Hydroxyzine (Vistaril)

Contents

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

HOW TO DOSE:
> 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

 

References

  1. Cooper, J. R., Bloom, F. E., & Roth, R. H. (2003). The biochemical basis of neuropharmacology (8th ed.). New York, NY, US: Oxford University Press.
  2. Iversen, L. L., Iversen, S. D., Bloom, F. E., & Roth, R. H. (2009). Introduction to neuropsychopharmacology. Oxford: Oxford University Press.
  3. Puzantian, T., & Carlat, D. J. (2016). Medication fact book: for psychiatric practice. Newburyport, MA: Carlat Publishing, LLC.
  4. J. Ferrando, J. L. Levenson, & J. A. Owen (Eds.), Clinical manual of psychopharmacology in the medically ill(pp. 3-38). Arlington, VA, US: American Psychiatric Publishing, Inc.
  5. Schatzberg, A. F., & DeBattista, C. (2015). Manual of clinical psychopharmacology. Washington, DC: American Psychiatric Publishing.
  6. Schatzberg, A. F., & Nemeroff, C. B. (2017). The American Psychiatric Association Publishing textbook of psychopharmacology. Arlington, VA: American Psychiatric Association Publishing.
  7. Stahl, S. M. (2014). Stahl’s essential psychopharmacology: Prescriber’s guide (5th ed.). New York, NY, US: Cambridge University Press.
  8. Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY, US: Cambridge University Press.
  9. Whalen, K., Finkel, R., & Panavelil, T. A. (2015). Lippincotts illustrated reviews: pharmacology. Philadelphia, PA: Wolters Kluwer.