Cetirizine (Cetzine) Pediatric Dosing
For children 6 years and older, cetirizine 10 mg once daily is the recommended dose, while children 6-11 months require 0.25 mg/kg (approximately 2.5 mg) twice daily, and children 12 months to under 6 years should receive 2.5 mg twice daily. 1, 2
Age-Specific Dosing Recommendations
Infants 6-11 Months
- Dose: 0.25 mg/kg twice daily (morning and evening) 3
- Typical volume: 2.5 mL twice daily 1
- Twice-daily dosing is necessary due to rapid oral clearance in very young children 1
- Safety has been established in this age group with no cardiac effects (QT prolongation) or increased adverse events compared to placebo 3
Children 12-24 Months
- Dose: 2.5-3.5 mL twice daily (morning and evening) 1
- Long-term safety established by the American Academy of Dermatology based on the ETAC trial 1
- Twice-daily dosing remains necessary in this age group 1
Children 2-5 Years
- Dose: 2.5 mg (2.5 mL) twice daily or 5 mg once daily 2
- FDA labeling recommends consulting a doctor for children under 6 years 2
Children 6-11 Years
- Dose: 5-10 mg once daily 4, 5
- Optimal dose: 10 mg once daily provides significantly greater symptom reduction than 5 mg 4, 5
- The 10 mg dose achieved 77-86% wheal suppression and 85-88% flare suppression from 2-24 hours 6
- Onset of action occurs within 20 minutes with 24-hour duration 7
Children 6 Years and Older
- Standard dose: 10 mg once daily 2
- Maximum: Do not exceed one 10 mg tablet in 24 hours 2
- A 5 mg dose may be appropriate for less severe symptoms 2
Important Clinical Considerations
Sedation Profile
- Cetirizine may cause sedation at recommended doses (13.7% in patients ≥12 years vs 6.3% placebo) 8
- Sedation risk is generally milder than first-generation antihistamines but more than fexofenadine, loratadine, or desloratadine 8
- Patients should be counseled about this risk, particularly when operating machinery or during school activities 8
Renal Impairment
- Moderate impairment: Reduce dose by 50% 8
- Severe impairment (creatinine clearance <10 mL/min): Avoid cetirizine 8
Hepatic Impairment
- Use with caution; dose adjustment may be necessary 8
Special Populations
- Pregnancy: Classified as FDA Pregnancy Category B; avoid if possible, especially in first trimester 8
- Low body weight: Standard age-based dosing may result in elevated mg/kg dosing and increased sedation risk 8
Clinical Efficacy
- Cetirizine demonstrates superior H1-antihistaminic activity compared to fexofenadine in children, with more rapid onset (significant suppression at 2 hours vs 4 hours) 6
- No tolerance develops to the wheal and flare response even after 1 month of daily treatment 7
- The 10 mg dose in children 6-11 years significantly improves symptoms of itchy eyes, nose, and mouth compared to placebo 4