Hydroxyzine Interactions: Is It Safe To Combine It With Other Substances?

Last Updated: July 22, 2021

Authored by Dr. Ahmed Zayed

Reviewed by Michael Espelin APRN

Hydroxyzine, under the brand name Vistaril, is under the drug class antiemetics and its main use is an antihistamine and additional use is for the treatment of seasonal allergic rhinitis. In 2018, around 3 million patients in the United States used this medication, and according to a study, there is a risk for drug-drug interactions to occur when patients using this medication are taking it out of the hospital. Moreover, the severity of interactions depends on the type of drug it interacts with. Some interactions can lead to fatal side effects like heart disease, while others only enhance drowsiness. In this article, information about Hydroxyzine interactions such as mixing it with alcohol, weed, interaction of Hydroxyzine and Benadryl, stimulants, antidepressants, opioids, sedatives, benzodiazepines, and NSAIDS, and how to avoid dangerous drug interactions will be provided.

Mixing Vistaril And Alcohol

Hydroxyzine interactions with alcohol is considered a food-drug interaction. According to a study, Vistaril is not a depressant, and its use leads to sedative effects due to the suppression activity of the drug in the central nervous system. Alcohol, on the other hand, is a depressant. So, taking it with alcohol produces a moderate to high drug interaction in the body.

When taken together, Vistaril and Alcohol could serve as CNS depressants and, thus, through the concomitant use, will produce a variety of undesired effects especially during pregnancy. In another study, alcohol enhances the effects of Vistaril on the central nervous system which leads to severe drowsiness, impaired cognitive function, loss of consciousness, decreased motor skills, and respiratory depression. In the same study, this interaction is more pronounced in elderly people with health conditions.

Mixing Vistaril And Alcohol.

Vistaril And Weed

This type of interaction is considered as drug-drug interaction and synergism. Synergism means when these two drugs are combined, much greater effects, which could be dangerous to one’s health, can be seen. According to a study, weed has sedative effects like that of Vistaril. For this reason, it can be said that the interaction of Hydroxyzine and weed is more likely the same as the interaction of alcohol and Vistaril. Taking it and weed together is dangerous not only to the health but also to life. When these two are taken together, severe drowsiness may occur which can lead to accidents including fatal road mishaps when a person using it is operating machinery.

Additionally, mixing them together reduces the alertness and clear vision of a person, increased fatigue, and severe sedation.

Mixing Vistail And Antihistamine

One use of Vistaril is an antihistamine and it works by suppressing the histamines in the body. It must be stressed, though, that Hydroxyzine interactions with other antihistamines can cause more problems than they solve if they are consumed without the instructions of a medical doctor. Moreover, it is possible to take two different antihistamines together but only a medical doctor can tell what antihistamine medications can be combined, what are the proper dosage strengths, and the frequency.

According to a study, mixing Vistaril with other antihistamines may cause overdose and symptoms such as increased daytime somnolence, increased drowsiness, and blurred vision. In the same study, topical antihistamines, such as Diphenhydramine cream, ointment, and spray), can also cause drug interactions which lead to increased antihistamine effects. One of the most frequent inquiries is whether Hydroxyzine and Benadryl can be mixed.

Hydroxyzine And Benadryl

Although allergic reactions rarely occur when taking Vistaril, combining it with another antihistamine is  dangerous to the health and one example of this is Benadryl. Hydroxyzine and Benadryl are FDA-approved antihistamines but for the former prescription is needed. Combining them together produces a moderate drug interaction. This means that the combination is undesirable due to the side effects it provokes.

Side effects of the interaction of these drugs include worsening symptoms of drowsiness, problems with urinating, cognitive problems like memory loss, blurred vision, dry mouth, heat intolerance, flushing, irregular heartbeat, abdominal cramping, and constipation. According to a study, taking Hydroxyzine and Benadryl together causes cardiac toxicity since there is an increased risk of QT prolongation (delay in the beating of the heart) and torsades de pointes (life-threatening heart rhythm disturbances) to occur.

Taking Hydroxyzine And Stimulants

Vistaril is considered a downer (depressants or tranquilizing drugs), while stimulants are uppers (increase energy and alertness). In general, it is unsafe to combine these groups of drugs as the combination may yield a hip of negative consequences on the patient’s body. At the same time, the outcome of interaction depends on the potency of the drugs used, as well as the time Vistaril stays in the system.

