Hydroxyzine Interactions: Drugs, Foods and Drinks to Avoid

Last Updated: May 24, 2024

David Levin Reviewed by David Levin
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Hydroxyzine, an antihistamine with anticholinergic and sedative properties, is widely recognized for its effectiveness in treating anxiety, allergies and symptoms of the common cold.

In 2021, this medication ranked as the 58th most frequently prescribed drug in the U.S., with over 11 million prescriptions. Given its widespread use, understanding hydroxyzine interactions is a first aid emergency kit since certain combinations can worsen side effects or reduce hydroxyzine’s effectiveness.

Continue reading to explore potential interactions between hydroxyzine and various substances and learn how to navigate hydroxyzine use safely.

Hydroxyzine Overview

Hydroxyzine is a first-generation antihistamine classified under the piperazine class of antihistamines. Hydroxyzine possesses anticholinergic, antiemetic and sedative properties, making it a handy choice for various therapeutic applications such as:

  • Allergies: It helps relieve itching and hives caused by allergic reactions.
  • Anxiety: Hydroxyzine’s calming effects make it useful for managing anxiety symptoms.
  • Sleep aid: Hydroxyzine is used short-term to promote relaxation and improve sleep before surgery.

It operates primarily by inhibiting the action of histamine—a chemical messenger involved in allergic reactions—thereby reducing symptoms such as itching, swelling, and rashes and managing anxiety and tension in adults and children. It’s available in several forms, including tablets, capsules, syrup, and injections.

Hydroxyzine Interactions: Drugs to Avoid

Hydroxyzine’s effectiveness and safety profile can be significantly influenced by its interactions with other drugs.

Understanding these hydroxyzine drug interactions is crucial for minimizing adverse effects and maximizing therapeutic efficacy. When combining hydroxyzine with other medications, it’s essential to be aware of the following drugs to avoid or use with caution:

Central Nervous System (CNS) Depressants

The concurrent use of hydroxyzine with other CNS depressants like opioids (i.e., oxycodone, morphine, and hydrocodone-acetaminophen), benzodiazepines (i.e., lorazepam and diazepam), barbiturates and muscle relaxants (i.e., cyclobenzaprine, metaxalone, and methocarbamol) can lead to enhanced sedation, respiratory depression and decreased cognitive function.

When administered alongside hydroxyzine, it’s recommended for the dosages of these drugs to be reduced by 50%.

Anticholinergic Agents

Hydroxyzine has anticholinergic effects, and using it alongside other anticholinergic drugs, such as certain antipsychotics (i.e., quetiapine and risperidone), tricyclic antidepressants, and antiparkinson agents, can increase the risk of anticholinergic side effects, including dry mouth, blurred vision, constipation, and urinary retention.


Combining hydroxyzine with selective serotonin reuptake inhibitors (SSRIs), like fluoxetine (Prozac), citalopram (Celexa), and Lexapro, can increase the risk of serotonin syndrome, a potentially life-threatening condition resulting from an excess of serotonin in the brain.

Symptoms of serotonin syndrome can include agitation, hallucinations, rapid heart rate, fluctuating blood pressure, increased body temperature, hyperreflexia (exaggerated reflexes) and gastrointestinal symptoms like nausea, vomiting, and diarrhea. In severe cases, serotonin syndrome can lead to seizures, irregular heartbeat, and unconsciousness.

QT Prolonging Drugs

Hydroxyzine has been associated with dose-dependent QT interval prolongation (interval on an ECG represents the time it takes for the heart to depolarize and repolarize).

Combining it with other medications known to prolong the QT interval (such as certain antiarrhythmics, antipsychotics, and antibiotics) may increase the risk of serious cardiac arrhythmias like Torsades de Pointes (a serious type of ventricular tachycardia).

Other Common Hydroxyzine Drug Interactions

Hydroxyzine Interactions with Xanax

Combining hydroxyzine with Xanax, a benzodiazepine used primarily to treat anxiety and panic disorders, can enhance the central nervous system (CNS) depressant effects of both drugs. This interaction may increase sedation, drowsiness, and decreased cognitive function.

Hydroxyzine Interactions with Vitamins

There are no well-documented, direct adverse interactions between hydroxyzine and most vitamins at typical supplemental doses.

However, it’s always sensible to approach any combination of medication and supplements cautiously. Certain vitamins at high doses or herbal supplements with sedative properties (such as valerian root or St. John’s Wort) could amplify hydroxyzine’s sedative effects.

Hydroxyzine interactions with Ibuprofen

Hydroxyzine and ibuprofen, a nonsteroidal anti-inflammatory drug (NSAID), are generally considered safe to use together for most individuals. There isn’t a significant interaction between these two medications. However, both drugs can cause gastrointestinal (GI) upset or discomfort.

