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Cetirizine

R06A - Antihistamines for systemic use ATC R06AE07 Small molecule approved 1995 Oral Parenteral Topical Natural product

JFDA label: Cetolerg Tab

Mechanism of Action

Mechanism of Actions Cetirizine, a human metabolite of hydroxyzine, is an antihistamine; its principal effects are mediated via selective inhibition of peripheral H 1 receptors. The antihistaminic activity of cetirizine has been clearly documented in a variety of animal and human models. In vivo and ex vivo animal models have shown negligible anticholinergic and antiserotonergic activity. In clinical studies, however, dry mouth was more common with cetirizine than with placebo. In vitro receptor binding studies have shown no measurable affinity for other than H 1 receptors. Autoradiographic studies with radiolabeled cetirizine in the rat have shown negligible penetration into the brain. Ex vivo experiments in the mouse have shown that systemically administered cetirizine does not significantly occupy cerebral H 1 receptors.

Indications

Approved

  • Eye Manifestations — eye allergy
  • Hypersensitivity — allergic disease

Off-label

  • Alopecia
  • Conjunctivitis, Allergic
  • Dermatitis
  • Eczema
  • Multiple Sclerosis
  • Pemphigus
  • Pruritus
  • Rhinitis
  • Rhinitis, Allergic, Perennial
  • Rhinitis, Allergic, Seasonal
  • Severe Acute Respiratory Syndrome

Contraindications

Source: openFDA

  • Cetirizine hydrochloride oral solution, USP is contraindicated in those patients with a known hypersensitivity to it or any of its ingredients or hydroxyzine. Absolute

Adverse Reactions

Very Common >10%Common 1–10%Uncommon 0.1–1% Rare 0.01–0.1%Very Rare <0.01%Not Known

Cardiac disorders (3)

Rare Cardiac disorder · Palpitations · Tachycardia

Vascular disorders (1)

Rare Hypotension

Nervous system disorders (11)

Very Common Headache · Somnolence

Common Dizziness

Uncommon Loss of consciousness · Syncope

Rare Amnesia · Convulsion · Dyskinesia · Memory impairment · Paraesthesia · Tremor

Hepatobiliary disorders (5)

Rare Blood bilirubin increased · Cholestasis · Hepatic function abnormal · Hepatitis · Transaminases increased

Renal and urinary disorders (4)

Rare Dysuria · Glomerulonephritis · Urinary retention · Urinary tract disorder

Blood and lymphatic system disorders (2)

Rare Haemolytic anaemia · Thrombocytopenia

Immune system disorders (3)

Rare Anaphylactic shock · Hypersensitivity · Immune system disorder

Gastrointestinal disorders (9)

Common Abdominal pain · Diarrhoea · Dry mouth · Dyspepsia · Gastrointestinal pain · Nausea · Vomiting

Uncommon Gastrointestinal disorder

Rare Increased appetite

Skin and subcutaneous tissue disorders (6)

Common Pruritus

Rare Angioedema · Dermatitis · Rash · Skin disorder · Urticaria

Musculoskeletal and connective tissue disorders (2)

Rare Musculoskeletal discomfort · Myalgia

Psychiatric disorders (7)

Common Insomnia

Rare Aggression · Agitation · Confusional state · Hallucination · Mental disorder · Suicidal ideation

Eye disorders (3)

Rare Eye disorder · Vision blurred · Visual impairment

Ear and labyrinth disorders (1)

Rare Vertigo

Infections and infestations (2)

Common Nasopharyngitis · Pharyngitis

Investigations (5)

Common Body temperature increased

Uncommon Weight increased

Rare Blood alkaline phosphatase increased · Feeling abnormal · Gamma-glutamyltransferase increased

General disorders and administration site conditions (20)

Common Asthenia · Fatigue · Otitis media

Uncommon Shock

Rare Accommodation disorder · Completed suicide · Discomfort · Drug eruption · Dysgeusia · Enuresis · Extrapyramidal disorder · Ill-defined disorder · Malaise · Movement disorder · Myoclonus · Nervous system disorder · Oculogyric crisis · Oedema · Stillbirth · Urethral disorder

Respiratory, thoracic and mediastinal disorders (4)

Common Bronchospasm · Cough · Epistaxis

Rare Dyspnoea

Dosing

Source: openFDA

Cetirizine hydrochloride oral solution, USP can be taken without regard to food consumption. Children 2 to 5 Years for Chronic Urticaria: The recommended initial dose of cetirizine hydrochloride oral solution, USP in children aged 2 to 5 years is 2.5 mg (½ teaspoonful) oral solution once daily. The dosage in this age group can be increased to a maximum dose of 5 mg per day given as 1 teaspoonful oral solution once a day or one ½ teaspoonful oral solution given every 12 hours. Children 6 months to < 2 years For Perennial Allergic Rhinitis and Chronic Urticaria: The recommended dose of cetirizine hydrochloride oral solution, USP in children 6 months to 23 months of age is 2.5 mg (½ teaspoonful) once daily. The dose in children 12 to 23 months of age can be increased to a maximum dose of 5 mg per day, given as ½ teaspoonful (2.5 mg) every 12 hours.