Moreover, the interaction between these drugs is considered as drug-drug interactions with antagonistic effects, meaning, one drug may block the effect of the other drug. In this section, information about the interaction of this drug with Adderall and caffeine will be provided.

Hydroxyzine And Adderall

There aren’t many major interactions between Hydroxyzine and Adderall. Most of the interactions are based on the dose of the medication. In this case, Vistaril is a potent downer that has the ability to lessen stimulatory activity of stimulants such as Adderall. In one study, it was reported that antihistamines like Hydroxyzine affect what the body does to the stimulant. Moreover, the side effects of taking Hydroxyzine and Adderall cause certain dangers to the health such as changes in the blood pressure of a patient which can lead to irregular heart rhythms and stroke.

Hydroxyzine And Caffeine

When taking Vistaril or any other medications, it is important to understand that diet is a great factor in optimizing the effectiveness of the medications being taken. Hydroxyzine and caffeine interaction is considered as food-drug interaction. Vistaril increases sedation while Caffeine decreases sedation. When a patient consumes caffeine, anxiety may occur and alertness may increase.

However, as the patient takes Vistaril, the anxiety is reduced and drowsiness will come. This Hydroxyzine and caffeine interaction, then, can be considered as antagonistic.

Mixing Vistarl And Antidepressants

The interaction between these two drug types can be considered as drug-drug interaction with synergistic effects and such drugs must not be taken together especially during pregnancy. Vistaril is used to treat allergic reactions, anxiety and relieving tension, which is similar to antidepressants. According to a study, mixing Hydroxyzine and antidepressants potentially cause heart problems, dizziness, and confusion. Moreover, elderly patients who accidentally consume these two drugs together may experience impaired thinking and judgment and decreased motor coordination. In this section, information about Hydroxyzine interactions such as Zoloft and Vistaril, Lexapro and Hydroxyzine, and Trazodone and Hydroxyzine will be provided.

Vistaril And Zoloft

Vistaril is an antihistamine while Zoloft is under the drug class Selective Serotonin Reuptake Inhibitor (SSRI) and both drugs are prescription medications. Mixing these two together causes a moderate drug interaction. However, even if the interaction is just moderate, patients may feel some side effects or symptoms such as problems focusing and concentrating, drowsiness, and impaired judgment. Moreover, Mixing these two together with alcohol can have fatal consequences for activities like driving. It is advisable for patients who are using these medications to not operate any machinery.

Lexapro And Hydroxyzine

Lexapro and Hydroxyzine interaction can lead to heart problems, such as irregular heart beating. Though this effect is rare, patients with existing cardiovascular disease are vulnerable and require an alternative combination of drugs for their main diagnosis. According to a study, taking Lexapro and Hydroxyzine together increases the risk of QT prolongation and Torsade de Pointes (a deadly rhythm of the heart). Additionally, patients with pre-existing diseases and conditions, electrolyte abnormalities such as unstable Potassium levels, and concurrent therapy with other drugs that affect heart rhythms must be cautious in this interaction in order to avoid deadly events.

Trazodone And Hydroxyzine

Trazodone and Hydroxyzine interactions are considered drug-drug. Trazodone is an antidepressant that is used to reduce anxiety and it works by balancing the serotonin levels in the brain. Taking Trazodone and Hydroxyzine together increases the risk of irregular heart rhythm to occur. Although this is rare and depends on the dose, it is still life-threatening. Moreover, the severity of QT prolongation can be increased when Trazodone and Hydroxyzine are combined.

Mixing Vistarl And Antidepressants.

Combining Vistaril And Opioids

Generally, in Hydroxyzine interactions with Opioids, the former enhances the effects of the latter and this type of interaction has potentiation effects. Potentiation means an addition of drug A with drug B to make drug B more potent. An example of an Opioid drug that may interact with Vistaril is Tramadol and information about it will be tacked below.

Vistaril and Tramadol

Taking these two together causes severe central nervous system depression that may lead to dangerous respiratory disease and distress, coma, and even death. According to a study, Tramadol overdose may occur when these two are taken together, leading to refractory shock which requires life support.

