Cetirizine

Pharmacologic Category

Histamine H₁ Antagonist; Histamine H₁ Antagonist, Second Generation; Piperazine Derivative

Dosing: Adult

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 (deShazo 2019).

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).

Anaphylaxis (adjunct to epinephrine for relief of cutaneous symptoms) (off-label use): Note: Do not use for initial or sole treatment of anaphylaxis because H₁ antihistamines do not relieve upper or lower airway obstruction or shock (AAAAI/ACAAI/JCAAI [Lieberman 2015]; Sheikh 2007; WAO [Simons 2011]; WAO [Simons 2015]).

Oral: 10 mg as a single dose (AAAAI/ACAAI/JCAAI [Lieberman 2015]; WAO [Simons 2011]).

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) (James 2017; Zuraw 2019).

Oral: 10 mg once or twice daily; may increase up to 20 mg twice daily (Cicardi 2014; James 2017; Zuraw 2019).

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 (Castells 2019; Durham 2018; Kirkham 2019).

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 (Castells 2019; Durham 2018).

Urticaria (acute and chronic spontaneous):

Acute:

Oral (off label): Initial: 10 mg once daily. If symptom control is inadequate, may increase to 10 mg twice daily (Asero 2020; Zuberbier 2018).

IV: 10 mg once daily as needed. If symptom control is inadequate, may increase to 10 mg twice daily (Asero 2020; Zuberbier 2018). Switch to scheduled oral dosing when feasible.

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. Reevaluate necessity for continued treatment periodically (Khan 2020; Zuberbier 2018).

* See Dosage and Administration in AHFS Essentials for additional information.

Dosing: Geriatric

Upper respiratory allergies, urticaria: Oral: 5 mg once daily (maximum dose: 5 mg daily). The previously available prescription product recommended a maximum dose of 10 mg once daily in patients <77 years of age or 5 mg once daily in patients ≥77 years of age (Zyrtec Prescribing Information, 2006).

Dosing: Renal Impairment: Adult

IV: No dosage adjustment necessary (formulation only intended for short-term use).

Oral:

Note: Renally adjusted dose recommendations are based on doses of 5 to 10 mg once daily.

CrCl >31 mL/minute: No dosage adjustment necessary.

CrCl 11 to ≤31 mL/minute: 5 mg once daily.

CrCl ≤10 mL/minute: There are no dosage adjustments provided in the manufacturer’s labeling. The Canadian labeling contraindicates use in patients with CrCl <10 mL/minute.

Hemodialysis (<10% dialyzable): 5 mg once daily; 5 mg 3 times per week administered before hemodialysis may also be effective (Noiri 2001).

Dosing: Hepatic Impairment: Adult

Mild to severe impairment: 5 mg once daily.

Dosing: Pediatric

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 (Canadian Paediatric Society [Cheng 2011]): Note: Do not use for initial or sole treatment of anaphylaxis; H₁ antihistamines are not effective for upper or lower airway obstruction or shock (AAAAI/ACAAI/JCAAI [Lieberman 2015]; WAO [Simons 2011]; WAO [Simons 2015]). 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.

Rhinitis, allergic(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.

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 (Canadian Paediatric Society [Cheng 2011]):

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: 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 (Zuberbier 2018).

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 (Caffarelli 2019; Del Pozzo-Magaña 2017)

Children ≥12 years and Adolescents: Oral: 10 mg once daily (Caffarelli 2019; Del Pozzo-Magaña 2017)

Dosing: Renal Impairment: Pediatric

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 (Aronoff 2007):

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%.

Dosing: Hepatic Impairment: Pediatric

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.

Calculations

• Creatinine Clearance by Cockcroft-Gault
• Creatinine Clearance by Cockcroft-Gault (SI units)
• Creatinine Clearance by Cockcroft-Gault with IBW
• Creatinine Clearance by Cockcroft-Gault with IBW (SI units)
• Creatinine Clearance by Jelliffe
• Creatinine Clearance by Sanaka
• Glomerular Filtration Rate by Abbreviated MDRD
• Glomerular Filtration Rate by Abbreviated MDRD (SI units)
• Glomerular Filtration Rate by MDRD
• Glomerular Filtration Rate by MDRD (IDMS-Traceable SCr)
• Glomerular Filtration Rate by MDRD (SI units)
• Glomerular Filtration Rate by Schwartz
• Glomerular Filtration Rate Estimate in African Americans by AASK Equation

Use: Labeled Indications

Oral:

Allergic rhinitis: Relief of symptoms associated with allergic rhinitis.

Urticaria, chronic spontaneous: Treatment of uncomplicated skin manifestations of chronic spontaneous urticaria.

Injection:

Urticaria, acute: Treatment of acute urticaria.

* See Uses in AHFS Essentials for additional information.

