DEAR DR. ROACH: Should a person be concerned about serious side effects from long-term use of Claritin-D? My son has been using the medication continuously for about nine years. He has had allergy shots, which were minimally helpful. He cannot use nasal rinses or sprays because they cause nosebleeds. He does have some sleeping problems, but since he’s been taking Claritin-D for so long, it’s hard to tell if that medication is the cause. — M.S.

ANSWER: Claritin-D is a combination of the antihistamine loratadine and the decongestant pseudoephedrine. Loratadine is considered safe in most people. Pseudoephedrine is safe for younger people, but it can raise blood pressure and pulse, and in older men, can cause urinary symptoms. He might try plain Claritin, which is just the loratadine, and save the Claritin-D for his worst days. Less pseudoephedrine is probably better.

DEAR DR. ROACH: A recent visit to the doctor included some blood tests. I was concerned that the eGFR reading decreased by 23 points (from 93 to 69) in a year’s time. Both my cardiologist and my preferred care provider advised that since the reading of 69 was still in the safe zone, there is no reason to be concerned. I have had protein in my urine for years.

My concern is not that it is still acceptable, but that the rate of decrease indicates to me that something is going on with my kidneys. My creatinine level has risen steadily from 0.8 in January 2018 to 0.9 in March; 0.95 in August, and 1.1 in January 2019. Is my concern warranted? — D.L.L.

ANSWER: That’s a steady increase in creatinine, meaning a steady decrease in kidney function. Combined with the protein, I certainly would recommend you ask your doctor again about seeing a kidney specialist, a nephrologist. Your primary care doctor is right that the creatinine is still in the normal range, but the trend shows a 30 percent loss of kidney function in a year. That deserves an evaluation before the kidney function becomes worse. It is also appropriate to review any medications or supplements you might be taking. For example, if your cardiologist started you on an ACE inhibitor, a 25 percent apparent decrease in eGFR may be due to the medication affecting blood flow to the kidney.

DEAR DR. ROACH: I have been on hydrochlorothiazide for the past three weeks. Have you heard of vivid dreams associated with this medicine? I am having difficulty with it. — L.G.

ANSWER: Vivid dreams are not typically associated with hydrochlorothiazide. HCTZ does not cross the blood-brain barrier, so it wouldn’t be expected to have this effect. However, HCTZ often is given along with other medications that can have this effect, especially beta blockers, such as propranolol. If you are taking it as part of a combination drug, I would look at the other drug.