Can I take Xyzal (levocetirizine) if I have glaucoma?

Xyzal (Levocetirizine) Use in Patients with Glaucoma

Patients with glaucoma should avoid taking Xyzal (levocetirizine) due to the risk of acute angle-closure glaucoma, as indicated in current diabetes care guidelines. 1

Safety Concerns for Antihistamines in Glaucoma

Levocetirizine (Xyzal) belongs to the antihistamine class of medications. According to the 2025 Diabetes Care guidelines, antihistamines are contraindicated in people at high risk for glaucoma due to the risk of acute angle-closure glaucoma 1. This warning is particularly important as it appears in current clinical practice guidelines.

Mechanism of Risk

Antihistamines like levocetirizine have anticholinergic properties that can:

• Cause pupillary dilation
• Narrow the anterior chamber angle
• Precipitate an acute angle-closure attack in susceptible individuals
• Increase intraocular pressure in patients with pre-existing glaucoma

Alternative Allergy Management for Glaucoma Patients

For patients with glaucoma requiring allergy management, consider these alternatives:

1. Non-sedating, second-generation antihistamines with minimal anticholinergic effects (if absolutely necessary and after ophthalmologist consultation)
2. Intranasal corticosteroids for allergic rhinitis (less systemic absorption)
3. Leukotriene receptor antagonists (e.g., montelukast)
4. Allergen avoidance strategies
5. Saline nasal irrigation

Glaucoma Management Considerations

The Primary Open-Angle Glaucoma Preferred Practice Pattern guidelines emphasize the importance of assessing patients for medication interactions 1. When managing glaucoma:

• Carefully evaluate all systemic medications that may interact with glaucoma or affect intraocular pressure
• Inform patients about potential drug interactions
• Consider that patients with glaucoma often take multiple medications (averaging 5.3 systemic drugs per patient) 2

Important Precautions

• Always inform all healthcare providers about your glaucoma diagnosis when receiving new prescriptions
• Be particularly cautious with over-the-counter medications containing antihistamines
• Maintain regular follow-up with your ophthalmologist to monitor intraocular pressure
• Report any visual changes or eye discomfort immediately to your healthcare provider

Patient Education

Patients should be educated about proper techniques for using their glaucoma medications and the importance of adherence to therapy 1. Additionally, they should understand which systemic medications may worsen their glaucoma, including antihistamines like Xyzal.

Proper management requires coordination between the ophthalmologist and other healthcare providers to ensure safe medication use and prevent complications that could lead to vision loss or increased morbidity.