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Dear Readers! I started this blog when my daughter was in the NICU. She had ventriculitis. Her CSF report grew E.coli. But, she was injected Teicoplanin directly into her brain. The doctors made two errors here:

Teicoplanin is for gram-positive bacteria only. It does not treat E.coli.
Teicoplanin is not for intraventricular use. The manufacturer strongly discourage injecting Teicoplanin into the brain.

My daughter bled into the brain. She lived for another two years and ultimately died.

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Hydroxyzine (Atarax) - Uses, Dose, Side effects, MOA, Brands

Hydroxyzine (Atarax) is a first-generation antihistamine that is used in the treatment of allergies manifesting as sneezing, itching, pruritus, and runny nose. It is also used for vomiting, sedation, and anxiety.

Hydroxyzine (Atarax) Uses:

Oral:

Anxiety:
- Symptomatic alleviation for tension and anxiety related to psychoneurosis; adjuvant in conditions of organic disease where anxiety is present.
- Perioperative adjunct:
  - When used as a premedication and after general anaesthesia, as a sedative
Pruritus:
- Management of histamine-mediated pruritus and allergic diseases that cause it (such as atopic dermatitis, chronic urticaria, and contact dermatitis).

Intramuscular:

Allergic conditions:
- Adjunctive treatment for allergic diseases with a significant emotional component (eg, chronic urticaria, asthma, and pruritus).
Antiemetic:
- Controls nausea and vomiting.
Anxiety:
- Management of anxiety related to organic disorders; management of anxiety during dental procedures; management of anxiety during emotional stress; management of tension and psychomotor agitation.
- Note: should not be utilised as the only form of treatment for cases of depression that can be conclusively shown to be real.
- Perioperative adjunct:
  - As a pre- and postoperative supplementary drug to ease anxiety, manage emesis, and allow a reduction in opioid dosage.
- Peripartum adjunct:
  - As a prenatal and postpartum supplementary drug to reduce the need for opioids, reduce anxiety, and manage emesis

Dose in Adults

Hydroxyzine dose as Antiemetic:

IM: 25 to 100 mg per dose

Hydroxyzine dose in the treatment of Anxiety:

Oral:

Manufacturer’s labeling:
- 50 to 100 mg 4 times in a day.
Alternative recommendations (off-label dosing):
- 5 to 75 mg each day in divided doses.
- IM:
  - Initial: 50 to 100 mg, then every 4 to 6 hours as required.
Peripartum adjunct:
- IM: 25 to 100 mg.
Perioperative adjunct:
- Oral: 50 to 100 mg.
- IM: 25 to 100 mg.

Hydroxyzine Dose for Pruritus:

Oral: 25 mg 3 to 4 times a day.

Hydroxyzine dose in Children

Hydroxyzine Dose as antiemetic:

Note:

Experts advise against using hydroxyzine as a treatment option for postoperative nausea and vomiting (PONV); instead, newer medications with better safety profiles are usually substituted.
Infants, Children, and Adolescents:
- IM: 1.1 mg/kg/dose;
- The maximum dose: 100 mg per dose.

Hydroxyzine Dose in the treatment of Anxiety:

Note:

Despite being FDA-approved for use in treating anxiety, there is a lack of information regarding its use in paediatric patients. Expert recommendations for paediatric patients do not view hydroxyzine as a therapeutic option for the management of anxiety disorders (such as specific phobias, panic disorders, generalised anxiety disorders, separation anxiety, and PTSD); instead, they believe that newer, more potent medications have largely replaced it.
Children and Adolescents:
- Oral:
  - every 6 hours, 0.5 mg per kilogramme of body weight
  - Age-dependent maximum dose
    - Age less than 6 years: 12.5 mg per dose
    - age ≥6 years: 25 mg per dose.

Note:

Despite the dearth of available data, several specialists have suggested lower beginning doses for paediatric patients.
Experts advise a lower daily dosage for adults of 37.5 to 75 mg divided into two doses.

Hydroxyzine Dose for treating Pruritus as in allergic conditions:

Children and Adolescents:
- Age-directed dosing:
  - Children <6 years:
    - Oral: 12.5 mg 3 to 4 times a day.
  - Children ≥6 years and Adolescents:
    - Oral: 12.5 to 25 mg 3 to 4 times a day
    - Note: According to pharmacokinetic studies, because to the extended half-life, dosage once daily (at bedtime) or twice daily may be sufficient.
- Weight-directed dosing:
  - Patient weight ≤40 kg:
    - Oral: 2 mg per kg per day divided every 6 to 8 hours as needed;
    - The maximum dose: 25 mg per dose.
    - Note: According to pharmacokinetic studies, because to the lengthy half-life, dosage once daily (at bedtime) or twice daily may be sufficient.
  - Patient weight >40 kg:
    - Oral: 25 to 50 mg once in a day at bedtime or twice daily.

Hydroxyzine Dose for treating Pruritus as in opioid use:

Children and Adolescents:
- IM, Oral: 0.5 mg per kilogramme per dosage given as needed every 6 hours
- The typical upper limit is 50 mg per dose.

