Cetirizine

Second-generation antihistamines

ATC code: R06AE07

Updated 24 Sep 2026 · Methodology

Indications

Allergic rhinitis

First line

First-line treatment for seasonal and perennial allergic rhinitis per ARIA guidelines. Reduces sneezing, rhinorrhea, and nasal/conjunctival itching. Adult dose is 10 mg once daily. Efficacy is comparable to loratadine, though cetirizine causes slightly more drowsiness.

Sources

J Allergy Clin Immunol: Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines: 2010 revision. (2010)
J Allergy Clin Immunol: Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines-2016 revision. (2017)
Braz J Otorhinolaryngol: Efficacy of different oral H(1) antihistamine treatments on allergic rhinitis: a systematic review and network meta-analysis of randomized controlled trials. (2023)
Allergy: Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). (2008)
AEMPS: Ficha técnica CETIRIZINA CINFA 10 mg COMPRIMIDOS RECUBIERTOS CON PELICULA EFG (2021)
Allergy: Allergic Rhinitis and Its Impact on Asthma (ARIA)‐EAACI Guidelines—2024–2025 Revision: Part II (2026)

ICD-10: J30.9 · ICD-11: CA08.0

Chronic urticaria

First line

First-line for chronic spontaneous urticaria. If the standard 10 mg dose fails to control symptoms, /GA2LEN guidelines allow up-dosing to 4-fold (40 mg daily) before stepping up to omalizumab. Tolerability of higher doses is generally good.

Sources

ICD-10: L50.1 · ICD-11: EB00.1

Itch in atopic dermatitis

Adjunct

Evidence for oral antihistamines in atopic dermatitis is limited. Systematic reviews do not confirm a meaningful impact on itch or disease course. In practice, however, cetirizine is sometimes used for severe nocturnal pruritus – its mild sedative effect may help with sleep.

Sources

ICD-10: L20 · ICD-11: EA80

Marketing claims without evidence base

The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.

Infectious conjunctivitis

Not recommended

Cetirizine is a second-generation antihistamine taken by mouth for allergic rhinitis and urticaria, and it is sometimes suggested for infectious conjunctivitis. There is no proof of benefit for this use: infectious conjunctivitis comes from a virus or bacteria, and blocking histamine does nothing about the cause of the inflammation. Bacterial cases respond to topical antibiotics prescribed by a doctor, while viral cases usually clear on their own with eye hygiene and supportive care. The substance is harmless in this role, but do not use it in place of treatment with proven benefit, since that risks missing the care you actually need.

Sources

ICD-10: H10.0 · ICD-11: 9A60.3

Common cold

Not recommended

Cetirizine is not effective for the common cold. The 2015 Cochrane review «Antihistamines for the common cold» (15 RCTs, 5,099 participants) showed that second-generation H1 antagonists (cetirizine, loratadine) do not reduce nasal symptoms. A weak effect on rhinorrhoea is seen only with first-generation H1 agents (chlorpheniramine, diphenhydramine) via their anticholinergic component, which cetirizine largely lacks. , , and CDC do not recommend antihistamines for the common cold. Widespread prescribing in post-Soviet practice is inconsistent with international evidence.

Sources

Cochrane Database of Systematic Reviews: Antihistamines for the common cold (2015)

ICD-10: J00 · ICD-11: CA00

Non-allergic rhinitis

Not recommended

Cetirizine is not used in non-allergic rhinitis (vasomotor, idiopathic, infectious URI-related, medication-induced). ARIA 2020 and explicitly separate allergic and non-allergic rhinitis: systemic H1 blockers are not useful in the latter because histamine plays no or minimal role in pathogenesis. Topical azelastine and topical corticosteroids work for vasomotor rhinitis. Oral cetirizine or loratadine «for a runny nose» is an incorrect choice.

