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Cetirizine, prominently marketed under the brand name Zyrtec among others, is a potent second-generation antihistamine used in the treatment of hay fever, allergies, angioedema, and urticaria. It acts as a selective antagonist of the histamine H 1 receptor.
Second-generation antihistamines like cetirizine are less able to cross the blood–brain barrier and therefore have diminished effects on the central nervous system compared to first-generation drugs. Because of this, they are less likely to cause drowsiness or memory impairment.
Contents
1 Medical uses
1.1 Allergies
1.2 Rhinovirus infection
1.3 Kimura’s disease
1.4 Available forms
2 Adverse effects
3 Pharmacology
3.1 Pharmacodynamics
3.2 Pharmacokinetics
3.2.1 Absorption
3.2.2 Distribution
3.2.3 Metabolism
3.2.4 Elimination
4 Chemistry
4.1 Synthesis
5 Society and culture
5.1 Brand names
5.2 Availability
6 References
6.1 Books and journals
7 External links
Medical uses
Allergies
Cetirizine’s primary indication is for hay fever and other allergies. Because the symptoms of itching and redness in these conditions are caused by histamine acting on the H 1 receptor, blocking those receptors temporarily relieves those symptoms.
Cetirizine is also commonly prescribed to treat acute and (in particular cases) chronic urticaria, more efficiently than any other second-generation antihistamine.
Rhinovirus infection
Interleukin 6 and interleukin 8 have been shown to be elevated in acute respiratory distress syndrome.
Kimura’s disease
Cetirizine is an effective agent in treating the symptoms of Kimura’s disease which predominantly affects the lymph nodes and soft tissue of the head and neck in the form of tumor-like lesions. Cetirizine’s properties of being effective both in the treatment of pruritus (itching) and as an anti-inflammatory agent make it suitable for the treatment of the pruritus associated with these lesions.
Available forms
Cetirizine is available over-the-counter in the form of 5 and 10 mg tablets. A 20mg strength is available by prescription only.
Adverse effects
Commonly reported side effects of cetirizine include headache (16%), dry mouth (5.7%), drowsiness (5–20%), and fatigue (5.6%), while more serious but rare side effects include cardiac failure, tachycardia, and edema.
Insatiable, generalized itching is the most commonly-reported withdrawal side effect, though others have reported severe rebound of original, pre-treatment systems as well, including sneezing and runny nose.
Pharmacology
L-Stereoisomer, levocetirizine (top) and D-stereoisomer of cetirizine.
Pharmacodynamics
Cetirizine acts as a highly selective antagonist of the histamine H 1 receptor.
Cetirizine crosses the blood–brain barrier only slightly, and for this reason, it produces minimal sedation compared to many other antihistamines.
Cetirizine has been shown to inhibit eosinophil chemotaxis and LTB4 release.
Pharmacokinetics
Absorption
Cetirizine is rapidly and extensively absorbed upon oral administration in tablet or syrup form.
Distribution
The mean plasma protein binding of cetirizine has been found to be 93 to 96% across a range of 25 to 1,000 ng/mL independent of concentration.
Metabolism
Cetirizine does not undergo extensive metabolism.
Elimination
Cetirizine is eliminated approximately 70 to 85% in the urine and 10 to 13% in the feces.
Chemistry
Cetirizine contains L – and D – stereoisomers. Chemically, levocetirizine is the active L – enantiomer of cetirizine. The drug is a member of the diphenylmethylpiperazine group of antihistamines. Analogues include cyclizine and hydroxyzine.
Synthesis
Cetirizine synthesis:
The 1-[(4-chlorophenylmethyl]-piperazine is alkylated with methyl (2-chloroethoxy)-acetate in the presence of sodium carbonate and xylene solvent to produce the Sn2 substitution product in 28% yield. Saponification of the acetate ester is done by refluxing with potash in absolute ethanol to afford a 56% yield of the potassium salt intermediate. This is then hydrolyzed with aqueous HCl and extracted to give an 81% yield of the carboxylic acid product.
Society and culture
A package of 10 mg cetirizine tablets. Zyrtec-D, a combination of cetirizine and pseudoephedrine.
Brand names
Cetirizine is marketed under the brand names Alatrol, Alerid, Alzene, Cetirin, Cetzine, Cezin, Cetgel,Histazine, Humex, Letizen, Reactine, Razene, Rigix, Triz, Zetop, Zirtec, Zirtek, Zodac, Zyllergy, Zynor, Zyrlek, and Zyrtec among others.
Availability
Formerly prescription-only in many countries, cetirizine is now available without prescription in most countries. In some countries it is available over-the-counter only in packages containing seven or ten 10 mg doses.
Like many other antihistamine medications, cetirizine is commonly prescribed in combination with pseudoephedrine, a decongestant. These combinations are often marketed using the same brand name as the cetirizine with a “-D” suffix ( Zyrtec-D, Virlix-D, etc.)

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