Hydroxyzine Dose for treating perioperative sedation as adjunctive treatment:

Note: Despite being FDA-approved, alternative medications have essentially taken the role of pre- and postoperative hydroxyzine.

Oral:

Children and Adolescents:
- 6 milligrammes per kilogramme, given once.
- 100 mg per dose is the maximum dosage.

IM:

Infants, Children, and Adolescents:
- A dosage of 1 mg per kilogramme
- 100 mg per dose is the maximum dosage.

Hydroxyzine Dose in the treatment of procedural sedation; as adjunctive treatment:

Children 2 to 12 years:
- Oral: Children have received a single dose of 1 mg per kg of body weight 30 to 45 minutes prior to the procedure, along with other sedatives (such midazolam or chloral hydrate), for dental operations or echocardiograms.
- 100 mg/dose is the maximum dosage.

Hydroxyzine Pregnancy Category: C

Hydroxyzine crosses over to the placenta.
After prolonged maternal use of hydroxyzine during pregnancy, neonates may experience withdrawal symptoms.
If systemic therapy is required, hydroxyzine can be used. However, it should be used with caution during pregnancy.
As an adjuvant therapy for pre- and postpartum, hydroxyzine can be used to alleviate anxiety, regulate emesis, reduce the dosage of opioids, or lower the risk of emesis.
Manufacturers warn against the use of early pregnancy. Other agents are better suited for treating nausea and vomiting.
For the treatment of pruritus caused by intrahepatic cholesterol in pregnancy, antihistamines should not be used.

Hydroxyzine use during breastfeeding:

It is unknown if breast milk contains hydroxyzine.
Second-generation antihistamines for breastfeeding women are preferable when treatment is required with an antihistamine.
Breastfed infants who were exposed to hydroxyzine have experienced sedation.
The manufacturer does not recommend breastfeeding.
If a first-generation antihistamine is administered to the newborn through breast milk, the manufacturer normally does not advise breastfeeding.
They need to be watched out for irritation and sleepiness symptoms.
Pregnancy may be affected by antihistamines.

Hydroxyzine Dose in Kidney disease:

Manufacturer's labeling doesn't provide any dosage adjustments;

GFR >50 mL/minute:
- No adjustment is necessary.
GFR ≤50 mL/minute:
- Administer 50 percent of the normal dose.
Continuous renal replacement therapy (CRRT):
- Administer 50 percent of the normal dose.
Intermittent hemodialysis:
- Administer 50 percent of the normal dose.
Peritoneal dialysis:
- Administer 50 percent of the normal dose.

Dose in Liver disease:

Manufacturer's labeling doesn't provided any dosage adjustments.
Changing the dosage frequency to every 24 hours is recommended for people with primary biliary cirrhosis.

Side effects of Hydroxyzine (Atarax):

Central nervous system:
- Drowsiness (transient)
Gastrointestinal:
- Xerostomia
Respiratory:
- Respiratory depression (high doses)

Contraindications to Hydroxyzine:

Early pregnancy
Extended QT interval
hypersensitivity to hydroxyzine and any other formulation ingredients

Additional contraindications

Oral: Hypersensitivity or levocetirizine/cetizine hypersensitivity
SubQ intravenous or IV delivery of an injection

Canadian labeling: Additional contraindications not in US labeling

Oral:
- significant bradycardia
- Family history of sudden cardiac deaths
- Significant electrolyte imbalance
- Use with QT-interval prolonging drugs, or CYP3A4/5 inhibitors in combination
- Porphyria
- hypersensitivity to ethylenediamine, aminophylline, and other piperazine compounds.
- Patients with asthma who have previously had a significant antihistamine-induced adverse bronchopulmonary impact

Warnings and precautions

Acute generalized exanthematous pustulosis:
- Acute global pustulosis (AGEP), a severe skin reaction that involves fever, pustules, and edematous broad regions, can only very rarely occur.
- If you experience a skin rash or an aggravation of any prior skin reactions, stop taking the drug right away.
  Stop therapy if you experience any symptoms or indicators that point to AGEP.
CNS depression:
- CNS depression can lead to mental or physical impairments.
- Patients should be cautious about driving, operating machinery, and other tasks that require mental alertness.
QT prolongation/ torsades de pointes:
- Has been documented, with the majority of cases happening in people who also have other torsades de pointes or QT prolongation risk factors (eg, preexisting cardiac disease, electrolyte imbalances, concomitant arrhythmogenic use).
- Patients with risk factors for QT prolongation, such as congenital long QT syndrome, a family history of long QT syndrome, or other diseases, such as recent myocardial damage, uncompensated cardiac failure, bradyarrhythmias, or others, should exercise caution.
- Patients with prolonged QT intervals should not take oral hydroxyzine.
Glaucoma:
- Patients with narrow-angle vision should be cautious. A cholinergic blockade could make the condition worse. Screening is highly recommended.
Prostatic hyperplasia/urinary restriction:
- Patients with prostatic hyperplasia or urinary stricture should be cautious.
Respiratory disease
- Patients with asthma or chronic obstruction of pulmonary disease (COPD) should be cautious.

