva, resulting in vaso-endothelial dilation and secondary chemosis, redness, tearing, lid swelling and intense itching. Unfortunately, this intense itching and reflex tearing can lead to a vicious cycle of eye rubbing, which subsequently degranulates more mast cells and furthers the response.

Instead of rubbing, instruct your patients to apply cool compresses and instill refrigerated eye drops. While icepacks work well, gel-filled facemasks work better and are readily available at most drug stores. The chilled drops soothe the eye, decrease vascular permeability of the conjunctiva vessels and reduce chemosis.

Finally, tell your patients to shower at night before they go to bed. Pollen and spores may get deposited on the skin or in hair after prolonged outdoor activity. Washing away these allergens before bedtime ensures they do not get transferred to sheets and pillowcases, which could make symptoms more chronic.

2. Lower viscosity preservative-free artificial tears. Just like our postoperative LASIK patient, it is not uncommon for someone with moderate ocular surface disease to be on a more viscous artificial tear, such as Refresh Liquigel, Refresh Celluvisc (Allergan) or Bion Tears (Alcon). When allergy strikes, however, a less viscous tear, such as Preservative Free Optive (Allergan) or Systane Ultra (Alcon), used more frequently would be better at washing out environmental allergens and inflammatory mediators from the ocular surface.

3. Limit punctal plug use. When confronted with a type I IgE mediated allergic reaction, the goal is usually to flush inflammatory mediators from the ocular surface. Punctal plugs are counter-productive for this goal. Also, intense itching promotes eye rubbing, which could put the patient at risk for several punctal plug associated complications, such as extrusion or canalicular migration with secondary nasolacrimal obstruction, canaliculitis or dacryocystitis.

If your patient has moderate ocular surface disease, and closure of the lacrimal punctum is warranted despite a history of seasonal allergic conjunctivitis, you might decide upon occlusion with extended-duration plugs. Extended-duration punctal plugs, which typically demonstrate a partial occlusive effect at four months post-insertion, are ideal for dry eye patients during the allergy “off-season.”

For patients who present with seasonal allergic rhinoconjunctivitis and have already undergone punctal cautery, dual therapy of topical antihistamine/mast-cell stabilizers and nasal corticosteroids should adequately reduce symptoms and histamine-related flare-ups.

4. Avoid oral antihistamines. As noted above, all oral antihistamines including newer-generation antihistamines, such as Claritin, Zyrtec (cetirizine, Pfizer) and Allegra (fexofenadine, Aventis Pharmaceuticals) dry the eye. This can worsen ocular allergies in two ways. First, less tear production means less tear flow and inadequate flushing of environmental allergens from the ocular surface. Second, decreased tear volume results in an increased concentration of inflammatory mediators on the ocular surface.

Instead, consider treating topical allergy topically. The third-generation topical antihistamines/mast-cell stabilizers, such as Pataday (olapatadine hydrochloride 0.2%, Alcon), Patanol (olapatadine hydrochloride 0.1%, Alcon) and Elestat have shown to be fast-acting and quite effective in quelling the allergic cascade, while reducing allergic ocular symptoms without the secondary effects of surface drying.19,20 As an added benefit, olapatadine 0.2% has shown potential in reducing allergic rhinitis symptoms in patients with a patent nasolacrimal duct system.21 For patients without prescription drug coverage, Zaditor (ketotifen 0.025%, Novartis Pharmaceuticals) is now available over the counter.

For exaggerated, late-phase allergic responses (i.e., conjunctival inflammation, including chemosis and lid edema), the safer topical ester-based steroids, including Alrex (loteprednol etabonate ophthalmic suspension 0.2%, Bausch & Lomb) and Lotemax (loteprednol etabonate ophthalmic suspension 0.5%, Bausch & Lomb), are ideal. Pulse therapy in conjunction with a fast-acting medicine, such as Patanol or Elestat, can minimize congestion and abort ocular symptoms.

For persistent symptoms of AR, intranasal glucocorticosteroids–delivered topically as a spray to the nasal mucosa–are generally considered very safe and effective. Contraindicated in patients with a history of nasal polyps or surgery, steroid nasal sprays, such as flunisolide, were found to be more effective at improving symptoms of AR when compared with intranasal antihistamines, such as azelastine HCl.22 In addition to flunisolide, this group of medications includes fluticasone propionate, mometasone, budesonide, triamcinolone, beclomethasone and fluticasone furoate.

For patients with contraindications or aversions to nasal sprays, oral leukotriene inhibitors such as Singulair (montelukast sodium, Merck) may be the answer. The FDA has approved montelukast for the treatment of AR. Additionally, Singulair has the added benefit of being non-drying.23 And, several studies show that montelukast was more beneficial than placebo and was equally as effective as loratadine for the treatment of seasonal AR.24,25

5. Remember Restasis. Restasis (topical cyclosporine A 0.05%, Allergan), a T-cell immunomodulating agent, was approved by the FDA in 2002 for the primary indication of treating immune-mediated dry eye.

However, since that time, Restasis has shown tremendous off-label benefits in the management of other ocular disease entities, such as allergic keratoconjunctivitis, posterior blepharitis and keratomycosis.26

Additional data show that Restasis also inhibits activation of mast cells and eosinophils.26 One of its most beneficial off-label uses is against vernal and atopic keratoconjunctivitis.26,27 Because Restasis is a very effective anti-inflammatory agent with a superb safety profile (no deleterious effect on intraocular pressure, premature cataract formation or phagocytosis), it has allowed physicians to decrease or limit the long-term use of topical steroids in managing many sight-threatening conditions.

That said, can Restasis play a role in the management of SAC? As a primary or first-line agent, probably not. However, in a patient with chronic OSD, Restasis may lesson the severity of future seasonal allergic attacks.

With adequate inquiry into a patients personal and family history of allergy, followed by education on lifestyle modification and treatment strategies for SAC, your dry eye patients will be better prepared for the onslaught of allergy season.

Dr. Mangan is chair of the refractive surgery and research committees for the Eye Center Group, a multi-specialty comanagement center in central Indiana and western Ohio. Additionally, he oversees the groups ocular surface disease clinic. He has no financial interest in any of the products mentioned.

