Non Drowsy Antihistamines: Your Ultimate Guide

Every spring blossoming flowers come and the not-so-welcome visitor – hayfever. For allergy sufferers, the changing season can transform the outdoors into a minefield of sneezing, itching, and watery eyes, leaving them longing for relief. Thankfully, science has gifted us with a powerful solution: non drowsy antihistamines.

What is hayfever?

Hayfever, also known as seasonal allergic rhinitis is a common condition which occurs mainly during spring and summer seasons. Hayfever occurs when the immune system overreacts to certain allergens present in the environment. The most common allergens responsible for triggering hayfever include pollen from trees, grasses, and weeds, as well as mould spores and dust mites.
Hayfever symptoms that happen in response to those allergens may include runny nose, sneezing and watery eyes. Thankfully there are few non-drowsy hayfever tablets, which are effective against hayfever.
Non drowsy antihistamines, which can be purchased over the counter in the UK include:

• Cetirizine
• Loratadine
• Acrivastine
• Fexofenadine

Are all hayfever tablets non-drowsy?

When it comes to hayfever treatment, antihistamines have been a trusted ally for decades. These remarkable medications work to combat the symptoms caused by the body’s overactive immune response to allergens, providing much-needed comfort during the peak of allergy season. However, the older generation of antihistamines came with a common side effect – drowsiness, often making it challenging for patients to carry on with their daily activities. First-generation antihistamines can cause profound sedation and therefore are commonly used as active ingredients in over the counter sleeping pills. Older generation antihistamines sold in the UK as temporary relief of sleeping problems include promethazine, and diphenhydramine with brands such as Sominex and Nytol.

Non drowsy antihistamines reviewed in this post are classified as second-generation antihistamines. Second-generation antihistamines are less likely to cause sedation than first-generation antihistamines.

Although second-generation antihistamines are classified as ‘non-drowsy’, drowsiness can rarely happen with this type of antihistamines. Out of all reviewed non drowsy hayfever tablets loratadine is the only antihistamine which does not list drowsiness and dizziness as a common side effect. Based on the chemical properties of the drug, fexofenadine may cause minimal to no drowsiness, however, most manufacturers list this side effect at a common frequency.

Can you buy non drowsy antihistamines over the counter?

Non drowsy antihistamines can be purchased over the counter from supermarkets and pharmacies. Larger packs of antihistamines may be classified as pharmacy-only products, which means they can only be sold from behind a pharmacy counter.
Which non-drowsy antihistamine is the best?

All second-generation antihistamines are considered to be of similar effectiveness (Mann et al., 2000). There are no long-term studies which compare the effectiveness of non-sedative antihistamines. When requesting an antihistamine in the pharmacy, customers are usually recommended a non-drowsy antihistamine to check if symptoms of hayfever are controlled. Customers who previously used antihistamine(s) usually choose one that they found to work the best for them.

Over the counter non drowsy antihistamines

1. Cetirizine

Cetirizine is one of the most popular over the counter non drowsy antihistamines. Cetirizine is also available as a liquid antihistamine for children. Regardless of brand, all cetirizine tablets contain the same amount of cetirizine – 10mg per tablet.

Most supermarkets and pharmacies sell their own ‘brands’ of cetirizine, for example, Tesco Allergy and Hayfever Relief 10mg tablets and Lloyds Pharmacy Antihistamine Hayfever Relief 10mg tablets, both produced by the same manufacturer. Common branded products containing cetirizine include Benadryl Allergy One a Day and Piriteze Antihistamine Allergy Relief Tablets.

Cetirizine: age restriction and dose

Cetirizine can be taken by children from 2 years of age. Babies and children can use liquid cetirizine. Tablets are recommended for children and adults over 12 years of age. The recommended dose for children under 12 is 5mg twice a day, therefore one would need to break 10mg tablet to meet this dose (unlicensed use) if tablets are preferred instead of liquid. Check the product information leaflet for the correct dose.

