Xyzal vs Zyrtec & Clarinex, Side Effects



Xyzal, generic levocetirizine, is a fairly new treatment for certain types of allergy such as allergic rhinitis and hives, or chronic idiopathic urticaria.  It was launched in parts of Europe in 2001 and was approved in 2007 for certain uses in the USA.

Xyzal, on a chemical level, consists entirely of the levo form of cetirizine.  Zrytec, the medication that came first and stopped being on patent, consists of both the levo and dextro form.  We discuss later what that actually means.

In terms of action on the body, Xyzal is an anti-histamine, which means it stops the action of histamine, a chemical messenger which is highly involved in causing inflammation and allergies.

Xyzal can also work to treat inflammation and allergic symptoms in other ways, such as directly changing the behavior of certain cells like eosinophils.

Is Xyzal any different than Zyrtec?

As mentioned, Xyzal is basically just a form of Zyrtec.

What does the whole levo/dextro thing mean?  Well, imagine that you’re a gigantic drug molecule which is somehow able to see.  You’re standing in front of a mirror – so there are two versions of you.  Your mirror image is you but flipped over.

In medications sometimes the mirror image is more effective than the other form.  Xyzal, then, is just the levo, or “left-handed,” version of the chemical that makes up Zyrtec.  It is possible that this makes it more effective.  One study showed that Xyzal binds to certain histamine receptors with twice the affinity of Zyrtec.

Critics point out, however, that companies can take an old medication and say that a specific form of it is better, patent that form, and then sell it when their patent runs out on the old medication.  One study has shown, in fact, that Zyrtec actually provides longer symptom relief than Xyzal.

Xyzal vs Clarinex

One study of 373 patients showed that Xyzal and Clarinex, a popular allergy medication, worked about as well for nasal congestion and other symptoms of allergies.

Another study showed significant superiority of Xyzal over Clarinex in an artificial setting.  That study scratched people with something they were allergic to then waited for them to develop redness and swelling at the spot.  This is called a “wheel and flare” test, and is commonly done when testing someone for things they are allergic to.

The study then tested which medication worked best to reduce the wheel and flare response.

There, Xyzal had at least 70% suppression of allergic reaction in everyone within 1-3 hours and lasted for 20 hours.  Clarinex, on the other hand, suppressed the allergic reaction in only about 30% of those using it.

On the other hand, there are studies which have shown no difference in Clarinex and Xyzal on the wheel and flare test.

Xyzal’s side effects

As Xyzal reaches the brain at fairly low levels, it may have less side effects related to exhaustion and similar than other medications, particularly the earlier allergy medications.

That said, in one study a very high percentage of people reported some sort of sedation related effect, usually occurring within a week of treatment.

5-6% report somnolence, or feeling very tired

4% report nasopharyngitis or cold

A small amount of people report dry mouth or sore throat.

In children, there may be different side effects:

4% report pyrexia or fever

3% report cough

2% report nose-bleeds

This list is not comprehensive; consult manufacturer’s insert.

Effect on Driving

Xyzal has a warning that people taking it should avoid driving due to its potential to cause sedation.  To try to disprove this, researchers did a blind test where people were given either Xyzal or placebo then made to take various driving tests.

That study did not show an impact, but it hasn’t proven compelling enough to change the official labeling.

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Pharmaceutical analyst who loves blogging about health and medical issues. Has written more than 150 articles and a book on attention deficit disorder. Correctly predicted delayed approval of Bydureon, approval of Provenge by FDA, and the non-approval of Acthar on June 11.

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  1. Worked wonders for my itching. Nothing OTC worked long enough. Just remember to take at bed time. Doctor said if the problem is related to histamine, this works great. Text XYZAL to 62900 to receive a text coupon. I paid just $25 for my prescription.

  2. Two dwarves (itchy and sneezy)

    I tried OTC Zyrtec and Claretin each on two different occasions and could not even tell I was taking anything. I took OTC Benedryl daily for three years and then went for allergy testing when my itching became unbearable. After a month on Xyzal, I feel much better. I started out taking it at bedtime, but I was still tired when it was time to wake up. Now I take it when I get home from work in the evening (around 6:00 pm) and I am fine when it is time to wake up.

  3. I’ve dealt with a wide range of antihistamines for over 50 years. Xyzal is the only one that actually totally controls symptoms. I’m one of the lucky ones who’s had NO side effects and no drowsiness, although I do take it at bedtime to be sure. Zytec, it’s companion drug created non-stop side effects and didn’t work as well. I know it doesn’t make “science sense,” but it’s real.

  4. xyzal is this a placebo?

  5. Deforest Simmons

    Is xyzal a placebo?

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