Version July 2025
Upper respiratory allergies: Oral: 1 tablet (cetirizine 5 mg/pseudoephedrine 120 mg) twice daily (maximum: 2 tablets [cetirizine 10 mg/pseudoephedrine 240 mg] per day).
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
CrCl >31 mL/minute: No dosage adjustment necessary.
CrCl 11 to ≤31 mL/minute: 1 tablet (cetirizine 5 mg/pseudoephedrine 120 mg) once daily.
CrCl ≤10 mL/minute: There are no dosage adjustments provided in the manufacturer's labeling.
Hemodialysis (cetirizine <10% dialyzable): 1 tablet (cetirizine 5 mg/pseudoephedrine 120 mg) once daily.
Mild to severe impairment: 1 tablet (cetirizine 5 mg/pseudoephedrine 120 mg) once daily.
Limit cetirizine dose to 5 mg once daily; use with caution.
(For additional information see "Cetirizine and pseudoephedrine: Pediatric drug information")
Allergic symptoms, hay fever: Children ≥12 years and Adolescents: Cetirizine 5 mg/pseudoephedrine 120 mg per tablet: Oral: 1 tablet twice daily. Maximum dose: 2 tablets/24 hours.
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
Altered kidney function (Ref):
Children ≥12 years and Adolescents: Oral: Cetirizine 5 mg/pseudoephedrine 120 mg per tablet:
CrCl >31 mL/minute/1.73 m2: No dosage adjustment necessary.
CrCl 11 to ≤31 mL/minute/1.73 m2: 1 tablet once daily.
CrCl ≤10 mL/minute/1.73 m2: There are no dosage adjustments provided in the manufacturer's labeling.
Hemodialysis (cetirizine <10% dialyzable): 1 tablet once daily.
Mild to severe impairment: Children ≥12 years and Adolescents: Cetirizine 5 mg/pseudoephedrine 120 mg per tablet: Oral: 1 tablet once daily (Ref).
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Adverse reactions reported in adolescents and adults. Also see individual agents.
1% to 10%:
Gastrointestinal: Xerostomia (4%)
Nervous system: Dizziness (1%), drowsiness (2%), fatigue (2%), insomnia (4%)
Respiratory: Epistaxis (1%), pharyngitis (2%)
OTC labeling: When used for self-medication, do not use if you have hypersensitivity to cetirizine, pseudoephedrine, hydroxyzine, or any component of the formulation; use with or within 2 weeks of discontinuing MAO inhibitor therapy.
Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
Concerns related to adverse effects:
• CNS depression: May cause CNS depression, which may impair physical or mental abilities; patients must be cautioned about performing tasks which require mental alertness (eg, operating machinery or driving).
• Pruritus: Rebound pruritus has been reported within several days after stopping cetirizine, usually after long-term (eg, months to years) use.
Disease-related concerns:
• Cardiovascular disease: Use with caution in patients with cardiovascular disease (including hypertension and heart disease).
• Diabetes: Use with caution in patients with diabetes mellitus.
• Hepatic impairment: Use with caution in patients with hepatic impairment; dosage adjustment may be necessary.
• Increased intraocular pressure/glaucoma: Use with caution in patients with increased intraocular pressure or glaucoma.
• Prostatic hyperplasia/urinary obstruction: Use with caution in patients with prostatic hyperplasia and/or GU obstruction.
• Renal impairment: Use with caution in patients with renal impairment; dosage adjustment may be necessary.
• Thyroid dysfunction: Use with caution in patients with thyroid dysfunction.
Special populations:
• Older adult: Use with caution in the elderly; may be more sensitive to adverse effects.
• Pediatric: Antihistamines may cause excitation in young children.
Other warnings/precautions:
• Self-medication (OTC use): When used for self-medication, patients should be instructed to discontinue use and contact health care provider if symptoms do not improve within 7 days or are accompanied by fever; if nervousness, dizziness or sleeplessness occur; or if an allergic reaction occurs. Do not exceed recommended doses.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Tablet Extended Release 12 Hour, Oral:
All Day Allergy-D: Cetirizine hydrochloride 5 mg and pseudoephedrine hydrochloride 120 mg [DSC]
Allergy Relief/Nasal Decongest: Cetirizine hydrochloride 5 mg and pseudoephedrine hydrochloride 120 mg
FT All Day Allergy-D: Cetirizine hydrochloride 5 mg and pseudoephedrine hydrochloride 120 mg
ZyrTEC-D Allergy & Congestion: Cetirizine hydrochloride 5 mg and pseudoephedrine hydrochloride 120 mg
ZyrTEC-D Allergy & Sinus: Cetirizine hydrochloride 5 mg and pseudoephedrine hydrochloride 120 mg
Generic: Cetirizine hydrochloride 5 mg and pseudoephedrine hydrochloride 120 mg
Yes
Tablet, 12-hour (Cetirizine-Pseudoephedrine ER Oral)
5-120 mg (per each): $0.93 - $0.98
Tablet, 12-hour (ZyrTEC-D Allergy & Congestion Oral)
5-120 mg (per each): $1.38
Tablet, 12-hour (ZyrTEC-D Allergy & Sinus Oral)
5-120 mg (per each): $1.36
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
Oral:
Administer without regard to meals. Swallow tablet whole; do not break, crush, or chew.
