Yes, Xyzal is available over the counter in the United States. Sold as “Xyzal Allergy 24HR,” it can be purchased at pharmacies, grocery stores, and online without a prescription. The FDA approved the switch from prescription-only to OTC in 2017, following the same path that Zyrtec, Claritin, and Allegra took before it.
What Xyzal Treats Over the Counter
The OTC version of Xyzal is approved for two conditions: seasonal allergies and year-round (perennial) allergies. That covers the typical range of allergy symptoms, including sneezing, runny nose, itchy or watery eyes, and nasal congestion triggered by pollen, dust mites, pet dander, or mold.
Xyzal also treats chronic hives in adults and children as young as 6 months old, but that indication technically remains prescription-only. In practice, the OTC tablet contains the same active ingredient at the same dose a doctor would prescribe for hives, so some physicians simply recommend the OTC product rather than writing a prescription.
How It Works
Xyzal’s active ingredient is levocetirizine, which is a more refined version of cetirizine (the drug in Zyrtec). Cetirizine is actually a mix of two mirror-image molecules, and levocetirizine is the one that does most of the work blocking histamine receptors. By zeroing in on just that active half, Xyzal delivers allergy relief at a lower overall dose. It also undergoes very little processing in the liver, which means fewer drug interactions and a predictable effect from person to person.
Available Forms and Doses
OTC Xyzal comes in two forms: a 5 mg scored tablet that can be broken in half and an oral solution (2.5 mg per 5 mL) designed for children. Both are taken once daily in the evening.
- Adults and children 12 to 64: One 5 mg tablet once daily. A half tablet (2.5 mg) may be enough for milder symptoms.
- Children 6 to 11: Half a tablet (2.5 mg) once daily.
- Children under 6: The OTC label says “do not use.” Younger children may still receive a prescription version under a doctor’s guidance.
- Adults 65 and older: The OTC label directs you to ask a doctor before use, mainly because kidney function tends to decline with age and the drug is cleared almost entirely through the kidneys.
Taking it in the evening is the official recommendation, partly because any drowsiness peaks a few hours after the dose, and partly because levocetirizine provides a full 24 hours of coverage, so an evening dose means you’re protected when pollen counts rise the next morning.
Drowsiness and Other Side Effects
Xyzal is classified as a second-generation antihistamine, meaning it causes significantly less drowsiness than older drugs like Benadryl. That said, it’s not completely non-sedating. In clinical trials, about 6% of adults taking the standard 5 mg dose reported drowsiness, compared to 2% on a placebo. Fatigue showed a similar pattern: 4% on Xyzal versus 2% on placebo. Children aged 6 to 12 had lower rates, with about 3% reporting drowsiness.
For most people, any sleepiness is mild and tends to fade after the first few days of use. In longer-term trials lasting up to six months, roughly 2% of participants stopped taking Xyzal because of drowsiness or fatigue. Avoiding alcohol and other sedating medications reduces the chance of feeling overly drowsy.
Who Should Not Take OTC Xyzal
The biggest restriction involves kidney disease. Because the body clears levocetirizine almost entirely through the kidneys, impaired kidney function causes the drug to build up and increases the risk of side effects. The OTC label is straightforward: if you have kidney disease, do not use the product without medical supervision. People on dialysis or with severe kidney impairment should not take it at all.
Children aged 6 to 11 with any degree of kidney impairment are also advised against using it, since dose adjustments for this age group haven’t been well studied in that population. Adults with mild to moderate kidney problems can sometimes take a reduced dose, but this requires a doctor’s involvement to determine the right amount based on kidney function.
Xyzal vs. Other OTC Antihistamines
The OTC allergy aisle now has four major second-generation antihistamines: Xyzal (levocetirizine), Zyrtec (cetirizine), Claritin (loratadine), and Allegra (fexofenadine). All four are effective for seasonal and year-round allergies, and none requires a prescription.
Xyzal and Zyrtec are closely related, since levocetirizine is derived from cetirizine. Both tend to work faster and control symptoms slightly more completely than loratadine, but they also carry a modestly higher chance of drowsiness. Allegra is generally considered the least sedating of the group but may be slightly less potent for severe nasal congestion. The practical difference between these drugs is small enough that the best choice often comes down to which one works for you with the fewest side effects.
Store-brand versions of levocetirizine are now widely available and contain the same active ingredient at the same strength for a lower price. If cost matters, generic levocetirizine is identical to brand-name Xyzal Allergy 24HR.