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Fact Checked

Xyzal vs Zyrtec: What’s the Difference?

Approximately one out of every six Americans, or 50 million people, deal with seasonal or perennial allergies each year. The sneezing, runny nose, itchy, watery eyes, and more can make daily activities either challenging or impossible, and activities you once loved fall by the wayside. If you’re an allergy sufferer, you likely spend just as much time checking the pollen levels as you do checking the weather, and you understand first hand how frustrating it is when an allergy attack gets in the way of daily life. As the sixth most common chronic illness in the United States and the most common health issue affecting children, allergies affect so many people that substantial research and development has been done in order to discover new and more effective ways of treating symptoms. Antihistamine medications are often the first treatment option for people with allergy symptoms, but there are so many on the market, it can be difficult to figure out which one is right for you. If you are trying to decide between Xyzal vs Zyrtec, there are some key similarities and differences between the two over the counter medications that you should know in order to make an informed decision. 

Drug Class

Xyzal and Zyrtec both belong to a class of drugs known as antihistamines; specifically, Zyrtec is a second generation antihistamine while Xyzal is a third generation antihistamine. First generation antihistamines, such as Benadryl, were effective at treating allergy symptoms associated with allergic rhinitis, but caused significant drowsiness as a side effect. As a result, many people could not perform their daily activities while using the medication, and people could not safely drive or operate heavy machinery. Second generation antihistamines like Zyrtec provide allergy relief from symptoms of allergic rhinitis while lowering the risk of drowsiness associated with first generation antihistamines. However, some drowsiness is still a side effect of second generation antihistamines. Thus, third generation antihistamines like Xyzal were developed. These medications are less likely to reach the brain and cause drowsiness than both first and second generation antihistamines; however, it is still possible that the medication can cause drowsiness. The active ingredient in Zyrtec is cetirizine, while the active ingredient in Xyzal is levocetirizine.

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Conditions Treated

Allergic rhinitis, also known as hay fever, is a group of symptoms that are caused by the immune system’s overreaction to an allergen in the environment.  Allergens are everyday substances both inside and outside that do not cause reactions for most people but produce a strong immune response in others.  The immune system in a person with allergies recognizes the presence of an allergen as an invader and responds to the presence of the substance by attacking it, causing inflammation through the release of different inflammatory mediators, including histamines, during an allergy attack. The histamines bind to receptors on cells around the body, including the nasal passages, and cause symptoms like sinus pressure, nasal congestion, runny nose, sneezing, itchy/watery eyes, and itchy nose or throat.

There are many different triggers for allergic rhinitis, and the triggers can be found both indoors and outdoors.  Indoor allergens commonly include substances like pet dander, mold, pet hair, dust mites, smoke, and perfume; people with allergies to indoor allergens often have perennial (year round) allergy symptoms). Outdoor allergens  include pollen from grasses, flowers, trees, or weeds; people with allergies to outdoor allergens often experience their symptoms seasonally. A person can be allergic to both indoor and outdoor substances and experience some symptoms of allergic rhinitis seasonally and others perennially. 

How it Works

Second generation antihistamines like Zyrtec or Fexofenadine block the effects of histamines on the body.  Zyrtec binds to histamine receptors in the body, such as anticholinergic. Because the receptors are bound to Zyrtec, the cells are prevented from sending messages that cause symptoms like increased production of mucus, itching, and sneezing. When taken regularly, the medications can reduce the number of histamines produced by the body in response to allergens over a long period of time. Xyzal works similarly to Zyrtec, but as a third generation antihistamine, it is less likely to permeate the brain and cause symptoms of drowsiness.

Formulation and Use

Zyrtec, also sold under the generic name cetirizine, is available in the form of tablets, liquid gels, and dissolving tablets, while Xyzal is currently available only in tablet and oral solution form.   People taking Zyrtec who are ages six and older will take one 10 mg tablet per day; 5 mg tablets are also available for people with less severe symptoms. The manufacturer recommends consulting a doctor or allergist before using Zyrtec in patients who are over the age of 65 or younger than 6. Xyzal is commonly taken as a 5 mg tablet, but the tablets are breakable, which allows patients to take 2.5 mg for less severe symptoms. 

Effectiveness

Studies have been conducted that compare the effectiveness of Xyzal and Zyrtec (even Claritin, Loratadine and Allegra), and they indicate that both medications are highly effective over a 12 week study period. However, the results do indicate that Zyrtec is slightly more effective at treating symptoms of allergic rhinitis than Xyzal. Because both medications were found to be effective in relieving allergy symptoms,  the choice in which medication to take often comes down to personal preference and whether or not one medication or the other makes an individual feel drowsy, as drowsiness is a side effect that most people hope to avoid.

