Allergic r hinitis, perennial:
Infants 6 to <12 months: Oral: 2.5 mg once daily.
Children 12 to 23 months: Oral: Initial: 2.5 mg once daily; dosage may be increased to 2.5 mg twice daily.
Allergic symptoms, hay fever:
Children 2 to 5 years: Oral: Initial: 2.5 mg once daily; dosage may be increased to 2.5 mg twice daily or 5 mg once daily; maximum daily dose: 5 mg/day.
Children ≥6 years and Adolescents: Oral: 5 to 10 mg once daily.
Anaphylaxis; adjunctive for cutaneous symptoms: Limited data available (Ref): Note: Do not use for initial or sole treatment of anaphylaxis; H1 antihistamines are not effective for upper or lower airway obstruction or shock (Ref). If cutaneous symptoms persist, dose may be repeated in 24 hours (see Urticaria, acute dosing).
Infants ≥6 months and Children <2 years: Oral: 2.5 mg once.
Children 2 to 5 years: Oral 2.5 to 5 mg once.
Children >5 years and Adolescents: Oral: 5 to 10 mg once.
Urticaria, acute:
IV:
Infants ≥6 months to Children ≤5 years: 2.5 mg every 24 hours.
Children 6 to 11 years: 5 mg or 10 mg every 24 hours; reserve higher dose for more severe symptoms.
Children ≥12 years and Adolescents: 10 mg every 24 hours.
Oral: Limited data available (Ref):
Infants ≥6 months and Children <2 years: Oral: 2.5 mg once daily.
Children 2 to 5 years: Oral: 2.5 to 5 mg once daily.
Children >5 years and Adolescents: Oral: 5 to 10 mg once daily.
Urticaria, chronic spontaneous: Limited data available in Children >5 years and Adolescents. Note: Considered first-line therapy for management of chronic urticaria; if response inadequate after 2 to 4 weeks of therapy or symptoms intolerable, consider increasing the dose of cetirizine (as age and weight permits) as second-line treatment rather than changing therapy (Ref).
Infants 6 to <12 months: Oral: 2.5 mg once daily.
Infants ≥12 months and Children <2 years: Oral: Initial: 2.5 mg once daily; dosage may be increased to 2.5 mg twice daily.
Children 2 to 5 years: Oral: Initial: 2.5 mg once daily; dosage may be increased to 2.5 mg twice daily or 5 mg once daily; maximum daily dose: 5 mg/day.
Children 6 to 11 years: Oral: 5 mg once daily or twice daily (Ref).
Children ≥12 years and Adolescents: Oral: 10 mg once daily (Ref).
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
IV: Note: Has only been evaluated for acute indications (short-term therapy).
Infants ≥6 months and Children <6 years: Avoid use in patients with any degree of renal impairment; has not been studied.
Children ≥6 years and Adolescents: Moderate to severe impairment; end-stage renal disease on dialysis: No adjustment necessary; monitor for antihistamine side effects and adjust therapy if needed.
Oral: There are no dosage adjustments provided in the manufacturer's labeling; however, the following adjustments have been recommended (Ref):
Infants, Children, and Adolescents:
GFR ≥30 mL/minute/1.73 m2: No dosage adjustment necessary.
GFR 10 to 29 mL/minute/1.73 m2: Decrease dose by 50%.
GFR <10 mL/minute/1.73 m2: Not recommended.
Intermittent hemodialysis or peritoneal dialysis: Decrease dose by 50%.
IV: Note: Has only been evaluated for acute indications (short-term therapy).
Infants ≥6 months to Children <6 years: Avoid use with hepatic impairment; has not been studied.
Children ≥6 years and Adolescents: No dosage adjustment required; monitor for antihistamine side effects and adjust therapy if needed.
Oral: Infants ≥6 months, Children, and Adolescents: There are no dosage adjustments provided in manufacturer's labeling.
(For additional information see "Cetirizine (systemic): Drug information")
Allergic rhinitis or conjunctivitis: Oral: 10 mg once daily; alternatively, may be given as needed 2 to 5 hours before exposure to allergen, although this may be less effective than daily administration (Ref).
OTC labeling (patient-guided therapy for symptoms of hay fever or other upper respiratory allergies): 5 to 10 mg once daily (maximum: 10 mg/day).
