hydroxyzine

(hye drox' i zeen)

hydroxyzine hydrochloride
Oral preparations:
Apo-Hydroxyzine (CAN), Atarax, Novo-Hydroxyzine (CAN), Vistaril,
Parenteral preparations:
Multipax (CAN), Vistaril, Vistazine

hydroxyzine pamoate
Oral preparations:
Vistaril

Pregnancy Category C

Drug classes
Anxiolytic
Antihistamine
Antiemetic

Therapeutic actions
Mechanisms of action not understood; actions may be due to suppression of subcortical
areas of the CNS; has clinically demonstrated antihistaminic, analgesic, antispasmodic,
antiemetic, mild antisecretory, and bronchodilator activity

Indications
• Symptomatic relief of anxiety and tension associated with psychoneurosis;
adjunct in organic disease states in which anxiety is manifested; alcoholism and
asthma; prior to dental procedures
• Management of pruritus due to allergic conditions, such as chronic urticaria,
atopic and contact dermatosis, and in histamine-mediated pruritus
• Sedation when used as premedication and following general anesthesia
• Control of nausea and vomiting and as adjunct to analgesia preoperatively and
postoperatively (parenteral) to allow decreased opioid dosage
• IM administration: Management of the acutely disturbed or hysterical patient; the
acute or chronic alcoholic with anxiety withdrawal symptoms or delirium
tremens; as preoperative and postoperative and prepartum and postpartum
adjunctive medication to permit reduction in narcotic dosage, allay anxiety, and
control emesis

Contraindications and cautions

• Contraindicated with allergy to hydroxyzine, pregnancy, lactation.
• Use cautiously with uncomplicated vomiting in children (may contribute to
Reye's syndrome or unfavorably influence its outcome; extrapyramidal effects
may obscure diagnosis of Reye's syndrome).
Available forms
Tablets—10, 25, 50, 100 mg; syrup—10 mg/5 mL; capsules—25, 50, 100 mg; oral
suspension—25 mg/5 mL; injection—25, 50 mg/mL

Dosages
Start patients on IM therapy when indicated; use oral therapy for maintenance. Adjust
dosage to patient's response.
ADULTS
Oral
• Symptomatic relief of anxiety: 50–100 mg qid.
• Management of pruritus: 25 mg tid–qid.
• Sedative (preoperative and postoperative): 50–100 mg.
IM
• Psychiatric and emotional emergencies, including alcoholism: 50–100 mg
immediately and q 4–6 hr as needed.
• Nausea and vomiting: 25–100 mg.
• Preoperative and postoperative, prepartum and postpartum: 25–100 mg.
PEDIATRIC PATIENTS
Oral
• Anxiety, pruritus:
< 6 yr: 50 mg/day in divided doses.
> 6 yr: 50–100 mg/day in divided doses.
• Sedative: 0.6 mg/kg.
IM
• Nausea, preoperative and postoperative: 1.1 mg/kg (0.5 mg/lb).

Pharmacokinetics
Route Onset Peak Duration
Oral, IM 15–30 min 3 hr 4–6 hr

Metabolism: Hepatic; T1/2: 3 hr

Distribution: Crosses placenta; may enter breast milk
Excretion: Urine

Adverse effects
• CNS: Drowsiness, involuntary motor activity, including tremor and seizures
• GI: Dry mouth
• Hypersensitivity: Wheezing, dyspnea, chest tightness

Nursing considerations
Assessment
• History: Allergy to hydroxyzine or cetirizine, uncomplicated vomiting in
children, lactation, pregnancy
• Physical: Skin color, lesions, texture; orientation, reflexes, affect; R, adventitious
sounds
Interventions
• Determine and treat underlying cause of vomiting. Drug may mask signs and
symptoms of serious conditions, such as brain tumor, intestinal obstruction,
appendicitis.
• Do not administer parenteral solution SC, IV, or intra-arterially; tissue necrosis
has occurred with SC and intra-arterial injection, hemolysis with IV injection.
• Give IM injections deep into a large muscle. In adults, use upper outer quadrant of
buttocks or midlateral thigh; in children use midlateral thigh muscles; use deltoid
area only if well developed.

Teaching points
• Take this drug as prescribed. Avoid excessive dosage.
• These side effects may occur: Dizziness, sedation, drowsiness (use caution if
driving or performing tasks that require alertness); avoid alcohol, sedatives, sleep
aids (serious overdosage could result); dry mouth (use frequent mouth care; suck
sugarless lozenges).
• Report difficulty breathing, tremors, loss of coordination, sore muscles, or muscle
spasms.

Adverse effects in Italic are most common; those in Bold are life-threatening.