Iam Wondering What Time I Should Take

[carinara]

I just wonder what time i should take my 5mg zyrtek? Does it stay in our body for 24 hours? My doctor told me to take it sometime in the afternoon but i don't know if that makes sense because i go to work and really need to function between 8-5 on Mondays and 8-1 Tuesdays to Fridays. If i take the zyrtek in the afternoon will it be still be in my system the next day?

Thank you for your help.

Carinara

[juliegee]

Carinara,

Zyrtec was designed to be a non-sedating antihistamine. It doesn't make me sleepy at all, but note how it affects you. If you are like most folks, you should take it in the AM. Your dose is really low- 10mg is a standard adult dose. If you notice a benefit, I would consider also taking an OTC benadryl in the PM. I did that for years. The benadryl will make you sleepy & offer you H-1 protection through the night.

If you think the zyrtec is helping....you may want to talk to your doc about adding an H-2, like ranitidine or zantac. And, an anti-leuketreine, like singulair.

Hope you are feeling better-

Julie

[carinara]

Hi Julie, thank you for your respond. Can you please explain to me why i should ask my doctor for a an H-2, . And, an anti-leuketreine? How would it benefit me? since 5mg zyrtek is considered a tiny dose, would it be ok to take 5mg in the morning and 5mg in the evening?

thanks again for your help.

carinara

[juliegee]

Hi Julie, thank you for your respond. Can you please explain to me why i should ask my doctor for a an H-2, . And, an anti-leuketreine? How would it benefit me? since 5mg zyrtek is considered a tiny dose, would it be ok to take 5mg in the morning and 5mg in the evening?

thanks again for your help.

carinara

Sure, a 5mg zyrtec in the AM and PM is a good idea. Carefully note how this makes you feel. Do you see improvement with the H-1? If so, that combined with many of your new symptoms (I read your "shrimp" post) may indicate that your allergy-type symptoms are worsening your autonomic issues.

You may have undetected, underlying allergies that are worsening autonomic dysfunction OR your mast cells may be extremely reactive since your allergic reaction. In either case, the H-2 and anti-leuketreine will help settle things down.

Without an H-2, I have horrible GERD and hives. Without singulair, I often have a heavy chest and trouble breathing. I don't have asthma or allergies, but a condition called MCAD in which my mast cells overreact. When this happens, my autonomic symptoms are awful.

I hope this helps. Talk to your doctor before making any changes.

Julie

[Broken_Shell]

Hi Carinara,

Like Julie said, the newer anti-histamines like Zyrtec should not make you drowsy. Since everyone responds to things differently, you might want to take the first couple of doses in the early evening once you are home from work. Let us know how it goes!

Good Luck, Broken_Shell

[iheartcats]

I've taken Zyrtec for years...before that Claritin for years...and before that Allegra for years. This was long before POTS, even...POTS has just made my allergies worse OR I am more histamine sensitive possibly? I'm not sure. But I now have hives often from various things that make no sense and are very uncomfortable so I take Zantac too.

I take 10mg Zyrtec at night and 150mg Zantac at night, and am allowed the occasional Benadryl for a bad hive outbreak, especially when I notice any issues with breathing.

Maybe you can see an Allergist? 10mg of Zyrtec is a standard dose and it doesn't make me tired and I've not had any problems with it. I'm sure my allergies would be much worse without it! I hope you can see someone you can discuss your POTS + Allergies with. I think we have symptoms that aren't completely normal.

[carinara]

I cant thank you all enough for sharing your experiences and wisdom with me. This forum is a god send for me. You are all the best doctors i have met so far.

It feels as if the zyrtek is helping me. I felt a little better the last few days. Since i cant get in touch with my doctor next week, i decided to keep taking the 5mg zyrtek in the evenings and in case of an "emegency" another 5mg. I read somewhere that Histamin and Adrenalin are related. I wonder now, if all the intensive "surges" i experienced at my worsed in 2004, 2007 and last sunday were due to high Histamin levels. I always used to describe them as if there are 10 litres of pure adrenalin running through my system making my body go highwire. How do you know if the "surge" is due to too much histamine or due to too much adrenalin? If Histamine triggers the Adrenalin production, then i figured that an Antihistamine would also help with them so called "Adrenalin surges" . Last sunday when i ate the prawns i knew 100% that they were causing my "surge". 2 days later i ate some dried cranberries at work and 5 minutes later i experienced another big "surge" . I took 5mg of zyrtek and felt better soon after taking it. Before last sunday (when i found out about Histamine) i would have taken an extra Betablocker to calm my HR down in them sort of situation. But out of my experience i remember that the Betablocker didnt always work in them sort of situation in the past. So how do you know when to take an extra Betablocker and when an Antihistamin? Do you know how Adrenalin and Histamin are related?

