The Impact of Cetirizine on Kidney and Liver Health: What You Need to Know

Q: The Impact of Cetirizine on Kidney and Liver Health: What You Need to Know

Hello, thank you for your question. <br>Here are my responses： <br>1. <br>Is it true that Cetirizine is minimally metabolized by the liver? Could chronic urticaria due to inflammation in the body lead to elevated liver enzymes, and is liver function unrelated to Cetirizine? --> Y

Cetirizine and its effects on the kidneys and liver?

Hello Doctor, I am a 35-year-old male, weighing 72 kg and 162 cm tall.
I have been experiencing redness, swelling, and itching on various parts of my skin, which I believe started after I turned 20.
I have consulted many hospitals and have been diagnosed with chronic urticaria, atopic dermatitis, and seborrheic dermatitis.
I am not sure what my condition is, so I have been self-medicating with over-the-counter medication for over 10 years.
I have been taking Cetirizine 10 mg, initially one tablet daily, but later adjusted it to one tablet every two days due to concerns about kidney damage.
Currently, I take half a tablet every two days.
I start experiencing itching symptoms approximately 36 to 48 hours after taking the medication.

In February 2021, during a health check, my creatinine level was 1.2, which corresponds to a glomerular filtration rate (GFR) of 74.11.
In December 2021, my GFR was 68, and I had protein in my urine.
Recently, I came across a medical journal article with the following excerpt: PMID: 2892446.
The study evaluated the disposition of cetirizine, a new H1-receptor antagonist, in healthy adults and adults with varying degrees of renal insufficiency.
It found that the elimination half-life of cetirizine was prolonged in patients with mild and moderate renal insufficiency compared to age-matched individuals with normal renal function.

I would like to ask the following questions:
1.
Is it true that cetirizine is minimally metabolized by the liver? Could inflammation in some part of my body be causing chronic urticaria and leading to elevated liver enzymes, indicating that liver function is unrelated to cetirizine?
2.
Regarding my current medication regimen, is it possible that my renal function is not optimal, causing cetirizine to remain in my system longer, which explains why I only experience symptoms after about 36 hours?
3.
If I continue taking this medication, is there a possibility that my eGFR will continue to decline? Given that the average decline is 0.8 to 1.0 mL/min/1.73m² after the age of 30-40, could I potentially require dialysis by my 50s?
Additionally, I do not consume sugary drinks often, and I drink at least 2000 cc of water daily.
I also do not have a high-salt diet, yet my eGFR remains borderline, leading me to suspect that cetirizine may be a contributing factor (I currently take half a tablet every two days when I feel slightly itchy).
Thank you, Doctor, for your attention.

Chen Huan-yu, 30~39 year old female. Ask Date: 2022/08/03

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your question.
Here are my responses:
1.
Is it true that Cetirizine is minimally metabolized by the liver? Could chronic urticaria due to inflammation in the body lead to elevated liver enzymes, and is liver function unrelated to Cetirizine? --> Yes, most of it is metabolized by the kidneys.
I believe the elevated liver enzymes are unrelated to this medication.
2.
Regarding my current medication, I experience symptoms approximately 36 hours after taking it.
Based on the article, could it be that my kidney function is not very good, causing Cetirizine to remain in my body longer, which is why symptoms appear after 36 hours? --> I think this is unrelated to kidney function.
The itching may diminish over time, so it is related to the reduction of symptoms, not kidney function.
3.
If I continue taking this medication, is it possible that my eGFR will keep declining, considering that after the age of 30-40, it decreases by an average of 0.8 to 1.0 ml/min/1.73m² per year, potentially leading to the need for dialysis in my 50s? --> I don't think that will happen.
Recently, high temperatures and slight dehydration can cause a temporary increase in kidney function markers.
I recommend staying well-hydrated and checking your blood again next time.
The Allergy, Immunology, and Rheumatology Department at Changhua Hospital cares about you.

Reply Date: 2022/08/03

More Info

Cetirizine is an antihistamine commonly used to treat allergic reactions, including chronic urticaria (hives) and atopic dermatitis. Understanding its impact on kidney and liver health, especially in individuals with pre-existing conditions, is crucial for safe and effective use.

1. Metabolism of Cetirizine: Cetirizine is primarily eliminated through the kidneys, with minimal hepatic metabolism. This means that the liver does not significantly process cetirizine, which is beneficial for patients with liver issues. The elevated liver enzymes (GPT) you mentioned may not be directly related to cetirizine use. Instead, they could indicate an underlying condition or inflammation that may be contributing to your chronic urticaria. It is essential to investigate the cause of elevated liver enzymes further, as they can be influenced by various factors, including inflammation, alcohol use, or other medications.

2. Duration of Symptoms and Kidney Function: The pharmacokinetics of cetirizine indicate that its elimination half-life can be prolonged in individuals with renal insufficiency. Given your reported eGFR values (74.11 and 68 mL/min), it is possible that your kidney function is affecting how long cetirizine stays in your system. If your kidneys are not clearing the drug effectively, it could lead to prolonged effects, which might explain why you experience symptoms approximately 36 to 48 hours after taking the medication. However, it is also important to consider that the symptoms of chronic urticaria can fluctuate due to various factors, including stress, environmental triggers, and even dietary influences.

3. Long-term Use and Kidney Health: Regarding your concern about the potential decline in eGFR with continued cetirizine use, it is essential to note that while cetirizine is primarily eliminated by the kidneys, it is generally considered safe for individuals with mild to moderate renal impairment when dosed appropriately. The average decline in eGFR with age (0.8 to 1.0 mL/min/1.73m² per year) is a normal physiological process. However, maintaining hydration is crucial, especially if you are concerned about kidney function. Drinking adequate fluids (2,000 cc or more daily) is beneficial for kidney health, as it helps in the elimination of waste products and medications.

In summary, while cetirizine is primarily eliminated by the kidneys and has minimal hepatic metabolism, its long-term use in individuals with renal impairment should be monitored. Regular follow-ups with your healthcare provider, including kidney function tests, are essential to ensure that your renal health remains stable. If you notice any worsening of symptoms or changes in kidney function, it would be prudent to discuss alternative treatment options for your chronic urticaria. Additionally, addressing the underlying causes of your elevated liver enzymes may also provide insights into your overall health and guide your treatment plan.

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