Zykast (Cetirizine) Safety in Pregnancy
Cetirizine can be used during pregnancy and is considered one of the safer second-generation antihistamines, though you should consult with an obstetrician before starting it. 1, 2, 3
Evidence-Based Recommendation
Cetirizine is a preferred second-generation antihistamine for use during pregnancy based on extensive safety data. 2, 3 The drug has been studied more thoroughly than most other antihistamines in pregnant populations and shows reassuring outcomes.
Key Safety Data
A prospective controlled study of 39 women exposed to cetirizine during organogenesis found no increased risk of major or minor malformations, spontaneous abortion, or adverse pregnancy outcomes compared to controls. 4
Second-generation antihistamines like cetirizine and loratadine are the antihistamines of choice during pregnancy due to their superior safety profile compared to first-generation agents. 2, 3
Guidelines specifically recommend cetirizine as one of the preferred antihistamines for allergic rhinitis management during pregnancy. 1
Important Caveats
The FDA drug label states that pregnant women should "ask a health professional before use," indicating the need for medical consultation rather than self-medication. 5
First-generation antihistamines should be avoided during pregnancy due to sedative and anticholinergic properties, and some (like diphenhydramine) have been associated with cleft palate. 6, 1
No antihistamine has been categorized as completely "safe" during pregnancy by regulatory agencies, though cetirizine has among the most reassuring data. 7
Clinical Approach
When prescribing cetirizine in pregnancy:
Use it when the benefits of symptom control outweigh theoretical risks, particularly for moderate to severe allergic rhinitis that impacts quality of life. 1
Consider starting with non-pharmacologic measures first (saline nasal rinses, nasal valve dilators) before adding cetirizine. 1, 3
Combine with intranasal corticosteroids (particularly budesonide) if needed for more severe symptoms, as these have strong safety data. 6, 2, 3
Avoid oral decongestants, especially in the first trimester, due to associations with congenital malformations including gastroschisis and small intestinal atresia. 6, 1
Comparison to Alternatives
Cetirizine and loratadine are the most well-studied second-generation antihistamines in pregnancy, making them preferable to newer agents like desloratadine, azelastine, or levocetirizine which have limited pregnancy data. 6, 3