4. Fineman S. The burden of allergic rhinitis: beyond dollars and sense. Ann Allergy Asthma Immunol. 2002 Apr;88(4 Suppl 1):2-7.

5. Nathan RA, Meltzer EO, Derebery J, et al. The prevalence of nasal symptoms attributed to allergies in the United States: findings from the burden of rhinitis in an America survey. Allergy Asthma Proc. 2008 Nov-Dec;29(6):600-8.

6. Berger WE. Overview of allergic rhinitis. Ann Allergy Asthma Immunol. 2003 Jun;90(6 Suppl 3):7-12.

8. Nassaralla BA, McLeod SD, Boteon JE, Nassaralla JJ Jr. The effect of hinge position and depth plate on the rate of recovery of corneal sensation following LASIK. Am J Ophthalmol. 2005 Jan;139(1):118-24.

13. Vroman DT, Sandoval HP, Fernndez de Castro LE, et al. Effect of hinge location on corneal sensation and dry eye after laser in situ keratomileusis for myopia. J Cataract Refract Surg. 2005 Oct;31(10):1881-7.

14. Barequet I, Hirsh A, Levinger S. Effect of thin femtosecond LASIK flaps on corneal sensitivity and tear function. J Refract Surg. 2008 Nov;24(9):897-902.

17. Hansen J, Klimek L, Hormann K. Pharmacological management of allergic rhinitis in the elderly: safety issues with oral antihistamines. Drugs Aging. 2005;22(4):289-96.

19. Ousler GW 3rd, Workman DA, Torkildsen GL. An open-label, investigator-masked, crossover study of the ocular drying effects of two antihistamines, topical epinastine and systemic loratadine, in adult volunteers with seasonal allergic conjunctivitis. Clin Ther. 2007 Apr;29(4):611-6.

20. Mah FS, OBrien T, Kim T. Evaluation of olopatadine
hydrochloride 0.2% in an allergic conjunctivitis patient population with dry eye. Summary of paper presented at Western Society of Allergy, Asthma and Immunology scientific session. Maui, Hawaii: January 15-19, 2007.

21. Abelson MB, Gomes PJ, Vogelson CT, et al. Clinical efficacy of olopatadine hydrochloride ophthalmic solution 0.2% compared with placebo in patients with allergic conjunctivitis or rhinoconjunctivitis: a randomized double-masked environmental study. Clin Ther. 2004 Aug;26(8):1237-48.

22. Berlin JM, Golden SJ, Teets S, et al. Efficacy of a steroid nasal spray compared with an antihistamine nasal spray in the treatment of perennial allergic rhinitis. J Am Osteopath Assoc. 2000 Jul;100(7 Suppl):S8-13.

24. Meltzer EO, Malmstrom K, Lu S, et al. Concomitant montelukast and loratadine as treatment for seasonal allergic rhinitis: a randomized, placebo-controlled clinical trial. J Allergy Clin Immunol. 2000 May;105(5):917-22.

25. Pullerits T, Praks L, Ristioja V, Lotvall J. Comparison of a nasal glucocorticoid, antileukotriene, and a combination of antileukotriene and antihistamine in the treatment of seasonal allergic rhinitis. J Allergy Clin Immunol. 2002 Jun;109(6):949-55.

Could Your Medication Be Causing Dry Eye?

Dry eye, a painful condition that affects roughly 5 million Americans, can be brought on by a few factors. It’s more common in people older than 50, and it’s often associated with the use of contact lenses and prolonged periods of time staring at a computer or other screens.

If you’re experiencing dry eye symptoms, another possible culprit could be a prescription or over-the-counter drug you’re taking, and you may want to consult your doctor or an eye professional about your medications.

Here are some of the most common medications associated with dry eye symptoms.

Antihistamines If you are allergic to pollen, dust, or pets, antihistamines can help relieve symptoms like runny nose, sneezing, and itchy eyes. However, these medications can dry out the watery tear film that keeps the eye lubricated and healthy. People taking antihistamines may produce fewer tears, and the tears produced evaporate more quickly.

If you experience allergy symptoms in your eyes, you may be unsure if the irritation you feel is due to allergies or dry eye. Some people experience both. Seeing an eye doctor is important for ensuring a proper diagnosis and treatment plan.

Beta blockers Beta blockers work by blocking the effects of adrenaline, the hormone that is produced when you are under stress. These drugs slow the heart rate. They are used to treat high blood pressure and abnormal heart rhythms, and can improve survival after a heart attack.

Why beta blockers may contribute to dry eye symptoms is unclear. If you’re experiencing dry eye while taking a beta blocker, let your doctor know. But do not stop taking your medication. Your doctor may recommend switching to another drug.

Diuretics These medications are used to lower high blood pressure. They work on your kidneys to increase the amount of salt and water (in the form of urine) passed through the body. That reduces the overall fluid going through your blood vessels, which lowers blood pressure.

The reduction in fluid in the body can affect your eyes and their ability to produce tears.

Ibuprofen Ibuprofen is part of a class of drugs known as nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs work by blocking the production of prostaglandins, chemicals in the body that cause pain and inflammation.

A study published in April 2014 in the Journal of Ophthalmic and Vision Research found that dry eye seems to be associated with inflammation that can cause ocular surface damage. Research published in December 2013 in the International Journal of Ophthalmology suggests that anti-inflammatory treatments such as dietary supplementation with omega-3 fatty acids can benefit patients with dry eye.

Work with your doctor to find the right balance if you’re using medications to fight inflammation and pain, since like ibuprofen, some pain relievers can cause dryness of the eyes as well as blurriness and color-vision changes.

Can Artificial Tears Help Dry Eye?

Any stoppage or change to medications you are taking should always be discussed with your doctor.

According to Richard Davis, MD, an associate professor at UNC Eye, part of the medical school at the University of North Carolina at Chapel Hill, eliminating medications that cause dry eye will restore normal tear function. For some patients, however, that might not be possible. “Sometimes, the medications can’t be changed; in that case, tear supplements or artificial tears are useful,” he says.

Another treatment for increasing tear volume is punctal plugs, which are inserted in the tear duct to block drainage of liquid from the eye.

“These devices are either dissolvable or fixed,” Davis explains. “The dissolvable plugs are placed in the tear duct and remain for approximately three months before they dissolve. The more permanent plugs are sometimes placed in the four tear drainage ducts and remain for approximately one year, and then they must be replaced.”