Hydroxyzine: Drug Interaction

Risk Factor C (Monitor therapy)
Acetylcholinesterase Inhibitors	May diminish the therapeutic effect of Anticholinergic Agents. Anticholinergic Agents may diminish the therapeutic effect of Acetylcholinesterase Inhibitors.
Alcohol (Ethyl)	Alcohol's CNS depressing effect may be amplified by CNS depressants (Ethyl).
Alizapride	CNS depressants may have an enhanced CNS depressant impact.
Amantadine	May strengthen an anticholinergic agent's anticholinergic action.
Amezinium	Antihistamines may intensify Amezinium's stimulant effects.
Amphetamines	May lessen antihistamines' sedative effects.
Anticholinergic Agents	Other anticholinergic agents' negative or hazardous effects might be amplified.
Betahistine	Antihistamines may diminish the therapeutic effect of Betahistine.
Botulinum Toxin-Containing Products	May enhance the anticholinergic effect of Anticholinergic Agents.
Brexanolone	CNS Depressants may enhance the CNS depressant effect of Brexanolone.
Brimonidine (Topical)	May enhance the CNS depressant effect of CNS Depressants.
Bromopride	May enhance the CNS depressant effect of CNS Depressants.
Cannabidiol	May enhance the CNS depressant effect of CNS Depressants.
Cannabis	May enhance the CNS depressant effect of CNS Depressants.
Chloral Betaine	May enhance the adverse/toxic effect of Anticholinergic Agents.
Chlorphenesin Carbamate	May enhance the adverse/toxic effect of CNS Depressants.
CNS Depressants	HydrOXYzine may enhance the CNS depressant effect of CNS Depressants.
Dimethindene (Topical)	May enhance the CNS depressant effect of CNS Depressants.
Doxylamine	May enhance the CNS depressant effect of CNS Depressants. Management: The manufacturer of Diclegis (doxylamine/pyridoxine), intended for use in pregnancy, specifically states that use with other CNS depressants is not recommended.
Dronabinol	May enhance the CNS depressant effect of CNS Depressants.
Esketamine	May enhance the CNS depressant effect of CNS Depressants.
Gastrointestinal Agents (Prokinetic)	Anticholinergic Agents may diminish the therapeutic effect of Gastrointestinal Agents (Prokinetic).
Glucagon	Anticholinergic Agents may enhance the adverse/toxic effect of Glucagon. Specifically, the risk of gastrointestinal adverse effects may be increased.
Haloperidol	QT-prolonging Agents (Indeterminate Risk - Caution) may enhance the QTcprolonging effect of Haloperidol.
Itopride	Itopride's therapeutic impact may be diminished by anticholinergic drugs.
Kava Kava	May enhance the adverse/toxic effect of CNS Depressants.
Lofexidine	May enhance the CNS depressant effect of CNS Depressants. Management: Drugs listed as exceptions to this monograph are discussed in further detail in separate drug interaction monographs.
Magnesium Sulfate	May enhance the CNS depressant effect of CNS Depressants.
MetyroSINE	The sedative effects of metyroSINE may be strengthened by CNS depressants.
Mianserin	May strengthen an anticholinergic agent's anticholinergic action.
Minocycline	CNS depressants may have an enhanced CNS depressant impact.
Mirabegron	Anticholinergic drugs may make Mirabegron's harmful or hazardous effects worse.
Mirtazapine	The CNS depressing action of mirtazapine may be enhanced by CNS depressants.
Nabilone	CNS depressants may have an enhanced CNS depressant impact.
Nitroglycerin	Nitroglycerin absorption may be decreased by anticholinergic agents. Anticholinergic medications specifically have the potential to impede or prevent the absorption of nitroglycerin by reducing the breakdown of sublingual nitroglycerin pills.
Piribedil	CNS Depressants may enhance the CNS depressant effect of Piribedil.
Pitolisant	Antihistamines may diminish the therapeutic effect of Pitolisant.
Pramipexole	CNS Depressants may enhance the sedative effect of Pramipexole.
QT-prolonging Agents (Highest Risk)	QT-prolonging Agents (Indeterminate Risk - Caution) may enhance the QTc-prolonging effect of QT-prolonging Agents (Highest Risk). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk.
Ramosetron	Anticholinergic Agents may enhance the constipating effect of Ramosetron.
ROPINIRole	CNS Depressants may enhance the sedative effect of ROPINIRole.
Rotigotine	CNS Depressants may enhance the sedative effect of Rotigotine.
Rufinamide	May enhance the adverse/toxic effect of CNS Depressants. Specifically, sleepiness and dizziness may be enhanced.
Selective Serotonin Reuptake Inhibitors	CNS Depressants may enhance the adverse/toxic effect of Selective Serotonin Reuptake Inhibitors. Specifically, the risk of psychomotor impairment may be enhanced.
Tetrahydrocannabinol	May enhance the CNS depressant effect of CNS Depressants.
Tetrahydrocannabinol and Cannabidiol	May enhance the CNS depressant effect of CNS Depressants.
Thiazide and Thiazide-Like Diuretics	Anticholinergic Agents may increase the serum concentration of Thiazide and Thiazide-Like Diuretics.
Topiramate	Anticholinergic Agents may enhance the adverse/toxic effect of Topiramate.
Trimeprazine	CNS depressants may have an enhanced CNS depressant impact.
Risk Factor D (Consider therapy modification)
Barbiturates	Barbiturates' CNS depressive effects may be strengthened by Hydroxyzine. When using hydroxyzine along with a barbiturate, consider lowering the dose as necessary. Patients should be constantly watched for an excessive reaction to the combination when using it concurrently.
Benzylpenicilloyl Polylysine	Antihistamines may reduce Benzylpenicilloyl Polylysine's ability to diagnose. Management: Delay testing until systemic antihistaminic effects have subsided and discontinue systemic H1 antagonists for benzylpenicilloyl-polylysine skin testing. To determine whether permanent antihistaminic effects exist, a histamine skin test may be utilised.
Blonanserin	CNS Depressants may enhance the CNS depressant effect of Blonanserin.
Buprenorphine	CNS Depressants may enhance the CNS depressant effect of Buprenorphine. Management: Consider reduced doses of other CNS depressants, and avoiding such drugs in patients at high risk of buprenorphine overuse/self-injection. Initiate buprenorphine patches (Butrans brand) at 5 mcg/hr in adults when used with other CNS depressants.