Sources

Clinical & Experimental Allergy: BSACI guideline for the diagnosis and management of allergic and non‐allergic rhinitis (Revised Edition 2017; First edition 2007) (2017)

ICD-10: J30.0 · ICD-11: CA08.1

Pre-vaccination premedication for reaction prevention

Not recommended

Routine cetirizine before planned vaccination in healthy individuals without allergy history is not supported by international societies. CDC Pink Book, ACIP 2023, Vaccine Safety and Immunization Action Group: antihistamine premedication does not reduce anaphylaxis risk because the anaphylactic cascade is faster and stronger than H1-receptor blockade. Some data indicate reduced vaccine immunogenicity with antihistamine and paracetamol premedication (Prymula R et al. Lancet 2009, Saleh E et al. Pediatr Infect Dis J 2017) – antibody responses are 10–25 % lower for HIB, pneumococcal, and rotavirus vaccines. Patients with confirmed allergy to vaccine components are managed individually by an allergist, not «just in case».

Sources

ICD-10: Z29.8

How to read tiers A–F

AStrong evidence – first or second line in international guidelines
BRecommended in selected cases
CStudy data contradict each other
DBenefit not proven, no documented harm
FDocumented harm, or risk without benefit

Mechanism of action

Selective peripheral H1-receptor antagonist, second generation. Active metabolite of hydroxyzine. Minimal CNS penetration results in less sedation compared to first-generation antihistamines. Onset of action is 20–60 minutes after administration, duration up to 24 hours.

Safety

Contraindications

Hypersensitivity to cetirizine, hydroxyzine, or any component
Severe renal impairment (CrCl below 10 mL/min) without dose adjustment

Serious adverse effects

Anaphylaxis (very rare)
Severe cutaneous reactions (isolated reports)

Common adverse effects

Drowsiness (more common than loratadine but less than first-generation antihistamines)
Dry mouth
Headache
Fatigue

Pregnancy: can you take Cetirizine?

AEMPS summary of product characteristics (section 4.6): prospectively collected pregnancy data do not suggest maternal, embryonic or fetal toxicity above background rates. Animal studies show no direct or indirect harmful effects on pregnancy, embryonic or fetal development, delivery or postnatal development. Cetirizine should be prescribed to pregnant women with caution.

Breastfeeding: can you take Cetirizine?

Hale L2 · Probably compatible

Passes into breast milk in small amounts. Per LactMed, compatible with breastfeeding at standard doses.

RID, infant dose via milk: 1.8%
Milk-to-plasma ratio: 1

Calculate RID Full profile on NIH LactMed ↗

Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.

Practical notes

Timing and administration

Take 10 mg once daily at any time. If drowsiness is bothersome, evening dosing is preferred. Onset of action is 20–60 minutes. For chronic urticaria, if 10 mg is insufficient, the physician may increase to 20–40 mg daily per recommendations.

Food and drinks

Food does not affect the extent of absorption but may delay it by about 1 hour. In practice this difference is not clinically significant. Alcohol potentiates the sedative effect – patients should be warned.

Common myths

Second-generation antihistamines are prescribed far more broadly in Russia and post-Soviet countries than in international practice. Common unfounded uses include the following.

Myth: «cetirizine helps with a runny nose in a cold». Fact: second-generation H1 blockers do not work in URI. The 2015 Cochrane review on 5,099 participants confirmed the null effect. Nasal decongestants (short courses) and saline rinses work for colds, not systemic antihistamines.

Myth: «cetirizine clears up redness and eye irritation». Fact: systemic H1 blockers are not effective in viral or bacterial conjunctivitis. Histamine is not a mediator in infectious pathogenesis. Cold compresses and artificial tears for viral, topical antibiotics for bacterial.

Myth: «take suprastin or cetirizine an hour before a vaccination so there is no reaction». Fact: CDC, ACIP, and do not support this. Anaphylaxis is faster and stronger than H1 blockade; premedication does not protect. Some data show 10–25 % reduction in vaccine immunogenicity with antihistamine and antipyretic premedication, i.e. the vaccine works weaker.

Myth: «for any runny nose, allergic or not». Fact: in vasomotor, idiopathic, atrophic, medication-induced, or infectious rhinitis, H1 blockers do not work. ARIA separates allergic and non-allergic rhinitis with different pharmacotherapy. Oral antihistamines are for allergic only.

