Dosing & Uses
Dosage Forms & Strengths
tablet
- 10mg
- 25mg
- 50mg
capsule
- 25mg
- 50mg
- 100mg
syrup/oral suspension
- 10mg/5mL
injectable solution
- 25mg/mL
- 50mg/mL
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
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
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
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
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
Warnings
Contraindications
Documented hypersensitivity or related product including cetirizine and levocetirizine and components of the formulation
Prolonged QT interval
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)
Hydroxyzine may rarely cause acute generalized exanthematous pustulosis (AGEP), a serious skin reaction characterized by fever and numerous small, superficial, non-follicular, sterile pustules, arising within large areas of edematous erythema; if signs or symptoms suggest AGEP, do not resume use of hydroxyzine and consider alternative therapy; avoid cetirizine or levocetirizine in patients who have experienced AGEP or other hypersensitivity reactions with hydroxyzine, due to risk of cross-sensitivity
Drug interaction interview
- Caution recommended during concomitant use of drugs known to prolong QT interval including Class 1A (e.g., quinidine, procainamide) or Class III (e.g., amiodarone, sotalol) antiarrhythmics, certain antipsychotics (e.g., ziprasidone, iloperidone, clozapine, quetiapine, chlorpromazine), certain antidepressants (e.g., citalopram, fluoxetine), certain antibiotics (e.g., azithromycin, erythromycin, clarithromycin, gatifloxacin, moxifloxacin); and others (e.g., pentamidine, methadone, ondansetron, droperidol)
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.
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
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
Images
Patient Handout
Formulary
Adding plans allows you to compare formulary status to other drugs in the same class.
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.