Use: Off-Label: Adult

Anaphylaxis (adjunct to epinephrine for relief of cutaneous symptoms)Level of Evidence [G]

Based on joint guidelines from the American Academy of Allergy, Asthma & Immunology, American College of Allergy, Asthma & Immunology, and Joint Council of Allergy, Asthma and Immunology on the diagnosis and management of anaphylaxis and guidelines from the World Allergy Organization on anaphylaxis, cetirizine may be used as adjunctive treatment, although should not be used as monotherapy or as first-line therapy of anaphylaxis.

Angioedema, acute allergic or recurrent idiopathicLevel of Evidence [C]

Clinical experience suggests the utility of second-generation H₁ receptor antagonists (eg, cetirizine) for the treatment of acute allergic or recurrent idiopathic angioedema ^Ref.

Infusion reaction, premedicationLevel of Evidence [C]

Clinical experience suggests the utility of second-generation H₁ receptor antagonists (eg, cetirizine) as an adjunct to premedication prior to the infusion of certain chemotherapy agents (eg, certain taxanes) or biologics to prevent infusion reactions ^Ref.

Class and Related Monographs

Antihistamines

Comparative Efficacy

• CETIRIZINE HYDROCHLORIDE INJECTION

Clinical Practice Guidelines

Allergic Rhinitis:

AAO-HNS, “Clinical Practice Guideline: Allergic Rhinitis,” 2015

Anaphylaxis:

AAAAI/ACAAI, "Diagnosis and Management of Anaphylaxis," September 2010

AAAAI/ACAAI/JCAAI, “Anaphylaxis – a Practice Parameter Update 2015,” November 2015

Urticaria:

EAACI/GA²LEN/EDF/WAO, “Guideline for the Definition, Classification, Diagnosis and Management of Urticaria - 2017 Update,” April 2018

Administration: IV

For IV use only; do not administer IM or SubQ; administer as an IV push over 1 to 2 minutes.

Administration: Oral

May be administered with or without food.

Chewable tablet: Chew tablet before swallowing; may be taken with or without water.

Administration: Pediatric

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.

Storage/Stability

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.

Medication Patient Education with HCAHPS Considerations

What is this drug used for?

• It is used to ease allergy signs.

• It is used to treat hives.

Frequently reported side effects of this drug

• Fatigue

• Dry mouth

• Loss of strength and energy

• Signs of a significant reaction like wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat.

Note: This is not a comprehensive list of all side effects. Talk to your doctor if you have questions.

Consumer Information Use and Disclaimer: This information should not be used to decide whether or not to take this medicine or any other medicine. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this medicine. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not specific medical advice and does not replace information you receive from the healthcare provider. You must talk with the healthcare provider for complete information about the risks and benefits of using this medicine.

Medication Safety Issues

Sound-alike/look-alike issues:

International issues:

Contraindications

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).

Warnings/Precautions

Concerns related to adverse effects:

• CNS depression: May cause CNS depression, which may impair physical or mental abilities; patients must be cautioned about performing tasks that require mental alertness (eg, operating machinery or driving).

Disease-related concerns:

• Hepatic impairment: Use with caution.

• Renal impairment: Use with caution; consider dosage adjustment.

Concurrent drug therapy issues:

• Drug-drug interactions: Potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy. Consult drug interactions database for more detailed information.

• Sedatives: Effects may be potentiated when used with other sedative drugs or ethanol.

Special populations:

• Elderly: Use with caution in elderly patients; may be more sensitive to adverse effects.

* See Cautions in AHFS Essentials for additional information.

Geriatric Considerations

Adjust dose for renal function. Because of its OTC status, counsel patients on appropriate use.

Warnings: Additional Pediatric Considerations

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).

Pregnancy Considerations

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 (Powell 2015; Scadding 2017; Wallace 2008; Zuberbier 2018).

Breast-Feeding Considerations

Cetirizine is present in breast milk.

Drowsiness and irritability have been reported in breastfed infants exposed to antihistamines (Ito 1993). In general, second generation antihistamines (eg, cetirizine) are less sedating as compared to their first generation counterparts. If a breastfed infant is exposed to a second generation antihistamine via breast milk, they should be monitored for irritability, jitteriness, or drowsiness (Butler 2014).

When treatment with an antihistamine is needed in breastfeeding women, second generation antihistamines are preferred (Butler 2014; Powell 2015; Zuberbier 2018).

Antihistamines may decrease maternal serum prolactin concentrations when administered prior to the establishment of breastfeeding (Messinis 1985).

