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.
- Oral:
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.
- Children <6 years:
-
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.
- Patient weight ≤40 kg:
-
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.
|
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. |
|
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. |
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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. |
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Flunitrazepam |
CNS Depressants may enhance the CNS depressant effect of Flunitrazepam. |
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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. |
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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. |
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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. |
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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. |
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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) |
|
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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 |