Mixing Hydroxyzine And Sedatives

Vistaril and sedative drugs both produce sedation in people depending on the dose and potency of the drug. However, when these drugs are taken together, strong sedative effects can be seen. Typically such a combo of prescription drugs with similar effects will make one very sleepy, followed by problems with concentration and judgment. Because of this, one should avoid combining the two drugs before important tasks that require a clear mind. According to a study, taking Vistaril with sedatives might lead to a drug overdose. For this reason, it can be said that the type of interaction for these medications is drug-drug interaction with potentiation effects. One example of these sedative drugs is Ambien and more about its interactions will be tackled next.

Vistaril And Ambien

Hydroxyzine interactions with Ambien produce a moderate drug interaction with profound drowsiness, difficulty concentrating, slow coordination, and impaired judgment. A combination of these two drugs and alcohol will only potentiate the sedative effect on CNS. Moreover, Vistaril may increase the CNS depressant activity of Ambien which may lead to stroke.

Mixing Hydroxyzine And Sedatives.

Taking Vistaril And Benzodiazepines

Benzodiazepines like Xanax are used for the treatment of conditions like panic attacks and anxiety and both of these drugs are prescription medications. Vistaril is also used for anxiety, but they work differently to produce the same effect. Moreover, the interaction between these drugs can be considered as drug-drug interactions with additive effects. According to a study, taking these two together does not bring out greater anxiolytic effects but will result in increased sedation and impairment of motor function.

Xanax And Hydroxyzine

Xanax and Hydroxyzine are both common for anxiety treatment as they both serve as CNS depressants. However, the simultaneous use of both drugs leads to profound drowsiness and reduced mental acuity and these effects can be worsened by adding alcohol to an equation. As with many other combinations, the outcome is the same – oversedation, ventilation issues. Moreover, drowsiness and dry mouth are the most common side effects that can be seen when Xanax and Hydroxyzine are taken together. Therefore, if a patient has accidentally or intentionally taken these drugs together, it is important to monitor the patient as CNS and respiratory depression leading to death may occur.

Combining Hydroxyzine And Nonsteroidal Anti-Inflammatory Drugs (NSAID)

The interaction with these drugs can be considered as drug-drug interactions, and metabolism plays a big role in the interaction between Vistaril and NSAIDs. Generally, the metabolism of NSAIDs decreases when it is taken with Vistaril. In this section, information about the interaction between Hydroxyzine and Ibuprofen will be provided.

Hydroxyzine And Ibuprofen

There is no known interaction between Hydroxyzine and Ibuprofen. According to a study, there are patients who are allergic to NSAIDs and some of them use Vistaril to counteract the allergic reactions. However, it is always advisable to communicate with a medical doctor before taking them. Since the metabolism of a patient affects how both of the drugs will be eliminated from the body, the right dose and frequency or interval is important.

Avoiding Dangerous Hydroxyzine Interactions

It is important to remember that most Hydroxyzine interactions lead to profound sedation. These effects would be much more pronounced when one mixes two drugs or more drugs together with alcohol. The first step in avoiding Vistaril interaction is by always consulting a medical doctor before taking the medication especially when the patient has pre-existing health conditions especially those related to any heart disease. By this, a medical professional will tell the patient about the possible drugs that might interact with this medication. Eventually, a doctor will be able to prescribe the right amount and frequency of the drug. When Vistaril is taken with drugs or foods that interact with it, palpitations, seizures, and sudden cardiac death might occur.

Though Vistaril is not as addictive as other drugs, drug overdose is still a concern and this can happen when Vistaril is taken along with other drugs with the same effects as it has, like other alternative antihistamines.

Vistaril abuse, in combination with other substances, may provoke side effects that will affect not just the cardiac health of a patient but also mental and renal systems. People with signs and symptoms of Vistaril or polydrug abuse should be admitted to the drug rehabilitation center. Special addiction treatment programs for addicts allow for a personalized approach to a patient’s needs and a more coherent treatment course. Patients will start the treatment with detox, followed by a series of therapy sessions (CBT, DBT, Motivational Enhancement, etc.).


