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Do Doctors Know About Zyrtec Antihistamine Withdrawal ?

Why doesn't the FDA require a warning about cetirizine - Zyrtec antihistamine withdrawal on the OTC drug label? Ditto for levocetirizine (Xyzal). Help FDA!
A woman has after a mosquito bite a itchy skin and scratching

We first heard about the cetirizine – Zyrtec antihistamine withdrawal phenomenon a decade ago from a reader of our syndicated newspaper column:

“I have had terrible trouble trying to stop taking Zyrtec (the generic is cetirizine). After using this antihistamine for about three years while having allergy shots, I first attempted to stop taking it in preparation for allergy testing. Within three days, my entire body itched. It was so horrible that I was crying and preparing to go to the hospital for relief.

“Confused by the relentless itching, I forgot and took a Zyrtec by accident. Lo and behold, before I could get dressed and get in the car, my symptoms were GONE. Now, seven years later, I have tried unsuccessfully at least 10 times to quit this drug, and the reaction is more severe each time.

“Today while I was researching this problem online, I found a community of thousands of people who have had the same problems I have. There should be better warnings about this withdrawal problem.”

Notifying the FDA about Zyrtec Antihistamine Withdrawal:

After receiving over 700 comments from readers of our column, we reached out to the Food and Drug Administration. We wanted to know 1) if the FDA knew about this problem, 2) if the agency would alert health professionals and consumers about withdrawal itching, and 3) if the FDA and the drug company would provide some guidance on how to stop taking drugs like cetirizine or its chemical cousin levocetirizine (Xyzal).

The FDA eventually responded that it had reviewed the issue and listed the following adverse reaction in the cetirizine prescribing information:

“Rebound pruritus- pruritus within a few days after discontinuation of cetirizine, usually after long-term use (e.g. months to years) of cetirizine”.

“Pruritis” is doctorspeak for itching. Why can’t the FDA just use normal language? Itching is a perfectly good word.

Search as we might, we have not been able to find this information listed on the over-the-counter labeling for cetirizine (Zyrtec) or levocetirizine (Xyzal). We have repeatedly asked the FDA why consumers shouldn’t be informed of this Zyrtec antihistamine withdrawal phenomenon. To date, we have not received a clear answer. What’s more, we do not believe that the FDA has any solid scientific evidence to support its contention that this “usually occurs after long-term use.”

There are no guidelines on how to prevent Zyrtec antihistamine withdrawal. As a result, neither patients nor health professionals have easy access to information that would alert them to this problem.

Fast Forward to 2020:

A recent reader shares the same concern that a reader in 2010 brought to our attention.

Q. I have been complaining to doctors for years that I am physically addicted to Zyrtec. I can’t go more than three days off the drug before the itching becomes completely unbearable.

I am now on my fifth day off of it because I am getting allergy tests later this week. My co-workers said they’ve never seen me this unhinged. I feel like I’m flea-infested!

I’ve had to break down twice now and take a Benadryl just so I can function at work. That definitely helps, but the itch comes back as soon as the drug wears off. What else can I do?

A. We have been concerned about this withdrawal reaction for years. Although the FDA acknowledges that stopping cetirizine suddenly can cause itching, it provides no guidance for gradual withdrawal (Therapeutic Advances in Drug Safety, July 5, 2019). People who have reported their experience on our website have found that the itching fades within several weeks, if you can hold out that long.

Here are some additional articles about this problem:

Running Out of Zyrtec on a Remote Island Causes a Crisis
A reader who lives on a Pacific island discovered to his dismay that running out of Zyrtec triggered horrible itching and hives

The Itch That Won’t Quit | Itching After Stopping Xyzal (Levocetirazine)

Share your own experience with Zyrtec antihistamine withdrawal in the comment section below. If you have not had any problems stopping cetirizine (Zyrtec) or levocetirizine (Xyzal) please share your story too.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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Citations
  • Ekhart, C., et al, "Unbearable Pruritus After Withdrawal of (Levo)cetirizine," Drug Safety - Case Reports, Dec. 3, 2016, doi: 10.1007/s40800-016-0041-9
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I’ve been taking Zyrtec for years, since it first hit the market, for all-year-round allergies. I thought it was a God send. My sneezing, runny nose, tearing eyes and other symptoms literally disappeared without drowsiness.

Then the dry skin, mouth, and overall dehydration led me to trying to stop it. I went 1 day, and the itching was so unbearable I thought I’d lose my mind. I went back on it and did some research about withdrawal symptoms. I decided to go ahead and try to wean down slowly. I have been on 1/2 tablet for several months, and while I don’t have such severe itching I still experience some with no apparent reason. It seems the thread on my clothing even irritates my skin. My elderly mother was on it for years, and when she moved to assisted living the physician abruptly switched her off that to prn Claritin. Which did nothing for her nasal and respiratory symptoms but totally ignored her itching and basically blamed it on dementia.

