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hydroxyzine (Rx)Brand and Other Names:Vistaril

 
 
 

Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

tablet

  • 10mg
  • 25mg
  • 50mg

capsule

  • 25mg
  • 50mg
  • 100mg

syrup/oral suspension

  • 10mg/5mL

injectable solution

  • 25mg/mL
  • 50mg/mL
more...

Anxiety

Symptomatic relief of anxiety associated with psychoneurosis and as adjunct in organic disease states

50-100 mg PO divided q6hr or 50-100 mg IM divided q4-6hr

Dosing considerations

  • Continuation of therapy for >4 months has not been studied; reassess need for therapy periodically

Pruritus

Management of pruritus due to chronic urticaria, contact dermatoses, and histamine-mediated pruritus

25 mg PO/IM divided q6-8hr

Preoperative Sedation

50-100 mg PO or 25-100 mg IM

Dosing considerations

  • If treatment is initiated IM, subsequent doses may be administered PO

Nausea & Vomiting (Off-label)

25-100 mg IM

Dosing Modifications

Renal Impairment

  • >50 mL/min: Dose adjustment not necessary
  • ≤50 mL/min: Administer 50% normal dose

Hepatic Impairment

  • Change dosing interval to q24hr in patients with biliary cirrhosis

Dosage Forms & Strengths

tablet

  • 10mg
  • 25mg
  • 50mg

capsule

  • 25mg
  • 50mg
  • 100mg

syrup/oral susp

  • 10mg/5mL

injectable solution

  • 25mg/mL
  • 50mg/mL
more...

Anxiety

<6 years old: 50 mg/day PO divided q6hr

>6 years old: 50-100 mg/day PO divided q6hr

Pruritus

Management of pruritus due to chronic urticaria, contact dermatoses, and histamine-mediated pruritus

<6 years old: 50 mg/day PO divided q6hr

>6 years old: 50-100 mg/day PO divided q6hr

Preoperative Sedation

0.6 mg/kg PO 

0.5-1.1 mg/kg IM

Anxiety

Symptomatic relief of anxiety associated with psychoneurosis and as adjunct in organic disease states

50-100 mg PO divided q6hr or 50-100 mg IM divided q4-6hr

Continuation of therapy for >4 months has not been studied; reassess need for therapy periodically

Pruritus

25 mg PO/IM q6-8hr; increased to 25 mg q6-8hr

Nausea & Vomiting (Off-label)

25 mg IM

Dosing Modifications

Advanced age associated with reduced drug clearance and with greater risk of confusion, dry mouth, constipation, and other anticholinergic effects and toxicity; start at low end of dosage range, and observe closely

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Interactions

Interaction Checker

hydroxyzine and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            Frequency Not Defined

            Anticholinergic: Dry mouth

            Central nervous system: Drowsiness (usually transitory and may disappear in a few days of continued therapy or upon reduction of the dose), involuntary motor activity (tremor, convulsions) usually with doses considerably higher than those recommended

            Clinically significant respiratory depression has not been reported at recommended doses

            Postmarketing Reports

            Body as a whole: Allergic reaction

            Nervous system: Headache

            Psychiatric: Hallucination

            Skin and appendages: Pruritus, rash, urticaria, fixed drug eruptions

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            Warnings

            Contraindications

            Documented hypersensitivity

            SC, intra-arterial, or IV administration

            Cautions

            Nursing mothers

            May cause CNS depression resulting in drowsiness; avoid driving or operating dangerous machinery

            May cause oversedation and confusion in elderly patients; start on lower doses and monitor closely; avoid use

            IM only for parenteral use; switch to PO ASAP

            Use caution in patients with narrow-angle glaucoma, prostatic hyperplasia, or respiratory disease (asthma or COPD)

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            Pregnancy & Lactation

            Pregnancy category: Considered to be contraindicated in early (1st trimester) pregnancy until more human pregnancy data available; limited experience in human pregnancy, either for drug itself or drugs in same class or with similar mechanisms of action, including 1st trimester, current limited data suggests that the drug does not represent a significant risk of developmental toxicity including growth restriction, structural anomalies, functional/behavioral deficits, or death at any time in pregnancy

            Lactation: Excretion in milk unknown; use with caution

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            H1-receptor antagonist with low to moderate antihistaminic properties; inhibits respiratory, vascular, and GI smooth-muscle constriction

            Moderate to high anticholinergic and antiemetic properties

            Absorption

            Onset: 15-30 min (PO)

            Duration: Sedation, 4-6 hr; antipruritic, 1-12 hr; histamine-induced wheal and flare, 2-36 hr 

            Peak serum time: 1-2 hr

            Distribution

            Vd: 16 L/kg (adults); 23 L/kg (elderly)

            Metabolism

            Metabolized by liver

            Elimination

            Half-life: 20 hr (adults); 29 hr (elderly); 37 hr (hepatic dysfunction)

            Excretion: Urine

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            Administration

            IM Incompatibilities

            Additive: Aminophylline, amobarbital, chloramphenicol, ketorolac, penicillin G sodium/potassium, pentobarbital, phenobarbital

            Syringe: Aminophylline, dimenhydrinate, haloperidol, heparin, ketorolac, penicillin, pentobarbital, phenytoin, ranitidine, vitamin B complex with C

            IM Compatibilities

            Additive (partial list): Cisplatin, cyclophosphamide, cytarabine, dimenhydrinate, etoposide, lidocaine, methotrexate, nafcillin

            Syringe (partial list): Atropine, buprenorphine, cimetidine, diphenhydramine, fentanyl, glycopyrrolate, lidocaine, meperidine, midazolam, morphine, promethazine, scopolamine, sufentanil

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            Images

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            Formulary

            FormularyPatient Discounts

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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