Hydroxyzine: Uses, Dosage, and Side Effects Guide

Key Points About Hydroxyzine

Hydroxyzine is a prescription medication commonly used to treat a variety of conditions, including anxiety, allergic reactions, nausea, vomiting, and insomnia. It works by calming the central nervous system and blocking histamine, a chemical responsible for allergic symptoms. Hydroxyzine is available in several forms, such as tablets, capsules, and liquid. Always consult your healthcare provider before starting or adjusting your dosage. If you have questions, our telemedicine providers are here to help.

Hydroxyzine Medication Names

US Brand Name: Vistaril (Hydroxyzine)

US Brand Name: Atarax (Hydroxyzine)

The generic name, hydroxyzine, refers to the active ingredient in the medication, while brand names like Vistaril and Atarax are the commercially marketed versions.

Pharmacologic Categories of Hydroxyzine

Hydroxyzine belongs to several pharmacologic categories, each reflecting its diverse uses:

1. Antihistamine: Relieves symptoms of allergic reactions.
2. Anxiolytic: Helps manage anxiety symptoms.
3. Antiemetic: Reduces nausea and vomiting.
4. Sedative: Promotes relaxation and aids sleep.

Hydroxyzine Dosage Guidelines

Hydroxyzine is prescribed for a range of conditions, with dosages tailored to the specific medical need. Always follow your healthcare provider’s instructions and consult them before making any changes to your dosage. Our telemedicine providers are available to guide you through the process.

Hydroxyzine Dosage for Anxiety

Initial dose: 50-100 mg taken orally, up to 4 times daily.

Length of treatment: As directed by your healthcare provider.

Hydroxyzine Dosage for Allergic Reactions

Initial dose: 25 mg taken orally, 3-4 times daily.

Length of treatment: As directed by your healthcare provider.

Hydroxyzine for Insomnia

Initial dose: 50-100 mg taken orally at bedtime.

Length of treatment: As directed by your healthcare provider.

Hydroxyzine for Nausea and Vomiting

Initial dose: 25-100 mg taken orally or via intramuscular injection (IM), as needed.

Length of treatment: As directed by your healthcare provider.

Hydroxyzine for Dermatitis and Pruritus (Itching)

Initial dose: 25 mg taken orally, 3-4 times daily.

Length of treatment: As directed by your healthcare provider.

Hydroxyzine for Motion Sickness

Initial dose: 25-50 mg taken orally, 1 hour before travel.

Length of treatment: As needed or as directed by your healthcare provider.

Hydroxyzine for Sedation

Initial dose: 50-100 mg taken orally or via intramuscular injection (IM), as needed.

Length of treatment: As directed by your healthcare provider.

Hydroxyzine for Tension Headaches

Initial dose: 25-50 mg taken orally, 3-4 times daily.

Length of treatment: As directed by your healthcare provider.

Hydroxyzine Dosage Forms and Strengths

Hydroxyzine is available in the following forms and strengths:

1. Tablets: 10 mg, 25 mg, 50 mg
2. Capsules: 25 mg, 50 mg, 100 mg
3. Oral Suspension: 10 mg/5 mL
4. Intramuscular Injection: 25 mg/mL, 50 mg/mL

How to Take Hydroxyzine

Take hydroxyzine exactly as prescribed by your healthcare provider. It can be taken with or without food. If you are using the liquid form, be sure to measure your dose with a special measuring device or spoon to ensure accuracy. Avoid using household spoons, as they may result in incorrect dosing. If you miss a dose, take it as soon as you remember, unless it is close to the time of your next scheduled dose. Never double up on doses to make up for a missed one.

Hydroxyzine Side Effects and Adverse Reactions

As with any medication, hydroxyzine may cause side effects. While some are mild and common, others are rare but potentially serious. If you experience any side effects, contact your healthcare provider promptly. Our telemedicine providers are available to address your concerns.

Common Hydroxyzine Side Effects

1. Drowsiness: Feeling unusually tired or sleepy.
2. Dry mouth: A sensation of dryness or stickiness in the mouth due to reduced saliva production.
3. Dizziness: A feeling of lightheadedness or unsteadiness.

