Alternative Prescription Allergy Medicines to Levocetirizine

Second-Generation Antihistamine Options

The American Academy of Allergy, Asthma, and Immunology recommends desloratadine, fexofenadine, and loratadine as first-line options for patients requiring an alternative to levocetirizine due to their efficacy and favorable side effect profiles 1, 2
Fexofenadine is completely non-sedating even at higher than recommended doses, making it an excellent alternative for patients who need to remain alert 1
Loratadine is non-sedating at recommended doses, though may cause sedation at higher doses 1
Desloratadine is non-sedating at recommended doses with the longest elimination half-life (27 hours) 1, 2

All second-generation antihistamines have similar overall efficacy profiles for allergic conditions 1

The British Association of Dermatologists recommends avoiding acrivastine in moderate renal impairment 2
The British Association of Dermatologists suggests using loratadine or desloratadine with caution in severe renal impairment 2
The British Association of Dermatologists advises that cetirizine dose should be halved in moderate renal impairment 2
The British Association of Dermatologists recommends avoiding mizolastine in significant hepatic impairment 2
The British Association of Dermatologists advises avoiding chlorphenamine and hydroxyzine in severe liver disease 2
The American College of Obstetricians and Gynecologists recommends that all antihistamines should ideally be avoided in pregnancy, especially during the first trimester 3
The American College of Obstetricians and Gynecologists suggests that if treatment is necessary, chlorphenamine has the longest safety record 3
The American College of Obstetricians and Gynecologists notes that loratadine and cetirizine are classified as FDA Pregnancy Category B drugs 3

The American Academy of Allergy, Asthma, and Immunology recommends azelastine and olopatadine nasal sprays as effective alternatives for allergic rhinitis 1
The American Academy of Allergy, Asthma, and Immunology suggests that intranasal antihistamines may be considered as first-line treatment for allergic and non-allergic rhinitis 4
The American Academy of Allergy, Asthma, and Immunology notes that intranasal antihistamines may cause sedation (particularly azelastine) and bitter taste 1
The British Association of Dermatologists recommends adding an H2 antihistamine to an H1 antihistamine for better control of urticaria in some patients 2
The American Academy of Allergy, Asthma, and Immunology suggests that for allergic rhinitis, oral antileukotriene agents (like montelukast) alone or in combination with antihistamines have proven useful 4

The American Academy of Allergy, Asthma, and Immunology recommends trying fexofenadine if alertness is critical (driving, operating machinery, etc.) 1
The British Association of Dermatologists suggests considering loratadine or desloratadine if once-daily dosing is preferred 2
The British Association of Dermatologists advises trying cetirizine if a stronger antihistamine effect is needed and mild sedation is acceptable 1, 2
The American Academy of Allergy, Asthma, and Immunology recommends considering intranasal antihistamines for predominant nasal symptoms 4
The British Association of Dermatologists suggests increasing the dose of the second-generation antihistamine above the licensed recommendation when benefits outweigh risks for urticaria not responding to single agents 2

The American Academy of Allergy, Asthma, and Immunology advises not assuming all second-generation antihistamines have identical side effect profiles - there are important differences in sedation potential 1
The American Academy of Allergy, Asthma, and Immunology recommends avoiding first-generation antihistamines for daytime use due to significant sedation and performance impairment 1
The British Association of Dermatologists suggests remembering that individual response to antihistamines varies - patients should be offered at least two different options if the first is ineffective 2
The British Association of Dermatologists advises being aware that desloratadine has the longest elimination half-life and should be discontinued 6 days before skin prick testing 2

The American Academy of Allergy, Asthma, and Immunology recommends adding montelukast to antihistamine therapy for patients with concomitant asthma, providing superior control of both upper and lower respiratory symptoms 5