When To Take Clariton And Zantac

[kclynn]

Still working on trying to get my son's pots symptoms stabilized, and that is going pretty good. I am believe he has a mast cell component to this and both his GP and pots Dr. agree. He flushes, massive sweating episodes, rashes that come and go and big red welts when you lightly scratch his skin, digestive issues which I know could be pots or mast cell. We will get it all addressed but the Drs. want to go slowly in adding meds. Right now as I said his symptoms are steadily improving and even his sweating and other symptoms have become less frequent.

He has been taking zyrtek but GP felt clariton or allegra was better for him. Zyrtek apparently can make some people irritable and with my son's adrenaline and other stuff we don't need that. She also said to add Zantac. I see some people alternating and was wondering if there was a prefered time to take these. He has been taking Clariton in the morning and Zantac at night for the last few days.

Also, I used the brand names but we take the generic. Are they just as effective if he doesn't have any reactions to them?

[Godsgal]

I say if he has found something that is making him better and he's not reacting....don't mess with it! I've had SUCH difficulty with that lately....trying to find something that will actually help and not hurt. I wish you could get in to see a mast cell person. I was just diagnosed with a skin biopsy. I am still amazed at the amount of meds people with mast cell problems take. And if that is the case for him, then a mast cell specialist will help him so much. Has he had a 24 hour urine methyllhistamine test? That would help in a diagnosis. I know that a lot of the mast cell people I know take claritin in the morning and at night. In fact, that is what Dr. Afrin suggested I do...10 mg in the morning and 10 mg at night. If this is helping him, ask his doctors if he can add in an extra one at night. Same with the zantac...to take one in the morning and one at night. On the mast cell forums it would shock you the amounts these people are recommended to take by the mast cell experts!!! You can get an idea by looking at Sarah4 and Mack's Mom's meds. But I will tell you the box says not to and no pharmacist will approve it. Plus my doctors who know nothing about mast cell issues were hesitant until they spoke directly to Dr. Afrin himself. Where are you located? Maybe there is a mast cell doc he can see. But first some of the testing would be great for him to have done to confirm if he has this. The urine test would help, a serum tryptase level (blood test), and others maybe depending on those come up. Just thought I'd mention those just in case.

And you mentioned store brands......if he's taking one he tolerates, I wouldn't change it because the ingredients, fillers, etc. are different sometimes when you change brands.

So glad though he seems to be responding positively to these meds!

Take care and prayers for your son,

Jared

[juliegee]

kcmom-

You could be describing my son! The answer will be trial and error- whatever works for him. My son's docs at Hopkins agree that he may have a mast cell component as well. Mack takes generic claritin and zantac. He reacts with extreme drowsiness to even the non-drowsy H-1's so he takes the claritin at night. (BTW. zyrtec was way too sedating for him.) He takes the zantac in the middle of the day. What ultimately ends up being most important is the consistency of usage so the doses are always fairly level. Try one first and wait a few days to gage his response, then add the other. It helps to know which med is causes which side effect and/or benefit.

All the Best-

Julie

[ramakentesh]

This is some scary stuff. Diagnosis by internet...

[juliegee]

My son's treatment plan comes from Johns Hopkins- I am not DXing him. I am simply sharing WHEN he takes his meds. Obviously, EVERYTHING we do should be overseen or approved by a doc. Looks like KC's plan is overseen by his GP... What am I missing?

[kclynn]

Ram, not at all. I said two Dr. had said my son probably has some mast cell involvement - we are working on stabilizing the POTS symptoms. They don't want to add too much too soon, as it should be otherwise you don't know what is working or making things worse. His Dr. suggested starting with the Clariton and Zantac. No harm in asking many others who have taken the meds WHEN they take them.

I see the purpose of the forum to exchange information and then discuss that with your Dr. How many people learned about pots symptoms, then went to their Dr. and were finally diagnosed? Also important to weigh who the information is coming from. Certainly if I started advising people on Mast Cell issues based on things I have read, you all should move on pretty quickly But is those who have seen Drs. who are known specialists would certainly have a bit more knowledge to share.