Propranolol Hydroxyzine Interactions

Propranolol, a beta-blocker used to manage hypertension, anxiety and other conditions, can be safely used with hydroxyzine for most people. However, since both medications can lower blood pressure and slow heart rate, there is a potential for additive effects that could lead to hypotension or bradycardia in some individuals.

Allegra and Hydroxyzine Interactions

Hydroxyzine’s sedative effects could minimize Allegra’s non-sedating property, leading to increased drowsiness or sedation. This is particularly important for individuals who need to maintain alertness for activities such as driving or operating machinery.

Hydroxyzine Interactions: Foods to Avoid

When taking hydroxyzine, it’s relatively uncommon for specific foods to have a direct, adverse interaction with the medication in the way that certain drugs might. However, be mindful about:

  • Grapefruit interferes with drug breakdown, increasing hydroxyzine levels in your bloodstream.
  • Moderate foods are high in tyramine as it can affect blood pressure in some individuals.

Since there is evidence that hydroxyzine may affect blood pressure, it’s important to be cautious with substances that have similar effects.

Hydroxyzine Interactions: Drinks to Avoid

Unlike foods, certain beverages can interact with the medication, potentially leading to adverse effects or affecting its efficacy. Here are drinks to consider avoiding or consuming with caution:

Hydroxyzine Interactions with Alcohol

Alcohol is the most significant drink to avoid while taking hydroxyzine. The combination can significantly increase the sedative effects of hydroxyzine, leading to heightened drowsiness, impaired motor skills and decreased cognitive function.

This interaction can pose serious risks, especially when it comes to activities that require alertness. It’s best to abstain from alcohol consumption during your course of hydroxyzine.

Hydroxyzine Interactions with Caffeine

While not as serious as alcohol, caffeinated drinks like coffee, tea, energy drinks, and some sodas might also be consumed with caution.

Hydroxyzine has sedative effects that can be counteracted by the stimulatory impact of caffeine. This could potentially reduce the effectiveness of hydroxyzine in managing conditions like anxiety and insomnia. Monitoring your response to this combination and adjusting intake as necessary can help manage potential interactions.

When to Seek a Doctor

If you are taking hydroxyzine and experience any of the following, you should seek medical attention promptly:

  • If you feel excessively sleepy or have trouble staying awake during the day.
  • Any unusual mental changes, including difficulty concentrating or memory problems.
  • Any sensation of a racing, pounding, or irregular heartbeat.
  • Any new symptoms that develop or existing symptoms that worsen after starting hydroxyzine.
  • If you have concerns about your medication, such as side effects or interactions.

Hydroxyzine Interactions − Bottom Line

Hydroxyzine can interact with various medications, including CNS depressants, SSRIs, QT-prolonging agents, anticholinergic drugs, and even antibiotics, potentially leading to serious side effects like enhanced sedation, serotonin syndrome, and heart arrhythmias.

Remember, this is not an exhaustive list. Always disclose all medications you are taking, including over-the-counter drugs and supplements, before starting hydroxyzine. If you experience severe drowsiness, confusion, irregular heartbeats, or any other concerning symptoms, seek medical attention immediately.

People Also Ask

Can loratadine and hydroxyzine be taken together?

Loratadine and hydroxyzine are both antihistamines and may increase sedation. Avoiding this combination unless your doctor’s approval and guidance is best.

What can you not take with hydroxyzine?

Avoid taking hydroxyzine with alcohol, CNS depressants (like benzodiazepines or opioids), and drugs that prolong the QT interval, as these combinations can increase sedation and risk of adverse effects.

Is 25mg of hydroxyzine strong for anxiety?

For treating anxiety, the typical initial dosage ranges from 50 mg to 100 mg of hydroxyzine daily, divided into 12.5-mg to 25-mg doses taken two to four times a day. The maximum recommended dosage for adults is 100 mg, taken up to four times daily.

Page Sources

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  5. Kiningham, K. K. (2007). Hydroxyzine. XPharm: The Comprehensive Pharmacology Reference, 1-5. https://doi.org/10.1016/B978-008055232-3.61902-6
  6. Khan, S., Saud, S., Khan, I., Asif, M., Ismail, O., Salam, A., Yang, T. J., & Norville, K. J. (2018). Serotonin Syndrome Presenting with Concomitant Tramadol and Diphenhydramine Use: A Case Report of an Unlikely Side-Effect. Cureus, 10(4). https://doi.org/10.7759/cureus.2421
  7. Schlit, F., Delaunois, A., Colomar, A., Claudio, B., Cariolato, L., Boev, R., Valentin, P., Peters, C., Sloan, V. S., & G. Bentz, J. W. (2017). Risk of QT prolongation and torsade de pointes associated with exposure to hydroxyzine: Re‐evaluation of an established drug. Pharmacology Research & Perspectives, 5(3). https://doi.org/10.1002/prp2.309
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Published on: March 11th, 2020

Updated on: May 24th, 2024


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