Can you take Zyrtec while pregnant?

Zyrtec (cetirizine) is a popular over-the-counter antihistamine used to treat allergy symptoms like sneezing, stuffy or runny nose, and itching. Being pregnant doesn’t make you immune from allergies—and, in some cases, many find that their allergy symptoms actually get worse during pregnancy. So it’s understandable to wonder if you can take Zyrtec while expecting. 

Here’s what you need to know about the safety of Zyrtec during pregnancy, along with other pregnancy-safe alternatives for treating allergy symptoms. 

Can you take Zyrtec while pregnant?

Yes, Zyrtec is considered safe to take during all three trimesters of pregnancy, says Monte Swarup, MD, an OB-GYN based in Arizona and founder of HPV Hub. There have been numerous studies showing no link to birth defects with antihistamines taken during pregnancy. 

According to a review of studies released by the American Academy of Family Physicians (AAFP), at least four studies on Zyrtec during pregnancy have shown no evidence of increased risk to a developing fetus. Zyrtec is part of the second generation of over-the-counter (OTC) antihistamines along with Claritin (loratadine) and Allegra (fexofenadine), which the AAFP says have all been shown to be relatively safe for use during pregnancy.

Although Zyrtec has been shown to be safe, Dr. Swarup says you should still take it only when necessary. In other words, limit your Zyrtec use to those times when you are experiencing symptoms of hay fever or are going to be near something you’re allergic to, like cats or certain trees. You should also take the lowest effective dose (usually 10 milligrams). 

What are the risks of taking Zyrtec while pregnant?

The U.S. Food and Drug Administration (FDA) used to rely heavily on a letter-based rating system for drug safety during pregnancy, with category A drugs being the safest to take, category X drugs being contraindicated because the risks outweigh the benefits, and category B, C, and D drugs varying in safety and adverse effects. 

The FDA is beginning to move away from that rating system, says Alyssa Dweck, MD, an OB-GYN and medical adviser for INTIMINA. Zyrtec has always been a category B drug, which means it’s been proven safe in animal studies, but not enough adequate or well-controlled studies have been performed in humans for it to be a category A drug.

According to Dr. Swarup, there are no known risks for the fetus when a pregnant woman is taking Zyrtec, and the only potential risk for her is drowsiness. Drowsiness is a common side effect of many antihistamines, though it tends to be less common among second-generation antihistamines like Zyrtec.  

What can I take instead of Zyrtec during pregnancy?

If you need an antihistamine and can’t take Zyrtec, there are thankfully several other types of allergy medications that are considered safe for pregnancy. 

Claritin and Allegra, two other second-generation oral antihistamines, are the most obvious swaps, but if you prefer to stick with first-generation antihistamines, Dr. Dweck says OTCs chlorpheniramine and dexchlorpheniramine and prescription hydroxyzine are also safe, per the American College of Obstetricians and Gynecologists (ACOG). However, you should avoid Benadryl (diphenhydramine) during pregnancy as it crosses the placenta and can have significant fetal effects.

If you’re hoping to avoid oral antihistamines altogether, there are also alternative types of allergy medicines that can help treat and relieve allergic rhinitis symptoms.

According to Dr. Swarup, this includes intranasal steroid spray Flonase (fluticasone), which is available over the counter) and nasal saline rinses.

Several other OTC intranasal steroid sprays, such as Nasonex (mometasone) and Rhinocort (budesonide), have also been shown to be safe for use during pregnancy, per a 2018 study.

As always, it is best practice to speak with your healthcare provider before starting any new medications.

Natural remedies for allergies during pregnancy

Some pregnant women would prefer not to take any medication unless they have no other choice. If you’re on the hunt for non-pharmaceutical ways to treat your allergies during pregnancy, there are a few strategies you can try. 

• Find your triggers. Dr. Dweck says one of the best ways to relieve allergy symptoms is by identifying and avoiding common allergens like pollen and dust, or—better yet—figuring out what exactly you’re allergic to and taking steps to steer clear as much as possible. This might mean noting when your symptoms are the worst and doing a little detective work to figure out why and how to combat it (like putting dust mite covers on your bedding if your symptoms are worse after sleeping). 
• Allergy proof your home. Eliminate rugs and excess pillows (and carpet if possible), avoid scented candles, diffusers, and cleaners, and use allergy covers on pillows and mattresses. Clean your home weekly with wet cloths, a vacuum, and a mop and be sure to wash curtains and blinds. Use a high quality mask while cleaning. Do not allow pets to sleep on beds or furniture.
• Using saline nasal sprays. Irrigating your nasal passages with a saline solution is one of the safest ways to relieve allergy symptoms during pregnancy. You can use either a saline squeeze bottle, a sinus rinse bottle, or a neti pot, but be sure to always use distilled or boiled and cooled water and a saline solution to eliminate the risk of water-borne parasites. Always use warm water to avoid vertigo.
• Trying immunotherapy. Dr. Swarup says sublingual immunotherapy (SLIT), or allergy treatments given under the tongue, is a potential option for treating allergies during pregnancy. Previously, the recommendation was to avoid beginning this type of allergy treatment during pregnancy (though women already utilizing it when they got pregnant could safely continue), but newer research suggests that it’s likely also safe to begin SLIT during pregnancy.
• Getting acupuncture. Dr. Swarup also notes that acupuncture has been studied for the treatment of allergies, though the evidence is inconclusive. A 2014 review of studies summarizes this uncertainty, noting that some studies suggest it can help while others have been unable to confirm a link. In general, though, acupuncture is considered safe during pregnancy as long as it’s performed correctly by a licensed acupuncturist. 
• Using a humidifier. Humidifiers add extra water to the air, which can keep your sinuses from feeling dried out and stuffy. This can be especially helpful to do overnight, while you sleep.
• Use an air purifier to filter out dust, pollen, and micro allergens.
• Exercising regularly. Some studies have suggested that moderate physical activity can have protective effects against seasonal allergies and asthma like this 2019 study showing that winter exercise reduced allergic airway inflammation.
• Use an air conditioner and change the filter regularly. On warm days, it is beneficial to use an air conditioner instead of having windows open to reduce allergens indoors
• Making dietary changes. There is some research that foods like local honey can help relieve allergy symptoms, as well as some research suggesting that supplements like stinging nettle and butterbur may be beneficial. However, the evidence is somewhat lacking in these areas and you should always check with your healthcare provider before adding any kind of supplement to your diet or consuming higher amounts of certain foods as “medicine” to treat health conditions during pregnancy.