Angioedema, acute allergic or recurrent idiopathic (off-label use): Note: Not indicated for angioedema with anaphylaxis; use epinephrine if anaphylaxis symptoms are present (ie, risk of airway or cardiovascular compromise is present) (Ref).
Oral: 10 mg once or twice daily; may increase up to 20 mg twice daily (Ref).
Infusion reaction, premedication (adjunct) (alternative agent) (off-label use): Note: Used in some protocols as an alternative to a sedating antihistamine (eg, diphenhydramine). An optimal premedication regimen has not been identified; refer to institutional protocols as variations exist (Ref).
Oral: 10 mg typically administered 30 to 60 minutes prior to infusion of certain chemotherapy agents or biologics; may be given with an H2 antihistamine (eg, ranitidine) and/or a glucocorticoid (Ref).
Urticaria, new onset and chronic spontaneous:
New onset:
Oral (off-label use): Initial: 10 mg once daily. If symptom control is inadequate, may immediately increase to 10 mg twice daily (Ref).
IV: 10 mg once daily as needed.
Chronic spontaneous:
Oral: Initial: 10 mg once daily. If symptom control is inadequate, may increase in increments of 10 mg/day every 1 to 4 weeks up to 20 mg twice daily. Periodically reevaluate necessity for continued treatment (Ref).
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
The renal dosing recommendations are based upon the best available evidence and clinical expertise. Senior Editorial Team: Bruce Mueller, PharmD, FCCP, FASN, FNKF; Jason A. Roberts, PhD, BPharm (Hons), B App Sc, FSHP, FISAC; Michael Heung, MD, MS.
IV: No dosage adjustment necessary (formulation only intended for short-term use).
Oral: Note: Renally adjusted dose recommendations are based on usual doses of 5 to 10 mg once daily.
Altered kidney function:
CrCl >31 mL/minute: No dosage adjustment necessary.
CrCl 11 to ≤31 mL/minute: 5 mg once daily.
CrCl ≤10 mL/minute: 5 mg once every 48 hours; may increase to 5 mg once daily based on tolerability and response for short-term use only (drug may accumulate with prolonged use at this dose (Ref)).
Hemodialysis, intermittent (thrice weekly): <10% dialyzable; 5 mg 3 times per week (Ref); may increase to 5 mg once daily based on tolerability and response for short-term use only (drug may accumulate with prolonged use at this dose (Ref)).
Peritoneal dialysis: Unlikely to be significantly dialyzed (Ref): 5 mg once every 48 hours; may increase to 5 mg once daily based on tolerability and response for short-term use only (drug may accumulate with prolonged use at this dose (Ref).
Mild to severe impairment: 5 mg once daily.
Cetirizine may cause CNS depression, including sedated state, drowsiness, and fatigue (Ref). There are rare reports of psychosis and delusion (Ref). In overdose in children, sedation is more likely to occur than with other second-generation antihistamines (Ref).
Mechanism: Dose-related; low brain uptake, binding to ~30% of H1 cerebral receptors (Ref).
Onset: May occur after 1 or 2 doses (Ref). Onset of psychosis has occurred 2 to 7 days after initiation of cetirizine (Ref).
