Zyrtec vs. Xyzal

See how Zyrtec and Xyzal compare on approved uses, dosing, side effects, and cost.

Key Takeaways

  • Xyzal is the active metabolite of Zyrtec, so the two drugs act on the same receptor but Xyzal works at a lower milligram dose.

  • Both list somnolence as a common side effect, but Zyrtec's labeled rate (14%) is higher than Xyzal's (≥2%).

  • Zyrtec is approved for chronic idiopathic urticaria in general, while Xyzal's approval is limited to uncomplicated skin symptoms of urticaria.

Zyrtec vs. Xyzal Drug Summary

Zyrtec

Zyrtec is a second-generation antihistamine that treats seasonal and year-round allergy symptoms along with chronic hives. It blocks H1 histamine receptors and comes as a tablet, chewable tablet, capsule, or oral solution taken once daily.

Xyzal

Xyzal is a second-generation antihistamine that treats seasonal and perennial allergy symptoms along with uncomplicated hives from chronic urticaria. It is the active form of cetirizine and is taken once daily as a tablet or oral solution.

Zyrtec vs. Xyzal Side Effects

Zyrtec

Most common
Somnolence (up to 14%)
Fatigue (up to 6%)
Dry mouth (up to 5%)
Pharyngitis (up to 2%)

Xyzal

Most common
Somnolence (≥2%)
Fatigue (≥2%)
Dry mouth (≥2%)
Pharyngitis (≥2%)

Zyrtec vs. Xyzal Dosage

Zyrtec

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 2.5 mg once daily At the start
Maximum dose 10 mg once daily If needed
Dose changes 2 increases As tolerated

Xyzal

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 1.25 mg once daily At the start
Maximum dose 5 mg once daily If needed
Dose changes 2 increases As tolerated

Zyrtec vs. Xyzal Indications

Zyrtec

Zyrtec is FDA-approved to relieve sneezing, runny nose, and itchy eyes from allergic rhinitis, as well as itching and swelling from chronic idiopathic urticaria. It covers both seasonal allergies and year-round triggers like dust or pet dander.

  • Seasonal allergic rhinitis

  • Perennial (year-round) allergic rhinitis

  • Chronic idiopathic urticaria (hives)

  • Approved for children as young as 6 months

Xyzal

Xyzal is FDA-approved to relieve symptoms of seasonal and perennial allergic rhinitis, along with itching from uncomplicated chronic idiopathic urticaria. As cetirizine's active metabolite, it targets the same receptors at a lower milligram dose.

  • Seasonal allergic rhinitis

  • Perennial (year-round) allergic rhinitis

  • Uncomplicated skin symptoms of chronic urticaria

  • Approved for children as young as 6 months

Zyrtec vs. Xyzal Pros and Cons

Zyrtec

Zyrtec has been on the market since 1995 and comes in more forms than Xyzal, including chewable tablets and syrup. Its label lists a higher somnolence rate and notes it can be more sedating than some other second-generation antihistamines.

Pros

  • Available in more forms, including chewable tablets and syrup

  • Approved for chronic idiopathic urticaria without an 'uncomplicated' qualifier

  • Can be used with dose adjustment in kidney or liver impairment rather than being contraindicated

  • Longer track record, FDA-approved since 1995

Cons

  • Higher labeled somnolence rate (14%) than Xyzal

  • Noted on its label as more sedating than some other second-generation antihistamines

  • Requires a higher milligram dose (5 to 10 mg) for typical maintenance

Xyzal

Xyzal works at a lower milligram dose than Zyrtec because it is cetirizine's more potent active form, and its label lists a lower somnolence rate. It carries a stricter contraindication for people with severe kidney disease or those on dialysis.

Pros

  • Lower labeled somnolence rate than Zyrtec

  • Effective at a lower milligram dose since it is the active metabolite

  • Available in a 1.25 mg strength for more gradual dosing

  • Not specifically flagged on its label as more sedating than other second-generation antihistamines

Cons

  • Contraindicated, not just cautioned against, in end-stage renal disease and dialysis patients

  • Fewer available forms than Zyrtec, with no chewable tablet or capsule

  • Urticaria approval limited to 'uncomplicated' skin symptoms only

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