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Hydroxyzine

(Generic Vistaril®)

Disclaimer: This is not meant to be medical advice, and always discuss with your care manager, prescriber or other doctor before making any medication changes or taking action, unless otherwise indicated. Please refer to the package insert included with your medication.

What is Hydroxyzine (Vistaril®, Atarax®)?

Hydroxyzine (Vistaril®, Atarax®) is an FDA-approved medication for the treatment of anxiety. It helps people feel calmer, usually within 30 minutes and can be used on an as-needed basis or daily. Hydroxyzine is not a controlled substance, is non-habit forming and does not cause dependence or withdrawal symptoms. It is a good choice for patients with mild anxiety symptoms and those who do not want to take a daily medication or a federally controlled substance (Source). 

How does Hydroxyzine (Vistaril®)work?

Hydroxyzine primarily exerts its calming effects by blocking histamine 1 receptors in the brain. This mechanism is also responsible for the tired feeling people can experience after taking the medication. Hydroxyzine also has smaller effects on the transmission of other neurotransmitters. 

How long does it take Hydroxyzine (Vistaril®, Atarax®) to work?

Many patients experience an almost immediate calming effect, and thus Hydroxyzine is often used on an as needed basis for treatment of anxiety. Longer-lasting anti-anxiety effects may take a couple of weeks to take effect.

How do I take Hydroxyzine (Vistaril®) medication?

You can take Hydroxyzine with or without food. 

What if I miss a dose of Hydroxyzine (Vistaril®, Atarax®)?

Hopefully that means your anxiety is improving! Hydroxyzine does not need to be taken at the same time daily per se, so do not worry if you “miss” a dose. Do not take 2 doses at the same time or extra doses.

How do I store Hydroxyzine (Vistaril®) medication?

Please store at room temperature, in a dry place and keep away out of the reach of children and pets. Throw away unused or expired medications.

Can I take Hydroxyzine (Vistaril®, Atarax®) while drinking?

Since Hydroxyzine can cause sedation, it may increase the sedative effects of alcohol. Therefore, we recommend that people limit alcohol consumption. Additionally, excessive alcohol use can be a contributor to anxiety and depression, and may contribute to the symptoms you are trying to treat.

Is Hydroxyzine (Vistaril®, Atarax®) a controlled substance?

No, Hydroxyzine (Vistaril®, Atarax®) is not a controlled substance. It is not habit forming, making it a great choice for anxiety and an alternative to benzodiazepines for some people.

Can I take with other medications with Hydroxyzine (Vistaril®, Atarax®)?

Hydroxyzine has few interactions with other medications. As stated above, if you are taking antacids, you should take Hydroxyzine at least two hours before or after taking the antacid. Please see below for other medication interactions. Be sure to tell your Mantra-affiliated prescriber 

Important Safety Information

All medications have risks. While most of the side effects from Hydroxyzine are either mild or very rare, you should discuss the risks and benefits of the medication. If you experience any side effects, please notify your provider immediately. If you have a serious side effect, contact your in-person health care provider immediately. If you are having an emergency, call 911 or go to your nearest emergency room. 

 

Why is this medication prescribed?

Hydroxyzine is used in adults and children to relieve itching caused by allergic skin reactions. It is also used alone or with other medications in adults and children to relieve anxiety and tension. Hydroxyzine is also used along with other medications in adults and children as a sedative before and after general anesthesia for surgery. Hydroxyzine is in a class of medications called antihistamines. It works by blocking the action of histamine a substance in the body that causes allergic symptoms. It also works by decreasing activity in the brain.

How should this medicine be used?

Hydroxyzine comes as capsules, tablets, a syrup, and suspension to take by mouth. It usually is taken three or four times a day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take hydroxyzine exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Shake the suspension well before each use to mix the medication evenly.

Other uses for this medicine

This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information.

What special precautions should I follow?

