It can be frustrating to deal with allergies no matter your age, but in older adults, choosing an antihistamine can be a little more complicated. In those over 65, especially those with glaucoma, high blood pressure, or an enlarged prostate, certain medications carry additional risks.<\/p>\n
The good news is that newer antihistamine options<\/a> provide allergy relief without some of the side effects or risks that are problematic for older adults. If you\u2019re searching for a solution for issues like hay fever, allergic rhinitis, or annoying sneezing and itchy eyes, this article will help you understand the difference between antihistamine generations and give tips to help you choose a safe option.<\/p>\n Antihistamine choice matters more for older adults because, as Erika Gray, Pharm.D.<\/a>, chief medical officer at ToolBox Genomics.com says, \u201cThat\u2019s when life choices like to catch up to us!\u201d<\/p>\n \u201cOver the age of 65, individuals start to undergo different physiological changes especially with their liver and kidneys. For example, consuming alcohol in the past means our liver isn\u2019t as capable as it once was,\u201d she explains. \u201cAs we age, our liver and kidneys have a decreased ability to break down and excrete the medications, meaning the drug often stays around longer.\u201d<\/p>\n Additionally, there are two types of antihistamines (classified as first- and second-generation drugs), and first-generation antihistamines are generally not preferred in older people.<\/p>\n The first generation came along during the 1940s and includes medications like Benadryl<\/a> (diphenhydramine<\/a>) and hydroxyzine<\/a>. They work by blocking a chemical messenger known as acetylcholine as well as blocking histamine. This is known as an anticholinergic effect.<\/p>\n Acetylcholine plays an important role in regulating a lot of your body\u2019s normal operations, like memory, attention, digestion, saliva production, and even bladder function. When first-generation antihistamines block acetylcholine, they can cause unwanted side effects like constipation, dry mouth, trouble urinating, blurred vision, confusion, falls, delirium, and drowsiness.<\/p>\n These side effects can be troubling for anyone, but they become more concerning with age. Many older adults take several medications or have multiple health conditions, and your body starts processing medications differently as it ages. It may take longer for drugs to leave your system, or you may have more comorbidities.<\/p>\n This can lead to what is known as an anticholinergic burden, which is the cumulative effect of taking several medications that block acetylcholine.<\/p>\n The American Geriatrics Society\u2019s Beers Criteria<\/a> actually identifies a number of first-generation antihistamines<\/a> as medications that older adults should avoid due to their strong anticholinergic properties. These include the following generic medications:<\/p>\n Generally, second-generation antihistamines are preferable for older adults.<\/p>\n If you\u2019re looking for a starting point, second-generation antihistamines offer a better option for older adults. Around the mid-1980s, the FDA approved the first second-generation antihistamine (terfenadine), paving the way for drugs like loratadine, fexofenadine, and cetirizine.<\/p>\n These medications offer allergy relief without as many central nervous system effects as their first-generation counterparts. The older first-generation drugs are fat-soluble and easily cross the blood-brain barrier, whereas second-generation options are lipophobic (water-soluble) and are largely blocked from doing so.<\/p>\n The most common second-generation antihistamines include:<\/p>\n \u201cLoratadine is considered the best and most well-studied \u2018first line\u2019 option because it doesn\u2019t affect the CNS and sedation is minimal,\u201d Dr. Gray explains.<\/p>\n While second-generation antihistamines are preferable to first-generation medications in older adults, there are still some key considerations. For example, if you have liver or kidney issues, you may need to adjust your dosage to avoid severe complications. Talk with your provider before starting an antihistamine and alert them to any health conditions and medications you currently take.<\/p>\nWhy antihistamine choice matters more after 65<\/h2>\n
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Best antihistamines for seniors: Second-generation options<\/h2>\n
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