Allergic conjunctivitis is the name for the red, itchy eyes you get from allergies. It’s an annoying problem that brings people to the doctor, with more than 20% of people affected at some point during the year. Here are some of the medications that can help.

How do you know if you have allergic conjunctivitis?

First, here are some weird facts. Allergic conjunctivitis is mostly a disease of young adults, with an average age of onset of 20 years of age. Symptoms, for some reason, tend to decrease with age. Half of patients have a personal or family history of other allergic symptoms.

What you feel is itching, tearing, red and puffy lids, watery discharge, burning, and sensitivity to light. It’s usually in both eyes, but sometimes one will bug you more than the other.

Before you decide on a treatment, your doctor should make sure your red eyes are NOT infectious “pink eye,” dry eye, or blepharitis (inflammation of the eyelids). If your eyes itch, that’s a strong sign it is allergic and not an infection.

Also, start with some basic “treatment” before you get your prescription medications: Don’t rub your eyes, as that will cause worsening of symptoms. You can use artificial tears to help dilute and remove allergens, and cool compresses help, too.

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What are the best medications to treat allergic conjunctivitis?

OK, you took those steps, but you’re still suffering. Here are some medications for red, itchy eyes that can help. These may take some time to work, so be patient. It may also take some trial and error to find the medication that works best for you.

If you have glaucoma or wear contacts, check with your doctor before taking allergy eye drops.

Eye drops

The prescription eye drops that are your best choice are drops with both antihistamine and mast cell stabilizing properties. These medications both help block the release of histamines, a chemical your body releases that can cause allergy symptoms such as itchy eyes.

Olopatadine (available as brand names Pataday, Patanol, and now Pazeo) was the first drug in this class to be approved. The main difference here is that Pataday is taken once daily while Patanol is taken twice daily. Both are now available as generics: Patanol as olopatadine 0.1%, Pataday as olopatadine 0.2%.

Other popular medications in this class that work well for red, itchy eyes include azelastine and Alocril.

The only generic in this class also available over the counter is ketotifen fumarate (known as Claritin Eye, Itchy Eye, Alaway, or Zaditor).

Remember: These products are intended for short-term use only!

Antihistamine medications

If you hate eye drops, you can also try over-the-counter or prescription antihistamines. But eye drops are faster-acting and less likely to cause systemic side effects, so are usually preferred. Examples of antihistamines include:

  • Fexofenadine (Allegra)
  • Loratadine (Claritin)
  • Desloratadine (Clarinex)
  • Cetirizine (Zyrtec)
  • Levocetirizine (Xyzal)

Will my insurance cover these medications?

Prescription brand-name medications like Xyzal, Clarinex, and Alocril will likely be considered tier 2 or 3 medications by insurance companies, meaning you will have a moderate to high co-pay. Many of these medications can cost $100 per month or per bottle of drops.

Generic versions are more likely to be covered under your lowest co-pay as Tier 1 medications. They range from about $20 to $80 per month or per bottle.

The over-the-counter eye drops tend to range in price from $5 to $20 per bottle.

– – –

Dr. O.

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  • Can Medications Cause Dry Eyes?

    Conditions

    By Gary Heiting, OD

    Many common prescription and non-prescription (over-the-counter, or OTC) medications can contribute to dry eye symptoms. Categories and specific examples of medications associated with dry eyes include:

    Antihistamines and Decongestants These medications are used to treat the common cold, nasal congestion, allergies, hives, dermatitis and other allergy-related conditions. Brand names of OTC antihistamines and decongestants include Benadryl and Claritin. Newer brands (which may cause fewer dry eye problems) include Zyrtec, Clarinex and Allegra.

    Hypertension Drugs These medications are used to treat high blood pressure (hypertension), angina and migraine headaches, as well as other conditions. Hypertension drugs that are classified as beta blockers especially can cause dry eye symptoms. Thiazides and diuretics often are prescribed to treat congestive heart failure, and these medications can cause dry eyes as well.

    Hormones Hormone replacement therapy (HRT) prescribed for post-menopausal women can cause dry eyes, whether the HRT consists of estrogens alone or in combination with progestins. Also, the use of estrogen replacements and contraceptive agents is commonly associated with dry eyes.

    Drugs for Gastrointestinal Problems Medications called proton pump inhibitors that are prescribed for stomach and intestinal problems can cause dry eye symptoms. Brand names include: Prevacid, Prilosec, Nexium, Zantac and Tagamet.

    Pain Relievers Common OTC pain medications like Ibuprofen can cause dry eye problems, especially when higher doses (up to 800 mg) are prescribed. Several prescription pain relief medications also can cause dry eyes.

    Antidepressants Antidepressants and anti-anxiety medications also can produce dry eye symptoms. Brand name examples include Zoloft, Paxil, Elavil, Endep and Sinequan.

    Skin Medications Medications containing isotretinoin that are prescribed to treat acne, psoriasis and other dermatologic conditions can produce dry eye symptoms.

    Chemotherapy Medications Certain chemotherapy medications such as Cytoxan have been associated with the development of dry eye.

    Antipsychotic Medications Phenothiazine medications prescribed to manage schizophrenia can cause dry eyes. Brand names include Mellaril and Thorazine.

    If you are taking any of the medications described above and are experiencing dry eyes, discuss this with your doctor and see if there are alternative treatments that may be less likely to cause dry eye problems.

    In most cases, medication-related dry eye symptoms will reduce after the medication is discontinued, but it might take several weeks or even months for symptoms to resolve completely.

    Page updated February 2018

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    Gary Heiting, OD

    Gary Heiting, OD, is a former senior editor of AllAboutVision.com. Dr. Heiting has more than 30 years of experience as an eye care provider, health educator and consultant to the eyewear … read more

    Notes and References

    Which oral meds cause dry eye? Review of Cornea & Contact Lenses. June 2011.

