Cetirizine (Zyrtec) alternatives: What can I take instead of cetirizine?

Zyrtec (cetirizine) doesn't work for everyone. Loratadine, fexofenadine, levocetirizine, diphenhydramine, and Allegra-D are some cetirizine alternatives. Get the full list here.

By Stephanie Melby, Pharm.D. | Jun. 11, 2023

Cetirizine is a generic over-the-counter (OTC) medication that belongs to a group of medications called antihistamines and is available under the brand-name Zyrtec. Antihistamines like cetirizine can help treat symptoms of hay fever or other upper respiratory allergies. Some allergy symptoms that can be relieved by cetirizine include a runny nose, sneezing, itchy eyes, watery eyes, and an itchy nose or throat. Antihistamines work by blocking chemicals in the body called histamines that are released by the immune system. These drugs can also benefit certain itchy skin conditions like hives (urticaria). There are first-generation antihistamines known to cause more side effects like drowsiness, and second-generation antihistamines are newer and considered safer. An additional advantage of second-generation antihistamines is that they are long-acting and typically dosed once daily. Cetirizine is a second-generation antihistamine available as a capsule, tablet, oral solution, chewable tablet, and orally disintegrating tablet (ODT).

While an effective treatment for some people, cetirizine may not be the best and safest antihistamine medication for everyone. Although cetirizine is a newer antihistamine and is intended to be less drowsy, some people may have better luck with the side effects of other second-generation allergy treatment options. Studies in adults show that about 14% of people experienced somnolence or drowsiness while taking cetirizine. Sometimes, first-generation antihistamines are used to treat insomnia because of their side effect profile of causing drowsiness, so these may be a good option for people who also need help falling asleep. Additionally, some people may need a combination allergy medication that contains a decongestant for greater relief.

What can I take in place of cetirizine?

There are other options available to treat symptoms of hay fever or other upper respiratory allergies that do not improve with cetirizine. These alternative medications include other second-generation antihistamines, first-generation antihistamines, and combination drugs. These options may be more suitable for certain individuals due to their different uses, side effect profiles, and dosages.

Compare Zyrtec (cetirizine) alternatives
Drug name	Uses	Dosage	Savings options
Cetirizine (Zyrtec)	-Allergic rhinitis symptoms -Hay fever symptoms -Chronic spontaneous urticaria (hives)	Take 10 mg by mouth once daily	Zyrtec coupons
Cetirizine and pseudoephedrine (Zyrtec-D)	-Upper respiratory allergies	Take 1 tablet (cetirizine 5 mg/pseudoephedrine 120 mg) by mouth twice daily	Zyrtec-D coupons
Chlorpheniramine (Aller-chlor)	-Allergic rhinitis symptoms -Hay fever symptoms -Motion sickness	Immediate release: Take 4 mg by mouth every 4 to 6 hours Extended release: Take 12 mg by mouth every 12 hours	Aller-chlor coupons
Desloratadine (Clarinex)	-Allergic rhinitis symptoms -Hay fever symptoms -Chronic spontaneous urticaria (hives)	Take 5 mg by mouth once daily	Clarinex coupons
Diphenhydramine (Benadryl)	-Allergic rhinitis symptoms -Insomnia -Motion sickness	Take 25 mg by mouth every 4 to 6 hours or 50 mg by mouth every 6 to 8 hours as needed	Benadryl coupons
Fexofenadine (Allegra)	-Allergic rhinitis symptoms -Hay fever symptoms -Chronic spontaneous urticaria (hives)	Twice-daily formulations: Take 60 mg by mouth every 12 hours Once-daily formulations: Take 180 mg by mouth once daily	Allegra coupons
Levocetirizine (Xyzal)	-Allergic rhinitis symptoms -Hay fever symptoms -Chronic spontaneous urticaria (hives)	Take 5 mg by mouth once daily	Xyzal coupons
Loratadine (Claritin)	-Allergic rhinitis symptoms -Hay fever symptoms -Chronic spontaneous urticaria (hives)	Take 10 mg by mouth once daily	Claritin coupons

Other alternatives to cetirizine

For people seeking other alternatives to cetirizine, there are a variety of oral antihistamine medications including combination drugs with pseudoephedrine and alternative formulations such as nasal sprays.

Allegra-D (fexofenadine and pseudoephedrine)
Astepro (azelastine) nasal spray
Claritin-D (loratadine and pseudoephedrine)
Hydroxyzine
Patanase (olopatadine) nasal spray

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Top 5 cetirizine alternatives

The following are some of the most common alternatives to cetirizine.

