Levocetirizine vs. Cetirizine: Which Antihistamine Should You Choose?

If you suffer from seasonal allergies or chronic hives, you’ve likely come across levocetirizine (Xyzal) and cetirizine (Zyrtec). These two antihistamines are both popular choices, but what’s the real difference, and which one is better?

Below, we’ll break down how they compare in terms of effectiveness, safety, cost, and other factors.

What are Levocetirizine & Cetirizine?

Cetirizine (Zyrtec) and levocetirizine (Xyzal) are both second-generation antihistamines used to treat seasonal allergies, hay fever (allergic rhinitis), and hives (urticaria). They relieve symptoms like sneezing, itchy eyes, and runny nose while causing less drowsiness than older allergy medications.

They work by blocking histamine, a chemical your body releases during allergic reactions. In people with allergies, the immune system overreacts to harmless things like pollen or pet dander, triggering these symptoms.

Although levocetirizine (Xyzal) and cetirizine (Zyrtec) are very similar, a few key differences may make one a better fit for you than the other.  

First- vs. Second-generation Antihistamines

Zyrtec and Xyzal are both second-generation antihistamines, which means they’re designed to treat allergies with less drowsiness than older (first-generation) drugs like Benadryl (diphenhydramine), which cross into the brain more easily, making you feel sleepy.

Xyzal is sometimes even called a third-generation antihistamine because it was designed to cause even fewer side effects than Zyrtec.

Remember that everyone reacts differently, so it’s a good idea to be cautious when trying a new allergy medication.

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How Do They Differ?

Simply put, cetirizine (Zyrtec) is a mixture of levocetirizine (active ingredient) and dextrocetirizine (inactive ingredient), while levocetirizine (Xyzal) works by itself without the inactive ingredient dextrocetirizine. 

The table below highlights their key differences to help you decide which one might be right for you.

Key Differences

• Sedation: Levocetirizine may cause less drowsiness than cetirizine, though both are better than older antihistamines like Benadryl.

• Cost: Cetirizine is usually cheaper and available in more generic/store-brand forms.

• Potency: Some studies suggest levocetirizine may work slightly better for chronic hives and itching with fewer side effects.

What Are the Side Effects of Levocetirizine & Cetirizine?

If you’re concerned about adverse side effects when treating allergy symptoms, levocetirizine and cetirizine are generally well-tolerated by most people. 

However, like any medication, there are a few to keep an eye out for, ranging from common sedating effects to rare, severe side effects that require medical attention.

Common side effects

• Drowsiness

• Dry mouth

• Headache

• Nausea and vomiting

• Dizziness

Less common side effects

• Sore throat

• Persistent cough

• Diarrhea (more common in children)

• Stomach upset

• Restlessness

• Lower left abdominal pain

Rare but serious side effects

• Rapid heart rate

• Signs of anaphylactic shock (trouble breathing, swelling, severe rash)

• Liver or kidney problems

In May 2025, the FDA issued a warning about a potential side effect of cetirizine and levocetirizine. Although it is not extremely common, some individuals have reported experiencing severe itching after discontinuing these medications, particularly after long-term daily use lasting a few months to several years. 

If you begin to experience intense itching all over your body after stopping either cetirizine (Zyrtec) or levocetirizine (Xyzal), it is important to contact your healthcare provider. 

If you experience any severe or persistent symptoms, stop taking the medication and contact your healthcare provider immediately.

Who Should Avoid Levocetirizine And Cetirizine? 

While levocetirizine and cetirizine are safe for most people, you should avoid them if you:

• Have severe kidney disease or are on dialysis

• Are under 6 months old 

• Are allergic to levocetirizine, cetirizine, hydroxyzine, or similar medications

• Are pregnant or breastfeeding

• Take other sedating medications

If you have any chronic conditions, especially those affecting the liver, kidneys, or central nervous system, it’s best to consult your healthcare provider before starting either medication.

When to Choose Which Medication

Pick levocetirizine if you want a more refined, lower-dose option with a slightly reduced risk of drowsiness and other side effects. It’s considered the best option to treat chronic hives.

Pick cetirizine if you're looking for a budget-friendly, widely available option that works quickly and reliably.

The effectiveness of cetirizine and levocetirizine can vary depending on the specific condition being treated. Here's how they compare based on the condition being treated:

1. Allergies

Both medications provide substantial relief from hay fever and environmental allergies. However, levocetirizine may have a slight edge since it’s more refined. It can lead to fewer side effects and potentially greater results for some people.

