Zyrtec (Cetirizine) Does Not Need to Be Stopped Before Major Surgery
There is no evidence-based requirement to discontinue Zyrtec (cetirizine) before major surgery, and it can be safely continued through the perioperative period.
Rationale for Continuation
Antihistamines like cetirizine are not mentioned in any major perioperative medication management guidelines as requiring discontinuation before surgery 1, 2, 3.
The FDA label for cetirizine does not include any warnings about surgical procedures or perioperative use 4.
Medications should only be stopped preoperatively if they have withdrawal potential, increase surgical bleeding risk, or interact dangerously with anesthesia 2. Cetirizine does not meet any of these criteria.
What Actually Needs to Be Stopped
The perioperative medication management guidelines focus on entirely different drug classes that genuinely impact surgical outcomes:
High-Priority Medications Requiring Preoperative Management:
Anticoagulants (warfarin, apixaban, rivaroxaban, dabigatran): Stop 2-5 days before surgery depending on bleeding risk and renal function 1, 5
Anti-platelet agents (clopidogrel, prasugrel, ticagrelor): Stop 5-7 days preoperatively 1
ACE inhibitors/ARBs: Consider stopping 24 hours before surgery due to intraoperative hypotension risk 1, 6
NSAIDs: Stop 1-10 days before surgery depending on the specific agent 7
Clinical Bottom Line
Continue cetirizine through surgery without interruption 2, 3.
Focus your preoperative medication review on anticoagulants, anti-platelet agents, antihypertensives, and NSAIDs—these are the medications that actually affect surgical morbidity and mortality 1, 2, 7.
The only reason to stop cetirizine would be if the patient experiences an allergic reaction to the medication itself, which would require seeking immediate medical attention 4.