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Drug overview & main differences | Conditions treated | Efficacy | Insurance coverage and cost comparison | Side effects | Drug interactions | Warnings | FAQ
While browsing the allergy section at your local pharmacy, you may have come across Zyrtec and Zyrtec-D. Despite their names, Zyrtec and Zyrtec-D are not the same drug. They both contain cetirizine hydrochloride, which is used to treat allergy symptoms like sneezing, watery eyes, and an itchy, runny nose. However, Zyrtec-D has an added decongestant.
Zyrtec is classified as an oral antihistamine. Compared to Benadryl (diphenhydramine) and other first-generation antihistamines, Zyrtec causes less drowsiness. The main active ingredient in Zyrtec works by blocking histamine receptors to prevent the effects of histamine. Histamine is a chemical that is produced by the body when it’s exposed to allergens like pet dander and dust mites.
Zyrtec and Zyrtec-D are similar allergy medications, but there are some important differences to consider.
What are the main differences between Zyrtec and Zyrtec-D?
The main difference between Zyrtec and Zyrtec-D is that Zyrtec-D contains the decongestant pseudoephedrine. Also known by its brand name, Sudafed, pseudoephedrine works by shrinking blood vessels to reduce swelling and congestion in the nasal passages.
Zyrtec is the brand name for cetirizine. It is available as an oral syrup, orally disintegrating (ODT) tablet and oral tablet. Children aged 2 to 6 years old can be given the oral syrup. Zyrtec tablets can be administered to children, adolescents, and adults 6 years and older. Zyrtec can be purchased over the counter.
Zyrtec-D contains cetirizine and pseudoephedrine. It is only available as an oral tablet for adults and children 12 years and older. While Zyrtec can be found in the pharmacy aisles, Zyrtec-D is usually stored behind the counter at the pharmacy. This is because there are restrictions on how much pseudoephedrine can be sold to a person at a given time.
| Main differences between Zyrtec and Zyrtec-D | ||
|---|---|---|
| Zyrtec | Zyrtec-D | |
| Drug class | Second-generation antihistamine | Second-generation antihistamine |
| Brand/generic status | Brand and generic version available | Brand and generic version available |
| What is the generic name? | Cetirizine | Cetirizine-Pseudoephedrine |
| What form(s) does the drug come in? | Oral tablet Orally disintegrating tablet Oral syrup |
Oral tablet |
| What is the standard dosage? | One 5 mg or 10 mg tablet once daily |
One 5 mg-120 mg tablet twice daily |
| How long is the typical treatment? | As needed for seasonal or perennial allergies | As needed for seasonal or perennial allergies. Pseudoephedrine use should be limited to no more than 10 days. |
| Who typically uses the medication? | Adults and children 2 years and older | Adults and children 12 years and older |
Conditions treated by Zyrtec and Zyrtec-D
Zyrtec and Zyrtec-D are both FDA-approved to treat allergic rhinitis, also known as hay fever. Both drugs are primarily indicated for seasonal allergic rhinitis, which causes symptoms such as runny nose and sneezing. Both drugs can also treat other symptoms of seasonal allergies such as itchy, watery eyes (allergic conjunctivitis).
Zyrtec is FDA approved to treat hives, or chronic urticaria. Allergic reactions on the skin can often manifest as hives and itching. Because Zyrtec-D contains a nasal decongestant, regular Zyrtec is used for skin reactions.
| Condition | Zyrtec | Zyrtec-D |
| Allergic rhinitis | Yes | Yes |
| Hives | Yes | No |
Is Zyrtec or Zyrtec-D more effective?
For general symptoms of allergic rhinitis, such as sneezing and watery eyes, Zyrtec and Zyrtec-D are similarly effective. For a stuffy nose, or nasal congestion, Zyrtec-D would be more effective because of the added decongestant.
In a double-blind, clinical study, cetirizine was found to significantly improve symptoms of perennial allergic rhinitis. The study measured symptom improvement by total symptom severity complex (TSSC) and a questionnaire for four weeks. Compared to placebo, cetirizine significantly improved nasal symptoms after the first week (p<0.05).