    The News Feed

    D ry eye is a multi-factoral disease of the tears and ocular surface; one such factor is the patient’s use of systemic medications.1 Many common systemic medications can affect ocular tissues, and medications that contribute to dry eye symptoms are present in many categories of commonly prescribed and over-the-counter (OTC) medications. According to one estimate, four out of every five U.S. adults will use prescription medicines, over-the-counter drugs or dietary supplements in any given week, and nearly one-third of adults will take five or more different medications in the same timeframe.2 Older patients may be at greater risk for medication side effects because they often take multiple prescription medications. Of our patients who take six or more medications a week, at least half receive prescriptions from three or more physicians!3

    In this article we will discuss several categories of pharmaceuticals, each containing medications that can produce dry eye symptoms. Pharmaceuticals that can cause dry eye symptoms include certain medications used to treat hypertension such as central-acting agents and diuretics; antihistamines and decongestants, in concert with anticholinergics; hormones; certain antidepressants; pain relievers, such as ibuprofen and lortab; and dermatologic agents.

    Hypertensive Agents
    Physicians prescribe systemic beta blockers to treat angina pectoris, essential hypertension, myocardial infarctions and migraine headaches.4 Beta blockers reduce lysozyme levels and immunoglobulin A, causing a decrease in aqueous production and subsequently leading to symptoms of dry eye.5 Patients using beta blockers also exhibit corneal anesthesia, decreased tear film break-up times and ocular irritation.

    Thiazides or diuretics are often prescribed to treat congestive heart failure. This drug class causes decreased lacrimation, which may induce dry eye complaints. Hydrochlorothiazide (HCTZ) is a commonly used diuretic and can produce changes in the precorneal tear film, inducing a dry eye.6 Furosamide and HCTZ/triamterene are other common medications in this class.

    Lissamine green staining of conjunctiva and cornea in dry eye.

    Antihistamines and Decongestants
    Medications that block histamine receptors alleviate allergic conditions of rhinitis, uticaria, dermatitis and systemic allergies. The drugs in this class reduce mucous and aqueous production, which cause dry eye complaints.7 Their activity may also decrease the aqueous component of the precorneal tear film. In general, these effects occur with OTC preparations—most commonly with Benadryl (diphenhydramine, McNeil Consumer) and Chlor-Trimeton (chlorpheniramine, Schering)—and in recent offerings, such as Claritin (loratadine, Schering).

    The newer, more site-specific (H1 selective) antihistamines like Zyrtec (cetirizine, McNeil Consumer), Clarinex (desloratadine, Merck) and Allegra (fexofenadine, Sanofi-Adventis) are less likely to cause ocular dryness, but they may affect the tear film. The effect of these medications, however, is not as profound as earlier generation antihistamines.

    Antihistamines are combined with anticholinergics in many OTC medications, such as cold preparations, sedatives, antidiarrheals and nasal decongestants.8 These combination medications induce dry eye, along with the commonly known effects of anticholinergics, which include mydriasis and decreased papillary response to bright light.8

    Hormones
    Hormone replacement therapy (HRT) with estrogens alone or in combination with progestins is a commonly prescribed therapy for post-menopausal women. The use of estrogen replacements and contraceptive agents is commonly implicated in dry eye. The exact cause-and-effect relationship is unknown, but may be associated with a decreased aqueous component of the precorneal tear film.9

    A great deal of information is available about hormone replacement therapy in post-menopausal women. Debra A. Schaumberg, Sc.D., O.D., M.P.H., and colleagues reported a 69% increase in dry eye symptoms in women who were taking estrogen compared to the control group.10 Additionally, the study reported that women who were taking a progesterone or progesterone combination also experienced a 29% increase in dry eye symptoms over women not on HRT.

    This report, based on observations on 25,000 post-menopausal women, showed evidence of a significant increased risk of dry eye syndrome and severity of dry eye symptoms in women taking estrogen. Because this risk has been shown to increase with longer durations of estrogen use, patients on HRT with estrogens should be monitored for dry eye problems.11

    Antidepressants
    Widely prescribed anti-anxiety medications and tricyclic antidepressants can produce dry eye side effects. Symptoms of blurred vision, cycloplegia and dry eye are transient and reversible.7

    Two well-known antidepressants are Zoloft (sertraline, Pfizer) and Paxil (paroxetine, GlaxoSmithKline). Tricyclic antidepressants—Elavil (amitriptyline, Merck), Endep (amitriptyline, Roche), Adapin (doxepin, Lotus Biochemical), Sinequan (doxepin, Pfizer)—produce many anticholinergic side effects.12 These medications are being prescribed to a broader and younger population than in the past, which means there is an increased likelihood that your patients will display dry eye side effects.

    Pain Relievers
    Ibuprofen, a common OTC pain medication, can cause dry eye in addition to blurred vision, refractive changes, diplopia and color vision changes, especially when the higher dosages (up to 800mg) are prescribed.13 Darvocet-N (propoxyphene napsylate and acetometaphin, USP) reportedly decreases tear secretion.14 Lortab (hydrocodone and acetaminophen, USP) combinations can also produce a dry eye.

    Dermatologic Medications
    Dermatologists sometimes prescribe Accutane (isoretinoin, Genpharm) for the treatment of recalcitrant acne. Even though Roche Pharmaceuticals pulled Accutane from the market in 2009, generic versions of the drug may still be available by prescription.

    Isotretinoin (13-cis-retinoic acid) is a form of vitamin A that reduces the amount of oil released by oil glands in the skin.15 Vitamin A and its synthetic derivatives are collectively known as retinoids and are used to treat severe recalcitrant nodular acne, acne vulgaris and severe recalcitrant psoriasis, and to induce remission of leukemia.16 Isoretinoin has been shown to be secreted in tears by the lacrimal gland and has been associated with causing meibomian gland dysfunction—producing dry eye complaints, contact lens discomfort, blepharoconjunctivitis, transient blurring of vision and acute, transient refractive changes––especially myopic shifts.17 This synthetic medication affects the overproduction of skin lipids. Decreased meibomian gland function also impacts the production of the lipid layer of the precorneal tear film, leading to tear film instability and enhanced surface evaporation, which results in dry eye syndrome.

