Zyrtec vs Zyrtec-D: What the “D” Adds

Zyrtec vs Zyrtec-D at a Glance

Doses above are from the current U.S. Drug Facts or prescribing labels listed in Sources. Always follow the label on the package you buy, because store brands and formulations differ.

What Each Ingredient Does

Cetirizine is a second-generation antihistamine that blocks H1 receptors, relieving sneezing, itching and runny nose. It does not shrink swollen nasal tissue, so congestion is not on the plain Zyrtec label. Pseudoephedrine is a decongestant that narrows blood vessels in the nasal lining, reducing swelling and opening the airway. Because it acts on blood vessels and the nervous system generally, it can raise blood pressure and heart rate and cause nervousness or sleeplessness. A meta-analysis by Salerno and colleagues (2005) found pseudoephedrine caused a small average rise in systolic blood pressure (about 1 mm Hg) and heart rate (about 3 beats per minute), with larger increases at higher doses and with immediate-release forms.

Label Dosing

Zyrtec: adults and children 6 and older, one 10 mg tablet once daily; do not take more than 10 mg in 24 hours. Adults 65 and older and people with liver or kidney disease should ask a doctor.

Zyrtec-D: adults and children 12 and older, 1 tablet every 12 hours, no more than 2 tablets in 24 hours. Swallow whole; do not break or chew. Adults 65 and older, children under 12, and people with liver or kidney disease should ask a doctor.

Zyrtec-D Warnings

• MAOIs: do not use if you take a prescription monoamine oxidase inhibitor (for depression, psychiatric or emotional conditions, or Parkinson’s disease) or for 2 weeks after stopping one.
• Ask a doctor before use if you have heart disease, thyroid disease, diabetes, glaucoma, high blood pressure, trouble urinating due to an enlarged prostate, or liver or kidney disease.
• Stop and ask a doctor if you get nervous, dizzy or sleepless, or if symptoms do not improve within 7 days or come with fever.
• Both products: drowsiness may occur; avoid alcohol; be careful driving. Do not use if allergic to cetirizine or hydroxyzine. If breastfeeding: not recommended.

Why Zyrtec-D Is Behind the Counter

Under federal law, products containing pseudoephedrine are kept behind the pharmacy counter or in locked cases, buyers must show photo ID and sign a logbook, and daily and monthly purchase amounts are limited. FDA summarizes these requirements on its pseudoephedrine sales page.

Choosing

If your main symptoms are sneezing, itching and runny nose, plain cetirizine avoids decongestant side effects. If congestion is the main problem, a steroid nasal spray is another option; see Flonase vs Zyrtec. If you need a decongestant, see Sudafed vs Sudafed PE and Claritin vs Claritin-D.

Putting It Together: Common Situations

The scenarios below summarize what the labels and guidelines cited on this page say. They are general information, not a personal treatment plan. Your pharmacist can check the choice against your other medicines, and your clinician can tailor it to your health history.

• Sneezing and itching without stuffiness: plain cetirizine covers these on its label.
• Allergies plus sinus pressure: the Zyrtec-D label adds nasal and sinus congestion.
• High blood pressure or heart disease: the Zyrtec-D label says to ask a doctor first.

How to Read the Label Before You Buy

1. Find the active ingredient first. Brand names are often reused across products with different ingredients. The active ingredient and its strength appear at the top of the Drug Facts or Supplement Facts panel.
2. Check the “Uses” or labeled indication. A product is tested and labeled for specific uses. Using it for something else may not help.
3. Read the “Do not use” and “Ask a doctor before use” sections. They list conditions and medicines where the product may be unsafe.
4. Follow the directions for dose and duration. Note the maximum daily amount and how many days you can use it before checking with a clinician.
5. Check for duplicate ingredients. Combination products can contain the same ingredient as something else you take, which raises the risk of taking too much.
6. Note the “Stop use and ask a doctor” signs. These are the label’s own warning signs that a product is not working or is causing harm.

Common Mistakes to Avoid

• Breaking or chewing Zyrtec-D, which the label says not to do.
• Taking Zyrtec-D late in the evening if pseudoephedrine keeps you awake; talk to a pharmacist about timing.
• Assuming two products with similar names are interchangeable. Compare the active ingredients and strengths instead of the packaging.
• Forgetting to tell your clinician. Keep a current list of every prescription, OTC medicine and supplement you take, and bring it to appointments and the pharmacy.

FormulaCompare does not recommend one brand over another. Use the sources below to check the details for the exact product in front of you, since formulas and labels can change.

Children and Older Adults

Plain Zyrtec tablets are labeled for ages 6 and up, and children’s cetirizine liquids and chewables are available for younger ages under the direction on those labels. Zyrtec-D is labeled for ages 12 and up only; children under 12 should ask a doctor. Both labels say adults 65 and older should ask a doctor, which reflects that older adults may be more sensitive to drowsiness and, with Zyrtec-D, to the blood pressure and heart effects of pseudoephedrine.

Check Your Other Medicines

Many cold and sinus products also contain a decongestant or antihistamine. Taking Zyrtec-D with another pseudoephedrine product would double the decongestant, and combining cetirizine with other antihistamines or sedating medicines increases drowsiness. Read every Drug Facts label and ask a pharmacist to review your list, especially if you take medicines for depression, blood pressure or Parkinson’s disease. Keep the carton, since the Drug Facts information on it lists warnings you may need later, and store tablets as the label directs.

When to Talk to Your Doctor or Pharmacist

Ask a clinician before using Zyrtec-D if you have high blood pressure, heart disease, thyroid disease, diabetes, glaucoma or prostate enlargement, or take an MAOI. Seek urgent care for chest pain, a racing or irregular heartbeat, severe headache, or signs of an allergic reaction such as swelling or trouble breathing.

Frequently Asked Questions

Sources

• DailyMed: Zyrtec Allergy (cetirizine HCl 10 mg) Drug Facts label (Kenvue)
• DailyMed: Zyrtec-D Allergy & Congestion Drug Facts label (Kenvue)
• PubMed: Salerno et al., effect of oral pseudoephedrine on blood pressure and heart rate: a meta-analysis (2005)
• FDA: Legal requirements for the sale and purchase of drug products containing pseudoephedrine
• MedlinePlus: Cetirizine
• MedlinePlus: Pseudoephedrine

Related Comparisons

• Zyrtec vs Claritin
• Claritin vs Claritin-D
• Flonase vs Zyrtec
• Sudafed vs Sudafed PE
• All Medicines Comparisons