Friday, June 13, 2008

What is Xyzal? What forms is Xyzal available?

I have been asked a lot recently about levocetirizine (trade name Xyzal (click here for the FDA's summary)) by patients, the general public, and many health care professionals. I will summarize what I know about Xyzal. It has been available in many other countries for at least 5 years, although it is not always sold under the trade name of Xyzal. It has a good safety record. Xyzal is an antihistamine that is available by prescription only in the United States as a 5 mg pill, since September of 2007. Beginning in June of 2008, an oral solution of 2.5 mg per 5 ml will be available. Xyzal is indicated for relief from allergic rhinitis (hay fever) and chronic urticaria (hives) as: 1 pill or 10 ml for patients > age 12 years old and 1/2 pill or 5 ml for children 6 to 11 years old. The incidence of adverse reactions was quite low, with a slightly increased rate of tiredness and fatigue compared to placebo. This is compares favorably to cetirizine (Zyrtec), which has a higher reported rate of tiredness and fatigue. The only other antihistamines that are available by prescription for allergic rhinitis are oral branded desloratadine (Clarinex), oral generic fexofenedine (Allegra), a nasal spray of azelastine (Astelin), and a nasal spray of olopatadine (Patanase). Insurances companies aggressively seek to cut their expenses and because other non sedating antihistamines are available over-the-counter, the companies choose to place the four available, non generic antihistamines usually in the third tier, meaning a copay of about $45 on average for most consumers. The manufacturer has produced cards that offer a $20 discount off of copays for 5 months, but you'll have to ask your doctor for this card, because they're not available on Xyzal's website to my knowledge. The average cost for one entire month's supply of liquid Xyzal is about $80/month for one five-ounce bottle. Fexofenedine, being generic, should be in tier 1 theoretically with about $10 copay, but some insurance formularies have placed it in tier 2 anyways with about $25 copay. There is no proof that any one antihistamine is uniformly better than all the other available antihistamines. Xyzal is reportedly in clinical trials to try to get approval to give it to children down to age 6 months old. We'll have to wait and see what are the study results and then when if it gets approved. Finally, there are no plans to produce either a Reditab, which is a soft dissolveable tablet, or a combination pill of levocetirizine and the decongestant pseudoephedrine ("Xyzal-D").

Levocetirizine is a new antihistamine that is effective and usually well tolerated. It's high net price to consumers will be a drawback to patients getting and using it. Fortunately, there are other antihistamines available, which may be just as effective.

If you have questions about levocetirizine or your medications, ask your doctor.

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