Is Zyrtec (cetirizine) safe to take before surgery?

Perioperative Management of Cetirizine (Zyrtec)

Cetirizine (Zyrtec) can be safely continued prior to surgery and does not need to be discontinued before the procedure.

Rationale for Continuing Cetirizine

Cetirizine is a second-generation antihistamine that does not appear in any perioperative medication discontinuation guidelines. Unlike medications that require preoperative discontinuation, cetirizine:

• Does not increase bleeding risk
• Does not interact significantly with anesthetic agents
• Does not cause cardiovascular instability during surgery
• Is not sedating to the degree that would interfere with recovery

Perioperative Medication Management Principles

The Enhanced Recovery After Surgery (ERAS) guidelines provide clear recommendations on which medications should be discontinued before surgery 1:

• Long-acting anxiolytic drugs (especially benzodiazepines) should be avoided before surgery as they delay postoperative recovery
• Certain medications like angiotensin II antagonists may need to be held due to potential hypotensive effects during anesthesia 2
• Preoperative gabapentinoids and NSAIDs require careful consideration and dose adjustment 1

However, antihistamines like cetirizine are not mentioned in these discontinuation recommendations.

Benefits of Continuing Cetirizine

Continuing cetirizine before surgery offers several advantages:

• Prevents exacerbation of allergic symptoms during the perioperative period
• Avoids potential withdrawal of symptom control for patients with chronic allergic conditions
• Cetirizine is a second-generation antihistamine with minimal sedative effects compared to first-generation antihistamines

Special Considerations

1. Timing: If taking cetirizine on the day of surgery, follow standard preoperative fasting guidelines:

   • Clear liquids up to 2 hours before anesthesia
   • Solids up to 6 hours before anesthesia 1

2. Medication interactions: Cetirizine has minimal drug interactions with common anesthetic agents 3

3. Patient-specific factors: Consider the patient's underlying condition requiring cetirizine. If the patient has severe allergies, continuing the medication may actually reduce perioperative complications related to allergic reactions.

Common Pitfalls to Avoid

• Don't confuse with first-generation antihistamines: Unlike diphenhydramine (Benadryl) and other first-generation antihistamines, cetirizine has minimal sedative effects and does not significantly potentiate anesthetics.

• Don't discontinue without reason: Unnecessary discontinuation of cetirizine could lead to rebound allergic symptoms that might complicate the perioperative course.

• Don't confuse with medications that should be discontinued: Unlike benzodiazepines 4, angiotensin II antagonists 2, or certain anticoagulants 1, cetirizine does not require preoperative discontinuation.

In conclusion, cetirizine (Zyrtec) can be safely continued up to and including the day of surgery, following standard preoperative fasting guidelines for oral medications.