Chlormethiazole	May enhance the CNS depressant effect of CNS Depressants. Management: Monitor closely for evidence of excessive CNS depression. The chlormethiazole labeling states that an appropriately reduced dose should be used if such a combination must be used.
Droperidol	May enhance the CNS depressant effect of CNS Depressants. Management: Consider dose reductions of droperidol or of other CNS agents (eg, opioids, barbiturates) with concomitant use. Exceptions to this monograph are discussed in further detail in separate drug interaction monographs.
Flunitrazepam	CNS Depressants may enhance the CNS depressant effect of Flunitrazepam.
Hyaluronidase	Antihistamines may reduce Hyaluronidase's therapeutic impact. Treatment: Standard doses of hyaluronidase may not produce the appropriate clinical response in patients using antihistamines (especially at higher doses). Hyaluronidase may be needed at higher doses.
HYDROcodone	The CNS depressive action of HYDROcodone may be enhanced by CNS depressants. Management: Whenever feasible, refrain from using hydrocodone and benzodiazepines or other CNS depressants concurrently. Only in the event that other treatment choices are insufficient should these medications be combined. Limit the duration and dosage of each medicine when used together.
Meperidine	Meperidine's CNS depressive action may be strengthened by Hydroxyzine. When taken in conjunction with hydroxyzine, management should take this into account. Patients should be constantly watched for an excessive reaction to the combination when using it concurrently.
Methotrimeprazine	CNS Depressants may enhance the CNS depressant effect of Methotrimeprazine. Methotrimeprazine may enhance the CNS depressant effect of CNS Depressants. Management: Reduce adult dose of CNS depressant agents by 50% with initiation of concomitant methotrimeprazine therapy. Further CNS depressant dosage adjustments should be initiated only after clinically effective methotrimeprazine dose is established.
Opioid Agonists	CNS Depressants may enhance the CNS depressant effect of Opioid Agonists. Management: Avoid concomitant use of opioid agonists and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug.
OxyCODONE	CNS Depressants may enhance the CNS depressant effect of OxyCODONE. Management: Avoid concomitant use of oxycodone and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug.
Perampanel	May enhance the CNS depressant effect of CNS Depressants. Management: Patients taking perampanel with any other drug that has CNS depressant activities should avoid complex and high-risk activities, particularly those such as driving that require alertness and coordination, until they have experience using the combination.
Pramlintide	May enhance the anticholinergic effect of Anticholinergic Agents. These effects are specific to the GI tract.
Secretin	Anticholinergic Agents may diminish the therapeutic effect of Secretin. Management: Avoid concomitant use of anticholinergic agents and secretin. Discontinue anticholinergic agents at least 5 half-lives prior to administration of secretin.
Sodium Oxybate	May enhance the CNS depressant effect of CNS Depressants. Management: Consider alternatives to combined use. When combined use is needed, consider minimizing doses of one or more drugs. Use of sodium oxybate with alcohol or sedative hypnotics is contraindicated.
Suvorexant	CNS Depressants may enhance the CNS depressant effect of Suvorexant. Management: Dose reduction of suvorexant and/or any other CNS depressant may be necessary. Use of suvorexant with alcohol is not recommended, and the use of suvorexant with any other drug to treat insomnia is not recommended.
Tapentadol	May enhance the CNS depressant effect of CNS Depressants. Management: Avoid concomitant use of tapentadol and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug.
Zolpidem	CNS Depressants may enhance the CNS depressant effect of Zolpidem. Management: Reduce the Intermezzo brand sublingual zolpidem adult dose to 1.75 mg for men who are also receiving other CNS depressants. No such dose change is recommended for women. Avoid use with other CNS depressants at bedtime; avoid use with alcohol.
Risk Factor X (Avoid combination)
Aclidinium	May enhance the anticholinergic effect of Anticholinergic Agents.
Azelastine (Nasal)	CNS Depressants may enhance the CNS depressant effect of Azelastine (Nasal).
Bromperidol	May enhance the CNS depressant effect of CNS Depressants.
Cimetropium	Anticholinergic Agents may enhance the anticholinergic effect of Cimetropium.
Eluxadoline	Anticholinergic Agents may enhance the constipating effect of Eluxadoline.
Glycopyrrolate (Oral Inhalation)	Anticholinergic Agents may enhance the anticholinergic effect of Glycopyrrolate (Oral Inhalation).
Glycopyrronium (Topical)	May enhance the anticholinergic effect of Anticholinergic Agents.
Ipratropium (Oral Inhalation)	May enhance the anticholinergic effect of Anticholinergic Agents.
Levosulpiride	Anticholinergic Agents may diminish the therapeutic effect of Levosulpiride.
Orphenadrine	The CNS depressing action of orphenadrine may be enhanced by CNS depressants.
Oxatomide	May strengthen an anticholinergic agent's anticholinergic action.
Oxomemazine	CNS depressants may have an enhanced CNS depressant impact.
Paraldehyde	CNS Depressants may enhance the CNS depressant effect of Paraldehyde.
Potassium Chloride	Anticholinergic Agents may enhance the ulcerogenic effect of Potassium Chloride. Management: Patients on drugs with substantial anticholinergic effects should avoid using any solid oral dosage form of potassium chloride.
Potassium Citrate	Anticholinergic Agents may enhance the ulcerogenic effect of Potassium Citrate.
Revefenacin	Anticholinergic Agents may enhance the anticholinergic effect of Revefenacin.
Thalidomide	CNS Depressants may enhance the CNS depressant effect of Thalidomide.
Tiotropium	Tiotropium's anticholinergic action may be strengthened by anticholinergic drugs.
Umeclidinium	May strengthen an anticholinergic agent's anticholinergic action.