The whole point is to discover what to ask your Dr. about, isn't it? That is what I always thought.

Oh, and Jared's post talked strongly about seeing a specialist and getting diagnosed and never encouraged us to change or add anything (in fact she said don't change) and neither did Julie's and I thank them both for what they did share. Jared suggested some non invasive testing he might have.

Where did you read and diagnosis by internet? I think your post was a bit inflammatory.

[Noreen]

Thanks for the info on zyrtec sometimes being at the root of irritability and tiredness. I took my 15 yo autistic son to urgent care last month for an anaphylaxis episode - he said he couldn't breathe and so off we went for a shot of steroids. There had been no exposure to anything different. The end result was to add an H-2 to his zyrtec. His primary prescribed prilosec.

His autism presents with irritability and he has hypersomnolence (11 to 15 hrs per night) of unknown origin (nothing to put your finger on on sleep studies) so having a clue to switch back to claritin and when to time the meds is extremely valuable info.

Earlier this month he went in with a sore throat and saw a NP. He had developed an outbreak of his strange rashes and I finally had medical confirmation (hey if they don't see it it doesn't exist). This rash had developed between leaving the house and his sitting opposite me in the exam room - about 45 min. As the nurse took his vitals(bp 90/50 sitting) , she asked about it and I also told her about the dermographia and wrote Hi on his back. When the NP came in she checked him asked about the rash and I rashed his shirt to demonstrate the dermographia but the Hi was still there after the 5 to 7 minutes since the nurse had left. So we were left with it being noted in his file.

Now I can't predict when the rashes will appear so seeing a derm seems problematic. BTW, allergy testing showed nothing.

His psychiatrist noted the episodes but thought I had a handle on it (???) meaning I had knowledge of mast cell activation disorder. Frustrating in the extreme since she is an autism psych so should know that there is a tenfold incidence of autism in the mast cell population.

I am unsure whether claritin would control his seasonal allergy symptoms but would requesting opinions on whether the best trial would be claritin twice a day along with the rx prilosec or claritin in the AM and zyrtec at night.

Thanks for any insight you can share.

noreen

[kclynn]

Noreen,

In general his primary likes Zyrtek as first line recommendation. With my son's irritability and adrenaline issues she thought we should switch to Clariton OR Allegra. Couldn't find the allegra in generic so went with the generic Clariton. I had the same question about timing. I guess it would be good to know how long Zantac stays in the system. Maybe it would be good to give a half dose AM and PM. I know the Clariton is supposed to be 24 hours.

[juliegee]

Noreen-

A couple of things pop out at me from your post. First, prilosec is not an H-2. It is an PPI. If the doc was trying to hit the H-1/H-2 combo, zantac or ranitidine would fit the bill. Sorry to hear about the anaphylaxis- very scary. Happened to Mack once too.

Second, this might sound crazy, BUT has your son ever had his serum tryptase level tested? This is something that his GP can order. For the most part, it rules mastocytosis in or out. There have been several studies lately that are linking autism with mastocytosis: http://www.wickedlocal.com/brookline/news/x160320501/Brookline-doctor-seeks-autism-breakthrough#axzz1N6HpQ0Cm Given your son's symptoms, especially dermatographism, and episode of idiopathic anaphylaxis, it would probably be a good idea. In the event that his serum tryptase is normal, many docs would rule out mastocytosis and stop further exploration. At that point, It probably wouldn't hurt for your son to see a mast cell specialist to further look into MCAD. What part of the country do you live in? I might be able to recommend a specialist.

Regarding the insomnia, what medications is he currently on? I ask because sometimes children/teens have reactions opposite to what is typically expected. For instance, when my son's docs decided to up his lexapro, he literally didn't sleep at all for a few nights. We finally figured out that lexapro at night was wiring him. Dr. Rowe decided to harness that much needed energy and switched the timing of that med to AM. It worked like a charm. Mack had more vitality during the day & he was finally able to sleep at night.

