Cetirizine (Systemic) (Lexi-Drugs)

Pronunciation

(se TI ra zeen)

Brand Names: US

All Day Allergy Childrens [OTC]; All Day Allergy [OTC]; Allergy Relief [OTC]; Allergy Relief/Indoor/Outdoor [OTC]; Cetirizine HCl Allergy Child [OTC]; Cetirizine HCl Childrens Alrgy [OTC]; Cetirizine HCl Childrens [OTC]; Cetirizine HCl Hives Relief [OTC]; GoodSense All Day Allergy [OTC]; ZyrTEC Allergy Childrens [OTC]; ZyrTEC Allergy [OTC]; ZyrTEC Childrens Allergy [OTC]

Dosing: Adult

Upper respiratory allergies, urticaria: Oral: 5 to 10 mg once daily, depending upon symptom severity (maximum dose: 10 mg daily)

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

There are no dosage adjustments provided in the manufacturer’s labeling; however, the following adjustments have been recommended (Aronoff, 2007):

GFR >50 mL/minute: No dosage adjustment necessary.

GFR ≤50 mL/minute: 5 mg once daily

Intermittent hemodialysis: 5 mg once daily; 5 mg 3 times per week may also be effective.

Peritoneal dialysis: 5 mg once daily.

Dosing: Hepatic Impairment: Adult

There are no dosage adjustments provided in the manufacturer’s labeling.

Dosing: Pediatric

Chronic urticaria: Oral:

Infants 6 to <12 months: 2.5 mg once daily

Children 12 to 23 months: Initial: 2.5 mg once daily; dosage may be increased to 2.5 mg twice daily

Children 2 to 5 years: 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

Allergic rhinitis; perennial: Oral:

Infants 6 to <12 months: 2.5 mg once daily

Children 12 to 23 months: 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: 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: 5 to 10 mg once daily

Dosing: Renal Impairment: Pediatric

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

There are no dosage adjustments provided in manufacturer’s labeling.

Use: Labeled Indications

Upper respiratory allergies: Temporarily relieves symptoms of upper respiratory allergies.

Urticaria: Relieves itching due to urticaria.

Clinical Practice Guidelines

Allergic Rhinitis:

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

Urticaria:

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

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 our without water.

Storage/Stability

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).

Medication Patient Education with HCAHPS Considerations

• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)

• Patient may experience fatigue or dry mouth. Have patient report immediately to prescriber severe loss of strength and energy (HCAHPS).

• Educate patient about signs of a significant reaction (eg, 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. Patient should consult prescriber for additional questions.

Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for healthcare professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience and judgment in diagnosing, treating and advising patients.

Medication Safety Issues
  Sound-alike/look-alike issues:
  International issues:
Contraindications

Hypersensitivity to cetirizine, hydroxyzine, or any component of the formulation

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 which 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.

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; Zuberier 2018).

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

Lexicomp Pregnancy & Lactation, In-Depth
Briggs’ Drugs in Pregnancy & Lactation
Adverse Reactions

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

2% to 10%:

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

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%)

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, ageusia, alopecia, altered sense of smell, amnesia, anaphylaxis, angioedema, anorexia, anxiety, aphthous stomatitis, arthralgia, arthritis, ataxia, back pain, blepharoptosis, blindness, bronchitis, bullous rash, cardiac failure, chest pain, cholestasis, confusion, conjunctivitis, constipation, cutaneous nodules, cystitis, deafness, decreased libido, dehydration, depersonalization, depression, dermatitis, dermatological disease, 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, gastritis, glaucoma, glomerulonephritis, hematuria, hemolytic anemia, hemophthalmos, hemorrhoids, hepatic insufficiency, hepatitis, hot flash, hyperesthesia, hyperkeratosis, hyperkinesia, hypermenorrhea, 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, leg cramps, leukorrhea, lower extremity edema, lymphadenopathy, maculopapular rash, mastalgia (female), melena, migraine, myalgia, myasthenia, myelitis, myocardial infarction, nasal polyposis, nervousness, nightmares, orofacial dyskinesia, osteoarthritis, otalgia, ototoxicity, pain, pallor, palpitations, paralysis, paresthesia, periorbital edema, pneumonia, polyuria, pruritus, purpura, rectal hemorrhage, respiratory tract disease, 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, weakness, weight gain, xeroderma, xerophthalmia