    Dry eye complaints will disappear after medication use is discontinued, although it may take several months for the complaints to wane. Approximately 20% of previously successful contact lens wearers may need to decrease their wearing time, use preservative-free lubricating eye drops or discontinue contact lens wear while on this medication.18

    Gastrointestinal Medications
    This medication class includes the proton pump inhibitors: Prevacid (lansoprazole, Takeda), Prilosec (omeprazole, Procter & Gamble), Nexium (esomeprazole magnesium, AstraZeneca), Zantac (ranitidine, GlaxoSmithKline) and Tagamet (cimetidine, GlaxoSmithKline). Proton pump inhibitors have caused dry eye complaints, although this information does not appear in their individual package inserts. H2 receptor antagonists, like all antihistamines, can cause dry eye symptoms.

    Chemotherapy Medications
    A major drug in this class is Cytoxan (cyclophosphamide, Bristol-Myers Squibb), which is also used to treat ocular cicatricial pemphigoid and primary Sjögren syndrome. As many as 60% of patients taking cyclophosphamide have developed dry eye.19

    Antipsychotic Medications
    Phenothiazines are prescribed to manage schizophrenia. Mellaril (thioridazine, Mutual Pharmaceutical) is the best known of this class and has almost completely replaced Thorazine (chlorpromazine, GlaxoSmithKline) in the management of the condition. Both drugs decrease aqueous secretion, and symptoms are transient and dose dependent.20

    Do not consider this brief discussion exhaustive, as many other drugs and categories may have dry eye as a side effect. While these drug categories are the most common offenders in producing dry eye problems, exceptions exist in every drug category. No one can possibly remember all of the potential ocular adverse events associated with each medication. Fortunately, there are many resources available to help us with this information.

    Two useful resources in clinical practice are “Clinical Ocular Toxicology: Drug Induced Ocular Side Effects” by Frederick Fraunfelder, M.D., and Wiley Chambers and “Clinical Ocular Pharmacology,” 5th edition by James Bartlett, O.D., D.O.S., M.Sc., and Siret Jaanus, Ph.D., L.H.D.
    When selecting reference resources, choose those that are complete and updated frequently. Perhaps none is more current and readily available than Epocrates (www.epocrates.com), which is updated weekly can be downloaded to your mobile device.

    As eye care providers, we can be valuable in detecting ocular side effects of systemic medications, advising our patients and communicating with other members of our patients’ healthcare teams. As always, the best course is to educate our patients about the role their medications play in their dry eye complaints.

    Patients need to assume some responsibility here as well. They need to know the brand names and generic names of the medications they are taking. Recommend your patients use only one pharmacy so the pharmacist can help monitor for drug interactions. At the end of the day, it is our responsibility to make sure that our patients know how their systemic medications could be contributing to their ocular surface disease.

    Dr. Bowling is in private group practice in Tuscaloosa, Ala. He is also a diplomate in the Primary Care Section of the American Academy of Optometry.

    Dry eyes and what you can try

    Published: November, 2010

    If our eyes are healthy, we’re producing tears all the time and not noticing it very much, if at all. We need a thin layer of tears to lubricate, protect, and nourish the fronts of our eyes. That “tear film,” as ophthalmologists call it, isn’t just salty water but a complex mixture of substances produced and maintained by several glands and structures in and around the eyes. If the tear film degrades, we experience dry eyes. The symptoms are familiar to many of us: irritation, scratchiness, a burning sensation. Sometimes vision is affected, getting blurry off and on.

    Mild cases — and many are — can be treated rather easily with any of over a dozen different over-the-counter products. In a change from the past, dry eyes are now seen as having an inflammatory component, not just a loss of moisture. To combat the inflammation, some ophthalmologists prescribe drops that contain a very small amount of cyclosporine if the over-the-counter products don’t work. Cyclosporine is a drug that organ transplant recipients take to suppress the immune system so the organ is less likely to be rejected.

    Older and drier

    Dry eyes used to be thought of as a simple problem of not enough tear production, too much tear evaporation, or some combination of both. Dry eyes may still begin that way, but now the thinking is that localized inflammatory processes get started as the tear film loses moisture.

    Air conditioning during the summer — and indoor heat during the winter even more so — make the air inside our homes bone-dry, so water in tear film and other bodily surfaces evaporates easily. Blinking levels out and replenishes the fatty outer layer of the tear film, and normally we blink every 10 seconds or so. Activities that decrease that rate — watching television, working at a computer, driving a car — can cause dry eyes because they slow down the blink rate.

    Age is a factor: the older orb tends to be a drier one because the lacrimal and other glands become less productive. And with age, lower eyelids may sag, so they don’t form a good seal over the eye. In general, women are more prone than men to dry-eye problems.

    Autoimmune diseases, conditions in which the immune system turns on the body instead of throwing itself at invading infections as it is supposed to, can affect tear film ingredients and cause dry eyes. Lupus and rheumatoid arthritis are two such autoimmune diseases.

    Dry eyes are also a side effect of some commonly used medications, including antihistamines, beta blockers, and the selective serotonin reuptake inhibitor (SSRI) antidepressants, such as citalopram (Celexa) and fluoxetine (Prozac). Some over-the-counter eye drops contain benzalkonium chloride, a preservative that can dry out eyes and have other side effects.

    Dry eyes are a common side effect of LASIK to correct nearsightedness and farsightedness, although it’s usually temporary. Contact lenses reside within the tear film, and dry eyes are one of the main reasons some people can’t wear contact lenses or can only do so on a limited basis. Sometimes switching contact lens solutions or trying lenses made out of a different material can help.

    Going by symptoms

    There isn’t any one specific test to diagnose dry eyes. Most ophthalmologists will as a matter of course examine the eyes with a slit lamp, the device with the chin rest and the bright light that the doctor uses to peer into our eyes. Eye drops with special stains can be used to evaluate the health of the eye surface and gauge the stability of the tear film.

    Frequently, though, the eye examination and test results are secondary in the diagnostic workup, especially if the problem is mild. Symptoms and the patient’s history are often the key pieces of information in arriving at a diagnosis.

    Not as good as the real thing

    If the source of the problem is dry air, using a humidifier can make a big difference. Limiting screen time (television, computer monitors), which is bad for many body parts, not just those we see with, can also help.

    But the first-line treatment for most people with dry eyes remains an over-the-counter topical treatment of some kind, typically drops. These products are referred to as artificial tears. The starting dose is usually a drop in each eye four times a day.

    The prescription cyclosporine drops are usually used after patients have tried the over-the-counter products. Cyclosporine drops take some time to work — between six and eight weeks in most cases. Price is a drawback: sold under the brand name Restasis, they cost about $250 a month. Moreover, people may have to use them indefinitely.

