Administration
Available Dosage Forms and Strengths
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Cetirizine is available as oral tablets, capsules, solutions, and orally disintegrating tablets. The dosing of cetirizine depends on the patient’s age. In adults and children 12 years or older, the recommended dose is 5 to 10 mg/d orally, depending on symptom severity.[21] Cetirizine is available in 5 mg and 10 mg tablets and 5 mg/5 mL oral solution and elixir. The ophthalmic formulation is 0.24% cetirizine hydrochloride eye drops in 5 mL and 7.5 mL bottles. Cetirizine 5 mg combined with pseudoephedrine HCl 120 mg is a nasal decongestant that temporarily relieves sinus congestion and pressure.
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Use in Specific Patient Population
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Breastfeeding Considerations: Occasional and small doses of cetirizine are acceptable while breastfeeding. Prolonged use of larger doses may cause a decrease in the milk supply or drowsiness and other adverse effects in the infant, particularly when combined with pseudoephedrine. The use of an ophthalmic formulation of cetirizine by the mother is thought to have minimal risk to the breastfed infant. Clinicians should advise the mother to apply pressure over the tear duct by the corner of the eye and remove the leftover solution to decrease the drug that reaches the breast milk.[23]
Pregnancy Considerations: Cetirizine is a former U.S. FDA pregnancy category B medicine. The American College of Obstetricians and Gynecologists and the American College of Allergy, Asthma, and Immunology (ACOG-ACAAI) recommend cetirizine for pregnant women who require antihistamine treatment. Cetirizine should be used in pregnancy only when necessary.[24][25]
Hepatic Impairment: According to the manufacturer’s prescribing information, the dose for 12-year-old and older patients with hepatic impairment should be reduced to 5 mg daily. The manufacturer also recommends lowering the dose for patients 6 to 11 years old with hepatic impairment. Intravenous administration of cetirizine is intended for short-term use; no dose adjustment is required per the manufacturer’s labeling.
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Renal Impairment: Manufacturers’ prescribing information suggests reducing the dose to 5 mg daily for patients aged 12 years and older with decreased renal function (CrCL 11 to 31 mL/min) and patients on hemodialysis. The manufacturer also recommends lowering the dose for 6 to 11-year-old patients with renal impairment. The IV formulation of cetirizine is intended for short-term use; no dose adjustment is required per the manufacturer’s labeling.
Pediatric Patients: According to one meta-analysis, there is moderate to low certainty evidence that cetirizine may improve clinical outcomes and quality of life in children with allergic rhinitis. Cetirizine demonstrates comparable efficacy with other antihistamines and is generally well tolerated, although there is an increased risk of somnolence in the pediatric population.[26] The intravenous formulation is FDA-approved for urticaria in children 6 months and older. For adolescents aged 12 years and older, the recommended intravenous dosage of cetirizine is 10 mg. Children aged 6 to 11 years old may receive either 5 mg to 10 mg, depending on symptom severity. For children aged 6 months to 5 years, the recommended intravenous dosage is 2.5 mg.
Older Patients: Efficacy evaluations did not include an adequate number of patients aged 65 years and older to determine potential divergent response patterns compared to younger patients. Safety assessments of cetirizine in older patients compared to younger adults revealed no significant differences. However, sensitivity to adverse drug reactions in certain older individuals remains a possibility.
Ophthalmic Formulation: Each bottle of 0.24% cetirizine hydrochloride contains benzalkonium chloride and can be absorbed by contact lenses. Manufacturers advise patients to remove contact lenses and wait 10 minutes after administration until the reinsertion of lenses. If irritation or redness persists after this precaution, contact lenses should be avoided. Cetirizine has proven safe and effective for pediatric patients 2 years and older in clinical studies.[27]
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