Pros: Non-sedating, No prescription required, no need to swallow, ubiquitous $4.00 coupon
Cons: No pill available--only fast melt tab, No insurance reimbursement, NOT non-sedating if taken >1X/day
Preface to remarks--I'm a board certified allergist. I've gotten 'somewhat helpful' ratings on previous reviews on epinions about my toaster and my wife's shampoo because they were 'too short'. Well, no one will say this one is too short, cuz I've got quite a bit to say about this medicine:
Claritin was one of the biggest selling medicines in the history of the USA. Although not the first non-sedating antihistamine for allergies, it took almost all of Seldane's market share when adverse cardiac side effects from Seldane became known in the early-mid 1990's. Claritin lost its patent in 2002, and ended up as an over-the-counter drug. Soon thereafter, the Advil folks came out with Alavert, which is chemically identical to Claritin. Nowadays, generic Claritin (a.k.a. loratadine) is becoming a commodity--this week's Eckerd's Drug circular in the Sunday paper has 100 loratadine tablets for $29.99!
First of all, what's an antihistamine and what does it do. Anti-histamines are drugs that compete with histamine for the histamine receptor. Translation: histamine can set off allergic symptoms, but not unless they get to a histamine receptor. If you take an antihistamine, it prevents and treats certain allergy symptoms. The symptoms that antihistamines can help include runny nose, itchy eyes and nose, dripping in the throat, and sneezing. Notice what I didn't say--I didn't say anything about stuffy nose, sinus pressure, or headache. Those symptoms need a decongestant (e.g., Sudafed) for relief.
Antihistamines have been around since the 1940's, but were limited in their use because they made so many people sleepy. Benadryl (the Histamine Blocker!), a popular OTC antihistamine, has the same active ingredient, diphenhydramine hydrochloride, as most over-the-counter sleeping aids! It wasn't until the mid-1980's that Seldane came along. It didn't cross the blood-brain barrier, so it had very little chance of causing sedation (sleepiness). Seldane was an absolute blockbuster drug for many years. However, Seldane was subsequently found to cause unusual heart rhythms in certain people when it was combined with several antibiotics (e.g., erythromycin), antifungals (e.g., Sporanox), and even grapefruit juice! Claritin (loratadine is the generic name) provided similar relief with no clinically relevant cardiac rhythm problems.
OK, back to the present--Alavert. Alavert comes in only one strength: a 10 mg tablet that dissolves on your tongue. It is mint-flavored, but the Altoids folks have little to worry about. Even though you don't need water to take a fast melt (or Reditab) tablet, I recommend that patients use water before and after dissolving the tablet. It hastens the dissolving, and minimizes the taste. Alavert, like Claritin, is a once-a-day medication. However, just as Claritin was not effective for about 1 out of 4 people with allergies who took it, Alavert doesn't work for everyone, either. It certainly doesn't last a full 24 hours in a whole bunch of folks. Its onset of action is fairly quick--about 2 or 3 hours. The replacement drug, Clarinex, has a more rapid onset of action and lasts longer, but is much more expensive and available only by Rx. Interestingly, Clarinex was developed by Sepracor, NOT by Schering Plough (the inventors of Claritin). Sepracor is a small drug company that re-invents current drugs to make them 'improved chemical entities'. Clarinex is actually an active metabolite of Claritin. That means that when your body's liver processes Claritin (loratadine), a good deal becomes Clarinex (desloratadine). Desloratadine is a much more powerful antihistamine than is loratadine in the test tube at least. My clinical experience with patients is that they're about the same.
What about the economic aspects of all this? When Claritin went OTC, it changed the landscape quite a bit. Now, insurance companies could claim that a patient shouldn't get reimbursement on their Allegra, Clarinex or Zyrtec because Claritin was available OTC, without a prescription. This absolutely sucked the first few months, when only Claritin and Alavert were out there, because they were priced at about $1.00 a pill. Those used to paying $10/month for their medicines saw some serious inflation. On the other hand, those with NO insurance coverage were happy to pay $1.00 a pill, as the prescription price of Claritin had been over $2.00 a pill. Most of my patients now have insurance coverage for the remaining non-sedating antihistamines, but with a catch or two. Either the co-payment is higher this year than last year, or you need a letter from your doctor stating that Claritin was not effective. As I said, I have now seen loratadine for 30 cents a pill this week at Eckerd's, and won't be surprised to see it at Wal-Mart next year for 15 cents a pill. That's pretty cheap. But what if it doesn't work for you?
