Incidence rates of allergies continue to increase and are commonly experienced by the elderly. Various treatment options are presently in place to manage allergies and the underlying conditions that trigger the allergies. Cetirizine is one among the various treatment options presently used for managing allergies, and is commonly prescribed/recommended for use in treating allergic rhinitis. Subsections offer a detailed look at the drug including cetirizine side effects in elderly to help individuals cope with the possible undesirable outcomes. It is of utmost importance to understand and identify symptoms and treat the same at the earliest.

Overview of cetirizine

Belonging to the category of selective Histamine-1 antagonist, cetirizine is also used in managing chronic urticaria, apart from sneezing, and commonly occurring nasal congestion and coughing. It is available as an OTC product and is therefore commonly used by patients with certain conditions. The medication comes in the form of capsules and tablets, and is usually recommended to be taken once daily. It is regularly used by patients diagnosed with hives, and various other allergies.  One of the reasons for the popularity of cetirizine, is the relatively lesser side effects when compared with other antihistamine agents.

Mechanism of action

Individuals who are exposed to certain substances experience allergies as the body releases histamine, a chemical. This chemical is the reason behind most of the allergic reactions. Cetirizine, and other drugs that are classified as antihistamine, work by blocking the effects of histamine, thereby offering relief from the symptoms.

As a second-generation H1 antihistamine, cetirizine works by selectively inhibiting the H1 receptor, and this is achieved without and sedative effects that are commonly experienced in other medications.  The mechanism of action includes selective inhibition of peripheral H1 receptors, and also possess limited anticholinergic and antiserotonergic properties. Studies have ascertained that the drug only works on the H1 receptor and also not affect the brain. This makes it a better choice among available options.

Cetirizine indication

Cetirizine is typically used by individuals with allergic symptoms that are known to last all year. Additionally, allergies such as hay fever, which are seasonal in nature are also managed with cetirizine. It is important to understand the difference here between treatment and management. Cetirizine does not treat the condition, but offers relief from the symptoms associated with the condition. The underlying condition is treated with different medications on the basis of diagnosis.

Conditions that are managed with cetirizine include sneezing, itching in the throat and the nose, apart from running nose and eyes that keep watering. Allergies have an effect on various organs of the body, and the use of antihistamines helps to manage the allergies effectively.

Ideal dosage of the antihistamine

One of the commonly reported problems and reasons for cetirizine side effects in elderly and others is incorrect dosage and schedule. This is especially true in the case of OTC medications. Most individuals tend to assume that OTC products are free from all effects and this results in abuse of medications. Excessive dosages are often taken in the assumption that stronger dose will help heal or treat or manage the condition faster and more effectively. It is necessary to stick to ideal or cetirizine max dose adults and seek medical advice in the event of any doubt. Cetirizine is not to be given to children below the age of 6 while individuals in other age categories may take the tablet or capsule. The ideal dosage is 10 mg once daily.

Experts caution against taking more than 10 mg in a day, doctors generally recommend dosages of 5 mg, either once daily or to be split and taken twice a day. Certain categories of patients are to seek medical advice before taking this OTC medication, to prevent undesirable outcomes. For instance, children between the age of 2 and six are to consult a specialist before commencing the treatment. Similarly, elderly patients, above the age of 65 and individuals with liver/kidney ailments are also to seek explicit specialist approval before taking the medication.

Commonly reported undesirable effects of cetirizine

Cetirizine is regarded as a better molecule in terms of effectiveness, and it is also known to have lesser side effects than other antihistamines. For instance, it is not known to result in adverse conditions such as overpowering drowsy feelings, and dry mouth. It also does not cause blurring of vision.  However, the medication is not free from undesirable effects. All medications come with the possibility of undesirable effects, and there are possible cetirizine side effects in adults.  Effects may be mild or moderate in nature, that are essentially short lived, and may not require any kind of treatment. These effects are generally known to resolve naturally. The other category of effects is serious or adverse effects that are typically rare in occurrence, but require medical intervention.

It is necessary to bear in mind that not all individuals may experience effects, with some users of medications free from all effects whatsoever. Here is a small compilation of some of the commonly occurring undesirable effects. This is not a complete or exhaustive list, but is intended to serve as a broad reference of the possible effects.

Patients on the medication are known to feel slightly drowsy, though not at the scale or level of drowsiness associated with the first generation of antihistamines. The individual may feel lethargic and tired, while some are likely to end up with a dry mouth. Pain in the stomach is also another possible undesirable effect. Many are known to experience diarrhea and vomiting when on cetirizine.