Drug–drug interactions

5 pairs found. Sorted from critical to minor.

MajorAlprazolamBenzodiazepines. Short-to-medium-acting anxiolytics

Mechanism

Alprazolam depresses the central nervous system, and its label approved by the US Food and Drug Administration () lists antihistamines among the drugs that add to this effect. At the recommended 10 mg dose, objective tests show no relevant effect of cetirizine on driving ability, but in sensitive patients other CNS depressants can further reduce attention and performance (cetirizine SmPC).

Symptoms

Drowsiness, reduced attention and slower reactions, impaired coordination (cetirizine SmPC; alprazolam SmPC). In older or debilitated patients alprazolam more often causes ataxia and oversedation (alprazolam SmPC).

Management

The alprazolam label approved by the US Food and Drug Administration () requires limiting the dose and duration of alprazolam used with CNS depressants and lists antihistamines among them. The Spanish alprazolam SmPC sets the same limit for sedating antihistamines (alprazolam SmPC). The patient is warned about drowsiness and told not to drive or operate machinery until it is clear how they tolerate the combination; the cetirizine dose is not exceeded (cetirizine SmPC; alprazolam label, FDA). In older or debilitated patients alprazolam is started at 0.25 mg two or three times daily and kept at the lowest effective dose to avoid ataxia and oversedation (alprazolam SmPC). The US over-the-counter cetirizine label tells people taking tranquilizers or sedatives to ask a doctor or pharmacist before use (cetirizine label, FDA).

Sources

Pair details →Alprazolam →

ModerateAmitriptylineTricyclic antidepressants (TCA)

Mechanism

Additive anticholinergic effect and sedation. Cetirizine is a second-generation antihistamine with minimal central activity, but the effect adds up with amitriptyline. Older patients: high delirium risk.

Symptoms

Dry mouth, constipation, urinary retention (anticholinergic effect). Drowsiness, ataxia. Older patients: delirium and fall risk.

Management

In older patients, an alternative antihistamine with minimal anticholinergic load: fexofenadine or bilastine. Take cetirizine during the day, not at bedtime. Monitor cognition in prolonged therapy.

Sources

FDA: Amitriptyline HCl tablets prescribing information (2014)

Pair details →Amitriptyline →

ModerateMorphineNatural opium alkaloids

Mechanism

Cetirizine penetrates the blood-brain barrier at higher doses. With opioids, additive CNS depression and sedation occur.

Symptoms

Sedation, fatigue, slowed reactions, impaired coordination. In older patients: fall and fracture risk. Driving and operating machinery: accident risk.

Management

On the combination, cap cetirizine at 10 mg/day (at bedtime). Avoid the combination in older patients — fall risk. In palliative care, alternatives: loratadine (minimal sedation) or bilastine (minimal sedation and no sedating metabolites). With marked sedation, stop the antihistamine.

Sources

FDA: Tylenol 8 HR Arthritis Pain (acetaminophen) – label (2020)

Pair details →Morphine →

MinorAscorbic acidVitamins. Antioxidants

Mechanism

Ascorbic acid does not affect cetirizine metabolism. The two are often combined in symptomatic preparations for acute respiratory infections.

Symptoms

The combination usually causes no specific symptoms. Each drug's individual side effects remain.

Management

No dose adjustment needed. The combination is standard in symptomatic formulations for acute respiratory infections and allergy.

Sources

FDA: Tylenol 8 HR Arthritis Pain (acetaminophen) – label (2020)

Pair details →Ascorbic acid →

MinorParacetamolAnilides. Analgesics and antipyretics

Mechanism

Paracetamol and cetirizine are metabolised by different pathways. No direct pharmacokinetic interaction.

Symptoms

The combination usually causes no specific symptoms. Each drug's individual side effects remain.

Management

No dose adjustment needed. The combination is standard in symptomatic formulations for acute respiratory infections and allergy.

