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Does cetirizine raise blood pressure?

Zyrtec is unlikely to cause an increase in blood pressure on its own
Ashley Broadwater, writer for SingleCare
By | Aug. 15, 2024 Medically reviewed by Anne Jacobson, MD, MPH
A blood pressure cuff and an exclamation mark: Does cetirizine raise blood pressure?

Key takeaways

  • Zyrtec (cetirizine) alone is unlikely to raise blood pressure. But in combination with the decongestant pseudoephedrine, Zyrtec-D can increase blood pressure, especially in people who already have hypertension.

  • First-generation antihistamines, such as Benadryl and Dramamine, can increase heart rate, though usually not to a serious extent.

  • Other safe alternatives similar to Zyrtec are Claritin and Allegra, which can be taken in the long term. People with high blood pressure should avoid the combination forms of these medications, such as Claritin-D and Allegra-D.

  • Children and pregnant patients should take cetirizine with caution. Anyone with chronic health conditions should talk to a healthcare provider before starting the medication.

In this article:

Zyrtec is a popular brand-name over-the-counter (OTC) antihistamine. This medication belongs to a class of drugs called second-generation antihistamines. They are less likely to cause drowsiness and are considered non-sedating. The U.S. Food and Drug Administration (FDA) has approved Zyrtec to help relieve allergy symptoms such as itchy or watery eyes, runny nose, nasal congestion, sneezing, and hives. Zyrtec works by blocking histamine, a substance released by the body during an allergic reaction. Many may wonder if taking Zyrtec can impact their blood pressure. While Zyrtec (cetirizine) alone isn’t known to raise blood pressure, antihistamines like Zyrtec-D, which contain a decongestant, can raise blood pressure. Decongestants temporarily increase blood pressure by constricting blood vessels. This can be especially dangerous for people with hypertension (high blood pressure). 

Can cetirizine cause high blood pressure?

Cetirizine itself is not associated with high blood pressure or changes in heart rate. “Cetirizine, when used alone and not in combination with other medications, is not known to have common cardiovascular side effects,” says Dr. Tyler C. Melton, Pharm.D., MPH, BCPS, a pharmacist with UT Health Science Center.

“Not in combination with other medications” is the key phrase there. While cetirizine alone doesn’t increase blood pressure, some other medications taken in combination with Zyrtec can. 

Cetirizine and similar meds “are often used in combination with OTC cough and cold preparations that have other ingredients that may interact with blood pressure medications and possibly cause a rise in blood pressure,” says Dr. Christina M. Madison, Pharm.D., FCCP, AAHIVP founder and CEO of The Public Health Pharmacist, PLLC. More specifically, Allegra-D, Claritin-D, and Zyrtec-D, as well as phenylephrine, or Sudafed PE, are examples that can increase blood pressure.

Dr. Melton urges people to talk to a pharmacist before taking these OTC meds if they have a history of high blood pressure or cardiovascular issues.

Some allergy medicines can also make a person’s heart race. First-generation antihistamines (not Zyrtec, which is second-generation), in particular, can cause an increase in heart rate. However, this usually goes away over time and doesn’t cause major problems. “Overall, the likelihood of patients experiencing these side effects is rare,” Dr. Melton adds.

More common side effects of cetirizine, he says, are drowsiness, fatigue, and dry mouth. 

Can you take cetirizine with high blood pressure?

People with hypertension can typically take cetirizine safely. “Cetirizine has minimal drug interactions with other blood pressure medications and is generally safe to use in patients who have high blood pressure,” Dr. Melton says. 

Dr. Madison agrees it’s safe on its own. “The key is that it should be used alone, not in combination with other OTC cough, cold, or combination allergy medications that may include NSAIDs [like ibuprofen] or Tylenol [acetaminophen].” Those medications could impact blood pressure, as could formulations of the drug that contain a decongestant like pseudoephedrine.

It helps to have a healthcare professional involved in these decisions. Every person will react differently to medication. “Concerns about potential drug interactions and compatibility should always be discussed with a pharmacist and other healthcare providers to ensure products containing cetirizine are safe for patient use,” Dr. Melton says. Once approved by that provider, patients can buy Zyrtec at a lower cost using a SingleCare prescription discount card.

Cetirizine isn’t the only antihistamine that’s generally safe to take with high blood pressure. Pharmacists Melton and Madison agree that non-drowsy options, like Claritin (loratadine) and Allegra (fexofenadine), are safe bets. “However, please remember that these antihistamine products can be marketed as a combination product including pseudoephedrine, such as Claritin-D, Zyrtec-D, and Allegra-D,” Dr. Melton continues. “Pseudoephedrine may affect blood pressure and heart rate and should not be used in patients with high blood pressure without first speaking with a healthcare provider.”

Pills aren’t the only option, either. “If someone consults with their healthcare provider and they choose not to have them use an oral antihistamine, they can use a topical antihistamine or nasal spray like Flonase,” Dr. Madison says.

Who should avoid cetirizine?

Cetirizine is generally a safe OTC allergy medication for people with high blood pressure or heart disease. However, some people may still need to take precautions. 

“Patients over 65 years of age may experience increased side effects from cetirizine, such as drowsiness and fatigue, and caution should be used when taking this medication,” Dr. Melton says. “Cetirizine is not recommended in nursing mothers, as cetirizine is found in breast milk once taken.”

Regarding children and pregnant patients, a discussion with a healthcare professional is crucial. Dr. Melton says there’s limited information about how safe the use of cetirizine is in pregnant patients, and use in children older than two years of age should be monitored by the provider.

Alternatives to cetirizine

If cetirizine doesn’t work well for someone, or they only have other antihistamines in the medicine cabinet, that’s okay. Loratadine and fexofenadine aren’t known to have cardiovascular side effects either, have minimal blood pressure effects, and are generally safe for long-term use.

Benadryl, or diphenhydramine, can be effective depending on the symptoms but can cause other problems. “This antihistamine is older than cetirizine and has more side effects, including increased drowsiness and the small possibility of affecting heart rhythm in rare situations,” Dr. Melton adds. 

Dr. Madison also notes that Benadryl can be dangerous for older adults.

But again, every person is different and will react differently to medication. That’s why it’s important not to make these decisions alone and instead rely on medical advice. Talking with your community pharmacist or healthcare provider is the best option.

The bottom line

People have several options to manage allergy symptoms safely without exacerbating high blood pressure or heart rate issues. Medications such as Zyrtec (cetirizine), Allegra (fexofenadine), and Claritin (loratadine)—without an added decongestant—can help. Zyrtec should not be combined with Allegra or taken with Claritin, though. Air filters, inhaling steam, and avoiding allergens are also beneficial in managing allergies.

If you have chronic health conditions or questions, consult a healthcare provider before taking any new medication—even an over-the-counter allergy medication like cetirizine.

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