1. Loratadine (Claritin)

Loratadine is a generic OTC medication that is available under the brand-name Claritin. Like cetirizine, loratadine is a second-generation antihistamine used to treat the symptoms of hay fever or upper respiratory allergies. Cetirizine and loratadine are considered to be equally effective treatment options. Although both antihistamines are designed to be less sedating, loratadine may cause less sleepiness in people than cetirizine. This may be a suitable alternative for people concerned with drowsiness. Like cetirizine, loratadine comes in a variety of forms, like chewable tablets, oral syrup, tablets, capsules, and oral disintegrating tablets. Loratadine is typically dosed at 10 mg once a day.

2. Fexofenadine (Allegra)

Fexofenadine is a generic OTC medication that is available under the brand-name Allegra. Like cetirizine, fexofenadine is a second-generation antihistamine used to treat the symptoms of hay fever or upper respiratory allergies. Cetirizine and fexofenadine are considered to be equally effective treatment options. Fexofenadine is considered to be the least sedating of the second-generation antihistamines. This may be the best option for people who want to avoid sedation. Fexofenadine also comes in a variety of forms like oral liquid, tablets, and oral disintegrating tablets, and is available in 24-hour and 12-hour options. Fexofenadine is typically dosed at 60 mg taken every 12 hours for twice-daily dosing and 180 mg taken once a day for once-daily dosing.

3. Levocetirizine (Xyzal)

Levocetirizine is a generic OTC medication that is available under the brand-name Xyzal. With a similar sounding name to cetirizine, levocetirizine is chemically similar to cetirizine. Levocetirizine may cause less drowsiness than Zyrtec due to its slight difference in chemical structure. Less levocetirizine is needed to equal the same amount of cetirizine. People who experience drowsiness with cetirizine may be able to better tolerate levocetirizine. Available as both an oral liquid and tablet, levocetirizine is typically dosed at 5 mg once a day.

4. Desloratadine (Clarinex)

Desloratadine is a generic prescription medication available under the brand name Clarinex. Desloratadine, which sounds similar to loratadine, is an active metabolite of loratadine, meaning it is a modified form. As a more potent form of loratadine, the desloratadine needed for a dose is less. Desloratadine is an effective option with less sedation. It is only available as tablets and oral disintegrating tablets and is typically dosed at 5 mg once a day.

5. Cetirizine and pseudoephedrine (Zyrtec-D)

The combination of cetirizine and pseudoephedrine is a generic OTC medication available as a Zyrtec-D brand. Along with a second-generation antihistamine, this combination includes a decongestant. This option may be best suited for people experiencing increased nasal congestion. It’s important to know that this combination has more side effects, including headaches, anxiety, excitability, and possibly heart palpitations. Additionally, alternatives with pseudoephedrine should be used cautiously in people with cardiovascular disease, including hypertension (high blood pressure) and heart disease. Zyrtec-D is available as an extended-release tablet and is typically taken twice a day.

Natural alternatives to cetirizine

There are a variety of natural remedies for cetirizine, including saline rinses/nasal sprays, acupuncture, and techniques to avoid allergens. Making homemade saline rinses or using OTC saline nasal sprays can help remove and thin out excessive mucus associated with allergies. Additionally, saline can bring relief by removing allergens from the nostrils and sinuses. Acupuncture is a technique in which fine needles are inserted into the skin to treat health problems, and there is evidence it may be useful in allergy relief. While trying to avoid allergens completely is difficult, some techniques can help minimize exposure to allergens and reduce symptoms. Some techniques include keeping windows closed during pollen season, wearing glasses or sunglasses to reduce pollen exposure in the eyes, washing bedding frequently (especially for those with pet dander), and taking a shower after working or playing outdoors.

How to switch to a cetirizine alternative

1. Talk with a doctor about symptoms

Discussing with a doctor about allergy symptoms or itchy skin symptoms like hives can help guide treatment in the right direction. A doctor may perform allergy testing to identify the cause of symptoms. Additionally, a doctor may be able to recommend the best antihistamine medication for a patient based on the side effect profiles, drug interactions, and ease of dosing/drug administration.

2. Discuss all health conditions with a healthcare provider

Before switching from cetirizine to an alternative, it’s a good idea to inform the primary doctor so that they can review all health conditions. Alternatives may have serious side effects, precautions, or drug interactions that must be avoided. It’s best to seek medical advice before changing medication therapy.

3. Be aware of possible withdrawal symptoms

While most people can safely stop taking cetirizine, some may experience withdrawal symptoms such as severe itching. This may be more likely in people who have taken cetirizine for long periods (months to years), so it may be best to consider discontinuing the medication by slowly lowering the daily dose.