Effects that are a cause for concern

As outlined above, certain effects are serious or adverse in nature and need to be treated at the earliest. It may be necessary for patients be treated at a healthcare facility that has emergency triaging facilities. Reactions that need urgent treatment include symptoms of hives, also known as chronic idiopathic urticaria. Any difficulty in breathing is also to be treated at the earliest. Similarly, swelling on the face, especially on the lips, the tongue and throat are also to be considered as serious effects that require emergency treatment.

Symptoms that need to be reported for possible medical intervention

Patients experiencing fast, racy pounding of the heart are advised to report the same for treatment. Similarly, any feelings of weakness or difficulty in falling asleep or shaking that is abnormal and uncontrollable also requires medical intervention. Individuals may sometimes experience restlessness and may be hyperactive. There could be feelings of confusion, while some may have issues related to vision. It is also possible that patients may have difficulty in passing urine normally.

Precautions to be taken prior to taking cetirizine

It is necessary to exercise caution before taking any medications, and this applies to cetirizine. Despite the tag of OTC formulations, there is the possibility of a section of patients experiencing strong undesirable effects. It is therefore standard practice to understand certain conditions and discuss the same with the specialist. For instance, individuals with a history of allergies are at heightened risk of experiencing reactions. Patients who have reactions to certain food products, chemicals, dyes, preservatives and animal dander are considered as being allergic to specific substances.

Similarly, the age of the patient is to be taken into consideration. Cetirizine is not recommended for use in children below the of 6. For children between the ages of 6 and 12, the dosage needs to be altered in such a way so as not to pose undesirable effects. In the case of elderly patients, there is a possibility of aggravated or stronger effects. While there have been no documented effects that indicate that cetirizine may affect the elderly, it is safe to exercise caution and monitor for symptoms of side effects that are serious in nature.

Studies have not been conducted on breastfeeding women to ascertain the possibility of effects, and it is therefore important to use the medication only when there is a pressing need or if the doctor has recommended the medicine.

Cetirizine contraindications 

Similar to side effects, there is also the possibility of undesirable drug interactions when the antihistamine is taken with other drugs. This is not restricted to prescription medications, but may be experienced when taken alongside other OTC formulations, herbal products and supplements. Certain food products may also cause some kind of interactions, but this is extremely rare in occurrence. Typically, interactions may result in an increase in the potency of either of the two medications, or it could result in a decrease in the potency. It is also possible that interactions may result in aggravated side effects of either of the two medications. Here is a list of a few combinations that could trigger interactions.

Certain medications used for treating migraine headaches, cluster headaches, bacterial infections, protozoal infections, and some drugs used for treating tuberculosis. Similarly, antidepressant drugs are also known to cause interactions when taken with cetirizine. It is also important to avoid use of the antihistamine along with antibiotics such as linezolid. Certain MAOIs are also known to interact with cetirizine, such as nialamide. Certain drugs used for treating methemoglobinemia, such as methylene blue are also known to interact with the medication. Interactions are avoided by either discontinuing or temporarily suspending either of the two medications that are known to interact. This involves determining one that is less important or critical among the two. In the event, both the medications are indispensable, the best option is to alter the dosage and stagger the intake schedule, so as to minimize the possible effects.

Other general precautions

Individuals on the antihistamine are to avoid operating machinery or driving due to the possible drowsiness associated with cetirizine. This however, may depend on the actual effect as some are known to be less affected, while some may eel stronger effects. Drinking when on cetirizine is to be avoided at all costs. This could cause a possible impact on level of alertness and could induce greater drowsiness that could affect routines and responsibilities. Similarly, individuals are not to combine the antihistamine with other tranquilizers or sedatives. Patients on asthma medication, may experience strong effects, and this makes it necessary to avoid cetirizine when on asthma treatment. Patients with certain conditions are not to take the antihistamine due to the possible risks from the mechanism of action.

This is only a note of caution, and decisions are to be taken based on medical opinion. For instance, individuals diagnosed with heart disease, or patients with thyroid conditions are advised to choose other medications. Similarly, diabetics may also experience issues when on the medication. Other conditions that make cetirizine unsuitable for use include glaucoma, hypertension, and enlarged prostate with urinary retention. Patients with liver ailments or kidney diseases are also not to take the antihistamine and choose alternative medications.


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