Lexicomp Pregnancy & Lactation, In-Depth

• Cetirizine (Systemic)

Briggs' Drugs in Pregnancy & Lactation

• Cetirizine

Adverse Reactions

>10%: Nervous system: Drowsiness (adults 14%; children 2% to 4%), headache (children 11% to 14%, placebo 12%)

2% to 10%:

Gastrointestinal: Abdominal pain (children 4% to 6%), xerostomia (adults 5%), diarrhea (children 2% to 3%), nausea (children 2% to 3%; placebo 2%), vomiting (children 2% to 3%)

Nervous system: Insomnia (children 9%; adults <2%), fatigue (adults 6%), malaise (4%), dizziness (adults 2%)

Respiratory: Pharyngitis (children 3% to 6%; placebo 3%), epistaxis (children 2% to 4%; placebo 3%), bronchospasm (children 2% to 3%; placebo 2%)

<2% (as reported in adults and/or children): Abnormality in thinking, accommodation disturbance, acne vulgaris, acute myocardial infarction, ageusia, alopecia, altered sense of smell, amnesia, anaphylaxis, angioedema, anorexia, anxiety, aphthous stomatitis, arthralgia, arthritis, asthenia, ataxia, back pain, blepharoptosis, blindness, bronchitis, bullous rash, cardiac failure, chest pain, cholestasis, confusion, conjunctivitis, constipation, cutaneous nodule, cystitis, deafness, decreased libido, dehydration, depersonalization, depression, dermatitis, dermatological disorders, diabetes mellitus, diaphoresis, dysgeusia, dysmenorrhea, dyspepsia, dyspnea, dysuria, eczema, edema, emotional lability, enlargement of abdomen, eructation, erythematous rash, euphoria, eye pain, facial edema, fever, flatulence, flushing, furunculosis, fussiness in an infant or toddler, gastritis, glaucoma, glomerulonephritis, heavy menstrual bleeding, hematuria, hemolytic anemia, hemophthalmos, hemorrhoids, hepatic insufficiency, hepatitis, hot flash, hyperesthesia, hyperkeratosis, hyperkinetic muscle activity, hypertension, hypertonia, hypertrichosis, hyperventilation, hypoesthesia, hypotension, increased appetite, increased bronchial secretions, increased liver enzymes (transient), increased serum bilirubin, increased thirst, intermenstrual bleeding, irritability, lack of concentration, leukorrhea, lower extremity edema, lower limb cramp, lymphadenopathy, maculopapular rash, mastalgia (female), melena, migraine, myalgia, myasthenia, myelitis, nasal polyposis, nervousness, nightmares, orofacial dyskinesia, osteoarthritis, otalgia, ototoxicity, pain, pallor, palpitations, paralysis, paresthesia, periorbital edema, pneumonia, polyuria, pruritus, purpuric disease, rectal hemorrhage, respiratory system disorder, rhinitis, rigors, seborrhea, sialorrhea, sinusitis, skin photosensitivity, skin rash, sleep disorder, stomatitis, syncope, tachycardia, thrombocytopenia, tinnitus, tongue discoloration, tongue edema, tremor, twitching, upper respiratory tract infection, urinary frequency, urinary incontinence, urinary retention, urinary tract infection, urticaria, vaginitis, vertigo, visual field defect, voice disorder, weight gain, xeroderma, xerophthalmia

Postmarketing and/or case reports: Aggressive behavior, convulsions, hallucination, hypotension (severe), suicidal ideation

* See Cautions in AHFS Essentials for additional information.

Allergy and Idiosyncratic Reactions

• H₁ Antihistamine Allergy

Toxicology

• Histamine H₁ Antagonists, Second Generation

Metabolism/Transport Effects

Substrate of CYP3A4 (minor), P-glycoprotein/ABCB1; Note: Assignment of Major/Minor substrate status based on clinically relevant drug interaction potential

Drug Interactions Open Interactions

Acetylcholinesterase Inhibitors: May diminish the therapeutic effect of Anticholinergic Agents. Anticholinergic Agents may diminish the therapeutic effect of Acetylcholinesterase Inhibitors. Risk C: Monitor therapy

Aclidinium: May enhance the anticholinergic effect of Anticholinergic Agents. Risk X: Avoid combination

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

Amantadine: May enhance the anticholinergic effect of Anticholinergic Agents. Risk C: Monitor therapy

Amezinium: Antihistamines may enhance the stimulatory effect of Amezinium. Risk C: Monitor therapy

Amphetamines: May diminish the sedative effect of Antihistamines. Risk C: Monitor therapy

Anticholinergic Agents: May enhance the adverse/toxic effect of other Anticholinergic Agents. Risk C: Monitor therapy

Azelastine (Nasal): CNS Depressants may enhance the CNS depressant effect of Azelastine (Nasal). 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. Risk C: Monitor therapy

Blonanserin: CNS Depressants may enhance the CNS depressant effect of Blonanserin. Risk D: Consider therapy modification

Botulinum Toxin-Containing Products: May enhance the anticholinergic effect of Anticholinergic Agents. Risk C: Monitor therapy

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

Cannabidiol: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Cannabis: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Chloral Betaine: May enhance the adverse/toxic effect of Anticholinergic Agents. 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

Cimetropium: Anticholinergic Agents may enhance the anticholinergic effect of Cimetropium. Risk X: Avoid combination