Cetirizine: common side effects

Possible side effects which may be experienced when taking cetirizine and their estimated frequency (eMC, 2023):

• Headache (7%)
• Somnolence (10%)
• Dry mouth (2%)
• Dizziness (1%)
• Nausea (1%)
• Fatigue (2%)

Dizziness may be experienced by around 1 in every 100 people, and somnolence in 10 in every 100 individuals.

Where can you buy cheap cetirizine?

Supermarkets sell their brand of cetirizine, which is usually one of the cheapest options on the high street. Independent pharmacies provide similar value for money or even better, this may vary between pharmacies. Most cetirizine tablets sold in supermarkets and some pharmacies for example, Asda, Boots, Tesco, Morrisons, Co-op and Sainsburys are made by the same manufacturer.
Without a doubt, patients can buy a bulk of cetirizine tablets on Amazon.co.uk with provides the best value and a low price. These antihistamines are usually sold by 3rd party vendors (pharmacies).

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Customers have a choice of branded cetirizine 10mg, for example, Benadryl Allergy One a Day 10 mg Tablets. Branded versions of cetirizine contain the same amount of this drug – 10mg per tablet.

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2. Loratadine

Loratadine is the second equally popular non drowsy antihistamine. Loratadine comes in the form of tablets (10mg tablets) as well as in the form of liquid.

Loratadine: age restriction and dose

Over the counter loratadine can be used in adults and children over two years of age. The standard dose for adults and children (over 30kg) is 10mg daily.

Is loratadine a drowsy antihistamine?

Drowsiness is not listed as a common side effect of loratadine. No other common side effects are listed for loratadine.

Where can you buy cheap loratadine?

Loratadine availability mirrors cetirizine availability. You can buy loratadine in shops, supermarkets and pharmacies with larger packs (60 tablets) restricted to pharmacy-only sales. Supermarkets sell the cheapest loratadine, and again if you are looking for great savings, third-party sellers (pharmacies) offer the best value for money by selling bulk supply loratadine (6 or 12 months supply) on Amazon.co.uk

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Customers have also a choice of branded loratadine, which contains the same amount of loratadine – 10mg per tablet, for example, Clarityn Allergy relief tablets.

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3. Fexofenadine

Fexofenadine is the newest addition to non-drowsy antihistamine tablets. So far fexofenadine was only available on prescription. Fexofenadine is now available as over the counter medication (sold as a branded product: Allevia 120mg and Treathay 120mg) as recently fexofenadine was reclassified from prescription-only medicine to general sale medicine. Read more about Allevia (fexofenadine) over the counter.

Allevia 120mg – age restrictions

Allevia antihistamine tablets are licensed to relieve symptoms associated with seasonal allergic rhinitis (hayfever) in adults and children aged 12 years and over (Gov.UK, 2023).
Out of all non drowsy antihistamines, fexofenadine has the lowest potential to cause any drowsiness, due to the fact it does not penetrate the brain (Kawauchi et al., 2019). However, dizziness, drowsiness, and headache are listed as common side effects of fexofenadine.

A higher strength of fexofenadine (180mg tablets) and lower strength of fexofenadine 30mg for children (Telfast 30mg) are prescription-only medicines.

4. Acrivastine

Less-known acrivastine is sold as a branded product called Benadryl Allergy Relief Capsules. Each capsule contains 8mg of acrivastine. Acrivastine has a rapid onset of action, which means it starts to
work fast (Brogden et al., 1991).

Acrivastine: age restriction and dose

Benadryl Allergy Relief Capsules can be used by adults and children over 12 years of age. The recommended daily dose is one capsule to be taken up to three times a day. Customers can use Benadryl Allergy Relief Capsules ‘on demand’ due to their fast onset of action. Benadryl Allergy Relief Capsules get to work faster than cetirizine and loratadine tablets and capsules (marketing description).

Is acrivastine non drowsy antihistamine?

Although classified as non-sedating, dizziness and somnolence are listed as common side effects of Benadryl Allergy Relief Capsules. Another common side effect associated with acrivastine use is dry mouth.

Where can you buy acrivastine (Benadryl Allergy Relief capsules)?

Benadryl Allergy Relief Capsules are sold in supermarkets and pharmacies. Larger packs may be sold in pharmacies only.

