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Comment by im3w1l | Hacker News Reader

In the article they recommend using loratadine (Claritin). Is that insufficient as a replacement?

IMO, Claritin is only sufficient for minor sinus drip at the start of pollen season, for example. It does nothing for the significant draining during the height of allergy season and colds laugh at its feeble attempts to stop sinus drainage.

Of course, Claritin does nothing to help a stuffy nose. It's the wrong class of medicine. True pseudoephedrine (from behind the counter) is the go to for increasing drainage. The new stuff (OTC with phenylephrine) only works as well as a placebo.

The new stuff (OTC with phenylephrine) only works as well as a placebo.

That's going to depend on the person, at least as a nasal spray, for me at least it has a noticeable effect that I'm certain isn't placebo. Back when I took it, systemic oral pseudoephedrine (Sudafed) was noticeably better (stopped that route due to it exacerbating my anxiety).

Fortunately, there are nasal steroid sprays, and 2 of them are now OTC, and you can get a prescription for the azelastine antihistamine nasal spray (Astelin, Astepro), the latter ought to pose little risk to your brain. A combination of the two, with occasional very short courses of nasal spray phenylephrine (4 hour) or oxymetazoline (12 hour) curbed my rate of getting sinus infections from more than 1 a year to one every few years.

Oral phenylalanine has never done anything for me (24mg; no improvement or side-effects), even for relatively severe sinus infections. On the other hand, oral pseudoephedrine (120mg) is the closest thing to a miracle drug I have ever used - I go from being nauseated (from pain) every time I bend down to feeling somewhat OK (I suffer from near-constant headaches anyway, so difficult to really judge) in about twenty minutes.

Fortunately, it's still easy to get in the UK, and doesn't exacerbate my anxiety.

The 120 mg is the 12 hour sustained release formula, right?

I never tried that, in fact I'm pretty sure I stuck to the 30 mg immediate dosing version, which was useful but not quite a "miracle drug", then again I'm sure our sinuses are quite different. So I haven't really missed it, between the effect on anxiety, and much later living in a notorious area for meth, where my usual pharmacy is in a city where even dispensing of OTC versions requires a doctor's prescription.

If my doctors really wants to clear my sinuses while treating for an infection, they use a Medrol DosePak (serious steroid with a lot up front and then it quickly tapers), something my father is all to familiar with due to his poison ivy allergy and ability to get into the stuff.

> The 120 mg is the 12 hour sustained release formula, right?

It's two of the 60mg "Sudafed Decongestant" (UK Branding) tablets, which I don't believe are sustained release (typical/listed dose is 60mg - I confirmed with my GP that 120mg is fine FOR ME [do NOT take this as general advice] if taken infrequently). I generally only need a single dose during the day for my sinuses to stay clear enough to be manageable (and sinus infections are infrequent anyway), so the large upfront dose works for me and is well under the daily recommended maximum (240mg).

Loratadine is in a completely different drug class than pseudoephedrine, the article is recommending it as an alternative to Benadryl.

Loratadine and Benadryl are antihistamines, pseudoephedrine is a stimulant that has a decongestant affect.

There's Claritin branded combo pills that have Loratadine and a decongestant, but "Claritin" in normal conversation should probably be reserved for the one active ingredient Loratadine pills.

Claritin makes me feel weird, sort of light headed.

Back in the eighties in Seattle I would take a Benadryl every morning, because I was allergic to just about everything (I was poke tested). Eventually I downgraded to chlor-trimaton. So I guess I'm potentially doomed.

Here in Denver I rarely have allergy issues.

You could try looking into factors to actively reduce your risk. Exercise, eating healthy, and drink lots and lots of coffee. E.g. It's all poker and you're down on the pot but it just means you need to learn to play a different better hand. At least it's the approach I found to be beneficial.

It's certainly the only sane approach, I agree. It's like Lyle Lovett said, "You have to try ..."

My mention of doom is because I got the impression that the rise in risk (10%) was associated pretty hard with long term use, which I had, and distant past wasn't mentioned as a mitigation.

I dislike the way I feel on Claritin (I would call it a bit "fuzzy"). I've been taking Zyrtec lately without noticing any side effects.

Maybe try the other 2nd generation drugs next time you feel the need (Allegra is yet another compound)?

What about Zyrtec?

since loratadine is a second-generation histamin receptor blocker, probably not if you are looking for sedating effects, because minimizing those was the main reason for developing this class of drug.

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