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

Allergy and Idiosyncratic Reactions
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 

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

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 patches (Butrans brand) at 5 mcg/hr in adults when used with other 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

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

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

HYDROcodone: CNS Depressants may enhance the CNS depressant effect of HYDROcodone. Management: Avoid concomitant use of hydrocodone 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

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

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: May decrease the serum concentration of P-glycoprotein/ABCB1 Substrates. Lumacaftor 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: 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

Mirtazapine: CNS Depressants may enhance the CNS depressant effect of Mirtazapine. 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 C: Monitor therapy

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

Tapentadol: May enhance the CNS depressant effect of CNS Depressants. Management: Avoid concomitant use of tapentadol 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

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, 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) [dye free, gluten free; contains methylparaben, propylene glycol, propylparaben; 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 [DSC]) [dye free, sugar free; contains propylene glycol, sodium benzoate; bubble-gum flavor]

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

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]

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 (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: 0.7 hours (Simons 1999)

Duration of action: Suppression of skin wheal and flare: ≥24 hours (Simons 1999)

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: 1 hour

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).

Effects on Bleeding

No information available to require special precautions

Index Terms

Cetirizine Hydrochloride; P-071; UCB-P071

FDA Approval Date
December 12, 1995
References

Allegra L, Paupe J, Wieseman HG, et al, “Cetirizine for Seasonal Allergic Rhinitis in Children Aged 2-6 Years. A Double-Blind Comparison With Placebo,” Pediatr Allergy Immunol, 1993; 4:157-61.

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.

Barnes CL, McKenzie CA, Webster KD, et al, “Cetirizine: A New, Nonsedating Antihistamine,” Ann Pharmacother, 1993; 27:464-70.

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.[PubMed 24528912]

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

Dasgupta A, Wells A, and Datta P, “False-Positive Serum Tricyclic Antidepressant Concentrations Using Fluorescence Polarization Immunoassay due to the Presence of Hydroxyzine and Cetirizine,” Ther Drug Monit, 2007, 29(1):134-9.[PubMed 17333576]

Ito S, Blajchman A, Stephenson M, et al, “Prospective Follow-Up of Adverse Reactions in Breast-Fed Infants Exposed to Maternal Medication,” Am J Obstet Gynecol, 1993, 168(5):1393-9.[PubMed 8498418]

Kaiser HB, “Cetirizine in Allergic Rhinitis,” Pediatr Allergy Immunol, 1993; 4(Suppl):44-6.

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]

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.[PubMed 25711134]

Ramaekers JG, Uiterwijk MM, and O’Hanlon J, “Effects of Loratadine and Cetirizine on Actual Driving and Psychometric Test Performance, and EEG During Driving,” Eur J Clin Pharmacol. 1992;42:363-369.

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]

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, “The Diagnosis and Management of Rhinitis: An Updated Practice Parameter,” J Allergy Clin Immunol, 2008, 122(2 Suppl):1-84.[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.[PubMed 29336054]

