Xyzal: Advanced 24-Hour Relief for Allergic Rhinitis and Chronic Hives
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Synonyms | |||
Xyzal (levocetirizine dihydrochloride) is a prescription and over-the-counter second-generation antihistamine designed to provide long-lasting, non-drowsy relief from allergy symptoms. As the active enantiomer of cetirizine, it offers enhanced potency and a favorable pharmacokinetic profile, making it a first-line choice for clinicians managing allergic conditions. Its targeted mechanism selectively inhibits histamine H1-receptors, reducing inflammatory mediators responsible for sneezing, rhinorrhea, pruritus, and urticaria. Supported by robust clinical evidence, Xyzal delivers consistent symptom control with a well-established safety record for patients aged six years and older.
Features
- Active ingredient: Levocetirizine dihydrochloride 5 mg per tablet
- Formulation: Film-coated tablets and oral solution (2.5 mg/5 mL)
- Pharmacologic class: Second-generation selective H1-receptor antagonist
- Duration of action: 24-hour efficacy with single daily dosing
- Rapid onset: Symptom relief within one hour of administration
- Minimal metabolism: Primarily excreted renally unchanged (≥85%)
- Low protein binding: Approximately 90%, reducing interaction potential
Benefits
- Provides comprehensive 24-hour relief from indoor and outdoor allergy symptoms including sneezing, runny nose, itchy eyes, and throat
- Effectively manages chronic idiopathic urticaria (hives) with reduction in wheal formation and pruritus
- Demonstrated low incidence of sedation compared to first-generation antihistamines while maintaining efficacy
- Suitable for long-term management with no evidence of tachyphylaxis (loss of effectiveness) with continued use
- Pediatric formulation available for children aged 6 years and older with appropriate weight-based dosing
- Minimal cardiac effects with no clinically significant QT prolongation at therapeutic doses
Common use
Xyzal is indicated for the relief of symptoms associated with perennial and seasonal allergic rhinitis in adults and children 6 years of age and older. These symptoms include sneezing, rhinorrhea, pruritus of the nose, palate, and throat, and ocular symptoms (itching, redness, tearing). Additionally, it is indicated for the treatment of uncomplicated skin manifestations of chronic idiopathic urticaria in adults and children 6 years of age and older. Clinical studies have demonstrated efficacy in reducing hive size, number, and duration while providing relief from associated pruritus. Off-label uses may include adjunctive treatment in atopic dermatitis and other histamine-mediated conditions under physician supervision.
Dosage and direction
For adults and children 12 years and older: 5 mg (1 tablet or 10 mL oral solution) once daily in the evening. For children 6 to 11 years: 2.5 mg (½ tablet or 5 mL oral solution) once daily in the evening. Administration may be with or without food, though taking with food may slightly delay absorption. For patients with renal impairment (creatinine clearance 30-49 mL/min): 2.5 mg once daily; (creatinine clearance 10-29 mL/min): 2.5 mg every other day; (creatinine clearance <10 mL/min or hemodialysis patients): use not recommended. Hepatic impairment alone does not require dosage adjustment, but combined renal and hepatic impairment necessitates dosage reduction.
Precautions
Patients should be cautioned regarding engaging in activities requiring mental alertness such as operating machinery or driving until they know how Xyzal affects them. Although less sedating than first-generation antihistamines, somnolence has been reported in some patients. Use with caution in patients with predisposing factors for urinary retention (e.g., prostate hyperplasia) as antihistamines may exacerbate this condition. Monitor patients with narrow-angle glaucoma as anticholinergic effects may increase intraocular pressure. In elderly patients, consider age-related renal function decline and adjust dosage accordingly. Pregnancy Category B: Use only if clearly needed; insufficient human data exists. Excretion in human breast milk occurs—exercise caution when administering to nursing women.
Contraindications
Xyzal is contraindicated in patients with known hypersensitivity to levocetirizine, cetirizine, hydroxyzine, or any component of the formulation. Patients with end-stage renal disease (creatinine clearance <10 mL/min) or those undergoing dialysis should not use this medication. Concomitant use with alcohol or other central nervous system depressants should be avoided due to potential additive effects. Not recommended for children under 6 years of age due to insufficient safety and efficacy data in this population.
Possible side effects
Most common adverse reactions (≥2% and greater than placebo) include somnolence (6-14%), nasopharyngitis (3-6%), fatigue (5-6%), dry mouth (5%), and pharyngitis (3%). Less common side effects (<2%) include dizziness, headache, nausea, abdominal pain, cough, and weight increase. Rare but serious adverse effects include hypersensitivity reactions (angioedema, bronchospasm, anaphylaxis), seizures, and hepatitis. Pediatric patients experience similar adverse reaction profiles with somnolence being the most frequently reported. Most adverse reactions are mild to moderate and often transient, diminishing with continued therapy.
Drug interaction
Formal drug interaction studies demonstrate no clinically significant interactions with pseudoephedrine, ketoconazole, azithromycin, or erythromycin. However, theoretical interactions exist with CNS depressants (alcohol, benzodiazepines, opioids, sedating antidepressants) which may potentiate sedation. Use with theophylline may decrease levocetirizine clearance by approximately 16%. No significant interactions with warfarin have been observed. As levocetirizine is primarily renally excreted, drugs that affect renal function may alter its clearance. Monitor patients taking anticholinergic drugs concurrently for enhanced anticholinergic effects.
Missed dose
If a dose is missed, take it as soon as remembered unless it is nearly time for the next scheduled dose. Do not double the dose to make up for a missed one. Resume the regular dosing schedule with the next dose. Given the 24-hour duration of action, a single missed dose is unlikely to significantly impact symptom control, but consistent daily administration provides optimal therapeutic outcomes.
Overdose
Symptoms of overdose may include drowsiness, agitation, restlessness, and in children, initially agitation and restlessness followed by drowsiness. In adults, doses up to 50 mg have been administered and resulted in increased incidence of somnolence. General supportive measures are recommended, including gastric lavage if ingestion occurred within 2 hours. Levocetirizine is not effectively removed by dialysis due to high protein binding and extensive tissue distribution. There is no specific antidote; treatment should be symptomatic and supportive. Contact a poison control center for current recommendations.
Storage
Store at room temperature between 20°C to 25°C (68°F to 77°F) with excursions permitted between 15°C to 30°C (59°F to 86°F). Keep in the original container with the cap tightly closed to protect from moisture and light. Keep out of reach of children and pets. Do not use after the expiration date printed on the packaging. For the oral solution, use within 6 months of opening and do not freeze. Properly discard any unused medication after therapy completion.
Disclaimer
This information is for educational purposes only and does not constitute medical advice. Always consult with a qualified healthcare professional before starting, changing, or stopping any medication. The complete prescribing information should be reviewed before administration. Individual results may vary based on patient-specific factors including age, renal function, concomitant medications, and underlying medical conditions. Only a healthcare provider can determine if Xyzal is appropriate for your specific medical situation.
Reviews
Clinical trials demonstrate that 74% of seasonal allergy patients experienced significant symptom reduction compared to 38% on placebo. In chronic urticaria studies, 63% of patients showed marked improvement in hive count and pruritus. Patient-reported outcomes indicate high satisfaction with 24-hour symptom control, with 82% rating effectiveness as “excellent” or “good” in post-marketing surveys. Common positive feedback includes improved sleep quality due to reduced nighttime symptoms and minimal next-day drowsiness. Some patients report the evening dosing schedule helps manage next-day allergy symptoms effectively. A small percentage of users (approximately 6%) discontinued due to sedation, though most found this effect diminished with continued use.