Risk factors:
• Concurrent alcohol use (Ref)
• Older patients (Ref)
• More sedating than other second-generation antihistamines, including loratadine and fexofenadine, but less sedating than first-generation antihistamines such as diphenhydramine (Ref)
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
>10%: Nervous system: Drowsiness (adolescents and adults: 11% to 14%; children: 2% to 4%) (table 1) , headache (children: 14%; adults: <1%)
Drug (Cetirizine [Systemic]) |
Placebo |
Population |
Dose |
Number of Patients (Cetirizine [Systemic]) |
Number of Patients (Placebo) |
---|---|---|---|---|---|
4% |
1% |
Children |
10 mg |
215 |
309 |
2% |
1% |
Children |
5 mg |
161 |
309 |
14% |
6% |
Adolescents & adults |
5 mg or 10 mg |
2,034 |
1,612 |
14% |
6% |
Adolescents & adults |
10 mg |
N/A |
N/A |
11% |
6% |
Adolescents & adults |
5 mg |
N/A |
N/A |
1% to 10%:
Cardiovascular: Cardiac failure (<2%), chest pain (<2%), edema (<2%), facial edema (<2%), flushing (<2%), hypertension (<2%), lower extremity edema (<2%), palpitations (<2%), peripheral edema (<2%), syncope (<2%), tachycardia (<2%)
Dermatologic: Acne vulgaris (<2%), alopecia (<2%), bullous rash (<2%), cutaneous nodule (<2%), dermatitis (<2%), diaphoresis (<2%), eczema (<2%), erythematous rash (<2%), furunculosis (<2%), hyperkeratosis (<2%), hypertrichosis (<2%), maculopapular rash (<2%), pallor (<2%), pruritus (<2%), seborrhea (<2%), skin photosensitivity (<2%), skin rash (<2%), urticaria (<2%), xeroderma (<2%)
Endocrine & metabolic: Decreased libido (<2%), dehydration (<2%), diabetes mellitus (<2%), heavy menstrual bleeding (<2%), hot flash (<2%), increased thirst (<2%), intermenstrual bleeding (<2%), weight gain (<2%)
Gastrointestinal: Abdominal pain (children: 4% to 6%), ageusia (<2%), anorexia (<2%), aphthous stomatitis (<2%), constipation (<2%), dental caries (<2%), diarrhea (children: 2% to 3%), dysgeusia (<2%), dyspepsia (<2%), enlargement of abdomen (<2%), eructation (<2%), flatulence (<2%), gastritis (<2%), hemorrhoids (<2%), increased appetite (<2%), melena (<2%), nausea (children: 3%), sialorrhea (<2%), stomatitis (<2%), tongue discoloration (<2%), vomiting (children: 2% to 3%), xerostomia (adolescents and adults: 5%)
Genitourinary: Cystitis (<2%), dysmenorrhea (<2%), dysuria (<2%), hematuria (<2%), leukorrhea (<2%), mastalgia (<2%), urinary frequency (<2%), urinary incontinence (<2%), urinary retention (<2%), urinary tract infection (<2%), vaginitis (<2%)
Hematologic & oncologic: Hemophthalmos (<2%), lymphadenopathy (<2%), purpuric disease (<2%), rectal hemorrhage (<2%)
Hepatic: Hepatic insufficiency (<2%)
Hypersensitivity: Angioedema (<2%), tongue edema (<2%)
Nervous system: Abnormality in thinking (<2%), agitation (<2%), altered sense of smell (<2%), amnesia (<2%), anxiety (<2%), ataxia (<2%), confusion (<2%), depersonalization (<2%), depression (<2%), dizziness (adolescents and adults: 2%), emotional lability (<2%), euphoria (<2%), fatigue (4% to 6%) (table 2) , hyperesthesia (<2%), hypertonia (<2%), hypoesthesia (<2%), impaired concentration (<2%), insomnia (≤9%), malaise (≤4%), migraine (<2%), myasthenia (<2%), nervousness (<2%), nightmares (<2%), pain (<2%), paralysis (<2%), paresthesia (<2%), rigors (<2%), sleep disorder (<2%), twitching (<2%), vertigo (<2%), voice disorder (<2%)
Drug (Cetirizine [Systemic]) |
Placebo |
Population |
Dose |
Number of Patients (Cetirizine [Systemic]) |
Number of Patients (Placebo) |
---|---|---|---|---|---|
4% |
1% |
Children |
5 mg or 10 mg |
N/A |
N/A |
6% |
3% |
Adolescents & adults |
5 mg or 10 mg |
2,034 |
1,612 |
Neuromuscular & skeletal: Arthralgia (<2%), arthritis (<2%), asthenia (<2%), back pain (<2%), hyperkinetic muscle activity (<2%), lower limb cramp (<2%), myalgia (<2%), myelitis (<2%), osteoarthrosis (<2%), tremor (<2%)
Ophthalmic: Accommodation disturbance (<2%), blepharoptosis (<2%), blindness (<2%), conjunctivitis (<2%), eye pain (<2%), glaucoma (<2%), periorbital edema (<2%), visual field defect (<2%), xerophthalmia (<2%)
Otic: Deafness (<2%), otalgia (<2%), ototoxicity (<2%), tinnitus (<2%)
Renal: Polyuria (<2%)
Respiratory: Bronchitis (<2%), bronchospasm (children: 3%), dyspnea (<2%), epistaxis (children: 4%), hyperventilation (<2%), increased bronchial secretions (<2%), nasal polyposis (<2%), pharyngitis (2% to 6%), pneumonia (<2%), respiratory system disorder (<2%), rhinitis (<2%), sinusitis (<2%), upper respiratory tract infection (<2%)
Miscellaneous: Fever (<2%)
<1%:
Cardiovascular: Presyncope
Dermatologic: Hyperhidrosis
Nervous system: Feeling hot
Frequency not defined:
Hepatic: Increased serum transaminases (transient, reversible)
Nervous system: Irritability
Miscellaneous: Fussiness in an infant or toddler
Postmarketing:
Cardiovascular: Severe hypotension
Gastrointestinal: Cholestasis (Fong 2000)
Hematologic & oncologic: Hemolytic anemia, thrombocytopenia
Hepatic: Hepatitis (Pompili 2004), increased serum bilirubin
Hypersensitivity: Anaphylaxis (Afonso 2009)
Nervous system: Aggressive behavior, delusion (Garden 2013), hallucination, psychosis (Croitoru 2021), sedated state (Corsico 2019), seizure, suicidal ideation, suicidal tendencies
Neuromuscular & skeletal: Orofacial dyskinesia (Romo 2011)
Renal: Glomerulonephritis
Hypersensitivity to cetirizine, hydroxyzine, levocetirizine, or any component of the formulation.
