What are the effects of using hydroxyzine and Xyzal (levocetirizine) together?

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From the Guidelines

Taking hydroxyzine and Zyrtec together is not recommended due to the increased risk of adverse effects such as excessive sedation, dry mouth, and urinary retention without providing significant additional therapeutic benefit. According to the study published in the Journal of Allergy and Clinical Immunology 1, first-generation antihistamines like hydroxyzine are associated with sedative effects, performance impairment, and anticholinergic effects, which can be potentially dangerous. Second-generation antihistamines like Zyrtec are generally preferred over first-generation antihistamines for the treatment of allergic rhinitis due to their lower likelihood of adverse effects.

Some key points to consider when using antihistamines include:

  • First-generation antihistamines can cause sedation, performance impairment, and anticholinergic effects, which can be undesirable and potentially dangerous 1
  • Second-generation antihistamines have less or no tendency to cause these effects, making them a preferred choice for treating allergic rhinitis 1
  • Concomitant use of other CNS-active substances, such as alcohol or sedatives, can further enhance performance impairment from antihistamines 1
  • Older adults are more sensitive to the psychomotor impairment promoted by first-generation antihistamines and are at increased risk for complications such as fractures and subdural hematomas caused by falls 1

If you're finding that one antihistamine isn't adequately controlling your symptoms, it's better to consult your healthcare provider about alternative treatment options rather than combining these medications. Your doctor might recommend a different class of allergy medication, a higher dose of a single antihistamine, or adding a medication that works through a different mechanism, such as a nasal corticosteroid or leukotriene modifier, as suggested by the study 1. This approach would likely provide better symptom control with less risk than combining two antihistamines.

From the FDA Drug Label

Oral hydroxyzine hydrochloride is contraindicated in patients with known hypersensitivity to hydroxyzine hydrochloride products, and in patients with known hypersensitivity to cetirizine hydrochloride or levocetirizine hydrochloride. The FDA drug label does not answer the question about using hydroxyzine and Xyrtec (which is likely a misspelling of Zyrtec, another name for cetirizine) together, as it only mentions contraindications for patients with known hypersensitivity to cetirizine hydrochloride, but does not provide information on concomitant use. 2

From the Research

Hydroxyzine and Xyrtec (Cetirizine) Use Together

  • Hydroxyzine and cetirizine (Xyrtec) are both antihistamines, but they belong to different generations and have distinct properties 3.
  • Cetirizine is a potent histamine H1-receptor antagonist with antiallergic properties, and it is considered to be a nonsedating antihistamine 3.
  • Hydroxyzine, on the other hand, is a first-generation antihistamine that can cause sedation and has been used for the treatment of anxiety and allergic conditions 4.
  • There is no direct evidence to suggest that using hydroxyzine and cetirizine together is contraindicated, but it is essential to consider the potential for increased sedation and other adverse effects 5.
  • The use of antihistamines, including hydroxyzine and cetirizine, can affect mood, sleep quality, and daytime sleepiness, and these effects can vary depending on the specific medication and individual response 5.

Potential Interactions and Side Effects

  • Combining hydroxyzine and cetirizine may increase the risk of sedation, dry mouth, and other anticholinergic side effects 5.
  • Hydroxyzine has been shown to have negative influences on mood states, including increased depression, anxiety, and fatigue 5.
  • Cetirizine, as a nonsedating antihistamine, is generally considered to be well-tolerated, but it can still cause side effects such as headache, drowsiness, and gastrointestinal disturbances 3.

Clinical Considerations

  • When using hydroxyzine and cetirizine together, it is crucial to monitor patients for potential side effects and adjust the dosage or discontinue treatment if necessary 6.
  • The selection of antihistamines should be based on individual patient needs, including the specific allergic condition being treated, the presence of comorbidities, and the potential for drug interactions 6.
  • Patients should be informed about the potential risks and benefits of using antihistamines, including the possibility of increased sedation and other adverse effects when combining hydroxyzine and cetirizine 7.

References

Guideline

the diagnosis and management of rhinitis: an updated practice parameter.

Journal of Allergy and Clinical Immunology, 2008

Research

Hydroxyzine for generalised anxiety disorder.

The Cochrane database of systematic reviews, 2010

Research

Assessment of the effects of antihistamine drugs on mood, sleep quality, sleepiness, and dream anxiety.

International journal of psychiatry in clinical practice, 2014

Research

Evidence-based use of antihistamines for treatment of allergic conditions.

Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology, 2023

Research

Safety of Intranasal Steroids: an Updated Perspective.

Current allergy and asthma reports, 2020

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.