HYDROXYZINE HYDROCHLORIDE

(hye-drox'i-zeen)
Atarax, Hyzine-50, Quiess, Vistaril Intramuscular, Vistacon, Vistaject-25 & -50
HYDROXYZINE PAMOATE
Hy-Pam, Vamate, Vistaril Oral
Classifications: antihistamine; antipruritic
Pregnancy Category: C

Availability
Hydroxyzine HCl10 mg, 25 mg, 50 mg, 100 mg tablets; 10 mg/5 mL syrup; 25 mg/5 mL
oral suspension; 25 mg/mL, 50 mg/mL injection

Hydroxyzine Pamoate25 mg, 50 mg, 100 mg capsules

Actions
Piperazine derivative structurally and pharmacologically related to other cyclizines (e.g.,
buclizine, chlorcyclizine). In common with such agents, it causes CNS depression.

Therapeutic Effects
Its tranquilizing (ataractic) effect is produced primarily by depression of hypothalamus
and brain-stem reticular formation, rather than cortical areas. In addition it is an effective
agent for pruritus.

Uses
Emotional or psychoneurotic states characterized by anxiety, tension, or psychomotor
agitation; to relieve anxiety, control nausea and emesis, and reduce narcotic requirements
before or after surgery or delivery. Also used in management of pruritus due to allergic
conditions, e.g., chronic urticaria, atopic and contact dermatoses, and in treatment of
acute and chronic alcoholism with withdrawal symptoms or delirium tremens.

Contraindications
Known hypersensitivity to hydroxyzine; use as sole treatment in psychoses or depression.
Safe use during early pregnancy (category C) or lactation is not established.

Cautious Use
History of allergies; older adults.

Route & Dosage

Anxiety
Adult: PO 25–100 mg t.i.d. or q.i.d. IM 25–100 mg q4–6h
Child: PO <6 y, 50 mg/d in divided doses; >6 y, 50 mg/d in divided doses IM 1.1 mg/kg
q4–6h

Pruritus
Adult: PO 25 mg t.i.d. or q.i.d. IM 25 mg q4–6h
Geriatric: PO 10 mg 3–4 times daily
Child: PO >6 y, 50–100 mg/d in divided doses; <6 y, 50 mg/d in divided doses IM 1.1
mg/kg q4–6h

Nausea
Adult: IM 25–100 mg q4–6h
Child: IM 1.1 mg/kg q4–6h

Administration
Oral
 Note: Tablets may be crushed and taken with fluid of patient's choice. Capsule
may be emptied and contents swallowed with water or mixed with food. Liquid
formulations are available.

Intramuscular
 Give deep into body of a relatively large muscle. The Z-track technique of
injection is recommended to prevent SC infiltration.
 Recommended site: In adult, the gluteus maximus or vastus lateralis; in children,
the vastus lateralis.
 Protect all forms from light. Store at 15°–30° C (59°–86° F) unless otherwise
specified.

INCOMPATIBILITIES Solution/additive: Aminophylline, amobarbital,

chloramphenicol, dimenhydrinate, penicillin G, pentobarbital, phenobarbital.

Adverse Effects ( 1%)

CNS: Drowsiness (usually transitory), sedation, dizziness, headache. CV: Hypotension.
GI: Dry mouth. Body as a Whole: Urticaria, dyspnea, chest tightness, wheezing,
involuntary motor activity (rare). Hematologic: Phlebitis, hemolysis, thrombosis. Skin:
Erythematous macular eruptions, erythema multiforme, digital gangrene from inadvertent
IV or intraarterial injection, injection site reactions.
Diagnostic Test Interference
Possibility of false-positive urinary 17-hydroxycorticosteroid determinations (modified
Glenn-Nelson technique).

Interactions
Drug: Alcohol and cns depressants add to cns depression; tricyclic antidepressants and
other anticholinergics have additive anticholinergic effects; may inhibit pressor effects of
epinephrine.

Pharmacokinetics
Absorption: Readily absorbed from GI tract. Onset: 15–30 min PO. Duration: 4–6 h.
Distribution: Not known if it crosses placenta or is distributed into breast milk.
Metabolism: Metabolized in liver. Elimination: Probably excreted in bile.

NURSING IMPLICATIONS
Assessment & Drug Effects

 Evaluate alertness. Drowsiness may occur and usually disappears with continued
therapy or following reduction of dosage.
 Monitor condition of oral membranes daily when patient is on high dosage of
hydroxyzine.
 Reevaluate usefulness of drug periodically.
 Reduce dosage of the depressant up to 50% when CNS depressants are prescribed
concomitantly.

Patient & Family Education

 Do not drive or engage in other potentially hazardous activities until response to

drug is known.
 Do NOT take alcohol and hydroxyzine at the same time.
 Notify physician immediately if you become pregnant.
 Relieve dry mouth by frequent warm water rinses, increasing fluid intake, and use
of a salivary substitute (e.g., Moi-Stir, Xero-Lube).
 Give teeth scrupulous care. Avoid irritation or abrasion of gums and other oral
tissues.
 Consult physician before self-dosing with OTC medications.
 Do not breast feed while taking this drug without consulting physician.
Common adverse effects in italic, life-threatening effects underlined: generic names in
bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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