Hydroxyzine: Drug Interaction

Risk Factor C (Monitor therapy)
Acetylcholinesterase Inhibitors	May diminish the therapeutic effect of Anticholinergic Agents. Anticholinergic Agents may diminish the therapeutic effect of Acetylcholinesterase Inhibitors.
Alcohol (Ethyl)	Alcohol's CNS depressing effect may be amplified by CNS depressants (Ethyl).
Alizapride	CNS depressants may have an enhanced CNS depressant impact.
Amantadine	May strengthen an anticholinergic agent's anticholinergic action.
Amezinium	Antihistamines may intensify Amezinium's stimulant effects.
Amphetamines	May lessen antihistamines' sedative effects.
Anticholinergic Agents	Other anticholinergic agents' negative or hazardous effects might be amplified.
Betahistine	Antihistamines may diminish the therapeutic effect of Betahistine.
Botulinum Toxin-Containing Products	May enhance the anticholinergic effect of Anticholinergic Agents.
Brexanolone	CNS Depressants may enhance the CNS depressant effect of Brexanolone.
Brimonidine (Topical)	May enhance the CNS depressant effect of CNS Depressants.
Bromopride	May enhance the CNS depressant effect of CNS Depressants.
Cannabidiol	May enhance the CNS depressant effect of CNS Depressants.
Cannabis	May enhance the CNS depressant effect of CNS Depressants.
Chloral Betaine	May enhance the adverse/toxic effect of Anticholinergic Agents.
Chlorphenesin Carbamate	May enhance the adverse/toxic effect of CNS Depressants.
CNS Depressants	HydrOXYzine may enhance the CNS depressant effect of CNS Depressants.
Dimethindene (Topical)	May enhance the CNS depressant effect of CNS Depressants.
Doxylamine	May enhance the CNS depressant effect of CNS Depressants. Management: The manufacturer of Diclegis (doxylamine/pyridoxine), intended for use in pregnancy, specifically states that use with other CNS depressants is not recommended.
Dronabinol	May enhance the CNS depressant effect of CNS Depressants.
Esketamine	May enhance the CNS depressant effect of CNS Depressants.
Gastrointestinal Agents (Prokinetic)	Anticholinergic Agents may diminish the therapeutic effect of Gastrointestinal Agents (Prokinetic).
Glucagon	Anticholinergic Agents may enhance the adverse/toxic effect of Glucagon. Specifically, the risk of gastrointestinal adverse effects may be increased.
Haloperidol	QT-prolonging Agents (Indeterminate Risk - Caution) may enhance the QTcprolonging effect of Haloperidol.
Itopride	Itopride's therapeutic impact may be diminished by anticholinergic drugs.
Kava Kava	May enhance the adverse/toxic effect of CNS Depressants.
Lofexidine	May enhance the CNS depressant effect of CNS Depressants. Management: Drugs listed as exceptions to this monograph are discussed in further detail in separate drug interaction monographs.
Magnesium Sulfate	May enhance the CNS depressant effect of CNS Depressants.
MetyroSINE	CNS Depressants may enhance the sedative effect of MetyroSINE.
Mianserin	May enhance the anticholinergic effect of Anticholinergic Agents.
Minocycline	May enhance the CNS depressant effect of CNS Depressants.
Mirabegron	Anticholinergic Agents may enhance the adverse/toxic effect of Mirabegron.
Mirtazapine	CNS Depressants may enhance the CNS depressant effect of Mirtazapine.
Nabilone	May enhance the CNS depressant effect of CNS Depressants.
Nitroglycerin	Anticholinergic Agents may decrease the absorption of Nitroglycerin. Specifically, anticholinergic agents may decrease the dissolution of sublingual nitroglycerin tablets, possibly impairing or slowing nitroglycerin absorption.
Piribedil	CNS Depressants may enhance the CNS depressant effect of Piribedil.
Pitolisant	Antihistamines may diminish the therapeutic effect of Pitolisant.
Pramipexole	CNS Depressants may enhance the sedative effect of Pramipexole.
QT-prolonging Agents (Highest Risk)	QT-prolonging Agents (Indeterminate Risk - Caution) may enhance the QTc-prolonging effect of QT-prolonging Agents (Highest Risk). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk.
Ramosetron	Anticholinergic Agents may enhance the constipating effect of Ramosetron.