CloZAPine: Anticholinergic Agents may enhance the constipating effect of CloZAPine. Management: Consider alternatives to this combination whenever possible. If combined, monitor closely for signs and symptoms of gastrointestinal hypomotility and consider prophylactic laxative treatment. Risk D: Consider therapy modification

CNS Depressants: May enhance the adverse/toxic effect of other CNS Depressants. Risk C: Monitor therapy

Dimethindene (Topical): May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Doxylamine: May enhance the CNS depressant effect of CNS Depressants. Management: The manufacturer of Diclegis (doxylamine/pyridoxine), intended for use in pregnancy, specifically states that use with other CNS depressants is not recommended. Risk C: Monitor therapy

Dronabinol: May enhance the CNS depressant effect of CNS Depressants. 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. Exceptions to this monograph are discussed in further detail in separate drug interaction monographs. Risk D: Consider therapy modification

Eluxadoline: Anticholinergic Agents may enhance the constipating effect of Eluxadoline. Risk X: Avoid combination

Erdafitinib: May increase the serum concentration of P-glycoprotein/ABCB1 Substrates. Risk C: Monitor therapy

Esketamine: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Flunitrazepam: CNS Depressants may enhance the CNS depressant effect of Flunitrazepam. Risk D: Consider therapy modification

Gastrointestinal Agents (Prokinetic): Anticholinergic Agents may diminish the therapeutic effect of Gastrointestinal Agents (Prokinetic). Risk C: Monitor therapy

Glucagon: Anticholinergic Agents may enhance the adverse/toxic effect of Glucagon. Specifically, the risk of gastrointestinal adverse effects may be increased. Risk C: Monitor therapy

Glycopyrrolate (Oral Inhalation): Anticholinergic Agents may enhance the anticholinergic effect of Glycopyrrolate (Oral Inhalation). Risk X: Avoid combination

Glycopyrronium (Topical): May enhance the anticholinergic effect of Anticholinergic Agents. Risk X: Avoid combination

Hyaluronidase: Antihistamines may diminish the therapeutic effect of Hyaluronidase. Management: Patients receiving antihistamines (particularly at larger doses) may not experience the desired clinical response to standard doses of hyaluronidase. Larger doses of hyaluronidase may be required. Risk D: Consider therapy modification

HydrOXYzine: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Ipratropium (Oral Inhalation): May enhance the anticholinergic effect of Anticholinergic Agents. Risk X: Avoid combination

Itopride: Anticholinergic Agents may diminish the therapeutic effect of Itopride. Risk C: Monitor therapy

Kava Kava: May enhance the adverse/toxic effect of CNS Depressants. Risk C: Monitor therapy

Lasmiditan: May increase the serum concentration of P-glycoprotein/ABCB1 Substrates. 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

Levosulpiride: Anticholinergic Agents may diminish the therapeutic effect of Levosulpiride. Risk X: Avoid combination

Lofexidine: May enhance the CNS depressant effect of CNS Depressants. Management: Drugs listed as exceptions to this monograph are discussed in further detail in separate drug interaction monographs. Risk C: Monitor therapy

Lumacaftor and Ivacaftor: May decrease the serum concentration of P-glycoprotein/ABCB1 Substrates. Lumacaftor and Ivacaftor may increase the serum concentration of P-glycoprotein/ABCB1 Substrates. Risk C: Monitor therapy

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 adult dose of CNS depressant agents by 50% with initiation of concomitant methotrimeprazine therapy. Further CNS depressant dosage adjustments should be initiated only after clinically effective methotrimeprazine dose is established. Risk D: Consider therapy modification

MetyroSINE: CNS Depressants may enhance the sedative effect of MetyroSINE. Risk C: Monitor therapy

Mianserin: May enhance the anticholinergic effect of Anticholinergic Agents. Risk C: Monitor therapy

Minocycline (Systemic): May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Mirabegron: Anticholinergic Agents may enhance the adverse/toxic effect of Mirabegron. Risk C: Monitor therapy

Nabilone: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Nitroglycerin: Anticholinergic Agents may decrease the absorption of Nitroglycerin. Specifically, anticholinergic agents may decrease the dissolution of sublingual nitroglycerin tablets, possibly impairing or slowing nitroglycerin absorption. Risk C: Monitor therapy

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

Oxatomide: May enhance the anticholinergic effect of Anticholinergic Agents. Risk X: Avoid combination

Oxomemazine: May enhance the CNS depressant effect of CNS Depressants. Risk X: Avoid combination

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. Management: Patients taking perampanel with any other drug that has CNS depressant activities should avoid complex and high-risk activities, particularly those such as driving that require alertness and coordination, until they have experience using the combination. Risk D: Consider therapy modification