Carinara

[mkoven]

Several years ago I has having serious allergic-type reactions to almost anything I would eat that then triggered autonomic reactions. My local docs put me on prednisone, which was a nightmare. I saw a specialized allergist in Chicago, who put me on a mega-dose of antihistamines:

20mgs zyrtec, plus 360 mgs fexofenadine (allegra), plus singulair, plus 50mgs benadryl for breakthrough reactions. It worked and I tapered off after several weeks. It's just to say that, under supervision, for most people, high doses of antihistamines are usually safe.

Histamine isn't the whole story of my autonomic problems, but it's in there and has been my whole life, before getting pots/nmh.

I now regularly take 180 allegra, 10 singulair, with 25-50 benadryl for breakthrough. I also have an epipen, but I've never had to use it.

[Broken_Shell]

So how do you know when to take an extra Betablocker and when an Antihistamin? Do you know how Adrenalin and Histamin are related?

Carinara

Hi Carinara,

Without knowing your symptoms and if you can relate them to a certain trigger, I will send my few thoughts on your question...

An adrenaline surge will cause your heart to speed up inappropriately. Histamine on the other hand is a vasodilator, so it dilates your blood vessels and drops your blood pressure, so your body releases adrenaline to speed up your heart in order to compensate. Well, this is what happened in someone with a working autonomic nervous system... which we don't have! If you have other "histamine" type symptoms like flushing, itching, nasal and eye congestion, or if you have a low BP, then the cause may be histamine rather than a primary adrenaline surge that isn't occuring as a reaction to exess histamine production. The best thing is probably to try one medication, and if it doesn't help then try the other. Maybe try the Zyrtec first sometimes and the beta-blocker first other times when you have the same symptoms and see if one is more helpful. You might need both medications anyways though. I hope that helps some at least. Good luck!

~ Broken_Shell

[juliegee]

"An adrenaline surge will cause your heart to speed up inappropriately. Histamine on the other hand is a vasodilator, so it dilates your blood vessels and drops your blood pressure, so your body releases adrenaline to speed up your heart in order to compensate. Well, this is what happened in someone with a working autonomic nervous system... which we don't have! If you have other "histamine" type symptoms like flushing, itching, nasal and eye congestion, or if you have a low BP, then the cause may be histamine rather than a primary adrenaline surge that isn't occuring as a reaction to exess histamine production. The best thing is probably to try one medication, and if it doesn't help then try the other. Maybe try the Zyrtec first sometimes and the beta-blocker first other times when you have the same symptoms and see if one is more helpful. You might need both medications anyways though. I hope that helps some at least. Good luck!"

~ Broken_Shell

Great explanation, Broken Shell. I just wanted to add one complicating factor. The increased HR during an allergic reaction (histamine surge) CAN cause the BP to raise before it ultimately drops. Some patients spend extended periods with high HR, and high BP making the differentiation between an adrenaline surge or histamine issue more difficult. Looking for other histamine-type symptoms like....flushing, difficulty breathing, chest or throat tightness, hives, etc, around the same time as the tachy is an excellent suggestion.

Carinara, I notice your BP's are pretty high. Have beta blockers been a staple in your treatment regimen? You've found them to be generally helpful? I ask, because in MCAD- beta blockers are contraindicated. They can worsen allergy-type symptoms, including the autonomic ones. That's definately something to discuss with your doc.

Best of luck in sorting things out. I still think your zyrtec dose is very low and if you are getting benefit from it, I would consider at least raising your dose to a standard adult dose to see if the beneficial effect remains and, hopefully, improves. (I take the equivalent of 35mg of zyrtec daily.)

Julie

[carinara]

I have been taking my Betablockers for 5 years now. My BP is always on the higher side and nothing not even dieretics (which i got prescribed prior to my POTS Diagnosis and wich dilate bloodvessels) caused my BP to come down. So the dropping in BP is nothing i can look for to find out if its an Histamin "surge". But since last sunday i can definately say that the "hot face" thing and the tightness in my chest and breathin difficulties are back. These symptoms were with me in 2004 and 2007 when i was at my worse, so these must be an indication of the Histamin overload. Julie i think you are right by suggesting to higher my zyrtek dosis. Surprisingly i felt ok this morning, it changed again about 5 minutes after i ate something for lunch. The hot face plus a headache were there straight away, i took an extra 5mg. 30 minutes later the hot face and headache were gone but i got the chills instead. My doctor doesnt know much about POTS or MCAD so she isnt really somebody i can talk to. Over the past years i always felt that the Betablockers are helping me. I guess since i always took them, even when i was at my worsed, that i should carry on taking them. I saw 2 POTS specialists in the past 2 years and they both told me to definately take my Betablocker when i mentioned MCAD to them (because i read about it on Dinet), they didnt want to get into that. I dont know how to go about this Histamin, Mcad or allergie thing at the moment. Nobody seem to know anything about it. I guess my doctor will tell me to keep taking the zyrtek if it helps. But i probably never get an explanation or another diagnosis because remember, i have to teach my doctor. Is it really necessary to look further into getting a new diagnosis? or should i just take the antihistamin if it helps without questioning why? Like i mentioned before, these added symptoms only seem to show up every 2 - 3 years. In between they are totally gone.

