Is zyrtec safe during first trimester of pregnancy

Cetirizine is a non-sedating long-acting antihistamine with some mast-cell stabilizing activity. It is a metabolite of hydroxyzine. Cetirizine is used for the symptomatic relief of allergic conditions, such as rhinitis and urticaria [1]. Allergies are common in young and also pregnant women, but human pregnancy experience is so far limited.

No animal teratogenicity is described. According to the manufacturer administration up to 40, 180, and 216 times the human dose in pregnant mice, rats, and rabbits, respectively, did not produce an increase in congenital malformations in the offspring. In one published study, which we have examined only in abstract, there was no teratogenicity in rats or animals even at maternal toxic doses of 500 times the maximum human dose of cetirizine [2].

In 1997 Einarson et al. [3] published the first prospective cohort study on cetirizine and hydroxyzine in pregnancy. Among 39 cetirizine-exposed, 53 hydroxyzine-exposed pregnancies and a control group no significant differences were found in the pregnancy outcome concerning the rate of major or minor birth defects, fetal losses, mean birth weight, and gestational age at delivery. That was confirmed by the case series of Paulus et al. [4] who had collected 144 cetirizine-exposed pregnancies. Källén [5] published a study using the prospectively collected data of the Swedish Medical Birth Registry. He compared groups of antihistamines taken in early pregnancy concerning delivery outcome with all deliveries in the population. The two main antihistamine groups were drugs preferentially used for nausea and vomiting and drugs used for allergy. Cetirizine-exposed women (n = 917) were included in the allergy group. The percentage of infants with malformations was 3.16% in the general population and 3.95% after cetirizine, a difference which was statistically not significant.

With the evaluation of our data we wanted to assess the safety of cetirizine during the first trimester of pregnancy.

Cited by (60)

• Medical management of rhinitis in pregnancy

  2022, Auris Nasus Larynx

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  Medical treatment options for patients with rhinitis during pregnancy need careful considerations. It is important to distinguish between the causes of rhinitis, as this can influence treatment. Conservative options are important for patients with pregnancy-induced rhinitis (PIR) and pre-existing allergic or non-allergic rhinitis. Education and knowledge that PIR symptoms will resolve after pregnancy can offer some relief. Other strategies such as exercise, positioning, saline nasal douching/lavage, and nasal valve dilators are safe in pregnancy and can have a benefit in these patients with rhinitis of any aetiology. The main medical therapies usually used in rhinitis cannot always be directly translated to pregnant patients due to potential teratogenic effects. Topical corticosteroids have generally shown to be safe with budesonide having the strongest recommendations. Oral corticosteroids are mostly used in moderate-severe disease and should be avoided in the first trimester. Oral decongestants have associations with cardiac, ear, gut and limb abnormalities and are not recommended in the first trimester. Loratadine and cetirizine have been the most well-studied second-generation antihistamines and are generally considered safe. There has been no reported increased risk of teratogenicity with anticholinergics or cromones, with the latter being one of the first line options in pregnant women with allergic rhinitis. The role of allergen immunotherapy needs further research, but current guidance states it can be continued if already initiated prior to pregnancy. The management of rhinitis in pregnancy can therefore be complex. This review aims to evaluate the current medical management options for rhinitis in pregnancy.

• Atopic dermatitis and pregnancy

  2022, Journal of Allergy and Clinical Immunology

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  Fascinating immunologic mechanisms that are crucial for pregnancy can, however, lead to the development of different skin conditions, of which atopic dermatitis (AD) is the most frequent one. AD in pregnancy may occur de novo or as a recurrence or exacerbation of known chronic AD. The changes in hormone levels that occur during pregnancy influence the cytokine balance and can lead to manifestation of eczematous lesions, currently classified as atopic eruption of pregnancy. The diagnosis of atopic eruption of pregnancy may be challenging, especially in patients who developed this skin disease de novo during gestation. The treatment is another challenge, because it needs to be safe for both the mother and especially the unborn child. Emollients make up the basis of the therapy. Topical corticosteroids and calcineurin inhibitors are also safe treatment options, and ultraviolet therapy can be added, if required. Use of cyclosporin A is possible for systemic therapy during pregnancy, whereas safety data on new drugs such as biologics approved for AD are limited to small case series. This review is aimed at summarizing available data on the mechanisms that lead to AD during gestation, differential diagnostic evaluations, and treatment options.

• Management of dermatological conditions in pregnancy

  2021, Clinical Pharmacology During Pregnancy

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  The integumentary system undergoes significant changes during pregnancy. This may lead to new or worsening of dermatological conditions for which the pregnant or postpartum woman may seek over-the-counter remedies or the advice of the health care provider to resolve. Deciding upon an appropriate pharmacological approach is complex and often hazed by the dearth of evidence to guide clinical management. As a result, health care providers are seemingly perplexed concerning the safest course of action for this population. While there are a number of dermatological conditions, clinical guidance regarding common conditions, such as acne, psoriasis, dermatoses, bacterial infections, viral infections, fungal infection, and parasitic infections, can help to provide the much needed direction health care providers often seek.

