From the Guidelines
Cetirizine can be used in hemodialysis patients, but dose adjustment is necessary to prevent increased side effects and ensure optimal efficacy. For patients on hemodialysis, the recommended dose is 5 mg once daily instead of the standard 10 mg daily dose used in patients with normal renal function. This dose adjustment is crucial because cetirizine is moderately dialyzable, with approximately 30% removed during a typical hemodialysis session 1. The dose should be administered after the dialysis session on dialysis days to prevent removal of the medication. Patients should be monitored for increased side effects such as drowsiness, dry mouth, and fatigue, which may be more pronounced in patients with renal impairment due to decreased drug clearance. Cetirizine is primarily eliminated by the kidneys, which explains why dose reduction is necessary in hemodialysis patients 1. If antihistamine therapy is needed long-term in these patients, regular reassessment of symptoms and side effects is important to ensure the medication remains both effective and well-tolerated.
Some key considerations for the use of cetirizine in hemodialysis patients include:
- Monitoring for increased side effects due to decreased drug clearance
- Administering the dose after dialysis sessions to prevent removal of the medication
- Regular reassessment of symptoms and side effects to ensure the medication remains effective and well-tolerated
- Awareness of the potential for drug interactions and the need for dose adjustments in patients with other medical conditions or taking other medications.
It is also important to note that while the provided evidence does not directly address the use of cetirizine in hemodialysis patients, the principles of pharmacology and the known properties of cetirizine support the need for dose adjustment in patients with renal impairment 1. The guidelines for hemodialysis adequacy also emphasize the importance of individualized care and attention to the unique needs of each patient 1.
From the FDA Drug Label
Adults and children 6years and overone 10 mg tablet once daily, do not take more than one 10 mg tablet in 24 hours. ... Consumers with liver or kidney diseaseAsk a doctor The FDA drug label does not answer the question.
From the Research
Cetirizine in Hemodialysis Patients
- Cetirizine is a histamine H1-receptor antagonist that can be used in patients with end-stage renal failure (ESRF) on chronic hemodialysis (HD) 2.
- A multiple-dose study found that a prescription of 5 mg cetirizine three times a week during the predialysis period is effective and safe for ESRD patients on HD 2.
- The pharmacokinetics of cetirizine in patients with renal insufficiency have been studied, and it was found that the elimination half-life of cetirizine is prolonged in patients with mild and moderate renal insufficiency 3.
- Haemodialysis does not produce a clinically significant alteration in cetirizine elimination, and no supplemental dose is necessary after dialysis 4.
Dosage and Administration
- The recommended dosage of cetirizine for ESRD patients on HD is 5 mg three times a week during the predialysis period 2.
- The disposition of cetirizine is independent of age but dependent on renal function, and progressive decrements in creatinine clearance are not associated with similar changes in the pharmacokinetic parameters of cetirizine 3.
Comparison with Other Antihistamines
- The pharmacokinetics of loratadine, another antihistamine, have been studied in patients with renal insufficiency, and it was found that the disposition of loratadine is not significantly altered in patients with severe renal insufficiency 5.
- Unlike loratadine, cetirizine has been specifically studied in hemodialysis patients, and its use in this population has been recommended 2, 4.