Page Sources

  1. Block, R. I., Erwin, W. J., Farinpour, R., & Braverman, K. (1998). Sedative, stimulant, and other subjective effects of marijuana: relationships to smoking techniques. Pharmacology Biochemistry and Behavior, 59(2), 405-412.
  2. Daubin, C., Quentin, C., Goullé, J. P., Guillotin, D., Lehoux, P., Lepage, O., & Charbonneau, P. (2007). Refractory shock and asystole related to tramadol overdose. Clinical toxicology, 45(8), 961-964.
  3. Fein, M. N., Fischer, D. A., O’Keefe, A. W., & Sussman, G. L. (2019). CSACI position statement: newer generation H 1-antihistamines are safer than first-generation H 1-antihistamines and should be the first-line antihistamines for the treatment of allergic rhinitis and urticaria. Allergy, Asthma & Clinical Immunology, 15(1), 1-6.
  4. Glazier, H. S. (1990). Potentiation of pain relief with hydroxyzine: A therapeutic myth?. DICP, 24(5), 484-488.
  5. Hayes, J. (2012). Toolbox for treatment of primary insomnia. Mental Health Clinician, 2(2), 23-24.
  6. Kasi, P. M., Mounzer, R., & Gleeson, G. H. (2011). Cardiovascular side effects of atomoxetine and its interactions with inhibitors of the cytochrome p450 system. Case reports in medicine, 2011.
  7. Logothetis, I., Mylonas, I. A., Baloyannis, S., Pashalidou, M., Orologas, A., Zafeiropoulos, A., ... & Theoharides, T. C. (2005). A pilot, open label, clinical trial using hydroxyzine in multiple sclerosis. International journal of immunopathology and pharmacology, 18(4), 771-778.
  8. Naghibi, B., & Rayatnia, F. (2011). Co-administration of subeffective anxiolytic doses of diazepam and hydroxyzine in elevated zero-maze in mice. Psychiatry investigation, 8(2), 169.
  9. Okuda, T., Ito, Y., Nakagawa, N., Hishinuma, T., Tsukamoto, H., Iwabuchi, K., ... & Yanai, K. (2004). Drug interaction between methamphetamine and antihistamines: behavioral changes and tissue concentrations of methamphetamine in rats. European journal of pharmacology, 505(1-3), 135-144.
  10. Orriols, L., Luxcey, A., Contrand, B., Bénard-Laribière, A., Pariente, A., Gadegbeku, B., & Lagarde, E. (2017). Road traffic crash risk associated with prescription of hydroxyzine and other sedating H1-antihistamines: A responsibility and case-crossover study. Accident Analysis & Prevention, 106, 115-121.
  11. Overall, S. T. A. R., & Flow, D. P. Medical Pharmacology Chapter 17: Antidepressant Agents.
  12. Schlit, A. F., Delaunois, A., Colomar, A., Claudio, B., Cariolato, L., Boev, R., ... & 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), e00309.
  13. Shaw, P. J., Cirelli, C., Greenspan, R. J., & Tononi, G. (2000). Correlates of sleep and waking in Drosophila melanogaster. Science, 287(5459), 1834-1837.
  14. Staevska, M., Gugutkova, M., Lazarova, C., Kralimarkova, T., Dimitrov, V., Zuberbier, T., ... & Popov, T. A. (2014). Night‐time sedating H1‐antihistamine increases daytime somnolence but not treatment efficacy in chronic spontaneous urticaria: a randomized controlled trial. British journal of dermatology, 171(1), 148-154.
  15. Weathermon, R., & Crabb, D. W. (1999). Alcohol and medication interactions. Alcohol Research & Health, 23(1), 40.
  16. Wöhrl, S. (2018). NSAID hypersensitivity–recommendations for diagnostic work up and patient management. Allergo journal international, 27(4), 114-121.

Published on: March 11th, 2020

Updated on: July 22nd, 2021

About Author

Dr. Ahmed Zayed

Dr. Ahmed Zayed is a Bachelor of Medicine and Surgery. He is graduated from the University of Alexandria, Egypt. Dr. Ahmed Zayed has a passion for writing medical and health care articles and focuses on providing engaging and trustworthy information to readers.

Medically Reviewed by

Michael Espelin APRN

8 years of nursing experience in wide variety of behavioral and addition settings that include adult inpatient and outpatient mental health services with substance use disorders, and geriatric long-term care and hospice care.  He has a particular interest in psychopharmacology, nutritional psychiatry, and alternative treatment options involving particular vitamins, dietary supplements, and administering auricular acupuncture.