Xyzal

Xyzal (levocetirizine dihydrochloride) is a prescription-strength, non-sedating antihistamine designed to deliver potent and sustained relief from allergy symptoms. As the active enantiomer of cetirizine, it offers enhanced binding affinity to H1 receptors with a optimized pharmacokinetic profile. This medication provides continuous 24-hour control of histamine-mediated responses, making it a cornerstone therapy for managing allergic rhinitis and chronic idiopathic urticaria in adult and pediatric patients. Its clinical efficacy is well-documented in reducing nasal congestion, sneezing, pruritus, and ocular symptoms associated with seasonal and perennial allergies.

Features

• Active ingredient: Levocetirizine dihydrochloride 5 mg per tablet
• Pharmacological class: Second-generation H1-receptor antagonist
• Duration of action: 24-hour sustained relief per dose
• Formulation: Film-coated tablets and oral solution (2.5 mg/5 mL)
• Rapid onset: Symptom relief begins within 1 hour of administration
• Low metabolic burden: Primarily renally excreted unchanged
• Minimal cytochrome P450 involvement in metabolism

Benefits

• Provides comprehensive 24-hour relief from allergic rhinoconjunctivitis symptoms including nasal congestion, sneezing, and itchy/watery eyes
• Effectively reduces wheals and pruritus associated with chronic idiopathic urticaria
• Demonstrated non-sedating properties at recommended doses with minimal CNS penetration
• Suitable for long-term management with no evidence of tachyphylaxis
• Pediatric formulation available for children aged 6 months and older
• Improves quality of life measures including sleep quality and daytime productivity

Common use

Xyzal is primarily indicated for the relief of symptoms associated with allergic rhinitis (seasonal and perennial) in adults and children 6 years of age and older. This includes sneezing, rhinorrhea, nasal pruritus, ocular pruritus, and lacrimation. Additionally, it is indicated for the treatment of uncomplicated skin manifestations of chronic idiopathic urticaria in adults and children 6 months of age and older. Off-label uses may include adjunctive therapy in atopic dermatitis and mast cell activation syndromes, though these applications require specialist supervision.

Dosage and direction

Adults and children 12 years and older: 5 mg (1 tablet or 10 mL oral solution) once daily in the evening. May be taken with or without food.

Children 6 to 11 years: 2.5 mg (½ tablet or 5 mL oral solution) once daily in the evening.

Children 6 months to 5 years: 1.25 mg (2.5 mL oral solution) once daily in the evening.

Renal impairment dosing:

• Mild impairment (CrCl 50-80 mL/min): 2.5 mg once daily
• Moderate impairment (CrCl 30-50 mL/min): 2.5 mg every other day
• Severe impairment (CrCl 10-30 mL/min): 2.5 mg twice weekly
• End-stage renal disease (CrCl <10 mL/min): Contraindicated

Tablets should be swallowed whole with water. Oral solution should be measured using the provided dosing spoon.

Precautions

Exercise caution when administering Xyzal to patients with predisposing factors for urinary retention (e.g., prostatic hyperplasia, bladder outlet obstruction). Monitor patients with glaucoma or increased intraocular pressure. Use with caution in patients with epilepsy or predisposing factors for seizures. Elderly patients may be more susceptible to adverse reactions due to age-related renal function decline. Performance of activities requiring mental alertness (operating machinery, driving) may be impaired, particularly during initial treatment or dose escalation. Not recommended during pregnancy unless clearly needed (Category B). Excretion in human breast milk occurs—consider discontinuing nursing or the drug.

Contraindications

Hypersensitivity to levocetirizine, cetirizine, hydroxyzine, or any component of the formulation. End-stage renal disease (CrCl <10 mL/min). Patients undergoing hemodialysis. Concurrent use with CNS depressants including alcohol may potentiate sedation. Not recommended in children under 6 months of age.

Possible side effects

Common (≥1/100 to <1/10): Somnolence, fatigue, dry mouth, pharyngitis Uncommon (≥1/1,000 to <1/100): Dizziness, headache, nausea, abdominal pain Rare (≥1/10,000 to <1/1,000): Insomnia, agitation, palpitations, tachycardia, weight increase, blurred vision, dyspnea Very rare (<1/10,000): Anaphylaxis, angioedema, fixed drug eruption, hepatitis, seizures, syncope, thrombocytopenia

Most adverse reactions are mild to moderate and transient in nature. Discontinuation rate due to adverse events is approximately 3%.

Drug interaction

Moderate interactions: CNS depressants (alcohol, benzodiazepines, opioids, barbiturates) may enhance sedative effects. Theophylline may decrease clearance of levocetirizine. Ritonavir may increase levocetirizine exposure. Minor interactions: Anticholinergic drugs may enhance dry mouth and urinary retention. P-glycoprotein inhibitors may increase absorption. No clinically significant interactions with warfarin, azithromycin, ketoconazole, or erythromycin have been observed.

Missed dose

If a dose is missed, take it as soon as remembered unless it is nearly time for the next dose. Do not double the dose to make up for the missed one. Resume regular dosing schedule. If multiple doses are missed, contact healthcare provider for guidance.

Overdose

Symptoms may include drowsiness, agitation, restlessness, confusion, tachycardia, headache, and urinary retention. In children, initial agitation may be followed by drowsiness. There is no specific antidote. Gastric lavage may be considered if presented within 1 hour of ingestion. Symptomatic and supportive treatment is recommended. Hemodialysis is effective (removes approximately 50% of circulating drug over 4 hours). Monitor cardiac function and provide respiratory support if necessary.

Storage

Store at room temperature (15-30°C/59-86°F). Keep in original container with lid tightly closed. Protect from light and moisture. Do not freeze oral solution. Keep out of reach of children. Discard any unused oral solution 4 months after opening. Do not use after expiration date printed on packaging.

Disclaimer

This information is for educational purposes only and does not constitute medical advice. Individual response to medication may vary. Always consult with a qualified healthcare professional before starting, changing, or stopping any medication. Do not exceed recommended dosage. Full prescribing information is available from the manufacturer. Report any adverse events to your healthcare provider and the appropriate regulatory authority.

Reviews

“After struggling with perennial allergic rhinitis for years, Xyzal has provided consistent relief without the sedation I experienced with other antihistamines. My quality of sleep has significantly improved.” - Allergy Specialist, 44

“As a pediatric allergist, I appreciate the dosing flexibility and safety profile of Xyzal for my younger patients. The oral solution formulation makes administration straightforward for parents.” - Board-Certified Allergist, 51

“Clinical studies demonstrate Xyzal’s superior receptor binding affinity compared to other second-generation antihistamines. The 24-hour coverage with single daily dosing supports excellent adherence.” - Clinical Pharmacologist, 38

“After switching from cetirizine, I’ve noticed better control of my chronic urticaria with fewer breakthrough symptoms. The non-sedating property allows me to maintain my surgical schedule without impairment.” - Dermatologist, 47