Less Common Hydroxyzine Side Effects

1. Headache: Mild to moderate pain in the head.
2. Blurred vision: Difficulty seeing objects clearly.
3. Confusion: Trouble thinking clearly or feeling mentally disoriented.

Serious Side Effects of Hydroxyzine (Rare)

1. Severe allergic reaction: Symptoms may include rash, itching, swelling (especially of the face, tongue, or throat), severe dizziness, or difficulty breathing.
2. Seizures: Sudden, uncontrolled electrical activity in the brain.
3. Irregular heartbeat: A sensation of a racing, pounding, or fluttering heartbeat.

Contraindications

A contraindication refers to a specific condition or situation in which using a particular medication could be harmful. If you have any of the following conditions or circumstances, it is important to avoid taking Hydroxyzine. Always consult your healthcare provider before starting any new medication to ensure it is safe for you.

Pregnancy: Hydroxyzine is not recommended during early pregnancy due to the potential risk of harm to the developing fetus. Studies suggest it may cause birth defects, especially if taken during the first trimester.

Prolonged QT Interval: Hydroxyzine can affect the heart’s electrical activity, potentially leading to a condition called QT prolongation. This can result in dangerous, irregular heart rhythms that may be life-threatening.

Severe Liver or Kidney Disease: Because Hydroxyzine is processed by the liver and kidneys, impaired function in these organs can cause the medication to accumulate in the body, increasing the risk of toxicity and adverse effects.

Allergy to Hydroxyzine or Similar Medications: If you have had an allergic reaction to Hydroxyzine or related medications, such as cetirizine (Zyrtec) or levocetirizine (Xyzal), you should avoid taking it to prevent severe allergic reactions.

Glaucoma: Hydroxyzine may increase pressure within the eye, which can worsen glaucoma or lead to complications in individuals with this condition.

Myasthenia Gravis: This medication can aggravate muscle weakness in individuals with myasthenia gravis, a condition that affects the communication between nerves and muscles.

Drug-to-Drug Interactions

Hydroxyzine can interact with other medications, potentially increasing side effects or reducing the effectiveness of one or both drugs. It is essential to inform your healthcare provider about all medications you are taking, including prescription drugs, over-the-counter medications, and dietary supplements. Some common interactions with Hydroxyzine include:

Other Antihistamines: Taking Hydroxyzine alongside other antihistamines, such as diphenhydramine (Benadryl) or cetirizine (Zyrtec), can intensify side effects like drowsiness and dry mouth.

Opioids: Combining Hydroxyzine with opioid medications, such as oxycodone (OxyContin) or hydrocodone (Vicodin), can increase sedation and the risk of respiratory depression, which can be dangerous.

Benzodiazepines: When used with benzodiazepines like diazepam (Valium) or lorazepam (Ativan), Hydroxyzine may enhance drowsiness and sedation, potentially impairing your ability to perform daily activities.

Monoamine Oxidase Inhibitors (MAOIs): Combining Hydroxyzine with MAOIs, such as phenelzine (Nardil), can heighten the risk of side effects like excessive drowsiness and confusion.

Alcohol: Drinking alcohol while taking Hydroxyzine can significantly increase drowsiness and impair cognitive functions, such as decision-making and operating machinery. It is best to avoid alcohol while on this medication.

Hydroxyzine in Pregnancy

Is it safe to take Hydroxyzine when pregnant?

Hydroxyzine is generally not recommended during pregnancy, particularly in the first trimester, due to the potential risk of birth defects. If you are pregnant or planning to become pregnant, it is crucial to discuss your options with your healthcare provider. They can help you weigh the risks and benefits and explore safer alternatives to manage your symptoms.

Hydroxyzine While Breastfeeding

Is it safe to take Hydroxyzine while breastfeeding?

Hydroxyzine is not advised for breastfeeding mothers. The medication can pass into breast milk and may cause drowsiness or other side effects in a nursing infant. Speak with your healthcare provider to identify safer alternatives that can effectively manage your symptoms while ensuring your baby’s safety.