Physicians need to research the drugs they prescribe before doing so. Then maybe their 15-minute visits would be 30 minutes to an hour, and we’d have fewer drug interactions and more overall wellness. How many drug side effects are being treated with additional drugs, adding to poly pharmacy. I know this is a fact in the behavioral health arena!

I was diagnosed with chronic idiopathic urticaria (basically periodic hives of no known origin) after a few bouts in 2019. I was prescribed high doses of cetirizine (4 pills per day, 2 at night and 2 in the morning), for 6-8 weeks to treat the unbearable itching, the same sort of itch described by others in these comments as a withdrawal symptom. It’s a bit shocking to read that the drug I am using to treat itching will also cause the same sort of itching when stopped. This high dose worked, but after 5 weeks I felt it wasn’t right to take so much antihistamine, and I cut back to 3 pills for 4 days, then 2 per day. A mild rash on my legs reappeared but no itch of note, so I added an allegra at night with one of the cetirizine tablets out of fear the itch would return. This has been for the past week.

I looked online today to check on antihistamine concerns, and saw this article and these comments. I’m amazed at hearing all this from others, and feel somewhat reassured that others deal with this, but annoyed there is no summary information about these non-drowsy antihistamines, with treatment recommendations available.

Stopping Atarax (hydroxyzine): Is it metabolized to cetirizine? I take hydroxyzine for anxiety which my provider and I were planning on stopping in the near future because it can cause Qt prolongation.

Hydroxyzine is in fact metabolized to cetirizine. You and your doctor might plan accordingly.

After taking Zyrtec for a while, I really liked not having the allergy sneezing and congestion. I have stopped taking it regularly several times and experienced the itching. When the itching started I would take a Zyrtec then discontinue again until the itching stopped. Each time between doses would be longer than before. Then, the allergies would return and require trips to the doctor. I have since resigned myself to taking the Zyrtec every day. It is so much better for me to take it than to suffer the allergies.

Yep…this is amazing. I take Zyrtec off and on and have had no problems yet. I may switch to Allegra. Thanks.

I have taken generic Zyrtec alternated with Zyzol on a pretty regular schedule for 2-3 years. Prior to that I had taken chlorpheniramine (Chlortrimiton) 60+ years, off and on. I randomly stop when I feel the allergens are not present. I could be on one for a year or so and stop without any side effects.

Is there any chance that Telfast has the same rebound effect?
Been on Telfast for mast cell for nearly 2 years, stopped them for 3 days, and my face especially (but to a lesser degree over the body) developed itchy, painful hives. Started back on them today and now waiting to see if they have subsided.

Telfast is fexofenadine. The US brand name is Allegra. Some people do seem to have this reaction with fexofenadine, but it doesn’t seem to be as common as with cetirizine.

Are there the same withdrawal problems with taking other antihistamines like Claritin or Allegra every day for years?

We have not received the same number of reports related to the other antihistamines.

This happened to me as well. After years of taking it regularly, I had started to have weird symptoms (which is another thing you don’t know about Zyrtec unless it happens to you). It mostly happens to children but can happen to adults. It can cause severe restlessness (think an unbearable case of restless legs syndrome but over your entire body), severe insomnia, neurological symptoms (jerking, tremors, paresthesias), severe anxiety and agitation. I decided to stop taking it, and the itching was so severe I thought I would lose my mind. I couldn’t sit still; I couldn’t sleep; I couldn’t concentrate. It was literally a waking nightmare.

I did some research and read that weaning off was better than cold turkey, so I tried it. I weaned for almost two months, but when I finally stopped the unbearable itching came back, though not as severe. I just persevered because I was determined to stay off Zyrtec. It took MONTHS before the itching was finally diminished enough that I could live with it.

It has never truly gone away. On the advice of my allergist, I take Allegra for allergies and to alleviate the itching that invariably returns after 2-3 days. Allegra does not cross the blood/brain barrier, so will not cause the neuro/psych/physical side effects, apparently. I do switch off with Claritin every so often because if I take one or the other exclusively I become too accustomed to it, and it stops being effective.

Zyrtec has literally caused me a chronic itching problem, and I’m pretty convinced has caused some of the neuro/psych symptoms I still suffer from: paresthesias, restlessness, anxiety – all things I never had before I started taking it.

I was aware of this and take Loratidine and am now experiencing the itch.

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