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5. Benadryl Allergy Relief Plus Decongestant Capsules

Acrivastine is also sold in combination with pseudoephedrine (decongestant). Benadryl Allergy Relief Plus Decongestant Capsules contains acrivastine (8mg per capsule) and pseudoephedrine hydrochloride (60mg per capsule). Pseudoephedrine is classified as a decongestant, which effectively unblocks a stuffy nose.

Benadryl Allergy Relief Plus Decongestant is a pharmacy-only product, which means it can only be purchased from registered pharmacies including online chemists.

Benadryl Allergy Relief Plus Decongestant: age and other restrictions

Benadryl Allergy Relief Plus Decongestant can be used by adults and children over 12 years of age.

Benadryl Allergy Relief Plus: restrictions on use

Benadryl Allergy Relief Plus capsules should not be taken by some patients, because of pseudoephedrine content. Patients with the following conditions should not take Benadryl Allergy Relief Plus capsules:
• Cardiovascular disease and hypertension
• Diabetes
• Closed-angle glaucoma
• Hyperthyroidism
• Severe renal impairment
• Patients who take beta-blockers
• Patients who take monoamine oxidase inhibitors or recently stopped the treatment (within 14 days)

Benadryl Allergy Relief Plus Decongestant: common side effects

As with previously reviewed products, Benadryl Plus Decongestant can commonly cause dizziness and somnolence. Other common side effects include:
• headache
• dry mouth
• nausea
• insomnia and
• nervousness.

Prescription-only non drowsy hayfever tablets

There are about 20 licensed antihistamines in the UK (drowsy and non-drowsy). A total of 14.2mln prescriptions were issued for antihistamines in the last 12 months (Jun ’22—May ’23).

In order, cetirizine, fexofenadine and loratadine are the most commonly prescribed non-drowsy antihistamines in the UK. There is a significant gap between the top 3 most prescribed hayfever tablets and the next medication, which is desloratadine, an active form of loratadine (prescription-only medication).

Hayfever: alternative treatment

Individuals who cannot control hayfever symptoms with antihistamine tablets are usually recommended additional treatment with hayfever nasal sprays and hayfever eye drops, both of which can be purchased over the counter.

Conclusion

Customers have a good choice of non drowsy antihistamines, which can be purchased over the counter. Although named as non-drowsy, most antihistamines, except loratadine and fexofenadine have the potential to cause drowsiness. Second-generation antihistamines are much less likely to cause drowsiness than first-generation antihistamines, which are commonly associated with drowsiness and sedation.

References
Brogden RN, McTavish D. Acrivastine. A review of its pharmacological properties and therapeutic efficacy in allergic rhinitis, urticaria and related disorders. Drugs. 1991 Jun;41(6):927-40. doi: 10.2165/00003495-199141060-00008. Erratum in: Drugs 1991 Oct;42(4):639. PMID: 1715267. Available at: https://doi.org/10.2165/00003495-199141060-00008 Accessed on 27/07/2023
eMC (2023). SmPC: BecoAllergy 10mg Tablets. Available at: https://www.medicines.org.uk/emc/product/5332/smpc Accessed on 27/07/2023
Gov.UK (2020). Public Assessment Report of the Reclassification of Allevia 120mg Tablets. Available at: https://www.gov.uk/government/publications/public-assessment-report-of-the-reclassification-of-allevia-120mg-tablets Accessed on 27/07/2023
Kawauchi H, Yanai K, Wang DY, Itahashi K, Okubo K. Antihistamines for Allergic Rhinitis Treatment from the Viewpoint of Nonsedative Properties. Int J Mol Sci. 2019;20(1):213. Published 2019 Jan 8. doi:10.3390/ijms20010213 Available at: https://dx.doi.org/10.3390%2Fijms20010213 Accessed on 27/07/2023
Mann RD, Pearce GL, Dunn N, Shakir S. Sedation with “non-sedating” antihistamines: four prescription-event monitoring studies in general practice. BMJ. 2000;320(7243):1184-1186. doi:10.1136/bmj.320.7243.1184 Available at: https://dx.doi.org/10.1136%2Fbmj.320.7243.1184 Accessed on 27/07/2023