What is Hydroxyzine? Uses, Side Effects, Abuse Control and Treatment

Last Updated: May 20, 2024

David Levin Reviewed by David Levin
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Hydroxyzine is a versatile medication classified as an antihistamine for effectively treating allergic skin reactions.

However, since the drug known for its brand name Vistaril also acts as a sedative and opioid potentiator, its use has sparked debates, particularly surrounding its prescription as Vistaril. Researchers have raised questions about the drug’s addictive potential and safety.

In 2021, only in the U.S. were an estimated 11 million Hydroxyzine prescriptions. While Hydroxyzine is generally considered to have a low potential for addiction and abuse, as well as minimal risk of withdrawal symptoms, it is crucial to acknowledge the existing concerns of its administration.

What is Hydroxyzine?

Trade name: Vistaril (most common), but also available under brands like Atarax and Qiana

Generic name: Hydroxyzine

Hydroxyzine is a first-generation antihistamine medication with antihistaminic and anxiolytic properties. It is commonly prescribed for the treatment and control of anxiety and allergic conditions and as a sedative.

Hydroxyzine operates primarily by blocking the effects of histamine in the body. It exerts its action by antagonizing H1 receptors, alleviating allergic reaction symptoms. Hydroxyzine was approved in the United States in 1957 and continues to be widely used.

4 Hydroxyzine Medical Uses

Hydroxyzine is a versatile medication with several uses owing to its antihistaminic and anxiolytic properties. Some of the primary uses of hydroxyzine include:

Managing Anxiety:

  • Generalized Anxiety Disorder (GAD): Hydrozyxine is a common prescription for GAD, effectively reducing symptoms like worry, restlessness and muscle tension.
  • Premedication: In combination with other medications, Hydroxyzine is sometimes used before procedures to reduce anxiety and nausea.

Relieving Allergy Symptoms:

  • Histamine Blockage: As a first-generation antihistamine, Hydroxyzine combats allergic reactions by blocking histamine, a chemical causing itchiness, hives, and swelling.
  • Skin Reactions: It’s beneficial for alleviating allergic skin conditions like hives and eczema symptoms.

Promoting Sleep:

  • Mild Sedative Effect: Hydroxyzine’s sedative properties can aid in falling asleep and staying asleep, making it helpful for short-term management of insomnia.

Other Uses:

Hydroxyzine Side Effects

Common side effects of Hydroxyzine may include:

  • Drowsiness
  • Dry mouth
  • Blurred vision
  • Constipation
  • Urinary retention
  • Upset stomach
  • Headache
  • Confusion (especially in elderly people)
  • Nausea
  • Weight gain

Hydroxyzine Drug Interaction

Hydroxyzine may interact with various medications and substances, potentially affecting its effectiveness or increasing the risk of side effects. Some notable interactions with Hydroxyzine include:

Central Nervous System Depressants

Hydroxyzine can enhance the sedative effects of other central nervous system depressants, such as alcohol, benzodiazepines, and opioids. This combination can increase the risk of excessive sedation and respiratory depression.

Anticholinergic Medications

Combining Hydroxyzine with other drugs that have anticholinergic effects (e.g., certain antidepressants, antipsychotics, or medications for overactive bladder – Darifenacin, Tolterodine) may increase the risk of side effects like dry mouth, blurred vision, and constipation.

MAO Inhibitors (MAOIs)

Concurrent use of Hydroxyzine with MAOIs may lead to hypertensive crisis. It is generally advised to avoid using Hydroxyzine within 14 days of discontinuing MAOIs.

QT Prolonging Medications

Hydroxyzine may prolong the QT interval, and combining it with other medications that also have this effect (e.g., certain antiarrhythmics and antipsychotics) could increase the risk of serious cardiac arrhythmias.

CNS Stimulants

Stimulant medications, such as those used for attention deficit hyperactivity disorder (ADHD), may have reduced effectiveness when used concomitantly with Hydroxyzine.

What is Hydroxyzine Substance Abuse?

Hydroxyzine abuse refers to the non-medical use or misuse of Hydroxyzine. This medication is not typically considered to have a high potential for abuse compared to some other medications, but misuse can still occur.

Abuse of Hydroxyzine may involve:

Taking Higher-than-Prescribed Doses

Some individuals may take larger doses of Hydroxyzine than recommended by their healthcare provider to experience heightened sedative effects.

Combining with Other Substances

Hydroxyzine may be combined with other substances, such as alcohol or other drugs, to enhance its sedative or euphoric effects. This can be dangerous and increase the risk of adverse reactions.

Using Without a Prescription

Obtaining and using Hydroxyzine without a legitimate prescription from a healthcare professional is considered abuse.