Canadian labeling: Additional contraindications (not in US labeling): Hypersensitivity to piperazine derivatives; severe renal impairment (CrCl <10 mL/minute).
Concerns related to adverse effects:
• Pruritus: Rebound pruritus has been reported within several days after stopping cetirizine, usually after long-term (eg, months to years) use.
Disease-related concerns:
• Hepatic impairment: Use with caution; consider dosage adjustment.
• Renal impairment: Use with caution; consider dosage adjustment.
Concurrent drug therapy issues:
• Sedatives: Effects may be potentiated when used with other sedative drugs or ethanol.
Special populations:
• Older adult: Use with caution in elderly patients; may be more sensitive to adverse effects.
Safety and efficacy for the use of cough and cold products in pediatric patients <4 years of age is limited; the AAP warns against the use of these products for respiratory illnesses in young children. Serious adverse effects including death have been reported. Many of these products contain multiple active ingredients, increasing the risk of accidental overdose when used with other products. The FDA does not recommend OTC uses for these products in pediatric patients <2 years of age and recommends to use with caution in pediatric patients ≥2 years of age. Health care providers are reminded to ask caregivers about the use of OTC cough and cold products in order to avoid exposure to multiple medications containing the same ingredient (AAP 2018; CDC 2007; FDA 2017; FDA 2018).
Some dosage forms may contain propylene glycol; in neonates, large amounts of propylene glycol delivered orally, intravenously (eg, >3,000 mg/day), or topically have been associated with potentially fatal toxicities which can include metabolic acidosis, seizures, renal failure, and CNS depression; toxicities have also been reported in children and adults including hyperosmolality, lactic acidosis, seizures, and respiratory depression; use caution (AAP 1997; Shehab 2009).
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Capsule, Oral, as hydrochloride:
Allergy Relief (Cetirizine): 10 mg
ZyrTEC Allergy: 10 mg
Solution, Intravenous, as hydrochloride [preservative free]:
Quzyttir: 10 mg/mL (1 mL)
Solution, Oral, as hydrochloride:
Allergy Relief Childrens: 5 mg/5 mL (118 mL) [dye free, sugar free; contains propylene glycol, sodium benzoate; grape flavor]
Cetirizine HCl Allergy Child: 5 mg/5 mL (120 mL) [alcohol free, dye free, gluten free, sugar free; contains methylparaben, propylene glycol, propylparaben; grape flavor]
Cetirizine HCl Allergy Child: 5 mg/5 mL (120 mL [DSC]) [alcohol free, sugar free; contains methylparaben, propylene glycol, propylparaben; grape flavor]
Cetirizine HCl Allergy Child: 5 mg/5 mL (118 mL) [dye free, gluten free, sugar free; contains propylene glycol, sodium benzoate; grape flavor]
Cetirizine HCl Childrens Alrgy: 5 mg/5 mL (120 mL [DSC]) [contains methylparaben, propylene glycol, propylparaben; grape flavor]
Cetirizine HCl Childrens Alrgy: 5 mg/5 mL (118 mL) [dye free; contains methylparaben, propylene glycol, propylparaben; grape flavor]
Cetirizine HCl Childrens Alrgy: 5 mg/5 mL (118 mL) [dye free, sugar free; contains propylene glycol, sodium benzoate; grape flavor]