P-glycoprotein/ABCB1 Inducers: May decrease the serum concentration of P-glycoprotein/ABCB1 Substrates. P-glycoprotein inducers may also further limit the distribution of p-glycoprotein substrates to specific cells/tissues/organs where p-glycoprotein is present in large amounts (e.g., brain, T-lymphocytes, testes, etc.). Risk C: Monitor therapy

P-glycoprotein/ABCB1 Inhibitors: May increase the serum concentration of P-glycoprotein/ABCB1 Substrates. P-glycoprotein inhibitors may also enhance the distribution of p-glycoprotein substrates to specific cells/tissues/organs where p-glycoprotein is present in large amounts (e.g., brain, T-lymphocytes, testes, etc.). 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

Potassium Chloride: Anticholinergic Agents may enhance the ulcerogenic effect of Potassium Chloride. Management: Patients on drugs with substantial anticholinergic effects should avoid using any solid oral dosage form of potassium chloride. Risk X: Avoid combination

Potassium Citrate: Anticholinergic Agents may enhance the ulcerogenic effect of Potassium Citrate. Risk X: Avoid combination

Pramipexole: CNS Depressants may enhance the sedative effect of Pramipexole. Risk C: Monitor therapy

Pramlintide: May enhance the anticholinergic effect of Anticholinergic Agents. These effects are specific to the GI tract. Risk D: Consider therapy modification

Ramosetron: Anticholinergic Agents may enhance the constipating effect of Ramosetron. Risk C: Monitor therapy

Ranolazine: May increase the serum concentration of P-glycoprotein/ABCB1 Substrates. Risk C: Monitor therapy

Revefenacin: Anticholinergic Agents may enhance the anticholinergic effect of Revefenacin. Risk X: Avoid combination

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

Secretin: Anticholinergic Agents may diminish the therapeutic effect of Secretin. Management: Avoid concomitant use of anticholinergic agents and secretin. Discontinue anticholinergic agents at least 5 half-lives prior to administration of secretin. Risk D: Consider therapy modification

Selective Serotonin Reuptake Inhibitors: CNS Depressants may enhance the adverse/toxic effect of Selective Serotonin Reuptake Inhibitors. Specifically, the risk of psychomotor impairment may be enhanced. Risk C: Monitor therapy

Sodium Oxybate: May enhance the CNS depressant effect of CNS Depressants. Management: Consider alternatives to combined use. When combined use is needed, consider minimizing doses of one or more drugs. Use of sodium oxybate with alcohol or sedative hypnotics is contraindicated. Risk D: Consider therapy modification

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

Tetrahydrocannabinol: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Tetrahydrocannabinol and Cannabidiol: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Thalidomide: CNS Depressants may enhance the CNS depressant effect of Thalidomide. Risk X: Avoid combination

Thiazide and Thiazide-Like Diuretics: Anticholinergic Agents may increase the serum concentration of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor therapy

Tiotropium: Anticholinergic Agents may enhance the anticholinergic effect of Tiotropium. Risk X: Avoid combination

Topiramate: Anticholinergic Agents may enhance the adverse/toxic effect of Topiramate. Risk C: Monitor therapy

Trimeprazine: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Umeclidinium: May enhance the anticholinergic effect of Anticholinergic Agents. Risk X: Avoid combination

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

Food Interactions

Cetirizine's absorption and maximal concentration are reduced when taken with food. Management: May be taken without regard to meals.

Test Interactions

May cause false-positive serum TCA screen. May suppress the wheal and flare reactions to skin test antigens.

Monitoring Parameters

Relief of symptoms, sedation and anticholinergic effects

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Capsule, Oral, as hydrochloride:

Allergy Relief: 10 mg

ZyrTEC Allergy: 10 mg

Solution, Intravenous, as hydrochloride [preservative free]:

Quzyttir: 10 mg/mL (1 mL)

Solution, Oral, as hydrochloride:

All Day Allergy Childrens: 5 mg/5 mL (118 mL [DSC]) [contains methylparaben, propylene glycol, propylparaben]

All Day Allergy Childrens: 5 mg/5 mL (118 mL [DSC]) [dye free, gluten free; contains methylparaben, propylene glycol, propylparaben; grape flavor]

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) [alcohol free, sugar free; contains methylparaben, propylene glycol, propylparaben]

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: 5 mg/5 mL (118 mL) [contains methylparaben, propylene glycol, propylparaben]

Cetirizine HCl Childrens Alrgy: 5 mg/5 mL (118 mL, 120 mL) [contains methylparaben, propylene glycol, propylparaben; grape flavor]

Cetirizine HCl Hives Relief: 5 mg/5 mL (120 mL) [alcohol free, sugar free; contains methylparaben, propylene glycol, propylparaben; 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 (118 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:

All Day Allergy: 10 mg [contains corn starch]

Allergy Relief Cetirizine: 10 mg

Allergy Relief/Indoor/Outdoor: 10 mg [scored]

GoodSense All Day Allergy: 10 mg [contains corn starch, fd&c blue #1 aluminum lake]

