Zyrtec-D Discontinued in Singapore Amid Safety Concerns

Zyrtec-D, a combination of antihistamine and decongestant, is no longer available in Singapore. 

While GlaxoSmithKline (GSK) informed healthcare professionals about its discontinuation in March 2023, the news has resurfaced as clinics and pharmacies report dwindling supplies. 

The decision highlights concerns over pseudoephedrine, a key ingredient linked to rare but serious health risks.

The sudden unavailability of Zyrtec-D has left some long-time users surprised and frustrated. Many relied on the medication for its effective combination of allergy relief and decongestant properties.

One regular user, who prefers to be referred to as Mr. L and suffers from chronic sinusitis, shared:

“For years, Zyrtec-D was a reliable option to manage my sinus issues. It worked for both the congestion and my allergies, which made things easier. Without it, I’m not sure which medication will work as well or fit into my routine.”

Mr. L also expressed concern about how other options might affect him:

“Trying something new feels uncertain. I worry it might not be as effective, or I might need to use multiple products to get the same result.”

Why Has Zyrtec-D Been Discontinued in Singapore?

Zyrtec-D contains pseudoephedrine, a decongestant that works by narrowing blood vessels in nasal passages to reduce swelling and congestion. However, this mechanism has been linked to rare but serious conditions:

• Posterior Reversible Encephalopathy Syndrome (PRES)
  • Symptoms: Severe headaches, visual disturbances, seizures, and cognitive changes.
  • Cause: Temporary changes in blood flow in the brain.
• Reversible Cerebral Vasoconstriction Syndrome (RCVS)
  • Symptoms: Sudden spasms in brain blood vessels, severe headaches, and stroke-like symptoms.
  • Cause: Constriction of brain blood vessels, which typically resolves over time.

These conditions, while rare, prompted GSK to discontinue Zyrtec-D production globally. Cases reported overseas often resolved after discontinuing pseudoephedrine and starting treatment.

What Are the Alternatives to Zyrtec-D?

Although Zyrtec-D is discontinued, other forms of Zyrtec that do not include pseudoephedrine remain available in Singapore. These formulations rely solely on the antihistamine cetirizine to alleviate allergy symptoms, such as sneezing and runny nose, without decongestant effects.

Ms D, a licensed pharmacist in Singapore, shares the possible alternatives:

“You can consider topical decongestants such as decongestant nasal sprays containing oxymetazoline or xylometazoline. These sprays are safer as the medication acts locally on the tissues to bring about relieve of congestion symptoms.”

It is important to use topical nasal decongestants for short durations as excessive use can result in rebound congestion.

For those with persistent or chronic nasal congestion, corticosteroid nasal sprays may be a more appropriate option.

“Corticosteroid nasal sprays reduce inflammation, swelling and mucus in the nasal passageway. It is best to use them on a regular basis to manage chronic symptoms.” She elaborated.

Alternatively, one can use saline sprays or rinses liberally to clear the mucus and relieve nasal congestion. As these do not contain medications, only saline (salt) water, they are safe for regular use.

“In terms of oral medication, do be mindful that Zyrtec-D alternatives like Telfast-D (fexofenadine + pseudoephedrine) and Clarityn-D (loratadine + pseudoephedrine) do contain pseudoephedrine as well.” Ms D shared.

The other oral decongestant available in Singapore is the compound phenylephrine. However, FDA’s recent decision to ban oral phenylephrine has raised questions about Singapore’s regulatory stance. 

Read more: FDA Ban on Cold Medicines: Could Singapore Be Affected?

GSK’s Statement on Zyrtec-D Discontinuation

In response to the discontinuation of Zyrtec-D, a GSK spokesperson told The Straits Times:

“Following considered assessment of the risk, GSK’s global team has determined that the safety profile of Zyrtec-D remains favourable, which is to say that the likelihood of an ‘adverse event’ occurring is low, and the benefit of the product outweighs the risk of its availability in the market. As such, it is not presently considered necessary that Zyrtec-D be formally recalled from the market.”

What Should Consumers in Singapore Do?

Patients who previously relied on Zyrtec-D for allergy and congestion relief should consider alternative options, as the medication is no longer available. 

For Mr. L, the uncertainty of finding a replacement adds stress. Having managed his chronic sinusitis effectively with over-the-counter medication, he is now reluctant to consult a doctor for a prescription option.

“Seeing a doctor might mean moving to a prescription medication, which can be expensive and stressful,” he shared. “There’s also the trial-and-error period. If the alternative doesn’t work, my symptoms could come back, and they can be debilitating.”

Healthcare providers understand how challenging this transition can be, especially for those managing chronic conditions. They acknowledge that the prospect of moving to prescription options or enduring a trial-and-error period can feel overwhelming, stressful, and expensive. 

Despite these challenges, they encourage individuals to seek tailored advice to identify effective alternatives. With professional guidance, it is possible to minimise disruptions and ensure symptoms remain well-managed in the long term.

Learn more: Nurturing Your Nostrils: A Guide to Optimal Nasal Care

Alternatives and Safety Precautions for Consumers

Over-the-counter antihistamines like cetirizine (found in other Zyrtec formulations), loratadine, or fexofenadine can effectively address sneezing and runny nose associated with allergies. For individuals who require a decongestant, phenylephrine-based options remain available, although their effectiveness is under review globally.

The discontinuation of Zyrtec-D marks a significant change for many patients, leaving some feeling frustrated and uncertain about their next steps. Yet, as Mr. L highlights, prioritising safety and understanding the long-term risks of medications is ultimately what matters most.

“At the end of the day, I understand why this decision was made. It’s good to know these risks and put safety first. I’d rather deal with the inconvenience now than face potential long-term health effects,” he shared.

The Health Sciences Authority (HSA) encourages consumers to review medication labels carefully and consult a pharmacist or doctor if uncertain about a product’s safety or effectiveness. Additionally, the HSA’s Register of Therapeutic Products provides a publicly accessible list of approved medications in Singapore.

Disclaimer: The information in this article is intended for general educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the guidance of a qualified healthcare provider with any questions or concerns you may have regarding your health or medications. Do not disregard or delay seeking professional medical advice based on information provided here. Treatment options may vary depending on individual circumstances, and only a healthcare professional can provide guidance tailored to your specific needs.