FT Allergy Relief Childrens: 5 mg/5 mL (120 mL) [dye free, sugar free; contains propylene glycol, sodium benzoate]
GoodSense All Day Allergy: 5 mg/5 mL (118 mL) [dye free, gluten free, sugar free; contains propylene glycol, sodium benzoate; grape flavor]
GoodSense All Day Allergy: 5 mg/5 mL (118 mL) [dye free, gluten free, sugar free; contains propylene glycol, sodium benzoate, sorbitol]
ZyrTEC Childrens Allergy: 5 mg/5 mL (118 mL) [dye free, sugar free; contains propylene glycol, sodium benzoate]
ZyrTEC Childrens Allergy: 5 mg/5 mL (30 mL, 118 mL, 236 mL) [dye free, sugar free; contains propylene glycol, sodium benzoate; grape flavor]
Generic: 5 mg/5 mL (120 mL, 473 mL, 480 mL)
Tablet, Oral, as hydrochloride:
Allergy (Cetirizine): 10 mg [scored]
Allergy Relief (Cetirizine): 10 mg
Allergy Relief Cetirizine: 5 mg [contains corn starch]
Allergy Relief Cetirizine: 10 mg
Allergy Relief Cetirizine: 10 mg [contains corn starch]
Allergy Relief/Indoor/Outdoor: 10 mg [scored]
FT All Day Allergy: 10 mg [gluten free]
FT All Day Allergy 24 Hour: 10 mg
FT Allergy Relief Cetirizine: 10 mg [contains corn starch]
GoodSense All Day Allergy: 10 mg [gluten free; contains corn starch, fd&c blue #1 (brill blue) aluminum lake]
ZyrTEC Allergy: 10 mg
Generic: 5 mg, 10 mg
Tablet Chewable, Oral:
ZyrTEC Childrens Allergy: 2.5 mg [dye free; contains corn starch; grape flavor]
Tablet Chewable, Oral, as hydrochloride:
Cetirizine HCl Childrens: 5 mg [DSC], 10 mg [DSC] [contains aspartame, fd&c yellow #6(sunset yellow)alumin lake]
ZyrTEC: 10 mg [dye free; contains corn starch]
ZyrTEC Childrens Allergy: 10 mg [dye free; contains corn starch; grape flavor]
Generic: 5 mg, 10 mg
Tablet Disintegrating, Oral, as hydrochloride:
ZyrTEC Allergy: 10 mg [DSC]
ZyrTEC Allergy Childrens: 10 mg
ZyrTEC Allergy Childrens: 10 mg [citrus flavor]
May be product dependent
Capsules (ZyrTEC Allergy Oral)
10 mg (per each): $0.57
Chewable (Cetirizine HCl Oral)
5 mg (per each): $2.47 - $5.36
10 mg (per each): $2.47 - $5.36
Chewable (ZyrTEC Childrens Allergy Oral)
2.5 mg (per each): $0.98
10 mg (per each): $0.54
Chewable (ZyrTEC Oral)
10 mg (per each): $0.85
Solution (Cetirizine HCl Oral)
5 mg/5 mL (per mL): $0.83
Solution (Quzyttir Intravenous)
10 mg/mL (per mL): $372.00
Solution (ZyrTEC Childrens Allergy Oral)
1 mg/mL (per mL): $0.10
5 mg/5 mL (per mL): $0.10
Tablet, orally-disintegrating (ZyrTEC Allergy Childrens Oral)
10 mg (per each): $1.00
Tablets (Cetirizine HCl Oral)
5 mg (per each): $2.49 - $2.50
10 mg (per each): $0.05 - $2.50
Tablets (ZyrTEC Allergy Oral)
10 mg (per each): $0.69
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Tablet, Oral, as hydrochloride:
Reactine: 20 mg
Generic: 20 mg
Oral: Administer without regard to food.
Chewable tablet: Chew tablet before swallowing; may be taken with or without water.
Dissolving tablet: Allow tablet to melt in mouth; may be taken with or without water.
Liquid: Administer with an accurate measuring device; do not use a household teaspoon (overdosage may occur).
Parenteral: IV: Administer IV undiluted over 1 to 2 minutes; do not administer IM or SubQ.
Oral: May be administered with or without food.
Chewable tablet: Chew tablet before swallowing; may be taken with or without water.
