8 Zyrtec-D Side Effects to Consider: Dry Mouth, Drowsiness, and More

Zyrtec-D is an over-the-counter (OTC) combination medication that contains cetirizine and pseudoephedrine. The cetirizine portion is an antihistamine that helps treat allergy symptoms. The pseudoephedrine component is a nasal decongestant that can relieve a stuffy nose.

Zyrtec-D is generally well tolerated. But as with any medication, there are some potential side effects to be aware of.

Good to know: Zyrtec-D doesn’t require a prescription to purchase. But due to the risk of misuse and addiction with pseudoephedrine, it’s kept behind the pharmacy counter. There are also restrictions on how much you can buy per day and per month.

Zyrtec-D side effects at a glance

Below is a list of common Zyrtec-D side effects, plus some rare but serious side effects. Keep in mind that this medication has two active ingredients. You should consider the side effects of both cetirizine and pseudoephedrine before purchasing Zyrtec-D.

Common or mild Zyrtec-D side effects include:

• Drowsiness

• Fatigue

• Trouble sleeping

• Dry mouth

• Headache

• Dizziness

• Nausea

• Vomiting

• Diarrhea

• Sore throat

• Nervousness or anxiety

• Tremors

• Nosebleeds

• Cough

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Serious Zyrtec-D risks are generally rare, but they include:

• Raised blood pressure or heart rate

• Trouble urinating

• Allergic reactions

• Confusion or agitation

• Raised blood glucose (blood sugar)

• Hallucinations

• Abuse or misuse

• Blurry vision

• Mood or behavior changes

• Movement disorders

• Hearing problems

• Very low blood pressure

• Liver problems

Let’s take a closer look at eight Zyrtec-D side effects and how to manage them.

1. Drowsiness or insomnia

Both drowsiness and insomnia are possible Zyrtec-D side effects.

The cetirizine in Zyrtec-D can sometimes cause drowsiness and fatigue. But it’s less likely to make you sleepy than older antihistamines, such as diphenhydramine (Benadryl). If Zyrtec-D seems to cause drowsiness for you, try taking your dose in the evening.

On the other hand, the pseudoephedrine in Zyrtec-D can act like a stimulant in your body. This can cause insomnia (trouble sleeping) for some people. If you find Zyrtec-D is keeping you awake at night, try taking it in the morning.

Good to know: Older adults are more likely to experience sleep changes and other side effects while taking Zyrtec-D. If you’re 65 or older, speak with a healthcare professional before taking it. They may suggest a different allergy medication.

2. Dry mouth

Dry mouth is another common Zyrtec-D side effect. Both active ingredients in the medication can contribute to this side effect. It’s typically mild, and most people can manage it at home.

EXPERT PICKS: WHAT TO READ NEXT

• Getting the right dose: Learn from pharmacists about the standard recommended dosages for Zyrtec (cetirizine) and Zyrtec-D (cetirizine / pseudoephedrine).

• Reviewing your options: Zyrtec-D is one of many allergy medications available. Explore a few other options to decide which one is best for you.

• Safe combinations: Zyrtec-D is a safe allergy medication combination for many people, but not all allergy medications are safe to combine. Find out which ones shouldn’t be taken together.

Tips for relieving dry mouth caused by Zyrtec-D include:

• Sipping water or other fluids throughout the day

• Sucking on ice chips

• Chewing sugar-free gum

• Brushing and flossing your teeth at least twice a day

You can try using a saliva substitute, such as Biotene, if the above tips don’t seem to work. But if this side effect seems bothersome, let a healthcare professional know. You may need to try a different medication. Chronic dry mouth can lead to dental problems in the long run.

3. Headaches

Headaches are another common Zyrtec-D side effect. All antihistamines and decongestants can cause headaches. But keep in mind that nasal congestion can also cause them. So this symptom may not be due to the medication.

