Cetirizine-induced dystonic movements

Rajput, Alex; Baerg, Krista

doi:10.1212/01.wnl.0000191323.58722.38

Cited by 14 publications

(8 citation statements)

References 6 publications

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“…Studies have established cetirizine as causing oculogyric reactions, particularly in children in doses ranging from 5 to 10 mg, with symptoms commencing 3 to 184 days after commencement of treatment . Several case reports of cetirizine‐induced dystonic reactions have been reported . The US Food and Drug Administration has included cetirizine on its ‘drugs to watch list for oculogyric crisis’ .…”

Section: Discussionmentioning

confidence: 99%

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Cetirizine – how much is too much?

Garg

Cranwell

Chan

2018

Pharmacy Practice and Res

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Background Cetirizine hydrochloride is a commonly used over‐the‐counter antihistamine that may be prescribed in larger doses than are commonly used for allergic rhinitis for the management of chronic urticaria. Aim To describe a case report of a paediatric patient who was treated with long‐term and high‐dose cetirizine. Clinical details The patient developed a dystonic reaction probably as a result of the antihistamine overuse. The child involved in this case was taking the maximum daily dose regularly for several years. Outcomes The parent was advised to cease treatment with (high dose and prolonged use) cetirizine and substitute a lower intermittent dose of an alternative antihistamine. Conclusion Although cetirizine is widely considered a ‘safe’ medication, prescribers and pharmacists should be mindful that it has the potential to cause unacceptable side effects.

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Section: Discussionmentioning

confidence: 99%

“…3,4 Several case reports of cetirizine-induced dystonic reactions have been reported. [5][6][7][8] The US Food and Drug Administration has included cetirizine on its 'drugs to watch list for oculogyric crisis'. 9 Other reports have listed cetirizine as causing agitation, aggression, headaches and skin eruptions.…”

Section: Discussionmentioning

confidence: 99%

Cetirizine – how much is too much?

Garg

Cranwell

Chan

2018

Pharmacy Practice and Res

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“…Piperazines have central dopamine D^ receptor blockade (5). Cetirizine's large size, lipophobic nature, and greater affinity for peripheral H| receptors are believed to reduce CNS penetration and central side effects (2). However, one positron emission tomography study of cetirizine revealed approximately 30% H^ receptor binding in the cerebral cortex (1,2).…”

Section: Discussionmentioning

confidence: 99%

“…At-risk individuals may use the Internet to research particular methods of suicide (1,2), and a person's choice of method can infiuence case fatality (3). However, there is little research into the impact of news reports of suicide on subsequent Internet search activity.…”

Section: Internet Searches For a Specific Suicide Methods Follow Its Hmentioning

confidence: 99%

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Involuntary Movements Associated with Cetirizine Use

Romo¹,

Joshi²,

Waters³

2011

AJP

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To THE EDITOR: Cetirizine is approved by the U.S. Food and Drug Administration (FDA) for allergic rhinitis in all age groups (1). Published reports have described cedrizine-induced dystonic reacdons in the pédiatrie patient population and in one adult (2)(3)(4). We present the case of an adult who developed involuntary movements associated with cetirizine use and discontinuation. Case ReportA 24-year-old Caucasian woman presented to the local hospital emergency department with a nose laceration she sustained from walking into a glass window after acute alcohol intoxication (her blood alcohol level was 140 mg/dL). She reported taking 10 mg/day of cetirizine for 3 months, daily valacyclovir (for herpes simplex virus 1), and depot medroxyprogesterone. She denied a history of medication side effects, denied taking more than the recommended dosage, and was not taking over-thecounter or herbal products. She denied a history of head injuries, seizures, or loss of consciousness, and she also denied treatment with psychotropic medications. Initially, results fi-om her physical examination were unremarkable with the exception of a superficial laceration on her nose. The results of laboratory testing, including thyroidstimulating hormone and urine toxicology, were all within normal limits or negative.While in the emergency department, the patient developed acute involuntary "bizarre grimacing" and dysarthria. There was no evidence of oculogyric crisis, torticollis, tongue protrusions, opisthotonos, gait disturbances, or weakness in her extremities. She did not lose consciousness, and results of her neurological examination were negative. She was given intravenous diphenhydramine (50 mg), benztropine (2 mg), and lorazepam (2 mg). Neuroimaging results of her head and spine were negative, and her dystonia had resolved by the time a neurologist arrived at her bedside.A follow-up call 1 month later revealed that the patient had stopped taking cetirizine after she was discharged from the emergency department. She reported facial twitching on the day after discharge. Over the course of the month, she experienced two episodes of difficulty walking, hand "discoordination," and "muscle jerks of her throat." These episodes lasted approximately 20 minutes. An outpatient neurology consultation was arranged at the time of the call, but it is not known whether she kept that appointment. DiscussionCetirizine is a carboxylated metabolite of hydroxyzine (a piperazine histamine H, receptor antagonist) (1). Piperazines have central dopamine D^ receptor blockade (5). Cetirizine's large size, lipophobic nature, and greater affinity for peripheral H| receptors are believed to reduce CNS penetration and central side effects (2). However, one positron emission tomography study of cetirizine revealed approximately 30% H^ receptor binding in the cerebral cortex (1, 2). Cetirizine has negligible anticholinergic activity (6). We speculate that as a piperazine derivative, cetirizine blocked the striatal D^ receptors and resulted in an acute dystonic rea...

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