Sources

FDA: Tylenol 8 HR Arthritis Pain (acetaminophen) – label (2020)

Pair details →Paracetamol →

Label mentions5 mentions

Verbatim lines from the interaction sections, in the language of the label

From this drug’s label

depresores del SNCclass named in the label
«En pacientes sensiblesm el uso concomitante de alcohol u otros depresores del SNC puede provocar reducciones adicionales de la alerta y disminución del rendimiento aunque cetirizina no potencia el…»
AEMPS, section 4.5 · Open on CIMA
Pseudoephedrine
«Debido a la farmacocinética, farmacodinamia y perfil de tolerancia de cetirizina, no se esperan interacciones con este antihistamínico. De hecho, no se han notificado ni interacciones…»
AEMPS, section 4.5 · Open on CIMA
Theophylline
«Debido a la farmacocinética, farmacodinamia y perfil de tolerancia de cetirizina, no se esperan interacciones con este antihistamínico. De hecho, no se han notificado ni interacciones…»
AEMPS, section 4.5 · Open on CIMA

From other drugs’ labels

Azithromycin
«Recomendación relativa a la administración conjunta: No se observaron cambios clínicamente significativos en la exposición de azitromicina o de los medicamentos administrados conjuntamente en los…»
AEMPS, section 4.5 · Open on CIMA
Efavirenz
«Drugs Without Clinically Significant Interactions with Efavirenz: No dosage adjustment is recommended when efavirenz is given with the following: aluminum/magnesium hydroxide antacids, azithromycin…»
FDA, section 7 · Open on DailyMed

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Frequently asked

What is Cetirizine used for?

Cetirizine is evaluated for the following indications with varying evidence strength: Allergic rhinitis (evidence tier A), Chronic urticaria (evidence tier A), Itch in atopic dermatitis (evidence tier D). See the full indication matrix with dosing and citations above on this page.

What are the side effects of Cetirizine?

Common side effects of Cetirizine (≥ 1 in 100): Drowsiness (more common than loratadine but less than first-generation antihistamines), Dry mouth, Headache, Fatigue. See the Safety section for uncommon and serious reactions.

Is Cetirizine safe during pregnancy?

Is Cetirizine compatible with breastfeeding?

Passes into breast milk in small amounts. Per LactMed, compatible with breastfeeding at standard doses.

Can you drink alcohol while taking Cetirizine?

Alcohol potentiates the sedative effect – patients should be warned.

Who should not take Cetirizine?

Cetirizine is contraindicated in: Hypersensitivity to cetirizine, hydroxyzine, or any component; Severe renal impairment (CrCl below 10 mL/min) without dose adjustment. Full list in the Safety section.

cetirizine helps with a runny nose in a cold

second-generation H1 blockers do not work in URI. The 2015 Cochrane review on 5,099 participants confirmed the null effect. Nasal decongestants (short courses) and saline rinses work for colds, not systemic antihistamines.

cetirizine clears up redness and eye irritation

systemic H1 blockers are not effective in viral or bacterial conjunctivitis. Histamine is not a mediator in infectious pathogenesis. Cold compresses and artificial tears for viral, topical antibiotics for bacterial.

take suprastin or cetirizine an hour before a vaccination so there is no reaction

CDC, ACIP, and WHO do not support this. Anaphylaxis is faster and stronger than H1 blockade; premedication does not protect. Some data show 10–25 % reduction in vaccine immunogenicity with antihistamine and antipyretic premedication, i.e. the vaccine works weaker.

for any runny nose, allergic or not

in vasomotor, idiopathic, atrophic, medication-induced, or infectious rhinitis, H1 blockers do not work. ARIA separates allergic and non-allergic rhinitis with different pharmacotherapy. Oral antihistamines are for allergic only.

Official sources

Direct links to regulator labels. Open in a new tab.

AEMPS / CIMALabel dated 03/03/2026
FDA / DailyMedLabel dated 08/07/2026

Other drugs in this group

Chloropyramine, Chlorpheniramine, Desloratadine, Dexchlorpheniramine, Diphenhydramine, Fexofenadine, Loratadine, Dimenhydrinate