From the Guidelines
If loratadine isn't working for your allergy symptoms, consider switching to a nasal corticosteroid like fluticasone (Flonase) or triamcinolone (Nasacort), using 1-2 sprays per nostril daily, as they are the most effective medication class for controlling symptoms of allergic rhinitis 1. When loratadine is not effective, several alternatives can be considered. These include:
- Trying a different oral antihistamine such as cetirizine (Zyrtec) 10mg daily, fexofenadine (Allegra) 180mg daily, or desloratadine (Clarinex) 5mg daily, as individuals may respond differently to various antihistamines 1.
- Adding a nasal corticosteroid, which is the most effective class of medication for controlling symptoms of allergic rhinitis, including sneezing, itching, rhinorrhea, and nasal congestion 1.
- Using intranasal antihistamines, which can be effective for allergic and nonallergic rhinitis, and may be used as an alternative to oral antihistamines 1.
- Considering combination therapy with an intranasal antihistamine and an intranasal corticosteroid, which has been shown to be more effective than monotherapy with either agent for initial treatment of nasal symptoms in persons with seasonal allergic rhinitis 1. It's essential to note that if symptoms continue despite trying these options for 2-3 weeks each, consulting a healthcare provider is necessary, as you may need prescription options or have a condition requiring different treatment. Additionally, it's crucial to follow the recommended dosages and administration instructions for each medication to minimize side effects and maximize efficacy 1.
From the FDA Drug Label
WARNINGS AND PRECAUTIONS Hypersensitivity reactions including rash, pruritus, urticaria, edema, dyspnea, and anaphylaxis have been reported. In such cases, stop Desloratadine Tablets at once and consider alternative treatments. ( 5.1)
If loratadine isn't working, alternative treatments should be considered. The FDA drug label for desloratadine, a related antihistamine, suggests stopping the medication and considering alternative treatments in cases of hypersensitivity reactions 2. However, it does not provide a list of specific alternative treatments.
- No specific alternatives are mentioned in the provided drug labels.
- It is recommended to consult a healthcare professional to determine the best course of action if loratadine is not effective 2.
From the Research
Alternatives to Loratadine
If loratadine isn't working, there are several alternative treatments that can be considered. These include:
- Other nonsedating antihistamines such as terfenadine, astemizole, and acrivastine 3
- Fexofenadine, which has been shown to be effective in patients who do not respond to loratadine 4
- Desloratadine, a biologically active metabolite of loratadine, which has been shown to be effective in treating seasonal allergic rhinitis and chronic idiopathic urticaria 5
- Combination therapy with an intranasal corticosteroid such as mometasone furoate nasal spray, which can provide benefits similar to monotherapy with the corticosteroid 6
Comparison of Alternatives
Studies have compared the efficacy of these alternatives, including:
- A study that found desloratadine to be more effective than fexofenadine in patients who were dissatisfied with loratadine 7
- A study that found combination therapy with mometasone furoate nasal spray and loratadine to be no more effective than monotherapy with the corticosteroid 6
- A study that found loratadine to be as efficacious as existing antihistamines in relieving symptoms of allergic rhinitis, urticaria, and in suppressing wheal formation 3
Considerations for Choosing an Alternative
When choosing an alternative to loratadine, considerations should include:
- The severity of symptoms and the specific condition being treated
- The potential for drug interactions and side effects
- The efficacy and safety profile of the alternative treatment
- Patient satisfaction and quality of life 7