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 (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); Anti-Hist Allergy (IE); 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 (SK); Cetizin (BD); Cetrak (EG, LB); Cetrimed (TH); Cetrine (CN, IE); Cetrix (LT); 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); Histalong (VN); Histazine (IL); Histec (FI); Lergium (PE); Letizen (HR, SK); N-Alergya (IL); Nohist (SA); Noler (BD); Nosemin (KR); Omcet (AE, BH, JO, KW, QA, SA); Ozen (ID); Parlazin (HK, HU); Prixlae (PH); Razene (NZ); Reactin (BG); Reactine (BE, MX); Rigotax (CL); Rolinoz (UA); Ronex (LK); Ryvel (ID); Ryzen (ID); Ryzicor (ID); Selitex (KR); Simtec (MY); Stamidix (IT); Sunizine (SG); Sutac (TH); Talzic (VE); 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 (TH); Zetaler (PE); Zetalerg (BR); Zetop (NZ); Zilarex (AU); Zirec (TR); Zirpine (IE, MT); Zirtec (IT); Zirtek (GB, IE, UA); Zirtin (IN); Zodac (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)

Cetirizine (Systemic) (Patient Education – Adult Medication)
You must carefully read the “Consumer Information Use and Disclaimer” below in order to understand and correctly use this information
Pronunciation

(se TI ra zeen)

Brand Names: US

All Day Allergy Childrens [OTC]; All Day Allergy [OTC]; Allergy Relief [OTC]; Allergy Relief/Indoor/Outdoor [OTC]; Cetirizine HCl Allergy Child [OTC]; Cetirizine HCl Childrens Alrgy [OTC]; Cetirizine HCl Childrens [OTC]; Cetirizine HCl Hives Relief [OTC]; GoodSense All Day Allergy [OTC]; ZyrTEC Allergy Childrens [OTC]; ZyrTEC Allergy [OTC]; ZyrTEC Childrens Allergy [OTC]

Brand Names: Canada

Aller-Relief [OTC]; Apo-Cetirizine [OTC]; Extra Strength Allergy Relief [OTC]; PMS-Cetirizine; Reactine; Reactine [OTC]

What is this drug used for?
  • It is used to ease allergy signs.
  • It is used to treat hives.
What do I need to tell my doctor BEFORE I take this drug?
  • If you have an allergy to cetirizine, hydroxyzine, or any other part of this drug.
  • If you are allergic to any drugs like this one, any other drugs, foods, or other substances. Tell your doctor about the allergy and what signs you had, like rash; hives; itching; shortness of breath; wheezing; cough; swelling of face, lips, tongue, or throat; or any other signs.
  • If you are breast-feeding or plan to breast-feed.
  • This drug may interact with other drugs or health problems.
  • Tell your doctor and pharmacist about all of your drugs (prescription or OTC, natural products, vitamins) and health problems. You must check to make sure that it is safe for you to take this drug with all of your drugs and health problems. Do not start, stop, or change the dose of any drug without checking with your doctor.
What are some things I need to know or do while I take this drug?
  • Tell all of your health care providers that you take this drug. This includes your doctors, nurses, pharmacists, and dentists.
  • Avoid driving and doing other tasks or actions that call for you to be alert until you see how this drug affects you.
  • This drug may affect certain lab tests. Tell all of your health care providers and lab workers that you take this drug.
  • Avoid drinking alcohol while taking this drug.
  • Talk with your doctor before you use other drugs and natural products that slow your actions.
  • If you are 65 or older, use this drug with care. You could have more side effects.
  • Tell your doctor if you are pregnant or plan on getting pregnant. You will need to talk about the benefits and risks of using this drug while you are pregnant.
