Levocetirizine

 

1. Generic Name & Brand Names

• Generic Name: Levocetirizine

• Common Brands:

  • Xyzal® (Global)

  • Lezina® (India)

  • Vozet® (EU)

  • Generic equivalents (e.g., "Levocetirizine Dihydrochloride")

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2. Dosage Forms

• Oral:

  • Tablets (5 mg)

  • Oral Solution (0.5 mg/mL)

• No topical/injectable forms

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3. Drug Class

• Active Enantiomer of Cetirizine

• Second-Generation H₁ Antihistamine

• Non-sedating (lower risk than 1st-gen)

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4. Uses

• Allergic Rhinitis: Seasonal/perennial

• Chronic Idiopathic Urticaria: Hives of unknown cause

• Itch Relief: Eczema, insect bites

• Not for asthma or anaphylaxis

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5. Side Effects

Common (1-10%)	Rare (<1%)
Fatigue	Tachycardia
Dry mouth	Severe hypersensitivity
Headache	Seizures
Minimal drowsiness	Urinary retention
Pharyngitis	Hepatitis

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6. Key Warnings

• Renal Impairment:

  • ↓ Dose if CrCl <50 mL/min:

    • CrCl 30-50: 2.5 mg daily

    • CrCl 10-30: 2.5 mg every other day

• Pregnancy/Lactation:

  • Category B: Use only if benefits > risks

  • Excreted in breast milk

• Contraindications:

  • End-stage renal disease (CrCl <10)

  • Hypersensitivity to cetirizine/piperazine derivatives

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7. How to Take

Group	Dose	Timing
Adults & ≥12 years	5 mg once daily	Evening
Children 6-11 years	2.5 mg once daily	Evening
Children 2-5 years	1.25 mg (1.25mL)	Evening

• Key Notes:

  • Take on empty stomach (food delays absorption)

  • Max duration: 6 months for chronic urticaria without medical review

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8. Missed Dose

• Take ASAP if <12 hours late

• Skip if >12 hours; resume next scheduled dose

• Never double dose

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9. Overdose

• Symptoms: Drowsiness (adults), agitation (children), tachycardia

• Management:

  • Symptomatic treatment

  • Hemodialysis ineffective (94% protein-bound)

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10. Drug Interactions

Medication	Effect
Theophylline	↑ Levocetirizine levels (20%)
CNS Depressants	Potentiate drowsiness (alcohol, opioids)
Ritonavir	↑ AUC (use with caution)

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11. Storage

• Temperature: 15-30°C (59-86°F)

• Oral Solution: Discard 6 months after opening

• Protect from light/humidity

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Critical Safety Notes:

⚠️ Renal Dosing Essential:

• Mandatory dose adjustment for kidney patients - check CrCl before prescribing.

⚠️ Driving Precautions:

• 3-4% experience drowsiness - avoid driving until tolerance confirmed.

⚠️ Pediatric Use:

• Approved for ≥2 years (EU/India) vs. ≥6 months for cetirizine.

⚠️ Allergy Testing:

• Discontinue ≥72 hours before skin/IgE tests.

OTC Status: Prescription-only in some countries (e.g., US), OTC in others (EU/India).

Onset of Action: 1 hour (faster than cetirizine in some studies).

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Levocetirizine vs. Cetirizine:

Parameter	Levocetirizine	Cetirizine
Dose	5 mg	10 mg
Protein Binding	94%	93%
Renal Excretion	85%	70%
Sedation Risk	Slightly lower	Moderate

Prescribing Tip: Preferred for patients needing reduced daytime drowsiness or renal-adjusted dosing. Always screen for kidney function!