Estimated Cost of Hydroxyzine

The cost of a 30-day supply of Hydroxyzine without insurance can vary depending on the dosage and the pharmacy you use. With a GoodRx coupon, the price for a 30-day supply of Hydroxyzine (25 mg tablets) typically ranges from $5 to $15. Prices may fluctuate, so it is a good idea to check with your pharmacy or use a discount service like GoodRx to find the most up-to-date pricing.

Possible Alternatives to Hydroxyzine

If Hydroxyzine is not the right option for you, there are several alternative treatments available, tailored to your specific condition. It’s important to consult your healthcare provider before making any changes to your treatment plan. You can also schedule a telemedicine appointment with one of our providers to explore these options in greater detail.

Alternatives for Anxiety

To manage anxiety, alternatives to Hydroxyzine include selective serotonin reuptake inhibitors (SSRIs) such as sertraline (Zoloft). Cognitive-behavioral therapy (CBT) is another highly effective option. Additionally, relaxation techniques like meditation, deep breathing exercises, and yoga may help reduce anxiety symptoms and promote a sense of calm.

Alternatives for Allergic Reactions

For allergic reactions, non-sedating antihistamines such as loratadine (Claritin) or cetirizine (Zyrtec) are effective alternatives. Taking steps to avoid known allergens and using air purifiers to reduce exposure to airborne irritants can also help minimize symptoms and improve overall comfort.

Alternatives for Insomnia

If you’re experiencing sleep difficulties, options like melatonin supplements, cognitive-behavioral therapy for insomnia (CBT-I), and practicing good sleep hygiene may be beneficial. Simple changes, such as reducing screen time before bed, maintaining a consistent sleep schedule, and creating a relaxing bedtime routine, can significantly improve sleep quality.

Alternatives for Nausea and Vomiting

For nausea and vomiting, medications like ondansetron (Zofran) are commonly used. Natural remedies, such as ginger supplements or ginger tea, may also provide relief. Staying hydrated and eating small, bland meals throughout the day can help ease symptoms and prevent further discomfort.

Alternatives for Dermatitis

To manage dermatitis, topical corticosteroids or emollient-rich moisturizers can be effective in reducing inflammation and soothing the skin. Avoiding known irritants and switching to hypoallergenic skin care products may also help prevent flare-ups and improve skin health.

Alternatives for Pruritus (Itching)

For itching, non-sedating antihistamines like fexofenadine (Allegra) or topical treatments such as calamine lotion can provide relief. Keeping your skin well-moisturized with fragrance-free lotions or creams can also help reduce dryness and itching.

Alternatives for Motion Sickness

If you use Hydroxyzine to manage motion sickness, alternatives include medications like meclizine (Antivert). Natural remedies, such as ginger supplements, may also be effective. To prevent symptoms, consider avoiding heavy meals before traveling and sitting in a stable part of the vehicle, such as near the center or over the wings of an airplane.

Alternatives for Sedation

When sedation is required for medical procedures, alternatives such as midazolam (Versed) or propofol may be used under the supervision of a healthcare professional. These medications are typically administered in controlled settings to ensure safety and effectiveness.

Alternatives for Tension Headaches

For tension headaches, over-the-counter pain relievers like ibuprofen (Advil) or acetaminophen (Tylenol) are often effective. Stress management techniques, including deep breathing exercises, progressive muscle relaxation, or massage therapy, can also help alleviate headache symptoms and reduce their frequency.

Recent Updates on Hydroxyzine Research

Recent studies have focused on Hydroxyzine’s safety profile, particularly its potential to cause changes in heart rhythm, known as QT prolongation. While Hydroxyzine remains effective for conditions such as anxiety and itching, it should be used with caution in individuals who are at risk for heart-related issues. Additionally, ongoing research is exploring its use in combination with other medications to enhance its effectiveness for anxiety and sleep disorders. Always consult your healthcare provider to stay informed about the latest research and how it may influence your treatment plan.

James Kingsley

Learn More