Is it safe to take cetirizine with pseudoephedrine (Sudafed)?

Medical Advisory BoardAll articles are reviewed for accuracy by our Medical Advisory Board
Educational purpose only • Exercise caution as content is pending human review
Article Review Status
Submitted
Under Review
Approved

Last updated: June 3, 2025View editorial policy

Personalize

Help us tailor your experience

Which best describes you? Your choice helps us use language that's most understandable for you.

From the Guidelines

It is generally safe for most adults to take cetirizine with pseudoephedrine, as these medications are even available as a combination product. Cetirizine is an antihistamine that helps relieve allergy symptoms like sneezing and itching, while pseudoephedrine is a decongestant that reduces nasal congestion. The standard dosage for adults is typically one tablet of the combination product every 12 hours, not exceeding two tablets in 24 hours. However, certain individuals should exercise caution, including those with high blood pressure, heart disease, diabetes, thyroid problems, glaucoma, enlarged prostate, or liver/kidney disease. Pseudoephedrine can raise blood pressure and heart rate, so those with cardiovascular conditions should consult their healthcare provider first, as noted in the study 1. Additionally, these medications may cause side effects like drowsiness, dizziness, dry mouth, or insomnia. If you're taking other medications, especially MAO inhibitors, it's essential to speak with your healthcare provider before combining these drugs to avoid potentially dangerous interactions. Some key points to consider when taking cetirizine with pseudoephedrine include:

  • Monitoring blood pressure and heart rate, especially in individuals with pre-existing cardiovascular conditions 1
  • Being aware of potential side effects and reporting them to a healthcare provider if they occur
  • Avoiding use in infants and young children, as pseudoephedrine can cause serious side effects in this age group, including agitated psychosis, ataxia, hallucinations, and even death 1
  • Using the medication only as directed and not exceeding the recommended dosage to minimize the risk of adverse effects.

From the Research

Safety of Cetirizine with Pseudoephedrine

  • The combination of cetirizine and pseudoephedrine has been studied in patients with seasonal allergic rhinitis and concomitant mild-to-moderate asthma 2.
  • The study found that cetirizine-pseudoephedrine reduced total symptom severity complex scores by 42.3% overall compared to 23.6% with placebo, and also improved asthma symptom severity total scores and Asthma Quality of Life Questionnaire overall scores.
  • Pseudoephedrine has been shown to have no significant effect on systolic or diastolic blood pressure in patients with controlled hypertension 3.
  • Cetirizine is a second-generation antihistamine with a good safety record, and its combination with pseudoephedrine has been found to be well-tolerated in clinical studies 4, 5, 2.

Potential Interactions and Side Effects

  • Cetirizine has been shown to impair performance and cognition in several studies, although to a much lesser degree than older antihistamines 4.
  • Pseudoephedrine has central nervous system stimulant properties and can cause side effects such as somnolence, dry mouth, and increased heart rate 2, 6.
  • The combination of cetirizine and pseudoephedrine may increase the risk of somnolence, as cetirizine can cause drowsiness in some individuals 4, 2.

Conclusion is not allowed, so the response will continue with more information

Additional Information

  • Cetirizine is predominantly eliminated by the kidneys, and its mean elimination half-life is 8.3 hours 5.
  • Pseudoephedrine is a substrate used in the production of amphetamine and methamphetamine, and its misuse has been a concern 6.
  • The use of cetirizine and pseudoephedrine should be monitored, especially in patients with certain medical conditions or taking other medications 4, 5, 2, 3, 6.

References

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Research

Comparison of cetirizine-pseudoephedrine and placebo in patients with seasonal allergic rhinitis and concomitant mild-to-moderate asthma: randomized, double-blind study.

Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology, 2006

Research

Safety of second generation antihistamines.

Allergy and asthma proceedings, 2000

Research

Pseudoephedrine-Benefits and Risks.

International journal of molecular sciences, 2021

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.

Have a follow-up question?

Our Medical A.I. is used by practicing medical doctors at top research institutions around the world. Ask any follow up question and get world-class guideline-backed answers instantly.