IV: Injection: For IV use only; do not administer IM or SUBQ; administer as an IV push over 1 to 2 minutes.
Capsule, tablet, oral solution, injection: Store at 20°C to 25°C (68°F to 77°F); excursions are permitted between 15°C and 30°C (59°F and 86°F).
Injection: Discard unused portion.
Prescription products:
Oral syrup: Relief of symptoms associated with perennial allergic rhinitis (FDA approved in ages 6 to 23 months); treatment of the uncomplicated skin manifestations of chronic spontaneous urticaria (FDA approved in ages 6 months to 5 years).
Parenteral: Treatment of acute urticaria (FDA approved in ages ≥6 months and adults).
OTC products: Relief of symptoms of hay fever or other respiratory allergies, relief of symptoms of common cold (OTC products: Oral syrup: FDA approved in ages ≥2 years and adults; tablets: FDA approved in ages ≥6 years and adults). Note: Approved ages and uses for generic products may vary; consult labeling for specific information.
Has also been used as adjunct therapy in management of cutaneous symptoms of anaphylaxis.
Cetirizine may be confused with sertraline, stavudine
Quzyttir may be confused with Qsymia
ZyrTEC may be confused with Lipitor, Serax, Xanax, Zantac, Zerit, Zocor, ZyPREXA, ZyrTEC-D
The Institute for Safe Medication Practices (ISMP) includes this medication among its list of drugs (pediatric liquid medications requiring measurement) which have a heightened risk of causing significant patient harm when used in error (High-Alert Medications in Community/Ambulatory Care Settings).
Benadryl brand name for cetirizine [Great Britain, Philippines], but also the brand name for acrivastine and pseudoephedrine [Great Britain] and several products containing diphenhydramine [US, Canada]
Procet [Bangladesh] may be confused with Percocet brand name for oxycodone/acetaminophen [US, Israel, Puerto Rico]
Procet brand name for cetirizine [Bangladesh], but also brand name for acetaminophen [Kenya]
Substrate of CYP3A4 (minor), P-glycoprotein/ABCB1 (minor); Note: Assignment of Major/Minor substrate status based on clinically relevant drug interaction potential
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program
Alcohol (Ethyl): CNS Depressants may enhance the CNS depressant effect of Alcohol (Ethyl). Risk C: Monitor therapy
Alizapride: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy
Amezinium: Antihistamines may enhance the stimulatory effect of Amezinium. Risk C: Monitor therapy
Azelastine (Nasal): May enhance the CNS depressant effect of CNS Depressants. Risk X: Avoid combination
Benzylpenicilloyl Polylysine: Antihistamines may diminish the diagnostic effect of Benzylpenicilloyl Polylysine. Management: Suspend systemic H1 antagonists for benzylpenicilloyl-polylysine skin testing and delay testing until systemic antihistaminic effects have dissipated. A histamine skin test may be used to assess persistent antihistaminic effects. Risk D: Consider therapy modification
Betahistine: Antihistamines may diminish the therapeutic effect of Betahistine. Betahistine may diminish the therapeutic effect of Antihistamines. Risk C: Monitor therapy
Blonanserin: CNS Depressants may enhance the CNS depressant effect of Blonanserin. Management: Use caution if coadministering blonanserin and CNS depressants; dose reduction of the other CNS depressant may be required. Strong CNS depressants should not be coadministered with blonanserin. Risk D: Consider therapy modification
Brexanolone: CNS Depressants may enhance the CNS depressant effect of Brexanolone. Risk C: Monitor therapy
Brimonidine (Topical): May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy
Bromopride: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy
Bromperidol: May enhance the CNS depressant effect of CNS Depressants. Risk X: Avoid combination
Buprenorphine: CNS Depressants may enhance the CNS depressant effect of Buprenorphine. Management: Consider reduced doses of other CNS depressants, and avoiding such drugs in patients at high risk of buprenorphine overuse/self-injection. Initiate buprenorphine at lower doses in patients already receiving CNS depressants. Risk D: Consider therapy modification
Cannabinoid-Containing Products: CNS Depressants may enhance the CNS depressant effect of Cannabinoid-Containing Products. Risk C: Monitor therapy
Chlormethiazole: May enhance the CNS depressant effect of CNS Depressants. Management: Monitor closely for evidence of excessive CNS depression. The chlormethiazole labeling states that an appropriately reduced dose should be used if such a combination must be used. Risk D: Consider therapy modification
