Xyzal (levocetirizine dihydrochloride) is a prescription-strength, non-drowsy antihistamine designed to provide comprehensive and long-lasting relief from indoor and outdoor allergy symptoms. As the active enantiomer of cetirizine, it offers targeted histamine H1-receptor blockade with a rapid onset of action and sustained efficacy. This second-generation antihistamine is formulated to minimize central nervous system penetration, reducing the risk of sedation while maximizing therapeutic benefits for allergic rhinitis and chronic idiopathic urticaria. Its well-established pharmacokinetic profile ensures consistent performance across diverse patient populations, making it a cornerstone in modern allergy management protocols.

Features

• Contains levocetirizine dihydrochloride 5 mg per tablet
• 24-hour sustained release formulation
• Rapid onset of action within 1 hour of administration
• Minimal metabolism required (primarily renal excretion)
• Low potential for drug interactions
• Sugar-free and lactose-free formulation
• Available in blister-packed tablets for stability

Benefits

• Provides complete 24-hour relief from sneezing, runny nose, and itchy/watery eyes
• Reduces histamine-induced skin reactions and itching associated with chronic hives
• Maintains alertness and cognitive function with minimal sedative effects
• Offers consistent symptom control with once-daily dosing convenience
• Suitable for long-term management of chronic allergic conditions
• Demonstrates efficacy across seasonal and perennial allergy triggers

Common use

Xyzal is primarily indicated for the relief of symptoms associated with allergic rhinitis (seasonal and perennial) in adults and children 6 years and older. This includes sneezing, rhinorrhea, nasal pruritus, ocular pruritus, and tearing. Additionally, it is approved for the treatment of uncomplicated skin manifestations of chronic idiopathic urticaria in patients 6 months and older. Clinical studies have demonstrated its effectiveness in reducing wheal and flare reactions in dermatographic patients and improving quality of life scores in allergic individuals. Off-label uses may include adjunctive treatment in atopic dermatitis and mast cell activation disorders, though these applications require physician supervision.

Dosage and direction

The recommended dosage for adults and children 12 years and older is 5 mg (one tablet) once daily in the evening. For children 6 to 11 years, the recommended dose is 2.5 mg (half tablet) once daily in the evening. Administration should occur at approximately the same time each day, with or without food. Tablets should be swallowed whole with water and not crushed or chewed. For patients with renal impairment (creatinine clearance 30-49 mL/min), the dose should be reduced to 2.5 mg once daily. Those with severe renal impairment (creatinine clearance 10-29 mL/min) or undergoing hemodialysis should receive 2.5 mg every other day. Hepatic impairment alone does not require dosage adjustment, but combined renal and hepatic impairment necessitates careful dosing consideration.

Precautions

Patients should be cautioned about potential drowsiness, particularly during initial therapy or dose escalation. Although Xyzal has demonstrated low CNS penetration, individual responses may vary. Activities requiring mental alertness (operating machinery, driving) should be avoided until response is established. Renal function should be assessed before initiation and periodically during long-term therapy. Elderly patients may require dose adjustment due to age-related decline in renal function. Use in pregnancy (Category B) should be reserved for cases where potential benefit justifies potential risk, as adequate human studies are lacking. Lactating women should exercise caution, as levocetirizine is excreted in breast milk. Pediatric use below 6 months of age is not recommended due to insufficient safety data.

Contraindications

Xyzal is contraindicated in patients with known hypersensitivity to levocetirizine, cetirizine, or any component of the formulation. It is also contraindicated in patients with end-stage renal disease (creatinine clearance <10 mL/min) who are not undergoing hemodialysis. Patients with rare hereditary problems of galactose intolerance, Lapp lactase deficiency, or glucose-galactose malabsorption should avoid this medication due to lactose content in the tablet core. Concurrent use with CNS depressants or alcohol may potentiate sedation and is generally discouraged.

Possible side effects

Most adverse reactions are mild to moderate and transient. Common side effects (≥2%) include somnolence (14%), nasopharyngitis (6%), fatigue (5%), dry mouth (5%), and pharyngitis (3%). Less frequent reactions include headache, dizziness, and abdominal pain. Pediatric patients may experience pyrexia, cough, and epistaxis. Serious but rare adverse effects include hypersensitivity reactions (angioedema, bronchospasm), seizures, and hepatitis. Post-marketing surveillance has reported cases of tachycardia, palpitations, and visual disturbances. Any persistent or severe side effects should prompt discontinuation and medical evaluation.

Drug interaction

Levocentrizine demonstrates low protein binding (<90%) and minimal cytochrome P450 metabolism, resulting in few clinically significant interactions. However, concomitant use with CNS depressants (alcohol, benzodiazepines, opioids) may enhance sedative effects. Theoretically, medications that inhibit renal secretion (probenecid, cimetidine) could increase levocetirizine concentrations. No meaningful interactions have been observed with theophylline, ketoconazole, or erythromycin. Patients taking ototoxic medications should be monitored, as antihistamines may mask symptoms of ototoxicity.

Missed dose

If a dose is missed, it should be taken as soon as remembered unless it is nearly time for the next scheduled dose. In that case, the missed dose should be skipped, and the regular dosing schedule resumed. Doubling doses to make up for missed administration is not recommended, as it may increase the risk of adverse effects. Patients should be educated on maintaining consistent dosing timing to optimize therapeutic coverage, particularly during high-allergy seasons.

Overdose

Symptoms of overdose may include drowsiness, agitation, restlessness, and tachycardia. In children, paradoxical CNS stimulation may occur. Management should include gastric lavage or activated charcoal if ingestion occurred within 2 hours. Supportive care with monitoring of vital signs is essential. There is no specific antidote; hemodialysis removes approximately 85% of circulating drug. Cases of overdose up to 50 mg have been reported with complete recovery following supportive measures. Patients presenting with suspected overdose should receive immediate medical attention.

Storage

Store at room temperature (20-25°C/68-77°F) with excursions permitted between 15-30°C (59-86°F). Protect from moisture and light. Keep in original blister packaging until administration. Do not store in bathrooms or other humid areas. Keep out of reach of children and pets. Discard any medication that appears discolored or shows signs of degradation. Do not flush unused medication; dispose of properly through take-back programs or household trash following FDA guidelines.

Disclaimer

This information is provided for educational purposes only and does not constitute medical advice. Individual response to medication may vary. Patients should consult with a qualified healthcare professional before starting or changing any treatment regimen. The prescribing physician should be informed of all medical conditions and concurrent medications. This product is available by prescription only and should be used strictly as directed by a healthcare provider.

Reviews

Clinical trials demonstrate 84% of patients experience significant allergy symptom reduction within 1 hour of administration. Long-term studies show maintained efficacy over 6 months of continuous use with consistent safety profile. Patient satisfaction surveys indicate 89% preference over previous antihistamine therapies due to reduced drowsiness and reliable 24-hour coverage. Dermatology studies report 76% improvement in urticaria symptoms within 2 weeks of initiation. Real-world evidence supports high adherence rates due to once-daily dosing and minimal side effect profile.