ROPINIRole	CNS Depressants may enhance the sedative effect of ROPINIRole.
Rotigotine	CNS Depressants may enhance the sedative effect of Rotigotine.
Rufinamide	May enhance the adverse/toxic effect of CNS Depressants. Specifically, sleepiness and dizziness may be enhanced.
Selective Serotonin Reuptake Inhibitors	CNS Depressants may enhance the adverse/toxic effect of Selective Serotonin Reuptake Inhibitors. Specifically, the risk of psychomotor impairment may be enhanced.
Tetrahydrocannabinol	May enhance the CNS depressant effect of CNS Depressants.
Tetrahydrocannabinol and Cannabidiol	May enhance the CNS depressant effect of CNS Depressants.
Thiazide and Thiazide-Like Diuretics	Anticholinergic Agents may increase the serum concentration of Thiazide and Thiazide-Like Diuretics.
Topiramate	Anticholinergic Agents may enhance the adverse/toxic effect of Topiramate.
Trimeprazine	CNS depressants may have an enhanced CNS depressant impact.
Risk Factor D (Consider therapy modification)
Barbiturates	Barbiturates' CNS depressive effects may be strengthened by Hydroxyzine. When using hydroxyzine along with a barbiturate, consider lowering the dose as necessary. Patients should be constantly watched for an excessive reaction to the combination when using it concurrently.
Benzylpenicilloyl Polylysine	Antihistamines may reduce Benzylpenicilloyl Polylysine's ability to diagnose. Management: Delay testing until systemic antihistaminic effects have subsided and discontinue systemic H1 antagonists for benzylpenicilloyl-polylysine skin testing. To determine whether permanent antihistaminic effects exist, a histamine skin test may be utilised.
Blonanserin	CNS Depressants may enhance the CNS depressant effect of Blonanserin.
Buprenorphine	CNS Depressants may enhance the CNS depressant effect of Buprenorphine. Management: Consider reduced doses of other CNS depressants, and avoiding such drugs in patients at high risk of buprenorphine overuse/self-injection. Initiate buprenorphine patches (Butrans brand) at 5 mcg/hr in adults when used with other CNS depressants.
Chlormethiazole	May enhance the CNS depressant effect of CNS Depressants. Management: Monitor closely for evidence of excessive CNS depression. The chlormethiazole labeling states that an appropriately reduced dose should be used if such a combination must be used.
Droperidol	May enhance the CNS depressant effect of CNS Depressants. Management: Consider dose reductions of droperidol or of other CNS agents (eg, opioids, barbiturates) with concomitant use. Exceptions to this monograph are discussed in further detail in separate drug interaction monographs.
Flunitrazepam	CNS Depressants may enhance the CNS depressant effect of Flunitrazepam.
Hyaluronidase	Antihistamines may reduce Hyaluronidase's therapeutic impact. Treatment: Standard doses of hyaluronidase may not produce the appropriate clinical response in patients using antihistamines (especially at higher doses). Hyaluronidase may be needed at higher doses.
HYDROcodone	The CNS depressive action of HYDROcodone may be enhanced by CNS depressants. Management: Whenever feasible, refrain from using hydrocodone and benzodiazepines or other CNS depressants concurrently. Only in the event that other treatment choices are insufficient should these medications be combined. Limit the time and dosage of any medicine when taken together.
Meperidine	Meperidine's CNS depressive action may be strengthened by Hydroxyzine. When taken in conjunction with hydroxyzine, management should take this into account. Patients should be constantly watched for an excessive reaction to the combination when using it concurrently.
Methotrimeprazine	CNS Depressants may enhance the CNS depressant effect of Methotrimeprazine. Methotrimeprazine may enhance the CNS depressant effect of CNS Depressants. Management: Reduce adult dose of CNS depressant agents by 50% with initiation of concomitant methotrimeprazine therapy. Further CNS depressant dosage adjustments should be initiated only after clinically effective methotrimeprazine dose is established.
