Yes, levocetirizine is available over the counter in the United States. It was originally a prescription-only medication when the FDA approved it in 2007, but it switched to OTC status in January 2017. You can find it on pharmacy shelves under the brand name Xyzal Allergy 24HR, along with a children’s version called Children’s Xyzal Allergy 24HR.
What Levocetirizine Treats
Levocetirizine is a second-generation antihistamine, meaning it blocks the body’s histamine response without causing as much drowsiness as older allergy medications like diphenhydramine (Benadryl). It treats the classic cluster of seasonal and year-round allergy symptoms: sneezing, runny nose, itchy or watery eyes, and itching of the nose or throat. It’s also approved for hives.
The medication is closely related to cetirizine (Zyrtec). Levocetirizine is actually the more active half of the cetirizine molecule, which means it can deliver similar allergy relief at a lower dose. The standard OTC dose of levocetirizine is 5 mg, compared to 10 mg for cetirizine.
OTC Forms and Dosing
The OTC version comes in two forms: tablets for adults and an oral solution for children. Both are designed to be taken once daily in the evening, and the effects last a full 24 hours.
- Adults and children 12 and older: One 5 mg tablet or 10 mL of the oral solution, once daily in the evening.
- Children 6 to 11: 5 mL of the oral solution, once daily in the evening.
- Children 2 to 5: 2.5 mL of the oral solution, once daily in the evening.
- Children under 2: Not recommended for OTC use.
Do not exceed the listed dose in a 24-hour period. The children’s solution comes with a dosing cup for accuracy.
Prescription Versions Still Exist
Even though levocetirizine is available OTC, prescription versions haven’t disappeared. The FDA notes that both prescription and OTC forms remain on the market. A doctor might write a prescription for it if your insurance covers prescription antihistamines, or if you need guidance on adjusted dosing due to kidney problems. The active ingredient is the same regardless of whether you pick it up with or without a prescription.
Who Should Be Cautious
Levocetirizine is cleared from the body primarily through the kidneys, so people with reduced kidney function need to be careful. Those with mild kidney impairment typically require a lower dose, while people with moderate or severe kidney impairment may need to take it less frequently, sometimes only a few times per week. Anyone with end-stage kidney disease or on dialysis should not take it at all. If you have known kidney problems, talk to your doctor before starting levocetirizine, even though it’s available without a prescription.
You should also avoid levocetirizine if you’ve had an allergic reaction to it or to cetirizine in the past. The FDA has issued a safety communication warning that long-term use of either levocetirizine or cetirizine can occasionally cause severe itching when the medication is stopped abruptly. This rebound itching is not an allergic reaction itself, but it can be intense enough to be confused with one.
How It Compares to Other OTC Antihistamines
The OTC antihistamine aisle now includes several second-generation options: loratadine (Claritin), cetirizine (Zyrtec), fexofenadine (Allegra), and levocetirizine (Xyzal). All four are taken once daily and work for similar symptoms. Levocetirizine and cetirizine tend to be slightly more potent for symptom relief than loratadine or fexofenadine, but they also carry a somewhat higher chance of causing mild drowsiness. Taking levocetirizine in the evening, as the label recommends, helps minimize any sleepiness during the day.
Store-brand and generic versions of levocetirizine are also available OTC, often at a lower price than the Xyzal brand name. The active ingredient and dose are identical, so generics work the same way.