    November 2010 update

    The Aging Eye: Preventing and treating eye disease

    As the eyes age, problems with vision become more common. Learn how to recognize the risk factors and symptoms of specific eye diseases — cataract, glaucoma, age-related macular degeneration, and diabetic retinopathy — and what steps you can take to prevent or treat them before your vision deteriorates.

    Learn more ”

    Disclaimer:
    As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

    Dry Eye caused by Medications

    August 29, 2017

    Do you know that among the top 100 best-selling drugs in the US, 22 of them can cause dry eye?
    In fact, 62% of dry eye cases in the elderly can be attributed to systemic medications, including nonsteroidal anti-inflammatory drugs (NSAIDs), diuretics, vasodilators, analgesics/antipyretics, antiulcer agents, sulfonylureas, cardiac glycosides, anxiolytics/benzodiazepines, anti-infectives, antidepressants/antipsychotics, hypotensive agents, and antihistamines. “TFOS DEWS II iatrogenic report” has summarized research data in this area and compiled a very nice table below.
    Table 1. Systemic medications that contribute to dry eye.

    The reason why these drugs cause dry eye is not completely known, but it is thought that many of them have anticholinergic activity, which means they target intentionally or unintentionally a class of proteins on cells, and these proteins are important for the secretion of tear, mucous and lipid.
    Another reason why drugs can cause dry eye is that some drugs are secreted and form crystals in the tear, including amiodarone, aspirin, bisphosphonates, chloroquine, ibuprofen and clofazimine.

    EYE DROPS, CAN THEY MAKE YOUR EYES DRY?

    The answer is yes.
    We all know that artificial tear eye drops alleviate dry eye, but some other eye drops can actually cause dry eye or make it worse. One such example is glaucoma eye drops. It is estimated that they cause burning sensation and dry eye in up to 47% of patients. The reason is that most glaucoma eye drops contain a preservative called benzalkonium chloride (BAK), which is a known toxin for cells and causes inflammation on the surface of the eye, as we talked about previously (link here). Interestingly, once switched to preservative-free glaucoma eye drops, dry eye sensation reduce to 16%. It is noteworthy that because of the common dry eye issues associated with glaucoma eye drop use, eye doctors often prescribe artificial tears to be used while patients are using glaucoma drops. However, if patients use an artificial tear that contains preservatives such as BAK, their dry eye may be worse.
    For people with significant dry eye, it is recommended that preservative-free forms of glaucoma eye drops be used, and preservative-free artificial tears regularly supplemented as well. If you have such issues, ask your eye doctor about the preservative-free versions of glaucoma drops.
    Of note, the medicated eye drops that make dry eye worse can also be due to the active medication itself, in addition to the preservatives.
    Again, “TFOS DEWS II iatrogenic report” compiled a table of eye drops that may cause dry eye. A great reference to patients and doctors both.
    Table 2. Topical eye drops that cause dry eye.

    In the end, while we know that a number of systemic medications as well as topical eye drops can cause or make dry eye worse, this is not to say that we should discontinue these medications. However, it is helpful that doctors and patients are aware of the dry eye side effect of certain medications, and take measures to treat dry eye while on them, or switch to different medications if necessary.
    About the Author …
    Juan Ding, OD, PhD. has written an assortment of articles about eye health so that patients may better understand their diagnosis, treatments and management of their conditions.
    Dr. Ding is interested in promoting patient awareness and education of eye conditions and diseases. Dr. Ding is a member of TFOS.
    Dr. Ding works at UMass Memorial Medical Center in Worcester, Massachusetts (US) as an attending optometrist and an assistant professor of UMass Medical School. Dr. Ding specializes in comprehensive eye exams for adults and children, diabetic eye exams, refraction, contact lens fitting, and binocular visual dysfunctions.
    Please visit Dr. Ding’s website for additional articles about eye care: https://bostoneyeblink.com/

    Are my medications causing my Dry Eye?

    Dry eye is a very common problem. It affects women more than men and becomes more prevalent as people get older. It can present in many ways. Symptoms can include a foreign body sensation, burning, stinging, redness, blurred vision and dryness. Tearing is another symptom and occurs because the eye initially becomes irritated from the lack of moisture and then there is a sudden flood of tears in response to the irritation. Unfortunately, this flood of tears can wash out other important components of the tear film which are necessary for proper lubrication. Signs and symptoms can range from mild to severe.
    There are several medications which have the potential to worsen the symptoms of Dry Eye. Here are the broad categories and specific medications that have been known to potentially worsen the symptoms of Dry Eye.
    Blood Pressure Medications-Beta Blockers such as Atenolol (Tenormin), Diuretics such as Hydrochlorothiazide.
    GERD (gastro-esophageal reflux disorder) Medications – There have been reports of an increase in dry eye symptoms by patients on these medications including Cimetidine (Tagamet), Rantidine (Zantac), Omerprazole (Prilosec), Lansoprazole(Prevacid), Esomeprazole (Nexium).
    Antihistamines- More likely to cause dry eye: Diphenhydramine (Benadryl), loratadine (Claritin) Less likely to cause Dry Eye: Cetirizine (Zyrtec), Desloratadine (Clarinex) and Fexofenadine (Allegra). Many OTC decongestants and cold remedies also contain antihistamines and can cause Dry Eye.
    Antidepressants- Almost all of the antidepressants, antipsychotic and anti-anxiety drugs have the propensity to worsen the symptoms of dry eye.
    Acne medication- Oral Isotretinoin
    Hormone Replacement Therapy- The estrogen in HRT has been implicated in Dry Eye.
    Parkinson’s Medication- Levodopa/Carbidopa (Synamet), Benztropine (Cogentin), Procyclidine (Kemadrin)
    Eye Drops- In addition to oral medications many eye drops can actually increase the symptoms of dry eye especially drops with the preservative BAK.
    If you are suffering from dry and are using any of the medications above you should discuss this with your Ophthalmologist and Medical Doctor. Don’t stop these medications on your own with consulting your doctors.

    Benadryl (diphenhydramine)

    You may wonder how Benadryl compares to other medications that are prescribed for similar uses. Below are comparisons between Benadryl and several medications.