Sometimes, Claritin/Alavert/loratadine is just not strong enough for a patient's allergies. As a matter of fact, the New York Times did a fascinating exposition of Claritin a couple years back showing that it was BARELY more effective than placebo (a sugar pill used as a negative control in a clinical trial). Will two Alaverts work better than one? Sometimes. But what scares me a little is that this 'non-sedating' medicine is no longer 'non-sedating' at 20 mg. I wish it specifically said that on the label.
It's such a big deal to have a 'non-sedating' antihistmine out there without a prescription, but why? We've all seen 'non-drowsy' allergy medicines in the pharmacy. Well, look closely--all those 'non-drowsy' allergy medicines before loratadine had NO ANTIHISTAMINE in them! There are lots of nomenclature games--'non drowsy Benadryl' that contains no Benadryl (diphenhydramine), etc. But it's a big deal because this is all many folks need to keep from going to the doctor. Going to the doctor is time consuming and expensive. And frankly, as an allergist, if all you need is Claritin, then you really don't need me.
The cost of Alavert greatly depends on how big a box you choose. The box of six costs almost $1.00 a pill. But when you go for 48 pills, the cost comes down to almost $0.50 each. And, be sure to go to www.alavert.com and print out the $4.00 coupon that is good on boxes of 12 and larger. If you're on the prescription variety of Allegra, Clarinex or Zyrtec, don't be afraid to ask your doctor for free samples. Clarinex has also inundated my office with free 7 day prescription coupons. And www.allegra.com and www.zyrtec.com have $10.00 rebates to help offset the increased out of pocket costs.
What should YOU do if your insurance no longer covers your Allegra or Zyrtec, with or without a letter from your doctor, now that Claritin/Alavert is OTC. Actually, you have several options: One, ask your doctor is a nasal steroid would be a good choice. These drugs, like Flonase, Nasacort, Rhinocort and Nasonex, are so good that allergy practice parameters call them the Drugs of Choice for Allergic Rhinitis (Hay Fever). If you hate the funky smell of Flonase, Beconase, Vancenase or Nasonex that your doctor tried you on last year, try Nasacort or Rhinocort. Neither of those two has phenylethylalcohol, the preservative that smells like the flowers in a funeral parlor. Another choice that your insurance may cover is Astelin. Astelin is a nose spray, but it's not a steroid. It's actually an anti-histamine. For some reason, insurance companies haven't limited its coverage nearly as much as they have Allegra, Clarinex or Zyrtec. And what if the thought of sticking something up your nose totally grosses you out? New for allergic rhinitis this year is Singulair. Singulair is an anti-leukotriene. That's another chemical that the body releases, like histamine, during the allergic reaction. Singulair has been FDA-approved for several years for asthma, but just got permission to market itself for rhinitis (hay fever). My experience is that it's quite good for stuffy nose, but not so hot for itching or sneezing.
Remember a couple other things, too. If you're allergic, avoiding what you're allergic to is still the best advice. Many web sites give great advice for this. I like the American Academy of Allergy's site (www.aaaai.org), the American College of Allergy's (allergy.mcg.edu) and my clinic's site (www.theallergyclinic.net) <I should like my site--I set it up> I also really like Mission Allergy's site (www.missionallergy.com) for a no nonsense approach to avoiding what you're allergic to. Also remember that it often takes more than just one pill to relieve all of your symptoms. Sometimes we put a patient on a combination of nasal steroids, antihistamines and decongestants before we see relief.
Lastly, keep in mind that any of these medications you take will, in a best-case scenario, relieve or prevent your symptoms. That right, they treat symptoms. The day you stop taking them, the symptoms can return. For permanent relief of allergies, only allergy shots have been shown to work. Allergy shots work by teaching your body to tolerate what you're allergic to. They're expensive, and they don't work for everyone; but when they work, you can usually scratch Alavert right off your shopping list.
I hope that helps, and I look forward to feedback on my long-winded review.
Active Ingredient: Loratadine 10 mg/tablet
Inactive Ingredients: Artificial & Natural Flavor, Aprartame, Citric Acid, Colloidal Silicon Dioxide, Corn Syrup Solids, Crospovidone, Magnesium Stearate, Mannitol, Microcrystalline Cellulose, Modified Food Starch, Sodium Bicarbonate