The People's Perspective on Medicine

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 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.

Interesting. I have done a bit of study of Fexofenadine (recommended for dyshidrosis, my main field of study). I have stumbled upon people who have taken fexo in lieu of Zyrtec and gone back and forth between the two until the symptoms abate.
I would like to hear/read more on this.

So would we. Thank you for bringing this to our attention.

I had the same problem when trying to get off Zyrtec. I started weaning myself off, taking one every other day for a week, then every third day for a week, then every fourth day for a week. If I stopped cold turkey, the itching was unbearable but I found that weaning myself off over a period of time actually works.

I took Zyrtec-D for several months when I was having allergy issues. This was at least 10 years ago, possibly more. I stopped taking it when my symptoms of nasal congestion went away, and I was able to breathe normally again. I had no problems stopping it. I don’t know if the “D” part had anything to do with that but I’m feeling very fortunate after reading the problems other people have had.

When I quit taking Zyrtec, I soon discovered that I had very intense, painful itching. I would wake up at night clawing at my ankles or the palms of my hands. Absolutely nothing would soothe the itch. I thought that I must be going crazy. After looking on-line for information and discovering that I was not the only one to have the itch, I made the connection, which I had not made before, between stopping taking Zyrtec and the horrible itch. I immediately went to the drug store for more Zyrtec, took one, and – no more itch! I could sleep comfortably again.

I sought help from one of my doctors. He suggested that I take one Zyrtec for one month, then take 1/2 a tablet for one month, then 1/4 tablet for one month. Then none. I followed these directions. Each time I reduced the dose, I had a little mild itching, but it was bearable.

I will never take Zyrtec again and have cautioned others about this possible side effect.

I took Zyrtec for about five to six years, and then when I tried to come off of it I had extreme itching in my arms that lasted for about 3 years. I dug scars in my arms because I was itching so badly. The FDA really needs to get on the ball with this. When I had called the pharmacy and my doctor to find out about the itching neither one knew anything about it. I had even looked up online, and there was not much about it.

I, too, had severe itching when I discontinued Zyrtec. I couldn’t sleep and would pace around the house in the middle of the night because it was so bad. I read the article you published last summer and finally made the connection. I have shared the article with my doctors – none of whom had heard of this problem! With a protocol of gradually cutting back, I was able to overcome the itching in about 3 weeks. My allergist thanked me for the information, but it should be included on OTC Zyrtec/cetirizine without delay.

I didn’t know this was a thing!!! When I run out of zyrtec I literally break out in hives. I’ve been taking Zyrtec daily for probably about 10 years. I am constantly itchy even when on it.

It was a nightmare when I stopped taking Zyrtec. The itch was unbearable! It was an itch that’s hard to describe. I managed to tough it out and never will take Zyrtec again!

I have had this exact same experience! It seemed to be worse the first week or two, and then gradually the itching became less. One of those things where you just grit your teeth and bear it, or you could just try a lesser addicting antihistamine while you are going through the zyrtec withdrawal and then stop the other antihistamine after a few weeks when the zyrtec is out of your system.

I, too, had an issue after I stopped taking Zyrtec several years ago. I had been a long term user (5-7 yrs), and my gastroenterologist suggested I stop since it was a contributor to constipation. After a week of losing my mind from itching I checked online and saw that others had a similar experience. By then I just decided to tough it out since I’d already gone a week. In total it took about 2-3 weeks for the itching to totally abate. Now I just use Flonase daily and Claritin on rare occasions for allergy control. It was a horrible experience, and they should clearly state this side effect on the product.

I appreciate all of the articles highlighting the problems of Zyrtec withdrawal, but I’m frustrated that you haven’t written a succinct article on the solutions. Instead there are just links to many more articles about people suffering from withdrawal with only a few tidbits of information on solutions.

Please pull it all together with a list of solutions. From what I have read on other sites as well as yours, tapering back is one way and taking another antihistamine such as Allegra or Benadryl during the withdrawal time helps. My allergist is aware of the challenges in withdrawing and recommended I start by cutting the pills in half.

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