    Benadryl vs. Claritin

    Benadryl is a first-generation antihistamine. Claritin (loratadine) is a newer, second-generation antihistamine. The second-generation antihistamines are often called nonsedating antihistamines because they’re less likely to cause sleepiness compared to first-generation antihistamines.

    Both Benadryl and Claritin are over-the-counter medications.

    Uses

    Oral Benadryl products are approved for decreasing symptoms of hay fever and other respiratory allergies, and symptoms of the common cold such as sneezing and runny nose. Benadryl products that are topical (applied to the skin) are approved for decreasing pain and itchy skin caused by things such as hives and insect bites.

    Claritin is approved for decreasing symptoms of hay fever and other respiratory allergies.

    Drug forms

    Benadryl comes in many different forms, including:

    • oral tablets
    • oral liquid-filled capsules (liqui-gels)
    • oral chewable tablets
    • oral liquid solution
    • topical cream
    • topical gel
    • topical spray
    • topical stick

    Oral Benadryl products are usually taken every 4 to 6 hours. Topical products are typically used up to 4 times daily.

    Claritin is also available in many different forms, including:

    • oral tablets
    • orally disintegrating tablets
    • oral liquid-filled capsules (liqui-gels)
    • oral liquid syrup

    Claritin tablets, liquid-filled capsules, and syrup are taken once daily. The orally disintegrating tablets are used either once daily or twice daily.

    Side effects and risks

    Benadryl and Claritin have some similar side effects, and some that differ. Below are examples of these side effects.

    Both Benadryl and Claritin Benadryl Claritin
    More common side effects headache
    dry mouth
    sleepiness*
    weakness
    dizziness
    fatigue
    inflammation of the mouth and lips
    rash
    sore throat
    ear pain
    Serious side effects seizures
    fast heartbeat
    decreased memory
    impaired thinking
    confusion
    impaired driving
    dementia

    * Both Benadryl and Claritin can cause sleepiness, but it’s much more common in people who take Benadryl.

    Effectiveness

    Benadryl and Claritin are both effective for reducing symptoms of hay fever and other allergies, and for treating hives or itchy skin. However, Benadryl isn’t usually a first-choice treatment for these conditions due to its risk of side effects such as sleepiness.

    Claritin and other second-generation antihistamines are usually preferred.

    Costs

    Benadryl and Claritin are both brand-name, over-the-counter products. Claritin usually costs more than Benadryl.

    Both of these products have store-brand versions. Store brands are usually cheaper than the brand-name versions.

    Benadryl vs. Zyrtec

    Benadryl is a first-generation antihistamine. Zyrtec (cetirizine) is a newer, second-generation antihistamine. The second-generation antihistamines are often called nonsedating antihistamines because they’re less likely to cause sleepiness compared to first-generation antihistamines.

    Both Benadryl and Zyrtec are over-the-counter medications.

    Uses

    Oral Benadryl products are approved for decreasing symptoms of hay fever and other respiratory allergies, and symptoms of the common cold such as sneezing and runny nose. Benadryl products that are topical (applied to the skin) are approved for decreasing pain and itchy skin due to hives, insect bites, and other causes.

    Zyrtec is approved for decreasing symptoms of hay fever and other respiratory allergies.

    Drug forms

    Benadryl is available in many different forms, including:

    • oral tablets
    • oral liquid-filled capsules (liqui-gels)
    • oral chewable tablets
    • oral liquid solution
    • topical cream
    • topical gel
    • topical spray
    • topical stick

    Oral Benadryl products are usually taken every 4 to 6 hours. Topical Benadryl products are typically used up to 4 times daily.

    Zyrtec is also available in many different forms, including:

    • oral tablets
    • orally disintegrating tablets (dissolve tabs)
    • oral liquid gels
    • oral liquid syrup

    Zyrtec products are usually taken once daily.

    Side effects and risks

    Benadryl and Zyrtec have some similar side effects, and some that differ. Below are examples of these side effects.

    Both Benadryl and Zyrtec Benadryl Zyrtec
    More common side effects headache
    dry mouth
    sleepiness*
    weakness
    dizziness
    fatigue
    sore throat
    stomach pain
    Serious side effects seizures
    fast heartbeat
    decreased memory
    impaired thinking
    confusion
    impaired driving
    dementia
    glaucoma
    bronchospasm

    * Both Benadryl and Zyrtec can cause sleepiness, but it’s more common in people who take Benadryl.

    Effectiveness

    Benadryl and Zyrtec are both effective for reducing symptoms of hay fever and other allergies, and for treating hives or itchy skin. However, Benadryl isn’t usually a first-choice for these conditions because of its risk of side effects such as sleepiness. Zyrtec and other second-generation antihistamines are usually preferred.

    Costs

    Benadryl and Zyrtec are both brand-name over-the-counter products. Zyrtec usually costs more than Benadryl.

    Both of these products have store-brand versions. Store brands are usually cheaper than the brand-name versions.

    Benadryl vs. Allegra

    Benadryl is a first-generation antihistamine. Allegra (fexofenadine) is a newer, second-generation antihistamine. The second-generation antihistamines are often called nonsedating antihistamines because they’re less likely to cause sleepiness compared to first-generation antihistamines.

    Both Benadryl and Allegra are over-the-counter medications.

    Uses

    Oral Benadryl products are approved for decreasing symptoms of hay fever and other respiratory allergies, and symptoms of the common cold such as sneezing and runny nose. Benadryl products that are topical (applied to the skin) are approved for decreasing pain and itchy skin due to hives, insect bites, and other causes.

    Allegra is approved for decreasing symptoms of hay fever and other respiratory allergies, and itchy skin caused by hives, insect bites, and other causes.

    Drug forms

    Benadryl is available in many different forms, including:

    • oral tablets
    • oral liquid-filled capsules (liqui-gels)
    • oral chewable tablets
    • oral liquid solution
    • topical cream
    • topical gel
    • topical spray
    • topical stick

    Oral Benadryl products are usually taken every 4 to 6 hours. Topical Benadryl products are typically used up to 4 times daily.

    Allegra is also available in many different forms, including:

    • oral tablets
    • orally disintegrating tablets (meltable tablets)
    • oral gel-coated tablets (gelcaps)
    • oral liquid suspension

    Allegra products are taken once or twice daily.

