From the Guidelines
For someone with both allergic rhinitis and insomnia, a first-generation antihistamine like diphenhydramine (Benadryl) or chlorpheniramine would not be the best choice due to their potential for significant adverse effects, including sedation, performance impairment, and anticholinergic effects, as noted in the study by 1. Instead, consider using a non-sedating second-generation antihistamine like cetirizine (Zyrtec) or loratadine (Claritin) for daytime use, and a medication specifically intended for sleep, such as a melatonin receptor agonist, for insomnia. Some key points to consider:
- First-generation antihistamines have significant potential to cause sedation, performance impairment, and anticholinergic effects, which can be detrimental to quality of life and increase the risk of accidents and injuries, as reported in the study by 1.
- Second-generation antihistamines have less or no tendency to cause these effects, making them a safer choice for daytime use, as noted in the study by 1.
- Intranasal corticosteroids are the most effective medication class in controlling symptoms of allergic rhinitis, as stated in the study by 1.
- For insomnia, it is essential to address the underlying causes and consider non-pharmacological interventions, such as cognitive-behavioral therapy for insomnia (CBT-I), before resorting to medication.
- If medication is necessary, consider using a medication specifically intended for sleep, such as a melatonin receptor agonist, which has a more favorable safety profile compared to first-generation antihistamines.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Medications for Allergic Rhinitis
- Second-generation H1 antihistamines (eg, cetirizine, fexofenadine, desloratadine, loratadine) are recommended for mild intermittent or mild persistent allergic rhinitis 2
- Intranasal antihistamines (eg, azelastine, olopatadine) can be used as monotherapy or in combination with an intranasal corticosteroid for nonallergic rhinitis 2
- Intranasal corticosteroids (eg, fluticasone, triamcinolone, budesonide, mometasone) are recommended as first-line treatment for moderate to severe allergic rhinitis 2, 3, 4
Comparison of Medications
- Cetirizine was found to be more effective than loratadine in reducing symptoms of seasonal allergic rhinitis in a controlled pollen challenge study 5
- Cetirizine was also found to be more effective than loratadine in relieving symptoms of perennial allergic rhinitis in children aged 2-6 years 6
- Fluticasone propionate was found to have similar efficacy to intranasal beclomethasone dipropionate, flunisolide acetonide, and oral astemizole, and better efficacy than oral loratadine, terfenadine, and cetirizine in controlling nasal symptoms of allergic rhinitis 4
Treatment of Insomnia
- There is no direct evidence in the provided studies to support the use of a specific medication for insomnia in patients with allergic rhinitis
- However, some antihistamines, such as diphenhydramine, are known to have sedative effects and are sometimes used to treat insomnia, but this is not recommended for patients with allergic rhinitis without consulting a healthcare professional
Patient-Specific Treatment
- Pharmacotherapy for allergic rhinitis should be patient-specific, based on type, duration, and severity of symptoms, comorbidities, prior treatment, and patient preference 3