Can Xyzal Cause Palpitations?
Xyzal (levocetirizine) can rarely cause palpitations as a side effect, though it has a better cardiovascular safety profile compared to older antihistamines.
Cardiovascular Safety of Levocetirizine
- Levocetirizine (Xyzal) is a selective, potent, oral histamine H1 receptor antagonist of the latest generation used for treating allergic rhinitis and chronic idiopathic urticaria 1
- Unlike some older antihistamines, levocetirizine has a favorable safety profile with "lack of effect on the cardiovascular system" according to clinical studies 1
- Second-generation antihistamines like cetirizine (the parent compound of levocetirizine) are considered safe from cardiac arrhythmias via the IKr channel, unlike older antihistamines such as astemizole and terfenadine 2
Potential Cardiovascular Side Effects
- Calcium channel blockers, which are an entirely different class of medications, commonly cause palpitations as a side effect, particularly dihydropyridines 3
- While palpitations are not listed among the most common side effects of levocetirizine, any medication can potentially cause idiosyncratic reactions in some individuals 1
- Palpitations are defined as an unpleasant awareness of abnormal or irregular heartbeats, which may be described as pauses followed by strong beats or irregularities in heart rhythm 4
Risk Factors and Considerations
- Combination cold/allergy medications containing antihistamines may include decongestants like pseudoephedrine or phenylephrine, which can cause side effects such as palpitations 5
- Oral decongestants are α-adrenergic agonists that commonly cause side effects including insomnia, irritability, and palpitations 5
- Elderly patients may be more sensitive to medication side effects, but cetirizine (the parent compound of levocetirizine) is generally well-tolerated in this population 5
When to Seek Medical Attention
- Warning signs that require medical attention include palpitations accompanied by syncope or pre-syncope, palpitations with chest pain, or palpitations during exercise 4
- If palpitations occur after starting Xyzal, patients should consult their healthcare provider, especially if they have pre-existing cardiovascular conditions 4
- Many medications across various therapeutic classes can trigger arrhythmias, including bradyarrhythmias, atrial fibrillation/flutter, and other rhythm disturbances 6
Management Recommendations
- If a patient experiences palpitations while taking Xyzal, healthcare providers should consider the possibility that the medication could be contributing to the symptom 6
- Management of drug-induced arrhythmias includes discontinuation of the offending medication if a causal relationship is suspected 6
- Alternative second-generation antihistamines may be considered if palpitations occur with Xyzal use 1