    Side effects and risks

    Benadryl and Allegra have some similar side effects, and some that differ. Below are examples of these side effects.

    Both Benadryl and Allegra Benadryl Allegra
    More common side effects headache
    dizziness
    weakness
    dry mouth
    sleepiness
    vomiting
    cough
    diarrhea
    stomach upset
    fatigue
    muscle pain
    sore throat
    Serious side effects decreased memory
    impaired thinking
    confusion
    impaired driving
    seizures
    fast heartbeat
    dementia
    angioedema (swelling)

    Effectiveness

    Benadryl and Allegra are both effective for reducing symptoms of hay fever and other allergies and for treating hives or itchy skin. However, Benadryl isn’t usually a first-choice for these conditions because of the risk of side effects such as sleepiness. Allegra and other second-generation antihistamines are usually preferred.

    Costs

    Benadryl and Allegra are both brand-name, over-the-counter products. Allegra usually costs more than Benadryl.

    Both of these products have store-brand versions. Store brands are usually cheaper than the brand-name versions.

    Benadryl vs. Unisom

    Benadryl contains the ingredient diphenhydramine, a first-generation antihistamine.

    There are different forms of Unisom. Most of these also contain the ingredient diphenhydramine. However, one Unisom product contains a similar drug, doxylamine.

    Uses

    Oral Benadryl products are approved for decreasing symptoms of hay fever and other respiratory allergies, and symptoms of the common cold such as sneezing and runny nose. Benadryl products that are topical (applied to the skin) are approved for decreasing pain and itchy skin due to hives, insect bites, and other causes.

    Although it’s not approved for this purpose, some people take Benadryl to help improve their sleep.

    Unisom is approved for helping relieve occasional sleeplessness. It’s not intended to be used to treat ongoing or long-term insomnia (trouble sleeping).

    Drug forms

    Benadryl is available in many different forms, including:

    • oral tablets
    • oral liquid-filled capsules (liqui-gels)
    • oral chewable tablets
    • oral liquid solution
    • topical cream
    • topical gel
    • topical spray
    • topical stick

    Oral Benadryl products are usually taken every 4 to 6 hours. Topical Benadryl products are typically used up to 4 times daily. Oral Benadryl products aren’t approved for sleeplessness, but some people take oral Benadryl once before bedtime for that purpose.

    There are also several forms of Unisom products. These include:

    • diphenhydramine-containing products:
      • oral softgels (SleepGels)
      • oral mini capsules (SleepMinis)
      • oral liquid
      • orally disintegrating tablets (SleepMelts)
    • doxylamine-contain product:
      • oral tablets (SleepTabs)

    These products are usually taken once daily just before bedtime or at bedtime.

    Side effects and risks

    Benadryl and most Unisom products contain the same ingredient, diphenhydramine. One form of Unisom contains a different ingredient, doxylamine. Doxylamine is very similar to diphenhydramine and causes very similar common and serious side effects.

    The most common side effects of Benadryl and Unisom include:

    • headache
    • dizziness
    • weakness
    • dry mouth
    • sleepiness

    Some serious side effects can include:

    • decreased memory
    • impaired thinking
    • confusion
    • impaired driving
    • seizures
    • fast heartbeat
    • dementia

    Effectiveness

    Benadryl and most forms of Unisom contain the same active ingredient, diphenhydramine. Both products can help with falling asleep in people with occasional sleeplessness. This effect may decrease or wear off with continued use.

    According to the American Academy of Sleep Medicine, these products aren’t recommended to treat ongoing or long-term insomnia (trouble sleeping).

    Costs

    Benadryl and Unisom are both brand-name over-the-counter products. These products usually cost about the same.

    Both of these products have store-brand versions. Store brands are usually cheaper than the brand-name versions.

    Benadryl vs. melatonin

    Benadryl contains the ingredient diphenhydramine, a first-generation antihistamine.

    Melatonin is a hormone that naturally occurs in the body. It’s involved in regulating the wake-sleep cycle of the body. It’s available as a dietary supplement.

    Uses

    Oral Benadryl products are approved for decreasing symptoms of hay fever and other respiratory allergies, and symptoms of the common cold such as sneezing and runny nose. Benadryl products that are topical (applied to the skin) are approved for decreasing pain and itchy skin due to hives, insect bites, and other causes.

    Although it’s not approved, some people take oral Benadryl to help improve their sleep.

    Melatonin is most commonly used to help relieve sleeplessness.

    Drug forms

    Benadryl is available in many different forms, including:

    • oral tablets
    • oral liquid-filled capsules (liqui-gels)
    • oral chewable tablets
    • oral liquid solution
    • topical cream
    • topical gel
    • topical spray
    • topical stick

    Oral Benadryl products are usually taken every 4 to 6 hours. Topical Benadryl products are typically used up to 4 times daily. Oral Benadryl products aren’t approved for sleeplessness, but some people take oral Benadryl once before bedtime for that purpose.

    Melatonin is also available in different forms, including:

    • oral tablets
    • oral gummies
    • orally dissolving tablets (fast-dissolving tablets)
    • oral capsules
    • oral chewable tablets
    • oral liquid

    Melatonin is usually taken once daily at bedtime.

    Side effects and risks

    Benadryl and melatonin have some similar side effects, and some that differ. Below are examples of these side effects.

    Both Benadryl and melatonin Benadryl melatonin
    More common side effects headache
    sleepiness
    weakness
    dry mouth
    dizziness
    stomach upset
    Serious side effects seizures
    impaired thinking
    confusion
    fast or irregular heartbeat
    decreased memory
    impaired driving
    dementia
    angioedema (swelling)

    Effectiveness

    Benadryl can help with falling asleep in people with occasional sleeplessness. However, this effect may decrease or wear off with continued use of the product.

    In an analysis of clinical studies, melatonin slightly decreases the time it takes to fall asleep and increases total sleep time. These effects don’t decrease with continued use of the product.

    According to the American Academy of Sleep Medicine, neither Benadryl nor melatonin are recommended to treat ongoing or long-term insomnia (trouble sleeping).

    Costs

    Melatonin usually costs more than Benadryl.

    Both of these products have store-brand versions. Store brands are usually cheaper than the brand-name versions.

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