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
Xyzal
Zyrtec vs. Xyzal Dosage
Zyrtec
Xyzal
| 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 |
| 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
| 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
| 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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