Hydroxyzine (Vistaril): Uses, Warnings, and Key Facts

What is hydroxyzine?

Hydroxyzine is a medicine used for the treatment of anxiety, pruritus (itching), and urticaria (hives). The active ingredient may appear as hydroxyzine hydrochloride or hydroxyzine pamoate.

In the United States, the brand names listed in the source content include Vistaril, Atarax, and Hyzine.

How hydroxyzine works

Hydroxyzine’s action may be related to suppression of activity in certain regions of the subcortical area of the central nervous system. It has been described as having anxiolytic, antihistamine, antiemetic, bronchodilator, antispasmodic, and sympathicolytic effects.

In practical terms, this helps explain why it may be used for symptoms linked to anxiety or allergic-type itching.

Therapeutic uses and indications

According to the source content, hydroxyzine is used for:

• Symptomatic treatment of anxiety in adults
• Symptomatic treatment of pruritus and urticaria
• Premedication before anesthesia in adults and children, with age limits depending on the oral form

Dosage information from the source

The following dosing details were included in the original content. Always verify the exact dose, formulation, and schedule on the official leaflet or with a pharmacist, because dosing can vary by product and patient factors.

The source also noted that the accumulated dose in 24 hours should not exceed 2 mg/kg/day in children, and that dose reduction is recommended in liver failure and moderate or severe renal insufficiency.

Contraindications listed in the source

• Hypersensitivity to hydroxyzine, cetirizine, other piperazine derivatives, aminophylline, or ethylenediamine
• Porphyria
• Pregnancy and lactation
• Congenital or acquired QT interval prolongation
• Known risk factors for QT prolongation, including pre-existing cardiovascular disease, electrolyte imbalance, family history of sudden cardiac death, significant bradycardia, or use of other medicines that can prolong the QT interval or cause torsade de pointes

Warnings and precautions

The original content highlights extra caution in the following situations:

• Moderate or severe renal failure
• Liver failure
• Elderly patients (not recommended in the source content)
• Glaucoma
• Bladder outlet obstruction
• Decreased gastrointestinal motility
• Myasthenia gravis or dementia
• High risk of convulsions, especially in children
• Risk of QT prolongation; if symptoms suggest a cardiac rhythm problem, the source advises discontinuing treatment

Kidney and liver impairment

Liver failure

The source content says caution is needed and that a dose reduction is recommended.

Kidney failure

The source content says caution is needed in moderate or severe renal failure and that dose reduction is recommended because excretion of the metabolite cetirizine is decreased.

Drug interactions

Hydroxyzine may interact with other medicines and substances. The original content specifically mentions:

• Medicines that prolong the QT interval or may induce torsade de pointes, including some antiarrhythmics, antihistamines, antipsychotics, antidepressants, antimalarials, antibiotics, antifungals, gastrointestinal agents, cancer medicines, and methadone
• Alcohol, which can enhance effects
• Cimetidine, which may increase plasma concentration
• MAOIs, which should not be used simultaneously according to the source
• Adrenaline, with counterpressive action noted
• Betahistine and anticholinesterase drugs, whose effects may be antagonized
• Other substances that can cause hypokalemia or bradycardia
• Allergy tests or bronchial provocation tests with methacholine, which may be affected

Pregnancy and breastfeeding

The source content lists hydroxyzine as contraindicated in pregnancy and contraindicated during lactation. It also states that if therapy is necessary during breastfeeding, lactation should be discontinued.

Effects on driving and machinery

Hydroxyzine may reduce attention and reaction ability and may cause drowsiness, amnesia, or sedation, especially at the start of treatment or after a dose increase. The source advises avoiding driving vehicles or operating machinery until it is clear that these abilities are not affected.

Possible adverse reactions

The original content lists the following side effects:

• Drowsiness
• Headache
• Fatigue
• Dry mouth
• Sedation

What to verify with a doctor or pharmacist

If hydroxyzine has been prescribed or recommended, it is sensible to confirm the following with a healthcare professional or the official leaflet:

• Which formulation is being used: hydrochloride or pamoate
• The exact dose and timing for the intended use
• Whether any heart rhythm risk factors are present
• Whether kidney or liver impairment changes the dose
• Whether other medicines, alcohol, or sedating products could interact
• Whether the medicine is appropriate in pregnancy or breastfeeding

Safety reminder

FAQ

Sources and reference links

The original content referenced FDA and scientific database resources. For the most accurate product-specific information, consult the official medication guide and product labeling.

• FDA Medication Guides
• UNII: 30S50YM8OG
• ChemIDplus
• DrugPortal
• PubChem CID: 3658
• NCI Thesaurus: C29103