Is cetirizine (antihistamine) safe during pregnancy?

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Last updated: April 26, 2025View editorial policy

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From the Guidelines

Cetirizine is generally considered safe to use during pregnancy, with no increased risk of birth defects or adverse pregnancy outcomes, as supported by recent studies 1. The typical adult dose is 10 mg once daily. While no medication can be guaranteed 100% safe during pregnancy, cetirizine has been studied extensively and shows no significant risks. Some key points to consider when using cetirizine during pregnancy include:

  • It is a second-generation antihistamine with minimal sedating effects and doesn't cross the blood-brain barrier significantly.
  • It is preferred over first-generation antihistamines like diphenhydramine (Benadryl) for long-term use during pregnancy because it doesn't cause drowsiness that could affect daily activities.
  • As with any medication during pregnancy, it's best to use it only when necessary for symptom relief and to consult with your healthcare provider before starting any medication regimen during pregnancy. According to the most recent study 1, loratadine or cetirizine should be preferred as they have been most used, and there is no significant increase in congenital anomalies associated with their use. Additionally, a previous study 1 also confirmed the safety of second-generation antihistamines, including cetirizine, during the first trimester of pregnancy. However, another study 1 suggested that cetirizine is one of the second-generation antihistamines of choice, but it also mentioned that there may be a relationship between use of oral decongestants in early pregnancy and a rare birth defect, which is not directly related to cetirizine. Overall, cetirizine can be considered a safe option for pregnant women who need allergy relief, but it's essential to consult with a healthcare provider before starting any medication regimen during pregnancy.

From the FDA Drug Label

If pregnant or breast-feeding: if breast-feeding: not recommended if pregnant: ask a health professional before use. The FDA drug label does not answer the question.

From the Research

Cetirizine Safety in Pregnancy

  • Cetirizine is considered relatively safe to use during pregnancy, according to several studies 2, 3, 4.
  • A study published in 2016 found that second-generation antihistamines, including cetirizine, are safe to use during pregnancy 2.
  • Another study published in 2018 found that cetirizine exposure during pregnancy was not associated with adverse pregnancy outcomes above background rates 3.
  • A prospective observational cohort study published in 2008 found that the use of cetirizine during the first trimester was not associated with an increased risk of major birth defects 4.

Comparison with Other Antihistamines

  • A study published in 2020 found that desloratadine, another second-generation antihistamine, had a similar fetal safety profile to cetirizine 5.
  • A study published in 2003 found that loratadine, another second-generation antihistamine, did not represent a major teratogenic risk during pregnancy 6.
  • Cetirizine is often recommended as a safe alternative to other antihistamines during pregnancy, due to its relatively low risk of adverse effects 2, 3, 4.

Pregnancy Outcomes

  • Studies have found that cetirizine exposure during pregnancy is not associated with an increased risk of:
    • Major birth defects 3, 4
    • Spontaneous abortion 3
    • Preterm birth 3
    • Small size for gestational age 3
    • Stillbirth 3
  • However, it is essential to note that the majority of studies have found that cetirizine is relatively safe, but not completely risk-free 2, 3, 4.

References

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Research

Allergy Medications During Pregnancy.

The American journal of the medical sciences, 2016

Research

Safety of cetirizine in pregnancy.

Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology, 2018

Research

Desloratadine Use During Pregnancy and Risk of Adverse Fetal Outcomes: A Nationwide Cohort Study.

The journal of allergy and clinical immunology. In practice, 2020

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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