ZyrTEC Allergy: 10 mg

Generic: 5 mg, 10 mg

Tablet Chewable, Oral, as hydrochloride:

All Day Allergy Childrens: 10 mg [DSC] [tutti-frutti flavor]

Cetirizine HCl Childrens: 5 mg, 10 mg [contains aspartame, fd&c yellow #6 aluminum lake]

Generic: 5 mg, 10 mg

Tablet Disintegrating, Oral, as hydrochloride:

ZyrTEC Allergy: 10 mg

ZyrTEC Allergy Childrens: 10 mg

ZyrTEC Allergy Childrens: 10 mg [citrus flavor]

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Tablet, Oral, as hydrochloride:

Reactine: 20 mg

Generic: 20 mg

Anatomic Therapeutic Chemical (ATC) Classification

• R06AE07

Generic Available (US)

May be product dependent

Pricing: US

Capsules (ZyrTEC Allergy Oral)

10 mg (per each): $0.76

Chewable (Cetirizine HCl Oral)

5 mg (per each): $2.47 - $5.36

10 mg (per each): $2.47 - $5.36

Solution (Cetirizine HCl Oral)

5 mg/5 mL (per mL): $0.30

Solution (Quzyttir Intravenous)

10 mg/mL (per mL): $360.00

Solution (ZyrTEC Childrens Allergy Oral)

1 mg/mL (per mL): $0.09

5 mg/5 mL (per mL): $0.09

Tablet, orally-disintegrating (ZyrTEC Allergy Childrens Oral)

10 mg (per each): $0.92

Tablet, orally-disintegrating (ZyrTEC Allergy Oral)

10 mg (per each): $0.80

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): $0.64

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.

Mechanism of Action

Competes with histamine for H₁-receptor sites on effector cells in the gastrointestinal tract, blood vessels, and respiratory tract

Pharmacodynamics/Kinetics

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%).

Local Anesthetic/Vasoconstrictor Precautions

No information available to require special precautions

Effects on Dental Treatment

Key adverse event(s) related to dental treatment: Xerostomia and decreased salivation (normal salivary flow resumes upon discontinuation). Rare occurrence of aphthous stomatitis, altered taste, orofacial dyskinesia, stomatitis, tongue edema, tongue discoloration.

Effects on Bleeding

No information available to require special precautions

Index Terms

Cetirizine Hydrochloride; P-071; Quzyttir; UCB-P071

FDA Approval Date

December 12, 1995

References

American Academy of Pediatrics (AAP). Cough and cold medicines should not be prescribed, recommended or used for respiratory illnesses in young children. Updated June 12, 2018. Available at http://www.choosingwisely.org/clinician-lists/american-academy-pediatrics-cough-and-cold-medicines-for-children-under-four/.

American Academy of Pediatrics Committee on Drugs. "Inactive" ingredients in pharmaceutical products: update (subject review). Pediatrics. 1997;99(2):268-278.[PubMed 9024461]

Aronoff GR, Bennett WM, Berns JS, et al. Drug Prescribing in Renal Failure: Dosing Guidelines for Adults and Children. 5th ed. Philadelphia, PA: American College of Physicians; 2007, p 97, 169.

Asero R. New-onset urticaria. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed January 16, 2020.

Butler DC, Heller MM, Murase JE. Safety of dermatologic medications in pregnancy and lactation: Part II. Lactation. J Am Acad Dermatol. 2014;70(3):417. doi: 10.1016/j.jaad.2013.09.009.[PubMed 24528912]

Caffarelli C, Paravati F, El Hachem M, et al. Management of chronic urticaria in children: a clinical guideline. Ital J Pediatr. 2019;45(1):101. doi: 10.1186/s13052-019-0695-x.[PubMed 31416456]

Castells MC, Matulonis UA, Horton TM. Infusion reactions to systemic chemotherapy. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed February 22, 2019.

Centers for Disease Control and Prevention (CDC). Infant deaths associated with cough and cold medications--two states, 2005. MMWR Morb Mortal Wkly Rep. 2007;56(1):1-4.[PubMed 17218934]

Cetirizine hydrochloride syrup [prescribing information]. Carmel, NY: Silarx Pharmaceuticals; May 2014.

Cetirizine tablet [prescribing information]. Morgantown, WV: Mylan Pharmaceuticals Inc; February 2012.

Cheng A. Emergency treatment of anaphylaxis in infants and children. Paediatr Child Health. 2011;16(1):35-40.[PubMed 22211074]

Cicardi M, Aberer W, Banerji A et al; HAWK under the patronage of EAACI (European Academy of Allergy and Clinical Immunology). Classification, diagnosis, and approach to treatment for angioedema: consensus report from the Hereditary Angioedema International Working Group. Allergy. 2014;69(5):602-616. doi: 10.1111/all.12380.[PubMed 24673465]

Del Pozzo-Magaña B. Chronic Urticaria in Children: A Review. EMJ Dermatol. 2017;5(1):74-82.

deShazo RD, Kemp SF. Pharmacotherapy of allergic rhinitis. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed February 22, 2019.

