Home Drug Guide Cetirizine Hydrochloride and Pseudoephedrine Hydrochloride

Drug Guide

Generic Name

Cetirizine Hydrochloride and Pseudoephedrine Hydrochloride

Brand Names Zyrtec-D 12 Hour, Cetirizine Hydrochloride and Pseudoephedrine Hydrochloride

Classification

Therapeutic: Nasal Decongestant and Antihistamine combination

Pharmacological: Antihistamine (cetirizine), Sympathomimetic decongestant (pseudoephedrine)

FDA Approved Indications

  • Relief of nasal congestion, sneezing, runny nose, and watery eyes due to allergies or hay fever

Mechanism of Action

Cetirizine is a selective peripheral H1 antihistamine that inhibits the effects of histamine at H1 receptor sites, reducing allergy symptoms. Pseudoephedrine is a sympathomimetic agent that constricts blood vessels in the nasal mucosa, leading to decreased swelling and congestion.

Dosage and Administration

Adult: Typically, 5 mg cetirizine + 120 mg pseudoephedrine every 12 hours as needed. Adjust based on response and tolerability.

Pediatric: Not generally recommended for children under 12. For older children, dose adjustments should be made according to pediatric guidelines.

Geriatric: Use with caution; consider starting at lower doses due to potential increased sensitivity.

Renal Impairment: Adjust dose in patients with severe renal impairment; consult specific guidelines.

Hepatic Impairment: Use with caution; no specific dose adjustment recommended but monitor closely.

Pharmacokinetics

Absorption: Both drugs are well absorbed from the gastrointestinal tract.

Distribution: Cetirizine is extensively bound to plasma proteins; pseudoephedrine has minimal protein binding.

Metabolism: Cetirizine undergoes minimal hepatic metabolism; pseudoephedrine undergoes negligible hepatic metabolism.

Excretion: Primarily via urine for both drugs; pseudoephedrine also excreted unchanged.

Half Life: Cetirizine: approximately 8 hours; Pseudoephedrine: approximately 4-6 hours.

Contraindications

  • Known hypersensitivity to cetirizine, pseudoephedrine, or any component of the formulation.

Precautions

  • Use with caution in patients with hypertension, cardiovascular disease, hyperthyroidism, or increased intraocular pressure. Avoid in children under 12 without medical advice.

Adverse Reactions - Common

  • Dry mouth (Common)
  • Drowsiness or sedation (Less common)
  • Insomnia (Less common)

Adverse Reactions - Serious

  • Increased blood pressure, tachycardia (Rare)
  • Jaundice, allergic reactions, including anaphylaxis (Rare)

Drug-Drug Interactions

  • MAO inhibitors may enhance pseudoephedrine effects, increasing risk of hypertensive crisis.
  • Other antihypertensives or CNS depressants may have additive effects.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor for effectiveness (relief of allergy symptoms, reduction in nasal congestion) and adverse effects (drowsiness, hypertension).

Diagnoses:

  • Ineffective airway clearance related to nasal congestion.
  • Risk for decreased cardiac output related to increased blood pressure.

Implementation: Administer with or without food. Educate patient to avoid activities requiring mental alertness until response is known.

Evaluation: Assess symptom relief and monitor for adverse reactions.

Patient/Family Teaching

  • Advise patients to avoid excessive alcohol and CNS depressants.
  • Instruct on proper timing and dosing.
  • Explain potential side effects such as drowsiness or increased blood pressure.

Special Considerations

Black Box Warnings:

  • Pseudoephedrine may increase blood pressure and heart rate; use cautiously in hypertensive patients.

Genetic Factors: Consider genetic variations affecting metabolism, especially in poor metabolizers of pseudoephedrine.

Lab Test Interference: None known.

Overdose Management

Signs/Symptoms: Seizures, hallucinations, severe hypertension, CNS stimulation, drowsiness, coma.

Treatment: Supportive care, symptomatic treatment, activated charcoal if ingestion was recent. In cases of severe hypertension, appropriate antihypertensive therapy may be necessary.

Storage and Handling

Storage: Store at room temperature, away from moisture, light, and heat.

Stability: Stable under recommended storage conditions for shelf life.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.