• ICON: Diagnosis and management of allergic conjunctivitis

  2020, Annals of Allergy, Asthma and Immunology

  Citation Excerpt :

  Overall, oral antihistamines can offer relief from the symptoms of OA but have a delayed onset of action. Newer, second-generation H1 receptor (non or low sedating) antagonists are less likely to cause unwanted sedative or anticholinergic (dry eye) effects compared to earlier compounds.102-104 It has therefore been suggested that the concomitant use of an eye drop and a non-sedating oral antihistamine may be required to maximize the treatment of ocular allergic symptoms.95

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  Ocular allergy (OA), interchangeably known as allergic conjunctivitis, is a common immunological hypersensitivity disorder affecting up to 40% of the population. Ocular allergy has been increasing in frequency, with symptoms of itching, redness, and swelling that significantly impacts an individual's quality of life (QOL). Ocular allergy is an often underdiagnosed and undertreated health problem, because only 10% of patients with OA symptoms seek medical attention, whereas most patients manage with over-the-counter medications and complementary nonpharmacological remedies. The clinical course, duration, severity, and co-morbidities are varied and depend, in part, on the specific ocular tissues that are affected and on immunologic mechanism(s) involved, both local and systemic. It is frequently associated with allergic rhinitis (commonly recognized as allergic rhino conjunctivitis), and with other allergic comorbidities. The predominance of self-management increases the risk of suboptimal therapy that leads to recurrent exacerbations and the potential for development of more chronic conditions that can lead to corneal complications and interference with the visual axis. Multiple, often co-existing causes are seen, and a broad differential diagnosis for OA, increasing the difficulty of arriving at the correct diagnosis(es). Ocular allergy commonly overlaps with other anterior ocular disease disorders, including infectious disorders and dry eye syndromes. Therefore, successful management includes overcoming the challenges of underdiagnosis and even misdiagnosis by a better understanding of the subtleties of an in-depth patient history, ophthalmologic examination techniques, and diagnostic procedures, which are of paramount importance in making an accurate diagnosis of OA. Appropriate cross-referral between specialists (allergists and eyecare specialists) would maximize patient care and outcomes. This would significantly improve OA management and overcome the unmet needs in global health.

• The relation between antihistamine medication during early pregnancy and birth defects

  2015, Egyptian Journal of Medical Human Genetics

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  Antihistamines are a group of medications which can inhibit various histaminic actions at one of two histamine receptors (H1 or H2). H1 receptor antagonists are used for the relief of allergic dermatological and nondermatological conditions. We will review classes of antihistamines (H1 antagonists) and the relationship between specific antihistamines and specific birth defects. Although many findings provide reassurance about the relative safety of many antihistamine drugs and that any malformation reported is most probably caused by chance, studies are still required to assure fetal safety. As pruritus is sometimes troublesome for pregnant women topical medications like emollients should be tried first in the first trimester of pregnancy. Also pregnant women should be advised to consult their health care provider before taking any medication.

• Allergy and hyposensitization therapy

  2015, Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment: Third Edition

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  Allergic reactions are common during pregnancy, as throughout life. There is a large choice of antiallergic medications, but often, for pregnant women it is preferable to be more conservative and choose the older medications, that have safety evidence. This chapter includes information on antiallergic and desensitization pharmacotherapy during pregnancy.

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  Can I take Zyrtec at 6 weeks pregnant?

  Some oral antihistamines like Allegra (fexofenadine), Benadryl (diphenhydramine), Chlor-Trimeton (chlorpheniramine), Claritin (loratadine) and Zyrtec (cetirizine) appear to be safe after the first trimester. That means they have caused no known harm in studies so far.

  Can I take Zyrtec at 4 weeks pregnant?

  Many allergy drugs may be fine to keep taking during pregnancy, but have the discussion so you can have peace of mind. Oral antihistamines, like cetirizine (Zyrtec), chlorpheniramine (Chlor-Trimeton), diphenhydramine (Benadryl), fexofenadine (Allegra), and loratadine (Claritin) seem to be safe.

  What can I take for allergies while pregnant first trimester?

  Newer antihistamines, such as cetirizine and loratadine, also may be safe. There also is a corticosteroid nasal spray that is safe to use during pregnancy.

  Can I take Zyrtec 5 weeks pregnant?

  Many allergy medications really aren't safe to take during pregnancy. But loratadine (found in Claritin®) and cetirizine (found in Zyrtec® and Alleroff®) are two over-the-counter (OTC) antihistamine medications that doctors consider as being safe to use during pregnancy and while breastfeeding, Dr. Zanotti says.