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Due to the presence of pseudoephedrine, care should be taken when administering Zyrtec-D in patients with diabetes mellitus, overactive thyroid gland, high blood pressure, tachycardia, cardiac arrhythmia, ischemic heart disease, liver or renal insufficiency, prostate hyperplasia as well as increased eye-pressure in the treatment of elderly patients.
Caution (see Interactions) is also required in patients taking: sympathomimetic drugs such as decongestants, appetite suppressants, psychostimulants such as amphetamines (combined effects on the cardiovascular system); tricyclic antidepressants, antihypertensive drugs (reduction of antihypertensive effects); alcohol or other CNS depressants (enhanced CNS depression and impaired performance), digitalis (risk of cardiac arrhythmia); as well as in conditions where anticholinergic activity is undesirable, such as prostatic hypertrophy or bladder outflow obstruction.
Caution should also be exercised in patients with factors which could increase the risk of haemorrhagic stroke, as concomitant use of vasoconstrictors such as bromocriptine, pergolide, lisuride, cabergoline, ergotamine, or any other decongestant drug used as nasal decongestant, either by oral route or by nasal route (phenylpropanolamine, phenylephrine, ephedrine), due to the risk of vasoconstriction and increased blood pressure.
Due to vasoconstrictor effect of pseudoephedrine, caution is recommended in patients who are at risk for hypercoagulability, as in inflammatory bowel disease.
Caution is required in hypertensive patients who are treated concomitantly with NSAIDs, because both pseudoephedrine and NSAIDs can increase blood pressure.
As for other centrally acting stimulants, abuse has been observed for pseudoephedrine.
Patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption should not take this medicine.
Patients suffering from renal insufficiency: Zyrtec-D should not be administered in patients with intermediately pronounced or severe renal insufficiency, and only 1 tablet per day should be administered in patients suffering from a light renal insufficiency.
There have been rare cases of posterior reversible encephalopathy (PRES) / reversible cerebral vasoconstriction syndrome (RCVS) reported with sympathomimetic drugs, including pseudoephedrine. Symptoms reported included sudden onset of severe headache, nausea, vomiting, and visual disturbances. Most cases improved or resolved within a few days following appropriate treatment. Psuedoephedrine should be discontinued immediately and medical advice sought if signs/symptoms of PRES/RCVS develop.
Effects on ability to drive and handle machines: Cetirizine may lead to increased sleepiness. Therefore Zyrtec-D has an influence on the ability to drive or operate machinery.
No negative effect of pseudoephedrine on the vigilance has been reported nor is expected.