Signs of Hydroxyzine Addiction

While the misuse of non-habit-forming medications such as Hydroxyzine may not initially pose significant dangers, there is a risk of addiction when patients develop tolerance. The indicators of Hydroxyzine abuse closely mirror those of overdose, and the same applies to Hydroxyzine addiction.

Here are some of the physical symptoms of Hydroxyzine addiction:

  • Extreme sedation
  • Dizziness
  • Seizures
  • Nausea and vomiting
  • Fever
  • Serious skin reactions, such as:
  • Rashes
  • Swelling and redness on the skin
  • Lesions
  • Restlessness and coordination problems
  • Trembling or shaking

Hydroxyzine Addiction and Abuse Control and Treatment

The treatment of hydroxyzine abuse typically involves a comprehensive approach that addresses the physical and psychological aspects of addiction. Here are some components commonly included in the treatment of hydroxyzine abuse:

Hydroxyzine Medical Detoxification

For individuals who have developed a physical dependence on Hydroxyzine, a supervised medical detoxification may be necessary. This involves gradually reducing the dosage to manage withdrawal symptoms.

Behavioral Therapy

Various forms of behavioral therapy, such as cognitive-behavioral therapy (CBT) or contingency management, can be effective in addressing the underlying issues and behaviors associated with hydroxyzine abuse.

Counseling and Support Groups

Individual counseling and participation in support groups can provide emotional support and help individuals develop coping mechanisms for stressors that may contribute to substance abuse.

Relapse Prevention Planning

Developing a relapse prevention plan is essential to help individuals recognize and manage potential triggers and stressors that could lead to a return to hydroxyzine abuse.

Hydroxyzine Vistaril Final Considerations

Hydroxyzine, commonly known by its brand name Vistaril, is a versatile medication with applications ranging from allergy management to anxiety and nausea control. Its antihistamine properties and anxiolytic and antiemetic effects make it a valuable tool in various medical contexts.

However, be careful with Hydroxyzine interactions, especially those with central nervous system depressant or anticholinergic effects. While Hydroxyzine is generally considered to have a low potential for abuse, monitoring for signs of misuse is essential for maintaining the medication’s therapeutic benefits and avoiding potential complications.

People Also Ask

What is Hydroxyzine mostly used for?

Hydroxyzine is primarily used to treat allergic conditions, such as itching, hives, and other symptoms related to allergic reactions. It works as an antihistamine, blocking the effects of histamine in the body, a natural substance contributing to allergic reactions.

Is Hydroxyzine just like Xanax?

Hydroxyzine and Xanax are distinct medications used for anxiety with different mechanisms of action. Hydroxyzine, an antihistamine, exhibits anxiolytic effects through serotonin receptor antagonism. Xanax, a benzodiazepine, enhances GABA neurotransmission.

How long does hydroxyzine last?

Hydroxyzine generally lasts 4 to 6 hours per dose, with the onset of action occurring within 15 to 30 minutes. Always follow your professional healthcare provider’s recommendations regarding dosage and frequency to manage your symptoms effectively and safely.

Can I take Hydroxyzine and Lexapro together?

While it is possible to take Lexapro and Hydroxyzine together, it should be done under the guidance and supervision of a professional healthcare provider due to the potential for increased sedation and other side effects. Always consult your physician before starting this combination to ensure it is appropriate.

Can you take hydroxyzine with Benadryl?

Combining Hydroxyzine and Benadryl is generally not recommended. They belong to the same drug class of antihistamines. Both medications are used to treat allergy symptoms and share a common mechanism of action. Combining these drugs can increase the risk of side effects such as drowsiness, dizziness, and impaired coordination.

How does Hydroxyzine make you feel?

The subjective experience of taking hydroxyzine can vary from person to person. As an antihistamine, it may cause drowsiness and sedation, making some individuals feel relaxed or sleepy. The anxiolytic effects may contribute to a sense of reduced anxiety.

Can you overdose on hydroxyzine?

Yes, it is possible to overdose on hydroxyzine, and doing so can be dangerous. An overdose can lead to serious health complications and requires immediate medical attention.

Is hydroxyzine a controlled substance?

No, hydroxyzine is not a controlled substance. It is a prescription medication commonly used to treat anxiety, allergies, and nausea, among other conditions. Because hydroxyzine does not have a high potential for abuse or dependence, it is not classified under the Controlled Substances Act. Although this medication is not typically considered to have a high potential for abuse, its misuse can still occur.

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Retrieved on February 27, 2024.

Published on: March 11th, 2020

Updated on: May 20th, 2024

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