Hydroxyzine

Medically Reviewed by HaVy Ngo, Pharm.D.

Last Reviewed: Jun 10, 2022

Warnings

What are the risks of taking hydroxyzine?

Hydroxyzine can cause serious health issues that are even higher risk for certain groups. Talk to your doctor or pharmacist about other options if you have any worries or concern.
Birth defects:

There is not enough data to establish safety in early pregnancy. Therefore, hydroxyzine is contraindicated in early pregnancy. ts to check kidney function before starting lisinopril.

Prolonged QT interval:
Risk factors:Personal or family history of long QT syndrome; pre-existing heart disease; electrolyte imbalances; concurrent use of other drugs that can cause irregular heart rhythm.

Long QT syndrome is a heart rhythm condition causing fast, irregular heartbeat. Hydroxyzine can cause or worsen long QT syndrome. However, it is more prevalent in patients who already have one of the above risk factors. Inform your healthcare provider if you have a personal or family history of heart disease.

Increased risk of CNS (central nervous system) depression:
Risk factors: Concurrent use of other CNS depressant drugs and alcohol

Hydroxyzine can cause severe drowsiness, impaired thinking, and reactions. Patients receiving hydroxyzine should not drive or perform any activities that require mental alertness while taking hydroxyzine. You should not take other CNS depressant medications such as narcotics, non-narcotic pain medicines, barbiturates, or drink alcohol during hydroxyzine treatment, as these combinations can worsen drowsiness and enhance sedation. Therefore, when CNS depressant drugs are administered concomitantly with hydroxyzine, your doctor may decrease the dosage of the CNS depressants.

Increased risk of over-sedation and confusion:
Risk factor: Being 65 years and older

In addition to concomitant diseases and medications, elderly patients of 65 years and older typically have decreased liver, kidney, and heart function. Sedating drugs such as hydroxyzine may cause over-sedation and confusion in these patients. Therefore, patients in this age group should be started on low doses of hydroxyzine and monitored closely for sedation and adverse effects.

What should I tell my doctor before starting hydroxyzine?

You should tell your doctor if you are pregnant, as hydroxyzine may cause birth defects. It is unknown if hydroxyzine passes into breast milk; discuss with your doctor before breastfeeding while using hydroxyzine.

Let your healthcare professional know if you are allergic to hydroxyzine or if:

You are allergic to certirizine (Zyrtec) or levocetirizine (Xyzal)
You have a personal or family history of long QT syndrome
You recently had a heart attack

To ensure the most safety, inform your doctor if you have any of the following problems:

Glaucoma
Stomach or intestinal blockage
Urinary problems or bladder obstruction
Heart disease
Personal or family history of long QT syndrome
Electrolyte imbalances such as abnormal blood levels of potassium or sodium

What proper medical care should I take while on hydroxyzine?

Do not drive, operate hazardous machinery, or perform activities requiring mental alertness as hydroxyzine can impair your thinking and reactions.
Avoid taking other CNS depressants or drinking alcohol while on hydroxyzine.
If you use hydroxyzine for anxiety, let your doctor knows if your anxiety does not improve or worsen after a few months. There is no data regarding hydroxyzine’s efficacy and safety for the treatment of anxiety for longer than 4 months.
If you are 65 years or older, your family members or caregivers should be familiarized with the symptoms of oversedation as you are more prone to this adverse effect and confusion.
If you are getting skin tests for allergies, tell your doctor and laboratory personnel that you are taking hydroxyzine.
Hydroxyzine is for IM (intramuscular) injection only; do not inject hydroxyzine intravenously. Intravenous formulations are unavailable due to the risk of hemolysis (the breakdown of red blood cells).

What drugs can interact with hydroxyzine?

Drugs that make you drowsy or sleepy - taking hydroxyzine with other drugs that make you drowsy or sleepy can worsen this effect. Let your doctor know if you take narcotic pain medications, sleeping pills, muscle relaxers, or medicines to treat seizures, anxiety, or depression.
Drugs that can cause abnormal heart rhythm - antibiotics, antidepressants, antipsychotic drugs, and medicines to treat cancer, HIV/AIDS, malaria.

This is not a complete list. Other drugs, including prescriptions, over-the-counter products, herbal supplements, and vitamins, may interact with hydroxyzine. Not all potential drug interactions are listed in this guide. It is highly recommended to keep a list of all the drug products you are using (prescriptions, over-the-counter products, herbal supplements, natural products, and vitamins) and share it with your doctor and pharmacist.

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