From the Guidelines
Cetirizine should be avoided in dialysis patients with severe renal impairment, as it can cause confusion and other central nervous system effects due to decreased drug clearance and potential accumulation, as recommended by guidelines for evaluation and management of urticaria in adults and children 1. When considering the use of cetirizine in dialysis patients, it is crucial to assess the severity of their renal impairment.
- For patients with creatinine clearance < 10 mL min, cetirizine should be avoided due to the high risk of adverse effects, including confusion.
- If cetirizine is deemed necessary, the dose should be halved to minimize the risk of accumulation and central nervous system effects, as suggested by the guidelines 1.
- Alternative antihistamines, such as loratadine and desloratadine, may be considered for use in dialysis patients with severe renal impairment, but they should be used with caution.
- It is essential to monitor dialysis patients closely for signs of confusion, drowsiness, dizziness, and impaired cognition when using cetirizine or any other antihistamine, and to discontinue the medication if adverse effects occur.
- Healthcare providers should be notified immediately if confusion or other central nervous system effects develop in dialysis patients taking cetirizine, to ensure prompt evaluation and management of these adverse effects.
From the FDA Drug Label
Ask a doctor before use if you have liver or kidney disease. Your doctor should determine if you need a different dose. The FDA drug label does not answer the question.
From the Research
Cetirizine and Dialysis Patients
- The studies 2, 3, 4 investigated the pharmacokinetics of cetirizine in patients with renal insufficiency, including those on dialysis.
- According to 2, cetirizine levels were measured in 8 male end-stage renal failure patients on chronic hemodialysis, and the results supported the clinical use of cetirizine for these patients.
- The study 3 found that hemodialysis did not produce a clinically significant alteration in cetirizine elimination, suggesting that no supplemental dose is necessary after dialysis.
- However, 4 reported that the elimination half-life of cetirizine was prolonged in patients with mild and moderate renal insufficiency, which may be relevant to dialysis patients.
Confusion in Dialysis Patients
- None of the provided studies directly addressed the question of whether cetirizine can cause confusion in dialysis patients.
- However, it is known that antihistamines like cetirizine can cause cognitive impairment and confusion in some individuals, particularly the elderly or those with renal insufficiency 4.
- The study 5 investigated the pharmacokinetics of loratadine, another antihistamine, in patients with renal insufficiency, but did not report on cetirizine or confusion in dialysis patients.
- The study 6 discussed diuretic use in renal disease, but is not directly relevant to the question of cetirizine and confusion in dialysis patients.