Before taking hydroxyzine,

  • tell your doctor and pharmacist if you are allergic to hydroxyzine, cetirizine (Zyrtec), levocetirizine (Xyzal), any other medications, or any of the ingredients in hydroxyzine preparations. Ask your doctor or pharmacist for a list of the ingredients.
  • tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, and nutritional supplements you are taking or plan to take. Be sure to mention any of the following: antihistamines; azithromycin (Zithromax, ZMax), certain antidepressants such as citalopram (Celexa) and fluoxetine (Prozac, Sarafem, Selfemra); medications for anxiety; certain medications for arrhythmias such as amiodarone (Cordarone, Nexterone, Pacerone, ), procainamide, quinidine (in Nuedexta), and sotalol (Betapace, Sorine, Sotylize); barbiturates; clarithromycin (Biaxin, in Prevpac); droperidol (Inapsine); erythromycin (Eryc, Ery-Tab, PCE, others); gatifloxacin; certain medications for mental illness such as chlorpromazine, clozapine (Clozaril, Fazaclo ODT, Versacloz), iloperidone (Fanapt), quetiapine (Seroquel), and ziprasidone (Geodon); meperidine (Demerol); methadone (Dolophine, Methadose); moxifloxacin (Avelox); medications for pain; ondansetron (Zofran, Zuplenz); pentamidine (Nebupent, Pentam); and medications for seizures, sedatives, sleeping pills, and tranquilizers. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
  • tell your doctor if you have a prolonged QT interval (a rare heart problem that may cause irregular heartbeat, fainting, or sudden death) or if you plan to be pregnant or are pregnant. Your doctor will probably tell you not to take hydroxyzine.
  • tell your doctor if anyone in your family has or has ever had a prolonged QT interval or if you have or have ever had a slow or irregular heartbeat, low blood levels of potassium or magnesium, heart failure, a heart attack, or heart disease.
  • tell your doctor if you are breastfeeding. Do not breastfeed while taking hydroxyzine.
  • talk to your doctor about the risks and benefits of taking hydroxyzine if you are 65 years of age or older. Older adults should not usually take hydroxyzine because it is not as safe as other medications that can be used to treat the same condition.
  • you should know that this medication may make you drowsy. Do not drive a car or operate machinery until you know how this medication affects you.
  • ask your doctor about the safe use of alcohol while you are taking this medication. Alcohol can make the side effects of hydroxyzine worse.

What special dietary instructions should I follow?

Unless your doctor tells you otherwise, continue your normal diet.

What should I do if I forget a dose?

If your doctor has told you to take hydroxyzine regularly, take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

What side effects can this medication cause?

Hydroxyzine may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

  • dry mouth
  • constipation (especially in older adults)
  • confusion (especially in older adults)
  • dizziness
  • headache

Some side effects can be serious. If you experience any of the following symptoms, call your doctor immediately:

  • unintentional trembling or shaking movements
  • seizures

If you experience any of the following symptoms of a serious skin condition; stop taking hydroxyzine and call your doctor immediately:

  • rash
  • pus-filled, blister-like sores (lesions), areas of swelling and redness on the skin, and fever

Hydroxyzine may cause other side effects. Call your doctor if you have any unusual problems while you are taking this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online or by phone (1-800-332-1088).

What should I know about storage and disposal of this medication?

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from light, excess heat and moisture (not in the bathroom).

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website for more information if you do not have access to a take-back program.

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach.

In case of emergency/overdose

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911.

Symptoms of overdose may include the following:

  • sedation
  • dizziness
  • seizures
  • nausea
  • vomiting

What other information should I know?

Keep all appointments with your doctor.

Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

Tell your healthcare providers

Telemedicine does not replace your primary care physician. It is important to keep your primary care physician, other healthcare providers, and pharmacist informed of all medications you are taking, including those prescribed by your Mantra-affiliated provider, as they can interact with other medicines you may be taking.

Additional Resources

FDA Access Data: Hydroxyzine

Medline Plus: Hydroxyzine

Pfizer: Vistaril