Bariatric surgery: Tablet, extended release: Some institutions may have specific protocols that conflict with these recommendations; refer to institutional protocols as appropriate. Switch to separate components in IR formulation.
Oral: Administer without regard to meals. Swallow tablet whole; do not break, crush, or chew.
Upper respiratory allergies: Temporary relief of symptoms (nasal congestion; runny nose; sneezing; itching of the eyes, nose or throat) associated with sinusitis, allergic rhinitis, and other upper respiratory allergies.
ZyrTEC may be confused with Lipitor, Serax, Xanax, Zantac, Zocor, Zyprexa, Zyrtec-D
ZyrTEC-D may be confused with ZyrTEC
Refer to individual components.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.
Alpha1-Blockers: May decrease therapeutic effects of Alpha-/Beta-Agonists. Risk C: Monitor
Amezinium: Antihistamines may increase stimulatory effects of Amezinium. Risk C: Monitor
Atomoxetine: May increase hypertensive effects of Sympathomimetics. Atomoxetine may increase tachycardic effects of Sympathomimetics. Risk C: Monitor
Benzylpenicilloyl Polylysine: Coadministration of Alpha-/Beta-Agonists and Benzylpenicilloyl Polylysine may alter diagnostic results. Management: Consider use of a histamine skin test as a positive control to assess a patient's ability to mount a wheal and flare response. Risk D: Consider Therapy Modification
Benzylpenicilloyl Polylysine: Coadministration of Antihistamines and Benzylpenicilloyl Polylysine may alter diagnostic results. Management: Suspend systemic H1 antagonists for benzylpenicilloyl-polylysine skin testing and delay testing until systemic antihistaminic effects have dissipated. A histamine skin test may be used to assess persistent antihistaminic effects. Risk D: Consider Therapy Modification
Betahistine: Antihistamines may decrease therapeutic effects of Betahistine. Betahistine may decrease therapeutic effects of Antihistamines. Risk C: Monitor
Bornaprine: Sympathomimetics may increase anticholinergic effects of Bornaprine. Risk C: Monitor
Bromocriptine: May increase hypertensive effects of Alpha-/Beta-Agonists. Management: Consider alternatives to this combination when possible. If combined, monitor for hypertension and tachycardia, and do not coadminister these agents for more than 10 days. Risk D: Consider Therapy Modification
Cannabinoid-Containing Products: May increase tachycardic effects of Sympathomimetics. Risk C: Monitor
Certoparin: Antihistamines may increase therapeutic effects of Certoparin. Risk C: Monitor
Chloroprocaine (Systemic): May increase hypertensive effects of Alpha-/Beta-Agonists. Risk C: Monitor
CNS Depressants: Cetirizine (Systemic) may increase CNS depressant effects of CNS Depressants. Management: Consider avoiding this combination if possible. If required, monitor for excessive sedation or CNS depression, limit the dose and duration of combination therapy, and consider CNS depressant dose reductions. Risk D: Consider Therapy Modification
Cocaine (Topical): May increase hypertensive effects of Sympathomimetics. Management: Consider alternatives to use of this combination when possible. Monitor closely for substantially increased blood pressure or heart rate and for any evidence of myocardial ischemia with concurrent use. Risk D: Consider Therapy Modification
Dihydralazine: Sympathomimetics may decrease therapeutic effects of Dihydralazine. Risk C: Monitor
Doxofylline: Sympathomimetics may increase adverse/toxic effects of Doxofylline. Risk C: Monitor
Ergot Derivatives (Vasoconstrictive CYP3A4 Substrates): May increase vasoconstricting effects of Alpha-/Beta-Agonists. Risk X: Avoid
Gabapentin: Cetirizine (Systemic) may increase CNS depressant effects of Gabapentin. Cetirizine (Systemic) may decrease serum concentration of Gabapentin. Risk C: Monitor
Guanethidine: May increase hypertensive effects of Sympathomimetics. Guanethidine may increase arrhythmogenic effects of Sympathomimetics. Risk C: Monitor
Hexoprenaline: May increase adverse/toxic effects of Alpha-/Beta-Agonists. Risk X: Avoid
