Zyrtec, also known by its generic name cetirizine, is a second-generation antihistamine widely used to treat various allergy symptoms. Although it is considered safe and effective for most users, a rare adverse reaction known as Zyrtec withdrawal has been reported in a small number of individuals, primarily after long-term use. This withdrawal is chiefly characterized by intense itching.
The Rarity of Zyrtec Withdrawal
Reports of Zyrtec withdrawal are uncommon relative to the millions of people who use the medication. In May 2025, the FDA issued a safety communication regarding reports of severe itching following the discontinuation of cetirizine and levocetirizine after long-term use. The FDA analyzed reports from April 2017 to July 2023 and found only 209 documented cases of post-discontinuation pruritus worldwide. Considering the vast number of over-the-counter packages sold in the U.S. alone (an estimated 62.7 million in 2022), the incidence of Zyrtec withdrawal is statistically very low.
Understanding Zyrtec Withdrawal Symptoms
The most prominent symptom of cetirizine withdrawal is severe, widespread itching (pruritus), which is often described as more intense than original allergy symptoms. This itching can significantly affect daily life and has, in rare instances, required hospitalization.
Other Potential Symptoms
Some individuals have also reported other symptoms alongside the itching, including hives, vivid dreams, headaches, anxiety, and insomnia. These symptoms typically emerge within one to five days after stopping the medication and generally resolve within about a week, though this can vary.
Key Factors Influencing Withdrawal Risk
Data indicates a strong link between the duration of Zyrtec use and the occurrence of withdrawal symptoms.
Duration of Use
Over 90% of reported cases involved patients using cetirizine for more than three months, with the median duration of use being 33 months. This suggests that prolonged, daily use is a significant risk factor.
Abrupt Discontinuation
Stopping daily, long-term use suddenly appears to trigger withdrawal. Gradual tapering of the dose is often recommended to mitigate this risk.
Zyrtec Withdrawal vs. Other Antihistamines
The risk of withdrawal varies among different types of antihistamines, as shown below:
| Feature | Zyrtec (Cetirizine) | First-Generation (e.g., Benadryl) | Other Second-Generation (e.g., Allegra) |
|---|---|---|---|
| Primary Use | Allergies, hives | Allergies, colds, sleep aid | Allergies, hives |
| Main Withdrawal Symptom | Intense pruritus (itching) | Insomnia, anxiety, other central nervous system effects | Generally minimal or no reported withdrawal |
| Withdrawal Risk Factor | Long-term, daily use | Long-term, high-dose use | Very low or not observed |
| Tapering Recommended | Yes, for long-term users | Yes, for long-term or high-dose users | Generally not necessary |
Managing and Avoiding Zyrtec Withdrawal
For long-term Zyrtec users, a gradual tapering of the dose is recommended when discontinuing the medication. A healthcare provider can help develop a personalized tapering schedule. If severe itching occurs after stopping Zyrtec, restarting the medication and then tapering, along with supportive measures like moisturizing lotions or oatmeal baths, may provide relief. Consulting a healthcare professional is advised.
The Pharmacological Explanation
Cetirizine blocks histamine-1 (H1) receptors, which are involved in allergic reactions. The current hypothesis is that long-term suppression of these receptors can lead to a rebound surge in histamine activity upon discontinuation, causing the intense itching. While the exact mechanism is still being studied, the FDA has confirmed a causal link and is adding warnings to product labeling.
Conclusion
While Zyrtec is generally safe and effective, how rare is Zyrtec withdrawal is a question with a clear answer: it is very rare, but a documented risk for long-term daily users. The primary risk factor is continuous use over an extended period. To minimize the potential for severe itching or other withdrawal symptoms when discontinuing long-term use, a gradual tapering under medical guidance is recommended. The FDA provides further information on this issue.