Headaches from Zyrtec-D should go away as the medication wears off. Other things you can try to help with headache pain include:

• Drinking more water

• Resting when possible

• Getting adequate sleep at night

You can also ask a healthcare professional if it would be OK for you to take an OTC headache medication, such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin). These medications don’t interact with Zyrtec-D. But they’re not safe for everyone to take.

If your headaches seem severe or don't go away, talk to your healthcare team. This isn’t a typical Zyrtec-D side effect, and it should be evaluated.

4. Dizziness

Dizziness is also a common Zyrtec-D side effect caused by the cetirizine in the medication. It’s a possible side effect for all antihistamines. Dizziness can raise your risk of falls or accidental injury. This is especially true for older adults.

If you feel dizzy after taking Zyrtec-D, sit or lie down. Be careful when you’re changing positions, such as going from sitting to standing. Stand up slowly and hold onto a firm, sturdy surface.

Taking Zyrtec-D in the evening is a good tip if you know the medication makes you dizzy. This helps limit dizziness to when you’ll already be asleep. But if Zyrtec-D also causes insomnia, you may want to consider a different allergy medication. There are many allergy medications that don’t typically cause dizziness or sleep changes. For example, nasal steroids like fluticasone propionate (Flonase) don’t tend to cause these side effects.

5. Nausea

Zyrtec-D can cause nausea. But it’s not a very common side effect. Nausea should be mild and go away as the medication wears off.

You can take Zyrtec-D with or without food. So if it upsets your stomach, try taking it with food. Avoid spicy or greasy foods and alcohol, since they can worsen nausea. If your nausea gets worse or doesn’t improve, talk to a healthcare professional. This isn’t expected with Zyrtec-D, and there may be another cause for your symptoms.

6. Raised blood pressure or heart rate

The pseudoephedrine in Zyrtec-D can raise your blood pressure or heart rate. The longer you take pseudoephedrine, the more likely it is you’ll experience these side effects. That’s why you should only take oral decongestants for up to 7 days in a row without a healthcare professional’s OK.

It’s usually recommended that people with hypertension (high blood pressure) or heart problems avoid oral decongestants. Even short-term use of pseudoephedrine can cause blood pressure or heart rate changes for people with these conditions. In rare cases, these side effects can become life-threatening.

If you have a history of high blood pressure or heart problems, ask a healthcare professional if Zyrtec-D is safe for you before taking it.

7. Trouble urinating

Both active ingredients in Zyrtec-D can contribute to urinary retention (trouble urinating), a serious side effect. This risk is higher if you have certain medical conditions, such as an enlarged prostate. You may also have a greater risk if you take other medications that cause this side effect, such as muscle relaxers or some Parkinson’s disease medications.

Urinary retention doesn’t always cause noticeable symptoms. But if it’s left untreated, it can lead to serious infections or kidney damage. Discuss your risks for urinary retention with a healthcare professional before taking Zyrtec-D. Typically, people with a higher risk for this side effect shouldn’t take it.

8. Allergic reactions

Very rarely, allergic reactions have been reported with Zyrtec-D. They can range from mild to life-threatening. But they always warrant medical attention.

Mild allergic reactions could include things like a minor rash. More serious reactions include symptoms like trouble breathing or swelling of the throat or tongue (anaphylaxis).

If you think you’re having an allergic reaction to Zyrtec-D, stop taking it and contact a healthcare professional right away. But if you’re having severe symptoms, call 911 for immediate medical help.

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Written by:

Sarah Morin, RPh

Sarah Morin, RPh, has been a registered pharmacist for over 25 years. She started out as a hospital pharmacist, working at Rhode Island Hospital and then at the University of Connecticut Health Center.

Edited by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

Reviewed by:

Jennifer Gershman, PharmD, CPh, PACS

Jennifer Gershman, PharmD, is a licensed pharmacist in Florida. She has worked in the pharmacy industry for more than 15 years and is currently a medical writer.

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