What are some side effects that I need to call my doctor about right away?
  • WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:
  • Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.
  • Feeling very tired or weak.
What are some other side effects of this drug?
  • All drugs may cause side effects. However, many people have no side effects or only have minor side effects. Call your doctor or get medical help if any of these side effects or any other side effects bother you or do not go away:
  • Feeling sleepy.
  • Feeling tired or weak.
  • Dry mouth.
  • These are not all of the side effects that may occur. If you have questions about side effects, call your doctor. Call your doctor for medical advice about side effects.
  • You may report side effects to your national health agency.
How is this drug best taken?
  • Use this drug as ordered by your doctor. Read all information given to you. Follow all instructions closely.
  • All products:
  • Take with or without food. Take with food if it causes an upset stomach.
  • Chewable tablet:
  • Chew well before swallowing.
  • Liquid:
  • Measure liquid doses carefully. Use the measuring device that comes with this drug. If there is none, ask the pharmacist for a device to measure this drug.
  • Oral-disintegrating tablet:
  • Do not push the tablet out of the foil when opening. Use dry hands to take it from the foil. Place on your tongue and let it dissolve. Water is not needed. Do not swallow it whole. Do not chew, break, or crush it.
  • Use right away after this drug is removed from the foil. Do not store any part of the tablet for use at a later time.
What do I do if I miss a dose?
  • If you take this drug on a regular basis, take a missed dose as soon as you think about it.
  • If it is close to the time for your next dose, skip the missed dose and go back to your normal time.
  • Do not take 2 doses at the same time or extra doses.
  • Many times this drug is taken on an as needed basis. Do not take more often than told by the doctor.
How do I store and/or throw out this drug?
  • Store at room temperature.
  • Store in a dry place. Do not store in a bathroom.
  • Keep all drugs in a safe place. Keep all drugs out of the reach of children and pets.
  • Throw away unused or expired drugs. Do not flush down a toilet or pour down a drain unless you are told to do so. Check with your pharmacist if you have questions about the best way to throw out drugs. There may be drug take-back programs in your area.
General drug facts
  • If your symptoms or health problems do not get better or if they become worse, call your doctor.
  • Do not share your drugs with others and do not take anyone else’s drugs.
  • Keep a list of all your drugs (prescription, natural products, vitamins, OTC) with you. Give this list to your doctor.
  • Talk with the doctor before starting any new drug, including prescription or OTC, natural products, or vitamins.
  • Some drugs may have another patient information leaflet. If you have any questions about this drug, please talk with your doctor, nurse, pharmacist, or other health care provider.
  • If you think there has been an overdose, call your poison control center or get medical care right away. Be ready to tell or show what was taken, how much, and when it happened.
Cetirizine (Systemic) (Patient Education – Pediatric Medication)
You must carefully read the “Consumer Information Use and Disclaimer” below in order to understand and correctly use this information
Pronunciation