Another randomized, controlled trial compared cetirizine with other antihistamines, such as fexofenadine and desloratadine. The study looked at 150 patients’ response to antihistamines with a skin prick test. Results found that the antihistamines showed similar effectiveness.
Consult your doctor or pharmacist on allergy medications that may be best for you. Your healthcare provider can give you medical advice on what to take. They may even recommend another antihistamine like Claritin or Allegra instead of Zyrtec for your symptoms.
Coverage and cost comparison of Zyrtec vs. Zyrtec-D
Zyrtec is an over-the-counter medicine that isn’t generally covered by Medicare and insurance plans. In some cases, it may be covered with a prescription from a doctor. The average retail price of Zyrtec is around $15 to $20, depending on tablet strength and quantity. SingleCare offers a Zyrtec coupon card that can lower this price to as little as $3.
Most Medicare and insurance plans won’t cover Zyrtec-D because, like other oral antihistamines, it’s found over the counter. The average retail cost is around $30 to $50 depending on the number of tablets. If you have a prescription you can use a SingleCare discount card for Zyrtec-D to save more and bring the cost down to $10 for 12-hour tablets. Check with your pharmacy to see if they accept discount cards.
| Zyrtec | Zyrtec-D | |
| Typically covered by insurance? | No | No |
| Typically covered by Medicare Part D? | No | No |
| Standard dosage | One 10 mg tablet once daily (quantity of 30) | One 5 mg-120 mg tablet twice daily (quantity of 24) |
| Typical Medicare copay | Depends on your insurance plan | Depends on your insurance plan |
| SingleCare cost | $3–$4 | $10 |
Common side effects of Zyrtec vs. Zyrtec-D
The most common side effects of Zyrtec are drowsiness, headache, dizziness, and fatigue. Other side effects may include a dry mouth, cough, and sore throat.
Zyrtec-D shares similar side effects with Zyrtec because it contains cetirizine. However, since it also contains pseudoephedrine, other side effects may include insomnia, heart palpitations, and nervousness or anxiety.
| Zyrtec | Zyrtec-D | |||
| Side Effect | Applicable? | Frequency | Applicable? | Frequency |
| Drowsiness | Yes | * | Yes | * |
| Headache | Yes | * | No | – |
| Dizziness | Yes | * | Yes | * |
| Fatigue | Yes | * | Yes | * |
| Dry mouth | Yes | * | Yes | * |
| Cough | Yes | * | No | – |
| Sore throat | Yes | * | No | – |
| Skin rash | Yes | * | Yes | * |
| Insomnia | No | – | Yes | * |
| Heart palpitations | No | – | Yes | * |
| Nervousness | No | – | Yes | * |
This may not be a complete list of adverse effects that can occur. Please refer to your doctor or healthcare provider to learn more. *not reported
Source: DailyMed (Zyrtec), DailyMed (Zyrtec-D)
Drug interactions of Zyrtec vs. Zyrtec-D
Certain drugs should be avoided with Zyrtec or Zyrtec-D when possible. Some drugs have CNS depressant side effects that result in increased drowsiness with Zyrtec. Opioids, such as hydrocodone or oxycodone, can cause increased drowsiness and sedation when taken with Zyrtec.
Tricyclic antidepressants can also cause increased drowsiness with Zyrtec. Antidepressants may also worsen anticholinergic side effects like dry mouth. Other drugs with similar effects include anticonvulsants and muscle relaxants, among others.
