Safety of Xyzal (Levocetirizine) During Pregnancy
Xyzal (levocetirizine) is not recommended during pregnancy according to the FDA drug label, and pregnant women should consult a healthcare professional before use.
Current Evidence on Levocetirizine in Pregnancy
The FDA drug label explicitly states that Xyzal is not recommended during pregnancy and advises pregnant women to consult a healthcare professional before use 1. This represents the most authoritative guidance available.
According to the 2008 practice parameter on rhinitis management from the Journal of Allergy and Clinical Immunology, there are limited data on levocetirizine use during pregnancy 2. The guideline notes that while there are no reports of increased congenital malformations with some second-generation antihistamines, specific epidemiologic studies in human pregnancy for levocetirizine are lacking.
Alternative Antihistamine Options During Pregnancy
When considering antihistamine options for pregnant women:
- First-line options: Older antihistamines with more accumulated safety data should be considered first
- Second-generation alternatives: Some second-generation antihistamines have more pregnancy safety data than levocetirizine
Risk Assessment Framework
The historical FDA pregnancy risk categories placed many antihistamines in category B or C:
- Category B: Animal studies show no risk, but adequate human studies are lacking
- Category C: Animal studies show adverse effects, but potential benefits may warrant use despite risks
While these categories are no longer used by the FDA, they provide context for understanding relative risks.
Important Considerations
- First trimester caution: The greatest risk for teratogenicity occurs during the first trimester when organogenesis takes place
- Risk-benefit assessment: The British Journal of Dermatology suggests avoiding all medications, including herbal remedies, during pregnancy when possible, especially during the first trimester 3
- Maternal disease control: Untreated severe allergic symptoms can negatively impact maternal quality of life and potentially affect pregnancy outcomes
Practical Recommendations
- Avoid levocetirizine if possible: Based on the FDA recommendation and limited safety data
- Consider non-pharmacological approaches first:
- Allergen avoidance
- Saline nasal irrigation
- Environmental controls
- If medication is necessary: Consult with an allergist or obstetrician about antihistamines with better-established safety profiles during pregnancy
Common Pitfalls to Avoid
- Assuming that all antihistamines carry equal risk during pregnancy
- Failing to consider the severity of allergic symptoms when making treatment decisions
- Not discussing medication use with healthcare providers
The evidence suggests caution with levocetirizine during pregnancy, and alternative treatment options with better-established safety profiles should be considered when pharmacological intervention is necessary.