cetirizine HCl Nursing Considerations & Management

cetirizine hydrochloride

(se teer‘ i zeen)

Reactine (CAN), Zyrtec

Pregnancy Category B

Drug class

Antihistamine

Therapeutic actions

Potent histamine (H₁) receptor antagonist; inhibits histamine release and eosinophil chemotaxis during inflammation, leading to reduced swelling and decreased inflammatory response

Indications

• Management of seasonal and perennial allergic rhinitis
• Treatment of chronic, idiopathic urticaria
• Treatment of year-round allergic rhinitis and chronic idiopathis urticaria in infants > 6 mo

Contraindications and cautions

• Contraindicated with allergy to any antihistamines, hydroxyzine.
• Use cautiously with narrow-angle glaucoma, stenosing peptic ulcer, symptomatic prostatic hypertrophy, asthmatic attack, bladder neck obstruction, pyloroduodenal obstruction (avoid use or use with caution as condition may be exacerbated by drug effects); lactation.

Available forms

Tablets—5, 10 mg; chewable tablets—5, 10 mg; syrup—5 mg/5 mL

Dosages

ADULTS

• 5–10 mg daily PO; maximum dose 20 mg/day.

PEDIATRIC PATIENTS

• 6 mo–5 yr: 2.5 mg (one-half teaspoon) PO once daily. In children 1 yr and older, may increase to maximum 5 mg daily given as one-half teaspoon q 12 hr; 2–5 yr—one 5 mg chewable tablet per day.
• 6–11 yr: 5 or 10 mg daily PO.
• > 12 yr: Use adult dosage.

PATIENTS WITH HEPATIC OR RENAL IMPAIRMENT

• 5 mg PO daily.

Pharmacokinetics

Metabolism: Hepatic; T_1/2: 7–10 hr

Distribution: Crosses placenta; enters breast milk

Excretion: Urine and feces

Adverse effects

• CNS: Somnolence, sedation
• CV: Palpitation, edema
• GI: Nausea, diarrhea, abdominal pain, constipation
• Respiratory: Bronchospasm, pharyngitis
• Other: Fever, photosensitivity, rash, myalgia, arthralgia, angioedema

Nursing considerations

CLINICAL ALERT! Name confusion has occurred between Zyrtec (cetirizine) and Zyprexa (olanzapine); use caution.

Assessment

• History: Allergy to any antihistamines, hydroxyzine; narrow-angle glaucoma, stenosing peptic ulcer, symptomatic prostatic hypertrophy, asthmatic attack, bladder neck obstruction, pyloroduodenal obstruction; lactation
• Physical: Skin color, lesions, texture; orientation, reflexes, affect; vision examination; R, adventitious sounds; prostate palpation; renal function tests

Interventions

• Give without regard to meals.
• Provide syrup form or chewable tablets for pediatric use if needed.
• Arrange for use of humidifier if thickening of secretions, nasal dryness become bothersome; encourage adequate intake of fluids.
• Provide skin care for urticaria.

Teaching points

• Take this drug without regard to meals.
• You may experience these side effects: Dizziness, sedation, drowsiness (use caution if driving or performing tasks that require alertness); thickening of bronchial secretions, dryness of nasal mucosa (humidifier may help).
• Report difficulty breathing, hallucinations, tremors, loss of coordination, irregular heartbeat.