Have you ever taken hydroxyzine to relieve the symptoms of anxiety or allergies and felt drowsier than ever? Or maybe you’re wondering why you received an allergy medication for your anxiety? Chances are, you might not have been fully aware of hydroxyzine side effects.
Hydroxyzine, which you might also know from its brand names Atarax and Vistaril, is an antihistamine used primarily to help control anxiety and tension, relieve allergies, or induce sleep before surgery.
In this article, we will explore hydroxyzine medication and aim to provide a detailed overview of its side effects. Understanding a medication’s prescription label and potential side effects before taking it is imperative.
What is Hydroxyzine and How Does it Work?
When the immune system identifies a threat, the body releases the chemical histamine, binding to specific receptors on cells and causing symptoms like sneezing, itching, or a runny nose. Like other older (first-generation) H1-antihistamines, hydroxyzine blocks the action of histamine at the H1 receptor. While this assists with allergy symptoms, it is also thought to boost serotonin levels and reduce activity in the area of the brain that controls emotions: the subcortical region.
Hydroxyzine pamoate and hydroxyzine hydrochloride are different forms of the same medication, known most commonly by their brand names Vistaril and Atarax, respectively. (The latter is no longer on the market, however, there are generic alternatives.) While hydroxyzine pamoate comes in capsule form, hydroxyzine hydrochloride can be an oral tablet, syrup, oral solution, or intramuscular injection.
Hydroxyzine can treat allergies, sleep difficulty, nausea, vomiting, itching, and skin rash. Nana Mireku, MD, CEO of AllergenIQ and TexasAllergyMD, says that since hydroxyzine can have a sedative effect, it’s not her first choice for allergy treatment.
“As a board-certified allergist, I tend to use antihistamines that have a less sedative effect, such as 2nd-generation antihistamines like cetirizine or fexofenadine,” Dr. Mireku tells BDOPro.
Despite also being used to treat anxiety, psychiatrists, such as Gail Saltz, MD, say that hydroxyzine is not typically recommended for long-term usage. Dr. Saltz is a Clinical Associate Professor of Psychiatry at the New York Presbyterian Hospital and Weill-Cornell Medical College as well as a psychoanalyst with the New York Psychoanalytic Institute.
“Although it can decrease anxiety levels for some patients, it is sedating and it has not been studied in terms of long-term use,” Dr. Saltz tells BDOPro. “So it is only recommended to be used for a few months at most, and it usually makes people sedated too, as a side effect. Given we have other medications which are suitable for long-term use and are nonsedating, it is more likely a psychiatrist would prescribe one of these.”
Hydroxyzine can be used alongside other medications for surgery before and after general anesthesia.
Common Hydroxyzine Side Effects
While side effects can differ from person to person, some of the most common hydroxyzine side effects include:
- Drowsiness/sedation
- Dry mouth
- Headache
- Dizziness
- Constipation
- Dry eyes
- Blurred vision
- Confusion
Dry mouth is one of the most common hydroxyzine side effects. This anticholinergic medication also blocks the chemical acetylcholine, which reduces the amount of saliva your body creates.
If you experience dizziness or drowsiness from hydroxyzine, you should avoid driving or operating other heavy machinery. You should avoid consuming alcohol or any other medication that could make you drowsy.
Hydroxyzine can also affect the central nervous system, including symptoms such as tinnitus, headache, and hypotension.
Less Common but Serious Hydroxyzine Side Effects
Some individuals may experience some rare but serious side effects from taking hydroxyzine, such as the following:
- Confusion
- Trembling or shaking movements
- Rapid or irregular heartbeat (QT prolongation)
- Seizures
- Severe allergic reactions (rash, swelling, trouble breathing)
While it is rare for hydroxyzine to cause irregular heart rhythms, it is more likely to happen in people who have certain heart conditions or already have risk factors for QT interval prolongation. Before taking the medication, make sure to speak to your health care provider about your pre-existing conditions.
If you experience an allergic reaction to hydroxyzine, such as skin redness or pus-filled, blister-like sores on your skin, stop taking the medication and contact your health care professional.
Factors With a Higher Risk of Hydroxyzine Side Effects
Older adults are the most likely to experience unwanted side effects from taking hydroxyzine, such as confusion, drowsiness, or heart problems.
