Allergy meds help reader sleep better

DEAR DR. ROACH: I’m a 58-year-old male with seasonal allergies. I often take the generic versions of Zyrtec and Claritin to deal with the symptoms. While neither of those makes me drowsy, I do sleep much better — usually longer, and I don’t wake up in the middle of the night after taking either of these medications. This is more pronounced with Zyrtec than with Claritin.

Since I sometimes don’t sleep very well, I find myself taking these drugs more often than needed.

I wonder if this is something I should discontinue. Am I sleeping longer because my sleep is less restful, similar to the effect alcohol has on sleep?

I also read an article last year that indicated another allergy medication, Benadryl, was linked to an increased risk of dementia. Are there any similar concerns with these allergy medications?

— K.S.

ANSWER: A 2019 study linked several commonly used drugs, including diphenhydramine (Benadryl), with dementia, when used long term.

It was thought to be a property called the “anti-cholinergic” effect that was linked with dementia.

While it remains unclear whether these drugs truly increase the risk of dementia or whether they are commonly used by people with early symptoms of dementia, many physicians, including myself, think twice now about prescribing these medications long term.

Fortunately, neither cetirizine (Zyrtec) nor loratadine (Claritin) are anticholinergic.

Claritin can’t even get into the brain, due to a system called the blood-brain barrier, so is very safe from both dementia and drowsiness.

Zyrtec can get into the brain and causes drowsiness in a minority of people, and in my experience, far fewer than diphenhydramine does.

Since your better sleep seems to occur even with Claritin, I suspect it may be successful treatment of the allergy symptoms, perhaps making it easier to breathe at night, that is responsible for the longer sleep, and would not recommend you change as long as you are feeling well rested in the morning.

I would choose either Zyrtec or Claritin rather than switching.

DEAR DR. ROACH: I had a left hip replacement five years ago. I had severely reduced range of movement and pain. I have not been happy with the results of the first replacement. I walk daily, but some days I can hardly lift my left leg. The right hip now is bone on bone, according to X-rays. It does not cause me any pain or loss of movement.

Two doctors have recommended replacement of my right hip. Will delaying the replacement of the hip and the continued bone on bone movement cause more damage, or can I continue to hold off on the surgery until the pain becomes worse?

ANSWER: Most people are very satisfied with the results of their joint replacement surgeries, both knee and hip.

Over 90% of patients continue to work, and have no pain or complications 15 years postoperatively, but that leaves some people with worse outcomes.

Delaying surgery does not make surgery appreciably more difficult.

However, the most common feedback I get from my patients who have undergone

hip replacement surgery is that they wish they had had it done sooner.

Almost 60% of hip replacements last 25 years. A less than perfect result on one side does not necessarily mean you will have a bad outcome on the second side as well.

DEAR DR. ROACH: I’m 83 years old, and had two stents inserted in my left artery. I have been on atorvastatin, atenolol and amlodipine. At my recent yearly cardiologist visit, my blood pressure and cholesterol were fine.

Your response in a recent column seemed to suggest that atorvastatin should be stopped at 85 years old. Is that true?

— M.C.M.

ANSWER: Statin-type drugs can be given for primary prevention — that is, when a person has no known illness and the doctor wants to prevent the first heart attack — or for secondary prevention, when a person is known to have blockages in the artery and may (or may not) have had a heart attack.

In the case of secondary prevention, the benefits from statin therapy are so great that it is appropriate to give them, even to the oldest patients, except in the cases where there has been a conscious decision to stop treatment (for example, in people with untreatable cancers who choose to do so).

The benefits outweigh the small risks of statins, even though those risks may increase with advancing age.

By contrast, the benefits of statin drugs in primary prevention are smaller, and the potential risks are similar to or exceed potential benefits as people get older.

There is no specific age cutoff when this happens, but most people 85 and older do not get a net benefit from statins when they do not already have a diagnosis of blockages in the arteries or history of heart attack.

Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, Fla., U.S.A., 32803.