(se TI ra zeen)

Brand Names: US

All Day Allergy Childrens [OTC]; All Day Allergy [OTC]; Allergy Relief [OTC]; Allergy Relief/Indoor/Outdoor [OTC]; Cetirizine HCl Allergy Child [OTC]; Cetirizine HCl Childrens Alrgy [OTC]; Cetirizine HCl Childrens [OTC]; Cetirizine HCl Hives Relief [OTC]; GoodSense All Day Allergy [OTC]; ZyrTEC Allergy Childrens [OTC]; ZyrTEC Allergy [OTC]; ZyrTEC Childrens Allergy [OTC]

Brand Names: Canada

Aller-Relief [OTC]; Apo-Cetirizine [OTC]; Extra Strength Allergy Relief [OTC]; PMS-Cetirizine; Reactine; Reactine [OTC]

What is this drug used for?
  • It is used to ease allergy signs.
  • It is used to treat hives.
What do I need to tell the doctor BEFORE my child takes this drug?
  • If your child has an allergy to this drug, any part of this drug, or hydroxyzine.
  • If your child is allergic to any drugs like this one or any other drugs, foods, or other substances. Tell the doctor about the allergy and what signs your child had, like rash; hives; itching; shortness of breath; wheezing; cough; swelling of face, lips, tongue, or throat; or any other signs.
  • If your child is breast-feeding a baby:
  • Talk with the doctor if your child is breast-feeding a baby or plans to breast-feed a baby.
  • This drug may interact with other drugs or health problems.
  • Tell the doctor and pharmacist about all of your child’s drugs (prescription or OTC, natural products, vitamins) and health problems. You must check to make sure that it is safe for your child to take this drug with all of his/her drugs and health problems. Do not start, stop, or change the dose of any drug your child takes without checking with the doctor.
What are some things I need to know or do while my child takes this drug?
  • Tell all of your child’s health care providers that your child is taking this drug. This includes your child’s doctors, nurses, pharmacists, and dentists.
  • Alcohol may interact with this drug. Be sure your child does not drink alcohol.
  • Talk with the doctor before giving your child other drugs and natural products that may slow your child’s actions.
  • Have your child avoid tasks or actions that call for alertness until you see how this drug affects your child. These are things like riding a bike, playing sports, or using items such as scissors, lawnmowers, electric scooters, toy cars, or motorized vehicles.
  • This drug may affect certain lab tests. Tell all of your child’s health care providers and lab workers that your child takes this drug.
  • Use with care in children. Talk with the doctor.
  • If your child is pregnant:
  • Tell the doctor if your child is pregnant or becomes pregnant. You will need to talk about the benefits and risks of your child using this drug while pregnant.
What are some side effects that I need to call my child’s doctor about right away?
  • WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your child’s doctor or get medical help right away if your child has any of the following signs or symptoms that may be related to a very bad side effect:
  • Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.
  • Feeling very tired or weak.
What are some other side effects of this drug?
  • All drugs may cause side effects. However, many people have no side effects or only have minor side effects. Call your child’s doctor or get medical help if any of these side effects or any other side effects bother your child or do not go away:
  • Belly pain.
  • Dry mouth.
  • Feeling sleepy.
  • Feeling tired or weak.
  • Not able to sleep.
  • These are not all of the side effects that may occur. If you have questions about side effects, call your child’s doctor. Call your child’s doctor for medical advice about side effects.
  • You may report side effects to your national health agency.
How is this drug best given?
  • Give this drug as ordered by your child’s doctor. Read all information given to you. Follow all instructions closely.
  • All products:
  • Give this drug with or without food. Give with food if it causes an upset stomach.
  • Chewable tablet:
  • Have your child chew all the way up before swallowing.
  • Liquid:
  • Measure liquid doses carefully. Use the measuring device that comes with this drug. If there is none, ask the pharmacist for a device to measure this drug.
  • Oral-disintegrating tablet:
  • Do not push the tablet out of the foil when opening. Use dry hands to take it from the foil. Place on your child’s tongue and let it dissolve. Water is not needed. Do not let your child swallow it whole. Do not let your child chew, break, or crush it.
  • Use right away after this drug is removed from the foil. Do not store any part of the tablet for use at a later time.
What do I do if my child misses a dose?
  • If your child takes this drug on a regular basis, give a missed dose as soon as you think about it.
  • If it is close to the time for your child’s next dose, skip the missed dose and go back to your child’s normal time.
  • Do not give 2 doses at the same time or extra doses.
  • Many times this drug is given on an as needed basis. Do not give to your child more often than told by the doctor.
How do I store and/or throw out this drug?
  • Store at room temperature.
  • Store in a dry place. Do not store in a bathroom.
  • Keep all drugs in a safe place. Keep all drugs out of the reach of children and pets.
  • Throw away unused or expired drugs. Do not flush down a toilet or pour down a drain unless you are told to do so. Check with your pharmacist if you have questions about the best way to throw out drugs. There may be drug take-back programs in your area.
General drug facts
  • If your child’s symptoms or health problems do not get better or if they become worse, call your child’s doctor.
  • Do not share your child’s drug with others and do not give anyone else’s drug to your child.
  • Keep a list of all your child’s drugs (prescription, natural products, vitamins, OTC) with you. Give this list to your child’s doctor.
  • Talk with your child’s doctor before giving your child any new drug, including prescription or OTC, natural products, or vitamins.
  • Some drugs may have another patient information leaflet. If you have any questions about this drug, please talk with your child’s doctor, nurse, pharmacist, or other health care provider.
  • If you think there has been an overdose, call your poison control center or get medical care right away. Be ready to tell or show what was taken, how much, and when it happened.