Is Zykast (Cetirizine) Safe in Stage 2 Hypertension?
Yes, cetirizine is safe to use in patients with stage 2 hypertension presenting with cough and colds, as antihistamines like cetirizine do not affect blood pressure or interact with antihypertensive medications.
Key Safety Considerations
Antihistamines Are Safe in Hypertension
Cetirizine does not elevate blood pressure and is a second-generation antihistamine with no sympathomimetic activity, making it appropriate for hypertensive patients 1, 2.
The concern with cold medications in hypertension relates specifically to oral decongestants (pseudoephedrine, phenylephrine, phenylpropanolamine), not antihistamines 1, 3, 4.
Cetirizine has no cardiovascular effects and was not associated with cardiotoxicity in clinical studies 2.
What to Avoid in Hypertensive Patients
Oral decongestants should be used with extreme caution in patients with stage 2 hypertension, as they can elevate blood pressure through alpha-adrenergic stimulation 1, 3.
Pseudoephedrine and phenylephrine can cause blood pressure elevation, though this is "very rarely noted in normotensive patients and only occasionally in patients with controlled hypertension" 1.
Phenylpropanolamine and ephedrine should be avoided in hypertensive patients, as they pose the highest risk of blood pressure elevation 3, 4.
Cetirizine's Role in Respiratory Infections
Cetirizine is effective for allergic rhinitis symptoms (sneezing, rhinorrhea, nasal congestion from allergic causes) that often accompany or mimic viral upper respiratory infections 2.
It has a rapid onset of action and long duration, making it suitable for symptom relief in cough and cold presentations 2.
Cetirizine is well tolerated with minimal sedation compared to first-generation antihistamines, and does not impair cognitive function 2.
Clinical Pitfalls to Avoid
Do not confuse antihistamines with decongestants: Many combination cold products contain both cetirizine AND pseudoephedrine—ensure the patient receives cetirizine alone 1.
Monitor blood pressure if any decongestant is added: If nasal congestion requires treatment beyond antihistamines, topical decongestants (oxymetazoline) for short-term use (<3 days) are safer than oral agents 1.
Continue antihypertensive therapy: Stage 2 hypertension requires ongoing pharmacological treatment with combination therapy (ACE inhibitor/ARB plus CCB or thiazide diuretic), which should not be interrupted 1, 5.
Bottom Line
Cetirizine is safe and appropriate for symptomatic relief of cough and cold symptoms in patients with stage 2 hypertension. The blood pressure concern applies only to sympathomimetic decongestants, not antihistamines 1, 3, 4, 2.