Opioid Agonists	CNS Depressants may enhance the CNS depressant effect of Opioid Agonists. Management: Avoid concomitant use of opioid agonists and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug.
OxyCODONE	CNS Depressants may enhance the CNS depressant effect of OxyCODONE. Management: Avoid concomitant use of oxycodone and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug.
Perampanel	May enhance the CNS depressant effect of CNS Depressants. Management: Patients taking perampanel with any other drug that has CNS depressant activities should avoid complex and high-risk activities, particularly those such as driving that require alertness and coordination, until they have experience using the combination.
Pramlintide	May enhance the anticholinergic effect of Anticholinergic Agents. These effects are specific to the GI tract.
Secretin	Anticholinergic Agents may diminish the therapeutic effect of Secretin. Management: Avoid concomitant use of anticholinergic agents and secretin. Discontinue anticholinergic agents at least 5 half-lives prior to administration of secretin.
Sodium Oxybate	May enhance the CNS depressant effect of CNS Depressants. Management: Consider alternatives to combined use. When combined use is needed, consider minimizing doses of one or more drugs. Use of sodium oxybate with alcohol or sedative hypnotics is contraindicated.
Suvorexant	CNS Depressants may enhance the CNS depressant effect of Suvorexant. Management: Dose reduction of suvorexant and/or any other CNS depressant may be necessary. Use of suvorexant with alcohol is not recommended, and the use of suvorexant with any other drug to treat insomnia is not recommended.
Tapentadol	May enhance the CNS depressant effect of CNS Depressants. Management: Avoid concomitant use of tapentadol and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug.
Zolpidem	CNS Depressants may enhance the CNS depressant effect of Zolpidem. Management: Reduce the Intermezzo brand sublingual zolpidem adult dose to 1.75 mg for men who are also receiving other CNS depressants. No such dose change is recommended for women. Avoid use with other CNS depressants at bedtime; avoid use with alcohol.
Risk Factor X (Avoid combination)
Aclidinium	May enhance the anticholinergic effect of Anticholinergic Agents.
Azelastine (Nasal)	CNS Depressants may enhance the CNS depressant effect of Azelastine (Nasal).
Bromperidol	May enhance the CNS depressant effect of CNS Depressants.
Cimetropium	Anticholinergic Agents may enhance the anticholinergic effect of Cimetropium.
Eluxadoline	Anticholinergic Agents may enhance the constipating effect of Eluxadoline.
Glycopyrrolate (Oral Inhalation)	Anticholinergic Agents may enhance the anticholinergic effect of Glycopyrrolate (Oral Inhalation).
Glycopyrronium (Topical)	May enhance the anticholinergic effect of Anticholinergic Agents.
Ipratropium (Oral Inhalation)	May enhance the anticholinergic effect of Anticholinergic Agents.
Levosulpiride	Anticholinergic Agents may diminish the therapeutic effect of Levosulpiride.
Orphenadrine	CNS Depressants may enhance the CNS depressant effect of Orphenadrine.
Oxatomide	May enhance the anticholinergic effect of Anticholinergic Agents.
Oxomemazine	May enhance the CNS depressant effect of CNS Depressants.
Paraldehyde	CNS Depressants may enhance the CNS depressant effect of Paraldehyde.
Potassium Chloride	Anticholinergic Agents may enhance the ulcerogenic effect of Potassium Chloride. Management: Patients on drugs with substantial anticholinergic effects should avoid using any solid oral dosage form of potassium chloride.
Potassium Citrate	Anticholinergic Agents may enhance the ulcerogenic effect of Potassium Citrate.
Revefenacin	Anticholinergic Agents may enhance the anticholinergic effect of Revefenacin.
Thalidomide	CNS Depressants may enhance the CNS depressant effect of Thalidomide.
Tiotropium	Anticholinergic Agents may enhance the anticholinergic effect of Tiotropium.
Umeclidinium	May enhance the anticholinergic effect of Anticholinergic Agents.

