The proliferation of over-the-counter allergy products, especially those containing multiple ingredients, is encouraging puzzled customers to turn to their pharmacists for answers.
"We're getting more and more questions," says Keith Kramer, pharmacist at Hank's, Cornelius, Ore. "Each new product makes it more confusing for the customer."
"It's true," agrees Chuck Harris, pharmacist at Wray's, Yakima, Wash. "The customers want to know which products will treat different symptoms and which ones won't make them sleepy."
Nutan Patel, pharmacist at Zallie Supermarkets, Clementon, N.J., observes that her customers' questions have become more technical. Customers are aware that many OTCs contain a combination of antihistamines, decongestants and pain relievers, she explains, "Then they come to me to get a clearer idea of what each one does. They have a real need to educate themselves these days."
"We have a lot of people who aren't sure if they should get a combination product, a simple decongestant or an antihistamine," says Shelley Butts, a pharmacist at Giant Genie's, Charlotte, N.C. "But this encourages them to talk to us about their symptoms and allows us to make recommendations."
"There are so many OTC products, including a number that are similar, that it gets confusing for customers," says Tricia Campbell, pharmacist at Health Care Plus, located inside Moody's Market, Polson, Mont.
Pharmacists say manufacturers sometimes compound the customers' dilemma by altering a product's formulation.
"It's difficult when manufacturers use the same name for different products containing different ingredients," says Kramer. "For example, the nondrowsy Benadryl doesn't have diphenhydramine in it like the original does."
Pharmacists say the ensuing confusion can result in drug interactions when those being treated for high blood pressure or glaucoma attempt to self-treat their allergies, a situation that can be avoided by checking with a pharmacist.
"Harmful drug interactions are a possibility," says Nick Vajdos, pharmacist at Super S Pharmacy, Devine, Texas. "But so many people ask about allergy medications, especially those who are taking something else, that we can usually prevent any mishaps."
Nevertheless, pharmacists much prefer to recommend single-ingredient OTC antihistamines, or H1 blockers, for seasonal allergic conditions and they reserve combination products for customers who demonstrate multiple symptoms.
"If customers ask for a recommendation, I'll usually just tell them to get a single-ingredient medicine," says Campbell of Health Care Plus.
"If all you've got is allergies, why go with anything extra?" adds Kramer.
Neil Feinberg, pharmacist at the Hempfield Plaza Pharmacy located in Davis Supermarket in Greensburg, Pa., agrees. "I try to limit what a person takes to what their symptoms are. You have to avoid any shotgun treatments because that's just asking for trouble."
When choosing a single-ingredient treatment to recommend, pharmacists primarily consider a product's sedation factor and price. For these reasons, products like Chlor-Trimeton are especially popular. "I recommend Chlor-Trimeton," explains Patel. "Compared to other single-ingredient antihistamines, it causes the least amount of drowsiness, in my opinion, and is reasonably affordable."
Vajdos, who also prefers Chlor-Trimeton, adds, "It doesn't have the tendency to knock the patient out like some of the others."
Campbell recommends Dimatane, another single-ingredient antihistamine.
"The price is pretty good," she explains. "It's also my understanding that the body adjusts to it if it's taken regularly and the customer doesn't get as drowsy."
For customers who are especially worried about sedation, Butts says she usually recommends a newer product like Tavist. With these products, however, pricing becomes much more of a factor.
"It is more expensive," says Butts at Giant Genie's. "And in this area, with a lot of elderly people on tight budgets, we have to keep that in mind."
When pricing is a customer's primary consideration, many pharmacists like Vajdos recommend store brands of single-ingredient antihistamines.
Pharmacists say that OTC multi-ingredient allergy medicines are appropriate for customers suffering from a combination of symptoms.
"They're great if someone has allergies and a sinus congestion," adds Vajdos. "In that case, I'll usually recommend a combination antihistamine-decongestant product."
The combination products "have made my job easier," says Davis Supermarket's Feinberg. "They give me more to choose from when I'm recommending medications."
Name-brand or generic, single or multi-ingredient, pharmacists say adults prefer tablets.
"Even though you probably get faster results with a liquid," says Butts at Giant Genie's, "tablets are much more popular because of the convenience. Plus, a lot of the capsules are time-release formulas," she continues, "so you only have to take a pill twice a day, rather than drink a liquid every four to six hours."
For children, however, pharmacists unanimously recommend liquids like Benadryl or Dimetapp elixir.
Explains Butts, "The kids like the taste and the dosages are lower, so it's easier to treat their allergies regularly."
In addition to reduced-strength liquids, Vajdos also recommends children's Naldecon for ease of application.
In many regions, the allergic symptoms that these products treat become more pronounced during particular seasons of the year. "Early spring and early fall are the worst," says Butts of Giant Genie's in North Carolina. "Here [in Oregon], springtime is the worst," says Kramer. "But if we have a dry summer, it'll taper down until the ragweed comes out in the fall."
For those suffering from chronic year-round allergies, pharmacists usually recommend a doctor's visit.
"I wouldn't think that you'd use OTC drugs to treat someone who had severe allergies year-round," says Feinberg. "They need to be evaluated by a physician."
"We suggest that customers who get allergies year-round go to the doctor and get a prescription for a nondrowsy medication like Clariton," says Kramer.
"But if it's just seasonal," Kramer says, "the OTC medications work just as well, and you don't have to pay for a doctor's visit."