From the FDA Drug Label
consumers with kidney disease do not use The FDA drug label does not provide specific renal dosing instructions for levocetirizine, it only advises against use in patients with kidney disease.
From the Research
Xyzal (levocetirizine) requires dosage adjustment in patients with renal impairment, with the most recent and highest quality study 1 not directly addressing Xyzal but emphasizing the importance of renal function in drug dosing.
Key Considerations
- For adults with normal renal function, the standard dose is 5 mg once daily.
- For those with mild renal impairment (creatinine clearance 50-80 mL/min), the recommended dose remains 5 mg once daily.
- For moderate renal impairment (creatinine clearance 30-49 mL/min), the dose should be reduced to 2.5 mg once daily.
- In severe renal impairment (creatinine clearance 10-29 mL/min), the dose should be 2.5 mg every other day.
- Patients with end-stage renal disease (creatinine clearance <10 mL/min) or those on hemodialysis should not take Xyzal.
Rationale
These adjustments are necessary because levocetirizine is primarily eliminated unchanged through the kidneys, and reduced renal function leads to drug accumulation, potentially causing adverse effects like drowsiness, dry mouth, and fatigue, as highlighted by the importance of monitoring renal function in patients on long-term therapy 2, 3.
Monitoring and Adjustments
Elderly patients often have decreased renal function and may require dose adjustments based on their creatinine clearance. It's essential to monitor renal function periodically in patients on long-term therapy, especially if they have other conditions or medications that might affect kidney function, as studies have shown that drug dose adjustments are often inadequate in patients with renal impairment 4, 3.
Conclusion Not Applicable
Instead, the focus is on applying the most recent and relevant evidence to guide clinical decision-making for Xyzal dosing in patients with renal impairment, prioritizing morbidity, mortality, and quality of life outcomes.