Zyrtec


cetirizine hydrochloride

All-Day Allergy, Aller-Relief, Allergy Relief, Benadryl Allergy Oral Solution (UK), Benadryl One a Day (UK), Piriteze (UK), Pollenshield Hayfever (UK), Reactine, Zirtec (UK), Zyrtec

Pharmacologic class: Histamine1-receptor antagonist (peripherally selective)

Therapeutic class: Allergy, cold, and cough agent; antihistamine

Pregnancy risk category B

Action

Antagonizes histamine's effects at histamine1-receptor sites, preventing allergic response. Also has mild bronchodilatory effects and blocks histamine-induced bronchoconstriction in asthma.

Availability

Syrup: 5 mg/5 ml

Tablets: 5 mg, 10 mg

Indications and dosages

➣ Allergic symptoms caused by histamine release
Adults and children older than age 6: 5 to 10 mg P.O. daily
Children ages 2 to 5: 2.5 to 5 mg P.O. daily

Dosage adjustment

• Renal impairment

• Hepatic impairment

Contraindications

• Hypersensitivity to drug or hydroxyzine

• Acute asthma attacks

• Angle-closure glaucoma

• Pyloroduodenal obstruction

• Breastfeeding

Precautions

Use cautiously in:

• renal impairment, significant hepatic dysfunction

• elderly patients

• pregnant patients

• children younger than age 2 (safety not established).

Administration

• Give with or without food.

• Administer at same time each day.

Adverse reactions

CNS: dizziness, drowsiness, fatigue

CV: palpitations, edema

EENT: pharyngitis

GI: nausea, vomiting, abdominal distress, dry mouth

Musculoskeletal: myalgia, joint pain

Respiratory: bronchospasm

Skin: photosensitivity, rash, angioedema

Other: fever

Interactions

Drug-drug. CNS depressants: additive CNS effects

Theophylline: decreased cetirizine clearance

Drug-diagnostic tests. Allergy skin tests: false-negative results

Drug-behaviors. Alcohol use: additive CNS effects

Sun exposure: photosensitivity

Patient monitoring

• Monitor creatinine levels in patients with renal dysfunction.

• Assess hepatic enzyme levels in patients with hepatic disease.

Patient teaching

• Tell patient to take with full glass of water.

• Inform patient that drug may impair alertness and that alcohol may exaggerate this effect.

• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and behaviors mentioned above.

cetirizine

(se-ti-ra-zeen) cetirizine,

Aller Relief

(trade name),

Reactine

(trade name),

ZyrTEC

(trade name)

Classification

Therapeutic: allergy cold cough remedies
Pharmacologic: piperazines
Pregnancy Category: B

Indications

Relief of allergic symptoms caused by histamine release including:
  • Seasonal and perennial allergic rhinitis,
  • Chronic urticaria.

Action

Antagonizes the effects of histamine at H1-receptor sites; does not bind to or inactivate histamine.Anticholinergic effects are minimal and sedation is dose related.

Therapeutic effects

Decreased symptoms of histamine excess (sneezing, rhinorrhea, ocular tearing and redness, pruritus).

Pharmacokinetics

Absorption: Well absorbed following oral administration.Distribution: Unknown.Protein Binding: 93%.Metabolism and Excretion: Excreted primarily unchanged by the kidneys.Half-life: 7.4–9 hr (↓ in children to 6.2 hr, ↑ in renal impairment up to 19–21 hr).

Time/action profile (antihistaminic effects)

ROUTEONSETPEAKDURATION
PO30 min 4–8 hr24 hr

Contraindications/Precautions

Contraindicated in: Hypersensitivity to cetirizine, hydroxyzine or any component; Lactation: Excreted in breast milk; not recommended for use.Use Cautiously in: Patients with hepatic or renal impairment (dose ↓ recommended if CCr ≤31 mL/min or hepatic function is impaired); Obstetric / Pediatric: Safety not established for pregnant women or children <6 mo; Geriatric: Initiate at lower doses.

Adverse Reactions/Side Effects

Central nervous system

  • dizziness
  • drowsiness (significant with doses >10 mg/day)
  • fatigue

Ear, Eye, Nose, Throat

  • pharyngitis

Gastrointestinal

  • dry mouth

Interactions

Drug-Drug interaction

Additive CNS depression may occur with alcohol, opioid analgesics, or sedative/hypnotics.Theophylline may ↓ clearance and ↑ toxicity.

Route/Dosage

Oral (Adults and children ≥6 yr) 5–10 mg given once or divided twice daily.Oral (Children 2–5 yr) 2.5 mg once daily initially, may be ↑ to 5 mg once daily or 2.5 mg every 12 hr.Oral (Children 1–2 yr) 2.5 mg once daily; may be ↑ to 2.5 mg every 12 hr.Oral (Children 6–12 mo) 2.5 once daily.

Hepatic/Renal Impairment

Oral (Adults and Children ≥12 yr) CCr ≤31 mL/min, hepatic impairment or hemodialysis—5 mg once daily.

Hepatic/Renal Impairment

Oral (Children 6–11 yr) start therapy at <2.5 mg/day.

Hepatic/Renal Impairment

Oral (Children <6 yr) use not recommended.

Availability (generic available)

Tablets: 5 mgOTC, 10 mgOTCCapsules: 5 mgOTC, 10 mgOTCChewable tablets (grape): 5 mgOTC, 10 mgOTCOrally disintegrating tablets: 10 mg Syrupbanana-grape and bubblegum flavors: 1 mg/mLOTCIn combination with: pseudoephedrine (Zyrtec-D 12 hr) (See combination drugs).

Nursing implications

Nursing assessment

  • Assess allergy symptoms (rhinitis, conjunctivitis, hives) before and periodically during therapy.
  • Assess lung sounds and character of bronchial secretions. Maintain fluid intake of 1500–2000 mL/day to decrease viscosity of secretions.
  • Lab Test Considerations: May cause false-negative result in allergy skin testing.

Potential Nursing Diagnoses

Ineffective airway clearance (Indications)
Risk for injury (Adverse Reactions)

Implementation

  • Do not confuse cetirizine with sertraline. Do not confuse Zyrtec (cetirizine) with Lipitor (atorvastatin), Zantac (ranitidine), Zocor (simvastatin), Zyprexa (olanzapine), Zyrtec-D (cetirizine/pseudoephedrine), Zyrtec Itchy Eye Drops (ketotifen fumarate).
  • Oral: Administer once daily without regard to food.

Patient/Family Teaching

  • Instruct patient to take medication as directed.
  • May cause dizziness and drowsiness. Caution patient to avoid driving or other activities requiring alertness until response to medication is known.
  • Advise patient to avoid taking alcohol or other CNS depressants concurrently with this drug.
  • Advise patient that good oral hygiene, frequent rinsing of mouth with water, and sugarless gum or candy may minimize dry mouth. Patient should notify dentist if dry mouth persists >2 wk.
  • Instruct patient to contact health care professional if dizziness occurs or if symptoms persist.

Evaluation/Desired Outcomes

  • Decrease in allergic symptoms.

Zyrtec

(zŭr′tĕk′) A trademark for the drug cetirizine hydrochloride.

Zyrtec®

Cetirizine, see there.