Zyrtec and Zyrtec-D should not be used within two weeks of using a monoamine oxidase (MAO) inhibitor. Combining MAO inhibitors with cetirizine can cause increased adverse effects of the antihistamine. Pseudoephedrine in Zyrtec-D can also interact with MAO inhibitors, which could lead to dangerously high blood pressure.
| Drug | Drug Class | Zyrtec | Zyrtec-D |
| Codeine Hydrocodone Oxycodone |
Opioid | Yes | Yes |
| Gabapentin | Anticonvulsant | Yes | Yes |
| Carisoprodol Cyclobenzaprine |
Muscle relaxant | Yes | Yes |
| Amitriptyline Nortriptyline Clomipramine |
Tricyclic antidepressant | Yes | Yes |
| Selegiline Phenelzine |
MAO inhibitor | Yes | Yes |
Consult a healthcare professional for other possible drug interactions
Warnings of Zyrtec and Zyrtec-D
Cetirizine can cause drowsiness and affect your mental alertness. Avoid operating any machinery or driving an automobile while taking cetirizine as it can make you feel drowsy.
Pseudoephedrine stimulates the sympathetic nervous system and can raise blood pressure. While pseudoephedrine is generally safe, its use may increase the risk of abnormal heart rhythms, heart attack, and stroke, especially if you have other cardiovascular conditions like heart disease or diabetes. Those with known coronary heart disease, high blood pressure, or a history of stroke should use caution.
Cetirizine is processed through the liver and kidneys. In those with kidney disease or liver problems, cetirizine use should be monitored or avoided. The risk of adverse effects may be increased in the elderly, who are more prone to kidney or liver problems.
Frequently asked questions about Zyrtec vs. Zyrtec-D
Are Zyrtec and Zyrtec-D the same? / Is Zyrtec or Zyrtec-D better?
Zyrtec and Zyrtec-D are not the same drug. Although they can both be used for allergy relief, one contains a decongestant and the other does not. Zyrtec-D contains pseudoephedrine, a decongestant that can help relieve nasal congestion. If one of your primary symptoms is a stuffy nose, Zyrtec-D may be a better option than regular Zyrtec.
Can I use Zyrtec or Zyrtec-D while pregnant?
Zyrtec is generally safe for use during pregnancy. Zyrtec-D contains pseudoephedrine, which is not recommended during the first trimester or while breastfeeding. Pseudoephedrine can pass through breast milk. Although the risk of birth defects may be low, it’s best to use caution. Consult your doctor for the best allergy medicine to take while pregnant.
Can I use Zyrtec or Zyrtec-D with alcohol?
Drinking alcohol in moderation may not be a life-threatening concern with the occasional use of Zyrtec. Because alcohol can cause CNS depression, you may want to avoid drinking alcohol while on Zyrtec or Zyrtec-D because of the increased risk of drowsiness and sedation.
What is Zyrtec-D good for?
Zyrtec-D is good for symptoms of allergic rhinitis. Because it contains a decongestant, Zyrtec-D is especially good for sinus congestion. Zyrtec-D can also relieve itchy, watery eyes, and a runny nose.
When should I take Zyrtec-D?
Zyrtec-D can be taken at any time of the day. Those who experience drowsiness after taking Zyrtec-D may want to take it in the evening. Zyrtec-D also contains pseudoephedrine, which, on its own, is known to cause trouble sleeping.
Is Zyrtec-D safe to take every day?
Zyrtec-D is recommended for short-term use only. Zyrtec-D contains pseudoephedrine which should not be taken for more than 10 days at a time. If you find yourself needing Zyrtec-D for long-term nasal congestion, consult your healthcare provider.
Is Zyrtec-D good for a sinus infection?
Zyrtec-D is designed for treating allergy symptoms. Because symptoms of sinus infections and allergic rhinitis can overlap, Zyrtec-D may be useful for sinus infections if you’re also experiencing allergies. The pseudoephedrine in Zyrtec-D is a decongestant that can relieve nasal congestion. However, antihistamines are not generally recommended for sinus infections because they can dry out the nasal passages.
How quickly does Zyrtec-D work?
Most people experience relief from Zyrtec-D within an hour. It can take up to two hours for the drug to reach maximum levels in the body. Zyrtec-D lasts for approximately 12 hours and it’s usually taken twice daily for complete relief.
