People’s Pharmacy: Getting off Xyzal antihistamine takes patience

Q. I took Xyzal nightly for months and noticed my weight creeping up, so I stopped cold turkey. Within 48 hours, my whole body started itching. Another few tries showed me I needed a better plan.

To taper off this medicine SLOWLY without discontinuation symptoms, I bought the liquid form of Xyzal. This allowed me to measure out smaller and smaller doses.

The first month, I cut my dose in half to one-half teaspoon nightly. After that, I took one-half teaspoon every other night for a few weeks. Then I cut the dose to one-fourth teaspoon every night. Several weeks later, I went to one-fourth teaspoon every other night for two weeks. Last, one-eighth teaspoon every night for two weeks then one-eighth teaspoon every other night. At that point, I was able to stop completely with no itching.

This took forever, but going slowly and getting my body used to smaller and smaller doses made it tolerable.

A. Thank you for sharing your creative solution to this unpleasant problem. We have heard from many readers who experienced unrelenting itching after stopping levocetirizine (Xyzal) or cetirizine (Zyrtec).

After we prodded the Food and Drug Administration, it investigated this discontinuation syndrome. The agency reviewed its database of adverse events and found an association. It was written up in the journal Therapeutic Advances in Drug Safety, July 5, 2019. The authors concluded: “Patients and prescribers should have knowledge of this adverse event, given the widespread use and availability of cetirizine and potential impact on patient quality of life.”

Neither the FDA nor the drug company provides helpful information on how to taper off such antihistamines without itching. Your protocol could be helpful for others.

Q. I have been on lisinopril for at least five years and had no problems until today. I took my medicine around 2 p.m., and by 2:30 p.m., my tongue had swollen so much that I had to hold it down with my finger to get a breath.

When I called my sister, she rushed me to the emergency room. As soon as I said I was on lisinopril, the ER doctor knew exactly what it was and administered an IV medication to stop the swelling.

Before starting the IV, the doctor asked me if I would agree to being intubated if the med did not work. I said yes, as a tear rolled down my cheek and I asked my sister to call my son.

I was very scared and will forever be grateful to the ER team that quickly diagnosed the problem and got it under control. I was discharged within four hours, more than a little shaken. No more lisinopril for me.

A. What you experienced is called angioedema. It involves the buildup of fluid in the lips, tongue or throat and can lead to dangerous blockage of the airways. What makes this adverse reaction so challenging is that it can occur even after taking the drug safely for years.

One class of medications that is especially likely to trigger this reaction is called ACE (angiotensin converting enzyme) inhibitors. This includes drugs like benazepril (Lotensin), enalapril (Vasotec), lisinopril (Zestril) and quinapril (Accupril).

Although angioedema is considered a relatively rare side effect, 40 million Americans take an ACE inhibitor blood pressure medicine. It can also affect the intestines, a complication that is difficult to diagnose.

To learn more about this dangerous condition as well as other hypertension treatments, you may wish to consult our “eGuide to Blood Pressure Solutions.” This online resource can be found under the Health eGuides tab at www.PeoplesPharmacy.com.

In their column, Joe and Teresa Graedon answer letters from readers. Write to them in care of King Features, 628 Virginia Drive, Orlando, Fla., 32803, or email them via their website: www.PeoplesPharmacy.com. Their newest book is “Top Screwups Doctors Make and How to Avoid Them.”