Chlorphenesin Carbamate: May enhance the adverse/toxic effect of CNS Depressants. Risk C: Monitor therapy
CNS Depressants: May enhance the adverse/toxic effect of other CNS Depressants. Risk C: Monitor therapy
Daridorexant: May enhance the CNS depressant effect of CNS Depressants. Management: Dose reduction of daridorexant and/or any other CNS depressant may be necessary. Use of daridorexant with alcohol is not recommended, and the use of daridorexant with any other drug to treat insomnia is not recommended. Risk D: Consider therapy modification
DexmedeTOMIDine: CNS Depressants may enhance the CNS depressant effect of DexmedeTOMIDine. Management: Monitor for increased CNS depression during coadministration of dexmedetomidine and CNS depressants, and consider dose reductions of either agent to avoid excessive CNS depression. Risk D: Consider therapy modification
Difelikefalin: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy
Dimethindene (Topical): May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy
Doxylamine: CNS Depressants may enhance the CNS depressant effect of Doxylamine. Risk C: Monitor therapy
DroPERidol: May enhance the CNS depressant effect of CNS Depressants. Management: Consider dose reductions of droperidol or of other CNS agents (eg, opioids, barbiturates) with concomitant use. Risk D: Consider therapy modification
Esketamine: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy
Flunarizine: CNS Depressants may enhance the CNS depressant effect of Flunarizine. Risk X: Avoid combination
Flunitrazepam: CNS Depressants may enhance the CNS depressant effect of Flunitrazepam. Management: Reduce the dose of CNS depressants when combined with flunitrazepam and monitor patients for evidence of CNS depression (eg, sedation, respiratory depression). Use non-CNS depressant alternatives when available. Risk D: Consider therapy modification
Gabapentin: Cetirizine (Systemic) may enhance the CNS depressant effect of Gabapentin. Cetirizine (Systemic) may decrease the serum concentration of Gabapentin. Risk C: Monitor therapy
Hyaluronidase: Antihistamines may diminish the therapeutic effect of Hyaluronidase. Risk C: Monitor therapy
HydrOXYzine: May enhance the CNS depressant effect of CNS Depressants. Management: Consider a decrease in the CNS depressant dose, as appropriate, when used together with hydroxyzine. Increase monitoring of signs/symptoms of CNS depression in any patient receiving hydroxyzine together with another CNS depressant. Risk D: Consider therapy modification
Ixabepilone: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy
Kava Kava: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy
Kratom: May enhance the CNS depressant effect of CNS Depressants. Risk X: Avoid combination
Lemborexant: May enhance the CNS depressant effect of CNS Depressants. Management: Dosage adjustments of lemborexant and of concomitant CNS depressants may be necessary when administered together because of potentially additive CNS depressant effects. Close monitoring for CNS depressant effects is necessary. Risk D: Consider therapy modification
Lisuride: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy
Lofexidine: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy
Loxapine: CNS Depressants may enhance the CNS depressant effect of Loxapine. Risk D: Consider therapy modification
Magnesium Sulfate: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy
Methotrimeprazine: CNS Depressants may enhance the CNS depressant effect of Methotrimeprazine. Methotrimeprazine may enhance the CNS depressant effect of CNS Depressants. Management: Reduce the usual dose of CNS depressants by 50% if starting methotrimeprazine until the dose of methotrimeprazine is stable. Monitor patient closely for evidence of CNS depression. Risk D: Consider therapy modification
Metoclopramide: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy
MetyroSINE: CNS Depressants may enhance the sedative effect of MetyroSINE. Risk C: Monitor therapy
Minocycline (Systemic): May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy
Nabilone: May enhance the CNS depressant effect of CNS Depressants. Risk X: Avoid combination
Olopatadine (Nasal): May enhance the CNS depressant effect of CNS Depressants. Risk X: Avoid combination
Opioid Agonists: CNS Depressants may enhance the CNS depressant effect of Opioid Agonists. Management: Avoid concomitant use of opioid agonists and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. Risk D: Consider therapy modification
Orphenadrine: CNS Depressants may enhance the CNS depressant effect of Orphenadrine. Risk X: Avoid combination
Oxomemazine: May enhance the CNS depressant effect of CNS Depressants. Risk X: Avoid combination