Hyaluronidase: Antihistamines may decrease therapeutic effects of Hyaluronidase. Risk C: Monitor
Iobenguane Radiopharmaceutical Products: Alpha-/Beta-Agonists (Indirect-Acting) may decrease therapeutic effects of Iobenguane Radiopharmaceutical Products. Management: Discontinue all drugs that may inhibit or interfere with catecholamine transport or uptake for at least 5 biological half-lives before iobenguane administration. Do not administer these drugs until at least 7 days after each iobenguane dose. Risk X: Avoid
Kratom: May increase adverse/toxic effects of Sympathomimetics. Risk X: Avoid
Landiolol: Sympathomimetics may decrease therapeutic effects of Landiolol. Risk C: Monitor
Levothyroxine: May increase therapeutic effects of Sympathomimetics. Sympathomimetics may increase therapeutic effects of Levothyroxine. Levothyroxine may increase adverse/toxic effects of Sympathomimetics. Specifically, the risk of coronary insufficiency may be increased in patients with coronary artery disease. Risk C: Monitor
Linezolid: May increase hypertensive effects of Sympathomimetics. Management: Consider initial dose reductions of sympathomimetic agents, and closely monitor for enhanced blood pressure elevations, in patients receiving linezolid. Risk D: Consider Therapy Modification
Lisuride: May increase hypertensive effects of Alpha-/Beta-Agonists. Risk X: Avoid
Metergoline: May increase adverse/toxic effects of Alpha-/Beta-Agonists (Indirect-Acting). Risk C: Monitor
Monoamine Oxidase Inhibitors: May increase hypertensive effects of Alpha-/Beta-Agonists (Indirect-Acting). While linezolid is expected to interact via this mechanism, management recommendations differ from other monoamine oxidase inhibitors. Refer to linezolid specific monographs for details. Risk X: Avoid
Pergolide: May increase hypertensive effects of Alpha-/Beta-Agonists. Risk C: Monitor
Pilsicainide: May increase serum concentration of Cetirizine (Systemic). Cetirizine (Systemic) may increase serum concentration of Pilsicainide. Risk C: Monitor
Pitolisant: Antihistamines may decrease therapeutic effects of Pitolisant. Risk X: Avoid
Serotonin/Norepinephrine Reuptake Inhibitor: May increase tachycardic effects of Alpha-/Beta-Agonists. Serotonin/Norepinephrine Reuptake Inhibitor may increase vasopressor effects of Alpha-/Beta-Agonists. Management: If possible, avoid coadministration of direct-acting alpha-/beta-agonists and serotonin/norepinephrine reuptake inhibitors. If coadministered, monitor for increased sympathomimetic effects (eg, increased blood pressure, chest pain, headache). Risk D: Consider Therapy Modification
Solriamfetol: Sympathomimetics may increase hypertensive effects of Solriamfetol. Sympathomimetics may increase tachycardic effects of Solriamfetol. Risk C: Monitor
Spironolactone: May decrease vasoconstricting effects of Alpha-/Beta-Agonists. Risk C: Monitor
Sympathomimetics: May increase adverse/toxic effects of Sympathomimetics. Risk C: Monitor
Tedizolid: May increase adverse/toxic effects of Sympathomimetics. Specifically, the risk for increased blood pressure and heart rate may be increased. Risk C: Monitor
Tranylcypromine: May increase hypertensive effects of Alpha-/Beta-Agonists (Indirect-Acting). Risk X: Avoid
Tricyclic Antidepressants: May increase vasopressor effects of Alpha-/Beta-Agonists. Management: Avoid, if possible, the use of alpha-/beta-agonists in patients receiving tricyclic antidepressants. If combined, monitor for evidence of increased pressor effects and consider reductions in initial dosages of the alpha-/beta-agonist. Risk D: Consider Therapy Modification
See individual agents.
Refer to individual monographs.
Refer to individual monographs.
Cetirizine: Competes with histamine for H1-receptor sites on effector cells in the gastrointestinal tract, blood vessels, and respiratory tract.
Pseudoephedrine: Directly stimulates alpha-adrenergic receptors of respiratory mucosa causing vasoconstriction; directly stimulates beta-adrenergic receptors causing bronchial relaxation, increased heart rate and contractility.
See individual agents.