Durham CG, Thotakura D, Sager L, Foster J, Herrington JD. Cetirizine versus diphenhydramine in the prevention of chemotherapy-related hypersensitivity reactions [published online ahead of print November 12, 2018]. J Oncol Pharm Pract. doi: 10.1177/1078155218811505.[PubMed 30419768]

Food and Drug Administration (FDA). Most young children with a cough or cold don't need medicines. July 18, 2017. Available at https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm422465.htm. Last accessed November 2, 2018.

Food and Drug Administration (FDA). Use caution when giving cough and cold products to kids. Updated February 8, 2018. Available at https://www.fda.gov/drugs/resourcesforyou/specialfeatures/ucm263948.htm. Last accessed November 2, 2018.

Ito S, Blajchman A, Stephenson M, Eliopoulos C, Koren G. Prospective follow-up of adverse reactions in breast-fed infants exposed to maternal medication. Am J Obstet Gynecol. 1993;168(5):1393-1399.[PubMed 8498418]

James C, Bernstein JA. Current and future therapies for the treatment of histamine-induced angioedema. Expert Opin Pharmacother. 2017;18(3):253-262. doi: 10.1080/14656566.2017.1282461.[PubMed 28081650]

Khan DA. Chronic spontaneous urticaria: Standard management and patient education. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed January 16, 2020.

Kirkham B. Tumor necrosis factor-alpha inhibitors: An overview of adverse effects. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed February 22, 2019.

Lieberman P, Nicklas RA, Randolph C, et al. Anaphylaxis--a practice parameter update 2015. Ann Allergy Asthma Immunol. 2015;115(5):341-384. doi: 10.1016/j.anai.2015.07.019.[PubMed 26505932]

Messinis IE, Souvatzoglou A, Fais N, Lolis D. Histamine H1 receptor participation in the control of prolactin secretion in postpartum. J Endocrinol Invest. 1985;8(2):143-146.[PubMed 3928731]

National Heart, Lung, and Blood Institute and National Asthma Education and Prevention Program Asthma and Pregnancy Working Group, "NAEPP Expert Panel Report. Managing Asthma During Pregnancy: Recommendations for Pharmacologic Treatment-2004 Update," J Allergy Clin Immunol, 2005, 115(1):34-46.[PubMed 15637545]

Noiri E, Ozawa H, Fujita T, Nakao A. Pharmacokinetics of cetirizine in chronic hemodialysis patients: multiple-dose study. Nephron. 2001;89(1):101-104. doi: 10.1159/000046050.[PubMed 11528239]

Powell RJ, Leech SC, Till S, et al. BSACI guideline for the management of chronic urticaria and angioedema. Clin Exp Allergy. 2015;45(3):547-565. doi: 10.1111/cea.12494.[PubMed 25711134]

Quzyttir (cetirizine) [prescribing information]. Lake Forest, IL: TerSera Therapeutics LLC; October 2019.

Reactine (cetirizine) [product monograph]. Markham, Canada: McNeil Consumer Healthcare; August 2019.

Scadding GK, Kariyawasam HH, Scadding G, et al. BSACI guideline for the diagnosis and management of allergic and non-allergic rhinitis (revised edition 2017; first edition 2007). Clin Exp Allergy. 2017;47(7):856-889.[PubMed 30239057]

Shehab N, Lewis CL, Streetman DD, Donn SM. Exposure to the pharmaceutical excipients benzyl alcohol and propylene glycol among critically ill neonates. Pediatr Crit Care Med. 2009;10(2):256-259.[PubMed 19188870]

Sheikh A, Ten Broek V, Brown SG, Simons FE. H1-antihistamines for the treatment of anaphylaxis: Cochrane systematic review. Allergy. 2007;62(8):830-837. doi: 10.1111/j.1398-9995.2007.01435.x.[PubMed 17620060]

Simons FE, Ardusso LR, Bilò MB, et al; World Allergy Organization. World Allergy Organization anaphylaxis guidelines: summary. JAllergy Clin Immunol. 2011;127(3):587-593.e1-22. doi: 10.1016/j.jaci.2011.01.038.[PubMed 21377030]

Simons FE, Ebisawa M, Sanchez-Borges M, et al. 2015 update of the evidence base: World Allergy Organization anaphylaxis guidelines. World Allergy Organ J. 2015;8(1):32. doi: 10.1186/s40413-015-0080-1.[PubMed 26525001]

Simons FE, Simons KJ. Clinical pharmacology of new histamine H1 receptor antagonists. Clin Pharmacokinet. 1999;36(5):329-352.[PubMed 10384858]