Oxybate Salt Products: CNS Depressants may enhance the CNS depressant effect of Oxybate Salt Products. Management: Consider alternatives to this combination when possible. If combined, dose reduction or discontinuation of one or more CNS depressants (including the oxybate salt product) should be considered. Interrupt oxybate salt treatment during short-term opioid use Risk D: Consider therapy modification
OxyCODONE: CNS Depressants may enhance the CNS depressant effect of OxyCODONE. Management: Avoid concomitant use of oxycodone and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. Risk D: Consider therapy modification
Paraldehyde: CNS Depressants may enhance the CNS depressant effect of Paraldehyde. Risk X: Avoid combination
Perampanel: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy
Pilsicainide: May increase the serum concentration of Cetirizine (Systemic). Cetirizine (Systemic) may increase the serum concentration of Pilsicainide. Risk C: Monitor therapy
Piribedil: CNS Depressants may enhance the CNS depressant effect of Piribedil. Risk C: Monitor therapy
Pitolisant: Antihistamines may diminish the therapeutic effect of Pitolisant. Risk X: Avoid combination
Pramipexole: CNS Depressants may enhance the sedative effect of Pramipexole. Risk C: Monitor therapy
Procarbazine: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy
Ropeginterferon Alfa-2b: CNS Depressants may enhance the adverse/toxic effect of Ropeginterferon Alfa-2b. Specifically, the risk of neuropsychiatric adverse effects may be increased. Management: Avoid coadministration of ropeginterferon alfa-2b and other CNS depressants. If this combination cannot be avoided, monitor patients for neuropsychiatric adverse effects (eg, depression, suicidal ideation, aggression, mania). Risk D: Consider therapy modification
ROPINIRole: CNS Depressants may enhance the sedative effect of ROPINIRole. Risk C: Monitor therapy
Rotigotine: CNS Depressants may enhance the sedative effect of Rotigotine. Risk C: Monitor therapy
Rufinamide: May enhance the adverse/toxic effect of CNS Depressants. Specifically, sleepiness and dizziness may be enhanced. Risk C: Monitor therapy
Suvorexant: CNS Depressants may enhance the CNS depressant effect of Suvorexant. Management: Dose reduction of suvorexant and/or any other CNS depressant may be necessary. Use of suvorexant with alcohol is not recommended, and the use of suvorexant with any other drug to treat insomnia is not recommended. Risk D: Consider therapy modification
Thalidomide: CNS Depressants may enhance the CNS depressant effect of Thalidomide. Risk X: Avoid combination
Trimeprazine: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy
Valerian: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy
Zolpidem: CNS Depressants may enhance the CNS depressant effect of Zolpidem. Management: Reduce the Intermezzo brand sublingual zolpidem adult dose to 1.75 mg for men who are also receiving other CNS depressants. No such dose change is recommended for women. Avoid use with other CNS depressants at bedtime; avoid use with alcohol. Risk D: Consider therapy modification
Zuranolone: May enhance the CNS depressant effect of CNS Depressants. Management: Consider alternatives to the use of zuranolone with other CNS depressants or alcohol. If combined, consider a zuranolone dose reduction and monitor patients closely for increased CNS depressant effects. Risk D: Consider therapy modification
Cetirizine's absorption and maximal concentration are reduced when taken with food. Management: May be taken without regard to meals.
Guidelines for the use of antihistamines in the treatment of allergic rhinitis or urticaria in pregnancy are generally the same as in nonpregnant females. Cetirizine may be used when a second generation antihistamine is needed. The lowest effective dose should be used (BSACI [Powell 2015]; BSACI [Scadding 2017]; Zuberbier 2018).
Relief of symptoms, sedation, and anticholinergic effects.
Competes with histamine for H1-receptor sites on effector cells in the gastrointestinal tract, blood vessels, and respiratory tract
Onset of action: Suppression of skin wheal and flare: Oral: 20 to 60 minutes.
Duration of action: Suppression of skin wheal and flare: Oral: ≥24 hours.
Absorption: Rapid.
Distribution: Children: 0.7 L/kg; Adults: 0.56 L/kg (Simons 1999).
Protein binding, plasma: Mean: 93%.
Metabolism: Limited hepatic.
Half-life elimination: Children: 6.2 hours; Adults: 8 hours.
Time to peak, serum: Oral: 1 hour; IV: 108 seconds.
Excretion: Urine (70%; 50% as unchanged drug); feces (10%).
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