Hydroxyzine (Vistaril)


Clinical Information



HALF-LIFE: 20 hours

STARTING DOSE: 50mg-100mg

TARGET DOSING RANGE: 50mg-100mg PO every 4-6 hours as needed

BEST TIME TO DOSE: Bedtime or when anxious

> No titration needed
> Initial 50mg-100mg PO every 4-6 hours as needed
> Intramuscular formulation available

PREGNANCY: Minimal data on safety.

BREASTFEEDNG: Minimal data on safety.

Side Effects

  • Dry Mouth, Sedation, Dizziness, urinary retention, cognitive problems, fatigue, blurry vision

FDA Indications

  1. Anxiety and tension associated with neurosis
  2. Adjunct for anxiety from organic disease
  3. Pruritus from allergic reactions
  4. Histamine-mediated pruritus
  5. Premedication sedation
  6. Sedation following anesthesia
  7. Acute hysteria
  8. Alcohol withdrawal anxiety and DTs (IM formulation)
  9. Nausea and vomiting (IM formulation)

Mechanism of Action

  • Antihistamine
  • Reduces anxiety by blocking histamine (H-1) receptors (results in a general decrease in cortical activation)
  • Hydroxyzine also has anticholinergic properties

Additional Information

  • Has some dopaminergic properties
  • Rapid absorption from GI tract
  • Not a good agent for chronic anxiety



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