carinara

[juliegee]

I have been taking my Betablockers for 5 years now. My BP is always on the higher side and nothing not even dieretics (which i got prescribed prior to my POTS Diagnosis and wich dilate bloodvessels) caused my BP to come down. So the dropping in BP is nothing i can look for to find out if its an Histamin "surge". But since last sunday i can definately say that the "hot face" thing and the tightness in my chest and breathin difficulties are back. These symptoms were with me in 2004 and 2007 when i was at my worse, so these must be an indication of the Histamin overload. Julie i think you are right by suggesting to higher my zyrtek dosis. Surprisingly i felt ok this morning, it changed again about 5 minutes after i ate something for lunch. The hot face plus a headache were there straight away, i took an extra 5mg. 30 minutes later the hot face and headache were gone but i got the chills instead. My doctor doesnt know much about POTS or MCAD so she isnt really somebody i can talk to. Over the past years i always felt that the Betablockers are helping me. I guess since i always took them, even when i was at my worsed, that i should carry on taking them. I saw 2 POTS specialists in the past 2 years and they both told me to definately take my Betablocker when i mentioned MCAD to them (because i read about it on Dinet), they didnt want to get into that. I dont know how to go about this Histamin, Mcad or allergie thing at the moment. Nobody seem to know anything about it. I guess my doctor will tell me to keep taking the zyrtek if it helps. But i probably never get an explanation or another diagnosis because remember, i have to teach my doctor. Is it really necessary to look further into getting a new diagnosis? or should i just take the antihistamin if it helps without questioning why? Like i mentioned before, these added symptoms only seem to show up every 2 - 3 years. In between they are totally gone.

carinara

Sounds like an allergy/MCAD thing is to blame for your worsening symptoms simply based on how you are reacting to the zyrtec. BTW, I get a headache too when my symptoms are bad, sometimes every day.

As far as seeking a DX, it's certainly preferable for a few reasons. ONE, if you are dealing with MCAD, beta blockers may be worsening things (BUT DON"T STOP TAKING THEM without a doctor's oversight!) And, if your allergy things progressed to anaphylaxis, the epi-pen won't work as well with the beta blockers in your system. TWO, there is an emergency protocol for the ER and a pre-surgery/procedure protocol for MCAD patients. Look at: www.tmsforacure.org for those protocols. It is The Mastocytosis Society Website. There is also an international forum/list-serve there where you may find more help.

I think you are in Germany. I know I've mentioned Prof. Molderings to you before. He is a German masto researcher who is a big advocate for MCAD patients. If you could print out some of his articles and bring them to your doctor.

All the best-

Julie

[carinara]

Hi Julie,

yes you mentioned Dr. Molderings to me before. I contacted him via Email and he was very friendly, but he told me that he is not seing any patients. He mailed me a few informations which i already took to my doctor about 3 months ago. BAck then i didnt have any symptoms yet but i just wanted to look into every opportunatey to find out as much as i can about what makes me feel worse every other year.

My doctor has got no time to read it all through and its all so very complicated. She took my tryptase but they came back ok. I dont know what to do now. Maybe i try to talk to my doctor again. But i know whe wont have time to get deep into it.

Well since i have experienced these bad "surges" so many times in the past 10 years and nothing happened. I figure iam quiet safe now with the zyrtek. I take only a tiny dosis of Betablocker anyway.

I dont want to get worried and panicky about anaphylaxis. I really hope that iam better prepared and safe then i have ever been with zyrtek now.

Thank you Julie, you and all the other ones are really a great help for me.

a big hug from carinara

[juliegee]

I'm sorry you can't see Dr. Molderings....but so glad you have info from him. I would study it yourself and learn, learn, learn. A normal serum tryptase level (in almost all cases) rules out mastocytosis, but not MCAD. And, as far as you know, you may be dealing with more typical allergic reactions to as of yet undetected triggers.

