What is a non-drowsy version of Zyrtec (cetirizine)?

Non-Drowsy Alternative to Zyrtec (Cetirizine)

If you need a truly non-drowsy antihistamine instead of Zyrtec (cetirizine), switch to loratadine (Claritin), desloratadine (Clarinex), or fexofenadine (Allegra), with fexofenadine being the most reliably non-sedating option even at higher doses. 1

Understanding Cetirizine's Sedation Profile

Cetirizine is marketed as "non-drowsy," but this is misleading:

• Cetirizine causes mild drowsiness in approximately 13.7% of patients compared to 6.3% with placebo 2, 1
• It may cause performance impairment at both standard (10 mg) and higher (20 mg) doses 2
• The sedative effect is greater than fexofenadine and loratadine in clinical trials 3
• Do not assume "non-sedating" means zero sedation risk—cetirizine carries meaningful sedation risk even at standard doses 2

Recommended Non-Drowsy Alternatives

First-Line Choice: Loratadine

• The American Academy of Allergy, Asthma, and Immunology recommends loratadine 10mg once daily as the first-line choice for most patients, especially those who need to drive or operate machinery 2
• Does not cause sedation at recommended doses 2, 1
• Preferred for school-aged children and working adults due to lower sedative potential 2
• Only causes sedation when dosed at higher than recommended levels 2

Most Reliably Non-Sedating: Fexofenadine

• Fexofenadine maintains its non-sedating properties even at higher than FDA-approved doses, making it truly non-sedating 1
• Particularly advantageous for older adults who are more sensitive to psychomotor impairment 1
• Does not cause sedation at recommended doses 1

Alternative Option: Desloratadine

• Does not cause sedation at recommended doses 1
• May cause sedation only at doses exceeding the recommended dose 1
• Similar non-sedating profile to loratadine 1

Clinical Decision Algorithm

When switching from cetirizine:

1. If patient experienced drowsiness with cetirizine → prescribe loratadine or fexofenadine 2
2. If patient needs to drive, operate machinery, or requires guaranteed alertness → prescribe fexofenadine 1
3. For elderly patients → prefer loratadine or fexofenadine due to lower sedative potential and reduced risk of falls 2
4. For patients with low body mass → monitor closely with any antihistamine, as standard age-based dosing may lead to elevated mg/kg levels and drowsiness 2, 1

Important Caveats

• All second-generation antihistamines have similar efficacy for allergic symptoms—no single agent is conclusively superior 2
• The primary difference between these medications is their sedation profile, not their effectiveness 2
• Patients with a history of sedation with antihistamines should specifically be prescribed loratadine or fexofenadine 2
• First-generation antihistamines (diphenhydramine, chlorpheniramine) should be avoided due to significant sedation and anticholinergic effects 1