Accessibility

Both Xyzal and Zyrtec are sold over the counter (OTC), which makes them highly accessible because  patients can purchase them at any big box store, pharmacy, or drug store. The medications can be purchased in both generic and brand name forms and the generic versions are highly affordable for most people. In both cases, patients can save more by getting a prescription for the generic form of the drug, because then they can use pharmacy discount cards like USA Rx for additional savings. When purchased through a pharmacy discount card program,  you can expect to pay about 18 dollars for 30 tablets of generic Xyzal and 26 dollars for 30 tablets of generic Zyrtec. 

Risks

Both Xyzal and Zyrtec are sold over the counter, which means they are generally considered safe for use by most people. However, FDA approved antihistamines like Xyzal, Diphenhydramine, and Zyrtec do carry some risks of use, particularly for people with certain medical conditions. Although the medications are sold over the counter, it is important that you speak to your doctor before taking Xyzal or Zyrtec if you have any of the following conditions:

  • Kidney disease

  • Liver disease

  • History of alcoholism or regular alcohol consumption, as using alcohol when taking Xyzal or Zyrtec can exacerbate the effects of drowsiness

  • Pregnancy, as not much is known about the effects of Xyzal and Zyrtec on unborn children

  • Breastfeeding, as Xyzal and Zyrtec both pass through breastmilk to a nursing infant and should not be taken when breastfeeding

 Side Effects

As over the counter medications, both Xyzal and Zyrtec are considered safe medications with a relatively low incidence of side effects. However, some side effects may occur. Side effects of Xyzal and Zyrtec are generally similar, with a few exceptions. Notably, although both medications list drowsiness as a side effect, Xyzal is less likely to cause drowsiness than Zyrtec. Common side effects of Xyzal that usually do not include medical attention include:

  • Drowsiness

  • Weakness

  • Stuffy nose

  • Sore throat

  • Vomiting

  • Constipation

  • Weight gain

  • Urticaria 

  • Fatigue

  • Tired feeling

  • Sleepiness or sedating feeling

  • Sinus pain

  • Cough

  • Diarrhea

  • Itchy eyes

  • Dry mouth

Serious side effects of Xyzal that may require medical advice include:

  • Lightheadedness

  • Pain or fullness in the ear

  • Depression

  • Aggression

  • Numbness or tingling around the lips or mouth

  • Painful or difficult urination

  • Foul-smelling stools

  • Stomach pain

  • Nosebleeds, especially in children

  • Hearing problems

  • Agitation

  • Hallucinations

  • Jaundice

  • Dark-colored urine

  • Fever

  • Loss of appetite

Common side effects of Zyrtec that usually do not include medical attention include:

  • Drowsiness

  • Tired feeling

  • Dry mouth

  • Cough

  • Constipation

  • Fatigue

  • Dizziness

  • Sore throat

  • Nausea

  • Headache

  • Stomach pain (in children)

  • Vomiting (in children)

Although rare, it is also possible for both Xyzal and Zyrtec to cause serious side effects that could require medical attention, including allergic reactions. Signs of an allergic reaction to these medications include::

  • Itching

  • Hives

  • Rash

  • Swelling of the feet, ankles, arms, hands, or lower legs

  • Difficulty breathing

  • Difficulty swallowing

Drug Interactions

Neither Xyzal or Zyrtec have many drug interactions, but patients should be sure to check the list of drug interactions for any medications they may be taking to ensure that the use of either medication will not impact the effectiveness of their other medications. If you are unsure about drug interactions between your current medications and Xyzal or Zyrtec, speak to your doctor or pharmacist.  Both medications may interact with the following medications, and Xyzal may also interact with ritonavir or theophylline:

  • Alcohol

  • Cold or allergy medications

  • Narcotic pain medications

  • Sleeping pills

  • Muscle relaxers

  • Medications for seizures

  • Medications for depression

  • Medications for anxiety

Sources:

https://www.healthline.com/health/xyzal-vs-zyrtec 

https://www.rxlist.com/zyrtec_vs_xyzal/drugs-condition.htm 

https://www.zyrtec.com/products/allergy-medicine-comparison/zyrtec-vs-xyzal 

https://www.aafa.org/allergy-facts/ 

https://pubmed.ncbi.nlm.nih.gov/19175892/ 

https://medlineplus.gov/ency/article/000813.htm 

https://www.healthline.com/health/allergic-rhinitis 

Published August 1st, 2020 by Bridget Reed
Fact Checked by Chris Riley

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