Pregnancy & Lactation

Pregnancy

FDA category B

Safe

Second-generation antihistamine; considered safe in pregnancy. Loratadine (also B) is the most frequently recommended

Lactation

Caution Hale L3 RID 1.77%

To substantially diminish the amount of drug that reaches the breastmilk after using eye drops, place pressure over the tear duct by the corner of the eye for 1 minute or more, then remove the excess solution with an absorbent tissue.

Chemistry & Properties

2D structure
FormulaC21H25ClN2O3
Molecular weight388.9 g/mol
IUPAC name2-[2-[4-[(4-chlorophenyl)-phenylmethyl]piperazin-1-yl]ethoxy]acetic acid
CAS83881-51-0
PubChem CID2678
InChIKeyZKLPARSLTMPFCP-UHFFFAOYSA-N
logP3.15 (XLogP 1.7)
Polar surface area53.01 Ų
H-bond acceptors / donors4 / 1
Drug-likeness (QED)0.70
Lipinski violations0
SMILESO=C(O)COCCN1CCN(C(c2ccccc2)c2ccc(Cl)cc2)CC1

Biology & Pharmacokinetics

Pharmacokinetics

BBB penetrantNo

Enzyme interactions

EnzymeRoleDetail
CYP2C19Substrate
CYP2D6Inhibitor
CYP3A4Substrate

Receptor binding (top 2)

TargetActionAffinity
H1 receptor (HRH1) Antagonist pKi 8.2
HISTAMINE H1 (HRH1) Binding pKi 8.2

Transporters

BCRP (Inhibitor)BSEP (Inhibitor)MATE1 (Inhibitor)MATE2 (Inhibitor)MDR1 (Inhibitor)MRP1 (Inhibitor)OATP1B1 (Inhibitor)OATP1B1 (Inhibitor)OATP1B3 (Inhibitor)OATP1B3 (Inhibitor)OATP2B1 (Inhibitor)OCT1 (Inhibitor)OCTN2 (Inhibitor)P-gp (Inhibitor)MDR1 (Substrate)P-gp (Substrate)

Drug–drug interactions (100+, DDInter)

Interacting drugSeverityManagement
Aldesleukin moderate
Alfentanil moderate
Alimemazine moderate
Alprazolam moderate
Amitriptyline moderate
Amobarbital moderate
Amoxapine moderate
Apraclonidine moderate
Aripiprazole moderate
Asenapine moderate
Azatadine moderate
Azelastine (nasal) moderate
Baclofen moderate
Benzatropine moderate
Benzhydrocodone moderate
Biperiden moderate
Brexanolone moderate
Brexpiprazole moderate
Brimonidine (ophthalmic) moderate
Brimonidine (topical) moderate
Brivaracetam moderate
Brompheniramine moderate
Buprenorphine moderate
Bupropion moderate
Buspirone moderate
Butabarbital moderate
Butalbital moderate
Butorphanol moderate
Candida albicans moderate
Cannabidiol moderate
Carbamazepine moderate
Carbinoxamine moderate
Cariprazine moderate
Carisoprodol moderate
Cenobamate moderate
Chloral hydrate moderate
Chlorcyclizine moderate
Chlordiazepoxide moderate
Chlormezanone moderate
Chlorphenesin moderate

Showing 40 of 100+.

Registered Products (39)