Depending on what they are taking the medication for, an adult takes between 25 mg to 100 mg of hydroxyzine three to four times per day. For anxiety, a typical hydroxyzine dosage is 50 mg four times per day. The maximum daily dosage is 400 mg.
If you have any pre-existing medical conditions, make sure to inform your medical provider so they can make the safest recommendation for you. It is not recommended to take hydroxyzine alongside other specific medications such as opioids, sedatives, some antibiotics, antipsychotic medications, or other antihistamines.
Avoid or limit alcohol usage while being treated with hydroxyzine.
Managing Hydroxyzine Side Effects
There are ways to manage and minimize hydroxyzine side effects. Dr. Mireku says it’s best to manage your dosage along with your doctor, recommending patients “ starting with a low dose and titrating upwards slowly.”
If you experience dry mouth, we recommend staying hydrated, sucking on ice chips, chewing sugar-free gum, or taking an over-the-counter saliva substitute.
If your hydroxyzine prescription makes you drowsy, it might be necessary to take the medication at night. To avoid risk, it is recommended to avoid alcohol and/or activities that require being alert, like driving.
Managing medication side effects can feel like a daunting task, but we recommend always speaking with your doctor if your side effects become concerning. This way, they can discuss alternative medications with you.
Hydroxyzine and Specific Populations
Several populations should be cautious with hydroxyzine.
Dr. Saltz warns that any individual taking medications with other antihistaminic or antimuscarinic effects should avoid hydroxyzine.
“They can [additionally] create worse side effects where they do become sedated,” Dr. Saltz said. “This causes a dangerous situation due to their life circumstances or line of work… like driving for a living, etc.”
It is not recommended for pregnant individuals to take hydroxyzine during their first trimester as it may cause fetal harm. The medication can be taken during the second and third trimesters with guidance from a health care professional. Breastfeeding mothers should opt for alternative antihistamines, as hydroxyzine can be found in breast milk.
While children and adolescents can take hydroxyzine, their doses vary. For children under the age of 6, the recommended dose is 50 mg orally per day in separate doses. For children over the age of 6, the recommended dose rises to 50 to 100 mg orally per day.
Elderly patients are the most likely to experience unwanted side effects from hydroxyzine. It is not recommended for individuals over 65 years old to take hydroxyzine, as other medications would be safer to treat the same conditions.
Patients with liver or kidney disease should be cautious when taking hydroxyzine as the body might not break down the medication as well, causing the level of the drug in the body to be too high. This could increase unwanted side effects.
Hydroxyzine Overdose
Symptoms of overdose on hydroxyzine include:
- Drowsiness
- Nausea
- Decreased awareness or responsiveness
- Seizures
- Severe sleepiness
- Vomiting
If you have taken over the recommended dose of hydroxyzine and suspect overdose symptoms, contact emergency services and seek immediate medical attention. Hydroxyzine overdose treatment typically includes IV fluids through a vein, laxatives, or breathing support.
Frequently Asked Questions (FAQ)
How long do hydroxyzine side effects last?
The duration of hydroxyzine side effects can vary. Some might last for just a few days, while some may last as long as you take the medication.
Can hydroxyzine cause weight gain?
While hydroxyzine does not directly cause weight gain, it can increase appetite, which could indirectly cause weight gain.
Is hydroxyzine addictive?
While it can be abused, hydroxyzine is not considered habit-forming.
Can I drink alcohol while taking hydroxyzine?
It is recommended to limit or avoid alcohol while taking hydroxyzine.
What should I do if I experience severe hydroxyzine side effects?
If you experience severe side effects from taking hydroxyzine, such as trembling or a skin reaction, contact your health care professional immediately.
Where should I keep my hydroxyzine prescription?
You should always keep your hydroxyzine prescription stored at room temperature.
Does hydroxyzine affect allergy tests?
Yes, since hydroxyzine works by blocking the effects of histamine, it can interfere with the accuracy of allergy skin tests. Talk to your doctor before taking any allergy tests.
Conclusion
Hydroxyzine, while effective for managing anxiety, allergies, and other conditions, can cause a range of side effects—from dry mouth and drowsiness to confusion or irregular heartbeat. Understanding these potential effects and monitoring how your body responds to the medication is crucial.
You should always consult a health care professional before starting a hydroxyzine prescription. If you experience unusual symptoms, call your doctor before you stop taking hydroxyzine to determine the best course of action for your health.