2. Chronic hives

Health professionals often prefer levocetirizine for chronic hives (urticaria) as it controls symptoms without causing daytime drowsiness. However, cetirizine is typically just as effective.

3. Non-allergic rhinitis

People with non-allergic rhinitis can use either drug off-label to manage symptoms such as nasal congestion or a runny nose. The choice depends on personal preference. 

4. Allergy-Triggered Asthma 

While neither cetirizine nor levocetirizine directly treats asthma, they can be prescribed off-label to help reduce asthma symptoms and allergic asthma flare-ups.

5. Atopic dermatitis

For people with atopic dermatitis, also known as eczema, intense itching is a common occurrence. While either medication may help relieve the itch, levocetirizine may be better tolerated for eczema due to its lower risk of sedation, especially in children.

6. Insect bites 

Both medications can effectively calm itchiness, redness, and swelling caused by insect bites or mild allergic skin reactions. 

How to Lower the Cost of Levocetirizine & Cetirizine Prescriptions

Prescription discount cards and coupons, like those BuzzRx offers, are accepted at many major pharmacies across the U.S. Here are some other ways to save:

1. Get a prescription savings card. Programs like BuzzRx offer free discount cards and coupons that can lower the price of these medications by up to 80%. Simply search your medication, find the best price at a local pharmacy, and show the coupon at checkout.

2. Look for manufacturer coupons. If you're using brand-name versions like Xyzal or Zyrtec, the manufacturer may offer coupons. These programs are designed to make brand-name medications more affordable, especially if you don’t have insurance or have high copays.

3. Choose generic over brand names. Opting for the generic form of either medication can significantly reduce costs. Generic levocetirizine and cetirizine offer the same effectiveness and safety as their brand-name counterparts at a considerably lower price. 

4. Buy in bulk if possible. Ask your doctor if you can fill a 90-day supply instead of a 30-day one. Many major pharmacies offer discounts for bulk prescriptions, especially on generics.

5. Search for store-brand OTC products. For cetirizine in particular, many major retailers offer store-brand versions that contain the same active ingredient and are more affordable. 

6 Alternative Allergy Medications & Treatments

If Levocetirizine or Cetirizine isn’t the right fit for you, several other medications and therapies can help manage allergy symptoms.

1. Loratadine (Claritin)

Loratadine (brand name Claritin) is a non-drowsy antihistamine commonly used to treat hay fever and other allergic reactions. It tends to cause less sedation than cetirizine and is available over-the-counter in tablet or liquid form.

2. Fexofenadine (Allegra)

Fexofenadine (brand name Allegra) is another virtually non-sedating antihistamine. It’s a good option for people who need daytime relief without feeling sleepy, and it's available in 12- and 24-hour formulas.

3. Diphenhydramine (Benadryl)

Diphenhydramine (brand name Benadryl) is a first-generation antihistamine that acts quickly and is effective at treating sudden allergic reactions, itching, and hives. However, it causes significant drowsiness and is generally better suited for short-term or nighttime use.

4. Nasal corticosteroids (Flonase, Nasacort)

Nasal sprays, such as fluticasone and triamcinolone (brand names Flonase and Nasacort), reduce inflammation in the nasal passages, making them effective for treating nasal congestion, sneezing, and a runny nose. They’re often used daily during allergy seasons and work well when combined with oral antihistamines.

Note: Nasal corticosteroids are typically used for a limited period. Long-term use should be guided by a healthcare provider to avoid potential side effects like nasal irritation or nosebleeds.

5. Allergy immunotherapy (Allergy shots or tablets)

Immunotherapy, such as allergy shots or tablets, involves gradually exposing your immune system to small amounts of allergens to build long-term tolerance. This treatment is typically recommended for people with moderate to severe allergies who don’t respond well to medications.

6. Saline nasal rinses

Non-drug treatments, such as saline rinses, can help flush out allergens, mucus, and irritants from the nasal passages. While they don’t stop allergic reactions, they can reduce symptoms like nasal congestion and improve breathing.

7. Lifestyle changes

Simple adjustments to your daily routine can significantly reduce allergy symptoms, such as:

• Use air filters at home.

• Keep windows closed during pollen season.

• Shower before bed.

• Wash bedding regularly.

• Avoid known triggers, such as pet dander, mold, or dust mites.