BrandForm / strengthPackAgentCitizen (JOD)
Omcet Suspension 5 mg/5 ml 100 ml Reda Jardaneh Drug Store 1.270
Omcet Tablet 10 mg 10 tab pack varies Reda Jardaneh Drug Store 1.440
Zertazine Syrup Syrup 5 mg/5 ml 100 ml Khoury Drug Store 1.740
Cetolerg Tab Tablet 5 mg 10 tab THE JORDANIAN PHARMACEUTICAL MANUFACTURING COMPANY/JORDAN 1.750
Allezine oral solution Solution 0.1 % 100 ml pack varies JERASH PHARMACEUTICALS LTD.CO/JORDAN 2.000
Finallerg drop Oral Drops 10 mg/ml 10 ml Pharma International Company/ Jordan 2.110
Zyrtec Oral Drops Oral Drops 10 mg/ml 10 ml Suleiman Tannous & Sons Co. Ltd 2.220
Zyrtec oral Solution Solution 1 mg/ml 75 ml Suleiman Tannous & Sons Co. Ltd 2.240
Sezonal Tablet 10 mg 10 tab pack varies UNITED PHARM.MFG.CO.LTD(UPM)/JORDAN 2.320
Omcet Injection 10 mg/ml 15 vial Reda Jardaneh Drug Store 2.370
Cerin Syrup Syrup 0.1 % 100 ml pack varies Hayat Pharmaceutical Industries CO.PLC/JORDAN 2.390
Cerin Tab Tablet 10 mg 10 tab pack varies Hayat Pharmaceutical Industries CO.PLC/JORDAN 2.390
Cetolerg Syrup Syrup 5 mg/5 ml 100 ml THE JORDANIAN PHARMACEUTICAL MANUFACTURING COMPANY/JORDAN 2.390
Cetolerg Tab Tablet 10 mg 10 tab THE JORDANIAN PHARMACEUTICAL MANUFACTURING COMPANY/JORDAN 2.390
Finallerg solution Solution 1 mg/ml 100 ml Pharma International Company/ Jordan 2.390
Finallerg tab Tablet 10 mg 10 tab pack varies Pharma International Company/ Jordan 2.390
Zain Tablets Tablet 10 mg 10 tab pack varies MIDDLE EAST PHARMA&CHEMICAL IND/JORDAN 2.390
Zeran Tablets Tablet 10 mg 10 tab pack varies The Arab Pharmaceutical Manufacturing PSC/Salt 2.390
Allezine oral solution Solution 0.1 % 120 ml pack varies JERASH PHARMACEUTICALS LTD.CO/JORDAN 2.400
Zertazine F.C Tab Film-Coated Tablet 10 mg 20 tab Khoury Drug Store 2.810
Siraz Syrup 5 mg/5 ml 100 ml Jordan Sweden Medical & Sterilization Co. 2.840
Siraz Tablet 5 mg 20 tab Jordan Sweden Medical & Sterilization Co. 2.850
Zyrtec Tablets Tablet 10 mg 10 tab pack varies Suleiman Tannous & Sons Co. Ltd 2.900
Cerin Syrup Syrup 0.1 % 125 ml pack varies Hayat Pharmaceutical Industries CO.PLC/JORDAN 2.990
Zeranase Tab Tablet 120 mg, 5 mg 14 tab pack varies The Arab Pharmaceutical Manufactruing Co. 3.390
Omcet Tablet 10 mg 28 tab pack varies Reda Jardaneh Drug Store 3.830
Finallerg tab Tablet 10 mg 20 tab pack varies Pharma International Company/ Jordan 4.540
Zain Tablets Tablet 10 mg 20 tab pack varies MIDDLE EAST PHARMA&CHEMICAL IND/JORDAN 4.540
Zeran Tablets Tablet 10 mg 20 tab pack varies The Arab Pharmaceutical Manufacturing PSC/Salt 4.540
Zeranase Tab Tablet 120 mg, 5 mg 20 tab pack varies The Arab Pharmaceutical Manufactruing Co. 4.690
Zyrtec Tablets Tablet 10 mg 20 tab pack varies Suleiman Tannous & Sons Co. Ltd 5.520
Cetirizine Dar Al Dawa Suspension 0.24 %/5 ml 5 ml Dar Al Dawa Development and Investment Co. Ltd. 5.850
Finallerg tab Tablet 10 mg 30 tab pack varies Pharma International Company/ Jordan 6.740
Zain Tablets Tablet 10 mg 30 tab pack varies MIDDLE EAST PHARMA&CHEMICAL IND/JORDAN 6.740
Cetolerg Solution Solution 10 mg/ml 30 ml THE JORDANIAN PHARMACEUTICAL MANUFACTURING COMPANY/JORDAN 7.000
Cerin Tab Tablet 10 mg 480 tab pack varies Hayat Pharmaceutical Industries CO.PLC/JORDAN 97.510
Cerin Tab Tablet 10 mg 500 tab pack varies Hayat Pharmaceutical Industries CO.PLC/JORDAN 101.570
Finallerg tab Tablet 10 mg 500 tab pack varies Pharma International Company/ Jordan 101.570
Sezonal Tablet 10 mg 1000 tab pack varies UNITED PHARM.MFG.CO.LTD(UPM)/JORDAN 197.200