Monitoring parameters:

Relief of symptoms, blood pressure, and mental status

How to administer Hydroxyzine?

IM:

Exclusively for use in IM. To avoid accidentally injecting into a blood vessel, aspirate before injecting.
Don't give medications intravenously, subq, or intraarterially (contraindicated).
Deep in the big muscle, administer IM.
The upper outer quadrant of the buttock or mid-lateral thigh are the recommended sites.
To reduce the risk of harm to the sciatic nerve, the upper outside quadrant of the gluteal region should only be utilised when absolutely essential.
To prevent damaging the radial nerve, the deltoid region should only be utilised with care. The lower or middle third of the upper arm shouldn't be injected into.

Oral:

Without regard to food, administer.
Before using, give the suspension a good shake.

Mechanism of action of Hydroxyzine (Atarax):

Competes for H-1 receptor sites on effector cells of the respiratory, gastrointestinal, and blood vessel systems. It contains bronchodilator and skeletal muscle relaxation effects.

The onset of action:

Oral: 15 to 30 minutes;
IM: Rapid

Duration:

Decreased histamine-induced wheal and flare areas:
- 2 to ≥36 hours;
Suppression of pruritus:
- 1 to 12 hours.

Absorption:

Oral: Rapid

Metabolism:

Hepatic to multiple metabolites, including cetirizine (active)

Half-life elimination:

Children and Adolescents 1 to 14 years (mean age: 6.1 ± 4.6 years):
- 7.1 ± 2.3 hours;

Note: Half-life rose with age and ranged from 4 hours for patients under 1 year old to 11 hours for a child who was 14 years old.

Adults: ~20 hours;
Elderly: ~29 hours;
Hepatic dysfunction: ~37 hours.

Time to peak: Oral administration:

Serum: ~2 hours;
Peak suppression of antihistamine-induced wheal and flare: 4 to 12 hours

Excretion:

Urine; active metabolite (cetirizine) is renally eliminated.

International Brands of Hydroxyzine:

Vistaril
Atarax Uce
Ataraxone
Aterax
Bestalin
Centilax
Dalun
Disron-P
Dormirex
Drotizin
Evazine
Fasarax
Fedox
Hadarax
Hiderax
Atarax
NOVO-Hydroxyzin
PMS-HydrOXYzine
PMS-HydrOXYzine HCl
Arax
Artica
Atarax
Hidroxin
Hidroxina
Histan
Histarax
Hixizine
Hizin
Hydarax
Hytis
Iremofar
Iterax
Nexit
Nirax
Paxistil
Pergo
Polizine
Prurid
Prurizin
Qualidrozine
Roxyzin
Sedazine
Serecid
Ucerax
Vistaril
Warazix
Xyril

Hydroxyzine Brand Names in Pakistan:

Hydroxyzine Tablets 10 Mg in Pakistan
Atarax	Glaxosmithkline
Meditrax	Mediate Pharmaceuticals (Pvt) Ltd
Nustaril	Neutro Pharma (Pvt) Ltd.
Polex	Zinta Pharmaceuticals Industries
Roxyzin	Valor Pharmaceuticals

Hydroxyzine Tablets 25 Mg in Pakistan
Atarax	Glaxosmithkline
Meditrax	Mediate Pharmaceuticals (Pvt) Ltd
Nustaril	Neutro Pharma (Pvt) Ltd.
Roxyzin	Valor Pharmaceuticals

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Emedz.net is not an online pharmacy:

We are not affiliated with any pharmaceutical companies:

Hydroxyzine (Atarax) - Uses, Dose, Side effects, MOA, Brands

Hydroxyzine (Atarax) Uses:

Oral:

Anxiety:

Pruritus:

Intramuscular:

Allergic conditions:

Antiemetic:

Anxiety:

Dose in Adults

Hydroxyzine dose as Antiemetic:

Hydroxyzine dose in the treatment of Anxiety:

Manufacturer’s labeling:

Alternative recommendations (off-label dosing):

Hydroxyzine Dose for Pruritus:

Hydroxyzine dose in Children

Hydroxyzine Dose as antiemetic:

Infants, Children, and Adolescents:

Hydroxyzine Dose in the treatment of Anxiety:

Children and Adolescents:

Hydroxyzine Dose for treating Pruritus as in allergic conditions:

Children and Adolescents:

Hydroxyzine Dose for treating Pruritus as in opioid use:

Children and Adolescents:

Hydroxyzine Dose for treating perioperative sedation as adjunctive treatment:

Children and Adolescents:

Infants, Children, and Adolescents:

Hydroxyzine Dose in the treatment of procedural sedation; as adjunctive treatment:

Children 2 to 12 years:

Hydroxyzine Pregnancy Category: C

Hydroxyzine use during breastfeeding:

Hydroxyzine Dose in Kidney disease:

Dose in Liver disease:

Side effects of Hydroxyzine (Atarax):

Central nervous system:

Gastrointestinal:

Respiratory:

Contraindications to Hydroxyzine:

Warnings and precautions

Acute generalized exanthematous pustulosis:

CNS depression:

QT prolongation/ torsades de pointes:

Glaucoma:

Prostatic hyperplasia/urinary restriction:

Respiratory disease

Monitoring parameters:

How to administer Hydroxyzine?

Mechanism of action of Hydroxyzine (Atarax):

International Brands of Hydroxyzine:

Hydroxyzine Brand Names in Pakistan:

Hydroxyzine Tablets 10 Mg in Pakistan

Hydroxyzine Tablets 25 Mg in Pakistan

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