You are so right not to worry about anaphylaxis. You've never gotten there yet...and most likely never will!

Feel better-

Julie

[iheartcats]

I'm on a Beta Blocker and Zyrtec and carry an epi-pen (which I've never had to use).

I don't have Mastycytosis (they did that serum test) and the allergist I was working with thinks I do have some autoimmune issues with allergies/hives. But he never said MCAD and wasn't familiar with it.

My Beta Blocker helps so much (and I take a low dose) that I'm still on it...even though the epi-pen won't be as effective. My allergist felt fairly confident I'd likely not have to use the epi-pen since I've not had that extreme of a reaction yet so let's hope!

I think it's awful some of us have to juggle POTS with allergy/histamine issues because of contradictions. I'm seeing a new allergist this week so I'll let you know if I get any new insight on what I'm dealing with. I hope you can see an allergist, too, but it sounds like you're having a difficult time getting treated.

[juliegee]

Goes to show how different we all are! I certainly believe there is a group of patients that need a beta blocker and have serious allergy issues. BUT, in many with severe allergy, asthma, MCAD, etc.- beta blockers worsen symptoms. It's so important to pay close attention to how YOUR body responds to any new med (or lipstick)

Sounds silly, but even keeping a journal when starting a new med is a good idea. For instance, I hard a GREAT response to turmeric......but over a period of time my shoulders began BURNING like they were badly sunburned. Then one of my eyes began persistently twitching . Not until I stopped taking the turmeric, did those weird symptoms go away. THIS is also a very good reason that we should always add ONE new med at a time in a low dose and slowly work up to a more therapeutic one.

Julie

[Tammy]

Basically I take an antihistimine when I've eaten something that causes me to flare like things with MSG or other preservatives in them that causes my histamine activity to increease. Than Benedryl or something like that will help. If I haven't eaten anything, like right when I wake up in the mornings, I need my beta blocker because just getting up will get my adrenaline going. Hope that helps.

[iheartcats]

I agree - one new med at a time is key for those of us who are reactive.

I even only try one new product at a time (like lipstick!) I'm serious - after I had a bad outbreak of hives on my face that required cortisone cream my former dermatologist said only try one new product at a time (including face cream, sunscreen, etc). He said he sees a lot of reactions to fragrance in products, especially in higher end brands! So one new thing at a time is a good policy to follow.

I have read Beta Blockers make MCAD worse...and I feel BETTER on my Beta Blocker. My hives are no worse than they were pre-Beta Blocker (about the same, and still as random). So I personally feel it's likely not MCAD for me. Maybe histamine intolerance. Maybe just crazy ANS/Autoimmune stuff.

So if the Zyrtec is making you feel better - and you said you've been on Beta Blockers for a while - I'd discuss keeping on the 10mg Zyrtec dose for now. We really have to learn what makes us function (and my, personally, even if there is a slight increase of risk I need to live my life). Hang in there and let us know if you can see an Allergist!

Some things I think we'll never quite figure out. My former allergist said he sees this most frequently in women (tends to fit me, I guess):

Definition

By Mayo Clinic staff

Chronic hives, also known as urticaria, are batches of raised, red or white itchy welts (wheals) of various sizes that appear and disappear. While most cases of hives go away within a few weeks or less, for some people they are a long-term problem. Chronic hives are defined as hives that last more than six weeks or hives that go away, but recur frequently.

In most cases of chronic hives, a cause is never clearly identified. In some cases, chronic hives may be related to an underlying autoimmune disorder, such as thyroid disease or lupus.

While the underlying cause of chronic hives is usually not identified, treatment can help with symptoms. For many people, antihistamine medications provide the best relief.

[carinara]

Hello everybody, i just want to give you a little update on whats going on with me. I do feel that the 5mg cyrtec help me. I honestly think that i would feel even worse if i didnt take it. I only had one big surge right after i ate dried cranberries 3 days ago. After i took another 5mg cyrtek i felt better soon. Overall my POTS Symptoms are worse since i ate the shrimps 1,5 weeks ago. My BP is higher and i cant hardly stand up at times. Iam totally exhausted and tired and have many headaches, i also notice that on the days (like yesterday) when i feel more sick, i have to pee a lot more but i still believe that i would feel even worse without the antihistamin. Well i went to see my doctor yesterday. My BP in her office was 180/110. We talked and after i told her that i feel the cyrtec is helping me a bit, she told me to take 10mg. What she didnt know was when i should take it, she said that she doesnt know how long it will stay in my blood. She recommended to take 2 times 5mg daily. 5mg in the morning and 5mg in the evening for at least 2 weeks. If it makes me feel better she was thinking about adding and H2 Blocker and something else (i dont remember the name right now). What iam insecure about now is, When should i take the zyrtec? I read somewhere that its recommended to take it in the evenings because it would work in during the night so you have the effect of the antihistamin the next day, is this true? If it is , should i then take 10mg in the evenings instead of 2mg in the morning and 5mg in the evening? Iam also insecure about what time in the morning i should take it? I always take the evening dose around 7 o'clock. I had to take 5mg around 10 in the morning today because of a little flare. I take my BB at 5.45 in the morning and work starts at 8 o'clock. Any ideas on how i should take zyrtec? Once a day (10mg) or twice a day (2x5mg)? And at what times?