Wallace DV, Dykewicz MS, Bernstein DI, et al; Joint Task Force on Practice; American Academy of Allergy; Asthma & Immunology; American College of Allergy; Asthma and Immunology; Joint Council of Allergy, Asthma and Immunology. The diagnosis and management of rhinitis: an updated practice parameter [published correction appears in J Allergy Clin Immunol. 2008;122(6):1237]. J Allergy Clin Immunol. 2008;122(2)(suppl):S1-S84. doi: 10.1016/j.jaci.2008.06.003.[PubMed 18662584]

Zuberbier T, Aberer W, Asero R, et al. The EAACI/GA²LEN/EDF/WAO guideline for the definition, classification, diagnosis and management of urticaria. Allergy. 2018;73(7):1393-1414. doi: 10.1111/all.13397.[PubMed 29336054]

Zuraw B. An overview of angioedema: Clinical features, diagnosis, and management. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed February 22, 2019.

Zyrtec Allergy (cetirizine) [prescribing information]. Fort Washington, PA: McNeil Consumer Healthcare; July 2015

Zyrtec (cetirizine hydrochloride) [prescribing information]. New York City, NY: Pfizer Labs; May 2006.

Brand Names: International

Aceterin (EE, LV); Aceto (LT); Acidrine (CO); Acitrin (BD); Acura (SE); Adezio (SG); Agelmin (GR, SG); Alarid (LK); Alatro (MY); Alercet (CO, EC, PE); Alercina (ES); Alergine (ID); Alerid (CZ, EG); Alerid-10 (ZW); Alertop (CL, PY); Allercet (ZW); Allergy-Care (IL); Allerkid (PH); Allersan (BG); Allertek (UA); Alyr (LV); Alzene (AU); Alzyr (FI); Alzytec (SG); Amertil (UA); Aricetin (KR); Arix (LK); Artiz (BH, SA); Ascet (ET); Askey (PH); Askey DT (PH); Atopix (AR); Atrizin (SG); Bluetec (VN); Cabal (AR); Cemediz (VN); Ceritec (MY, SG); Cetallerg (CH, LB); Cetigen (HU); Cetihexal (BR); Cetihis (HK, MY, TH); Cetimax (NO); Cetimed (LB); Cetiram (GR); Cetirax (CO); CetirHexal (AT); Cetirin (HK); Cetiristad (AT, BG); Cetix (PT); Cetixin (CZ, DE, SK); Cetizin (BD); Cetrak (EG, LB); Cetrimed (TH); Cetrine (CN, IE); Cetrix (LT, LV); Cetriz (IE); Cetro (QA, SA); Cetymin (ID); Cezera (LT); Cezin (IN, LK); Epirizine (EG); Estin (ID); Falergi (ID); Finallerg (BH, JO, KW, LB, SA); Gencet (AE); Glotrizine (AE, QA); Green Nose (KR); H-One (PH); Hismazine (MY); Histacet (ZW); Histacetin (UY); Histazine (IL); Histec (FI); Hyperreact (LU); Lergium (PE); Letizen (HR, SK); N-Alergya (IL); Nohist (SA); Noler (BD); Nosemin (KR); Omcet (AE, BH, JO, KW, QA, SA); Parlazin (HK, HU); Prixlae (PH); Rancet (AU); Razene (NZ); Reactin (BG); Reactine (BE, DE, MX); Rigotax (CL); Rolinoz (UA); Ronex (LK); Ryvel (ID); Ryzen (ID); Selitex (KR); Simtec (MY); Stamidix (IT); Sunizine (SG); Sutac (TH); Talzic (VE); Temprazin (PH); Terizin (PY, SG); Texzine (PH); Tirizine (AU); Triz (TH); Trizin 5 (PH); Virlix (ES, FR, MX, PH); Xero-Sed (IN); Zensil (TH); Zericin (PH); Zertin (ID); Zertine (AU, TH); Zetaler (PE); Zetalerg (BR); Zetop (NZ); Zilarex (AU); Zinecet (AU); Zirec (TR); Zirizine (AU); Zirpine (IE, MT); Zirtec (IT); Zirtek (GB, IE, UA); Zirtin (IN); Zodac (CZ, RU, SK, UA); Zyllergy (IL); Zyncet (ZW); Zyrac (TH); Zyrak (SY); Zyrcon (TH); Zyrfar (CO); Zyrlex (SE); Zyrrtec (VN); Zyrtec (AE, AR, AT, AU, BE, BG, BH, BR, CH, CL, CN, CR, CY, CZ, DE, DK, DO, EC, EE, EG, ES, FI, FR, GT, HK, HN, HU, IN, JO, KR, KW, LB, LT, LU, LV, MT, MX, MY, NI, NL, NO, NZ, PA, PE, PH, PK, PL, PT, QA, RO, RU, SA, SI, SK, SV, TH, TR, UY, VE, ZA); Zyrtec Allergy (BB); Zyrtec Childrens (BB); Zyrtec-R (SG)

Last Updated 3/13/20