If your son has seasonal allergies, is his doc actually recommending antihistamines twice a day OR are you just trying to better control his symptoms? With mast cell disorders antihistamines twice a day are pretty much standard. Claritin (loratidine) is usually great for day time even in sensitive teens. How does your guy do with benadryl for night? Maybe try 1/2 the normal dose to start. It may calm allergy symptoms and make him drowsy w/o the restlessness. Wonder if you could cut the zyrtec in half based on that same principle? Dr. Rowe also tried a liquid cyproheptadine for Mack at night. It is VERY sedating, but maybe just a tiny amount would do the trick & liquid is easier to dose with.

Forgive me for not responding sooner. I read your post and hesitated as I was unsure of your son's current meds and how they play into everything AND I was nervous to share my ideas due to recent criticism. Out of curiosity, how affected is he by his autism? How does it present?

For the record, I am not a doctor, I just play one on this forum Seriously, I'm just sharing my ideas based on mine & my family's experiences. Be sure to run everything by his doctor.

All the best-

Julie

[hilbiligrl]

wow you guys, i had no idea zyrtec caused irritability. I have always noticed when taking my mcad 'regimen' that includes the zyrtec that i have anger out of no where and alot of irritability and this has never been my norm. I just asked a question regarding these meds, but didnt see this post. Glad i read it, cuz i think i'll try claritin or allegra from now on. You guys have the best advice! And i didnt realize i could take this stuff at night.... i've been taking my zantac and zyrtec at 8 am every morning.... but having bad bad insatiable hunger all day long that has made me gain some poundage in a short period of time.

Glad i read this post.... thanks gals.... and good luck with your all's sons.

tennille

[juliegee]

Hey Tennille-

Good to see you posting . Zyrtec does not typically cause irritability. Apparently it can in some susseptible folks. I think they react in a paradoxical manner to how a patient would typically react. For instance, when I used to give my son benadryl (as a toddler) when he had a cold, instead of becoming drowsy, he'd be up all night jumping on his bed I learned that 3/4 of the recommended dose had the desired effect. Zyrtec typically makes a patient a slightly fatigued (more so for some), but the paradoxical reaction might be irritability or insomnia. I wonder if a slightly lower dose would work? OR, you are absolutely right- experiment with claritin or allegra or their generics to see what works. And, YEAH- all H-1's are appetite stimulants Mess around & see if other types affect you as strongly. I have to watch my diet & exercise to NOT gain weight- it *****. Doxepin was the worst for me.

Julie

[Noreen]

Julie-

My son's issue is sleeping too much (hypersomnolence) not insomnia. He needs 11 to 15 hrs of sleep and trying to wake him is like going into a grizzly's cage.

I had him on OTC zantac prior to seeing the nurse practitioner and mentioned that urgent care had recommended an H1 and H2. Oh well moving on. I think I will move his zyrtec to night and switch back to zantac.

[juliegee]

Reen- Sorry, gotcha. HYPER-somnolence. That changes things . Have you noticed that zyrtec knocks him out? It had that effect on Mack- even when taken at night. He was unable to fully wake up until late in the afternoon following PM ingestion. That's why he switched to claritin at night. Still helps with flushing, sweating, etc; but he can wake up the next morning & go to school. If your son needs a 2nd dose and isn't experiencing sleepiness with the claritin, he could try another in the AM. I doubt if the zyrtec is causing irritability if he's sleeping so well, BUT switching to claritin might help sort that out. Yeah, zantac is an H-2. He can take that anytime of day just as long as he's consistent.

Mack's had marathon sleep sessions too- big part of his problem. He always slept after school exhausted from the effort of being there & when I tried to awaken him 3-4 hours later, he said it felt like he was coming out of general anesthesia AND his bed & clothing were soaking wet. Weird.