Thank you all 1000 times. Carinara

[Broken_Shell]

Hi Carinara,

Thank you for the update You seem to have a lot of concern about taking the anti-histamine during the day. Did you read this recommendation about Zyrtec or general anti-histamines? With the older anti-histamines you can experience a lot of side effects like drowsiness, dizziness, and dry mouth which can be difficult to manage during the day, but if you are not experiencing any side effects during the day when you take the Zyrtec, then there is no reason to worry about taking it then. You should take it at the dosages and times that seem to help your symptoms the most, which unfortunately means trial and error. I hope that helps. Let us know what you decide about the H2-Blocker.

~ Broken_Shell

[carinara]

Thanks for your replies and thoughts. Iam always very concerned when i have to start a new medication. Thats because i had so many bad experiences in the past and i dont want any kind of wrong medication leaving me bedridden again. Since i am a single mother and also have a job i am really concerned about not being able to go to work again for weeks or months because of serious reactions to medication that cause big flare ups POTS wise. Well all your replies helped me to have a good feeling towards cyrtec. The past 3 days i took 5mg around 10 o'clock in the morning and another 5mg around 7 o'clock in the evening. I do really believe that it is helping me, i honestly feel that i would be worse of if i wouldnt take it. My question now is. Do you guys know for how long i should take it now? My doctor said that i should try it out for 2 weeks and then (if it helps), she wants me to try out and H2 Blocker as well. So what is the plan behind it? What does the H2 Blocker do and isnt it better to stop the zyrtec and just see if i feel worse again? Maybe it was just a phase? and i dont need any antihistamin anymore after a few weeks? Like i mentioned before, i know that with my big flare ups in the past (roughly about every 3 years) i knew something was on top of my usual POTS. Maybe thats when i should use and Antihistamin in the future, but whats with the time in between? How long do you guys take it before you try out how you feel without it again?

[juliegee]

Hey Carinara-

I agree. I recommend all 10mg in the morning. It is a tiny dose and will protect you all day.(I also take my h-2 blocker in the AM and another H-1 in the evening.) I plan to take zyrtec, other H-1 blockers and my H-2 blocker for the rest of my life. I used to take it "as needed" and spent alot more time being sick and in the hospital. Since I've ben consistent, my health is a lot more stable.

I wish I didn't have to take so may drugs, but what can I do?

Let us know what you decide.

Julie

[carinara]

Hi Julie,

thanks for your reply. Please let me know why you recommend to take 10 mg in the morning instead of 5mg in the morning and 5 mg in the evening (as i do at the moment). Would it make any difference? Iam just asking because at times i do feel that zyrtec is making me a little tired and i figured that if i take 10mg in the morning i might be getting too tired at work and that would be a problem. Sorry for even more questions. carinara

[juliegee]

Hi Julie,

thanks for your reply. Please let me know why you recommend to take 10 mg in the morning instead of 5mg in the morning and 5 mg in the evening (as i do at the moment). Would it make any difference? Iam just asking because at times i do feel that zyrtec is making me a little tired and i figured that if i take 10mg in the morning i might be getting too tired at work and that would be a problem. Sorry for even more questions. carinara

Because 10mg is a standard adult dose. This is supposed to be a non-sedating antihistamine, but I respect that it might affect you differently. I am afraid that 5mg is just too low to be effective...

Try it once & see! If you feel noticeably better, maybe consider another H-1 at night, like OTC benadryl.

Julie

[potsgirl]

Carinara,

I think it all comes down to what works for YOU. My antihistamine puts me to sleep, so I take it at night. Sometimes if my allergies are bad, I'll take a 1/2 dose during the day. When they're really bad, I'll take a whole one after lunch, lay down, and get a good nap, too. Why don't you try what the doctor suggested and see how it works for you. I can only take small doses of meds, so I might even take 1/2 a pill during the day, and the rest (7.5) at night. Experiment, and you'll figure out the best course for your own body.

Cheers,

Jana