HydroxyzineHydroxyzine Hydrochloride/Pamoate

About Hydroxyzine

MedlinePlus calls hydroxyzine an antihistamine. The label says it is not a cortical depressant and may act by suppressing activity in certain regions beneath the brain’s cortex; its antihistamine effects have been confirmed clinically, and its effects usually begin within 15 to 30 minutes of a dose. It is labeled for relief of anxiety and tension, including anxiety that accompanies a physical illness; for itching from allergic conditions; and as a sedative before and after general anesthesia. Its use for anxiety beyond four months has not been studied systematically, so prescribers reassess it periodically. Adults take 50 to 100 mg four times a day for anxiety and 25 mg three or four times a day for itching; children under 6 take 50 mg a day and older children 50 to 100 mg a day, in divided doses. It is not labeled for insomnia; using it for sleep is off-label and the prescriber’s decision.

Hydroxyzine has no boxed warning. It must not be used by people with a prolonged QT interval, early in pregnancy, or by anyone allergic to it or to cetirizine or levocetirizine. QT prolongation and a dangerous heart rhythm, torsades de pointes, have been reported, mostly in people with other risk factors, so it is used with caution in heart disease, after a recent heart attack, in uncompensated heart failure or slow heart rhythms, with electrolyte imbalances or a personal or family history of long QT syndrome, and with other drugs that prolong QT. It adds to the effects of other sedatives, such as opioids and barbiturates, whose doses should be lowered, and it can impair driving and strengthen alcohol’s effects. A rare severe pustular rash (acute generalized exanthematous pustulosis) means stopping it at the first sign of a rash. Side effects are usually mild and short-lived: drowsiness, which often fades within days, and dry mouth; rare tremor and seizures have been reported, usually at doses well above those recommended.

Older adults are more prone to confusion and oversedation, so they start on low doses, and MedlinePlus says older adults should not usually take it because other medicines are safer. The hydrochloride tablets and syrup and the pamoate capsules are different salts and forms; capsule strengths are stated as the hydrochloride equivalent, but the products are not rated equivalent to one another, so a pharmacist cannot exchange one for another without the prescriber. The Orange Book lists Atarax tablets and Vistaril capsules and suspension as discontinued. The label says hydroxyzine should not be given to nursing mothers.

Taking Hydroxyzine

How to take it

By mouth, usually three or four times a day, or as directed. Do not drive or operate machinery until you know how it affects you, and ask the prescriber about alcohol, which can make its side effects worse.

If you miss a dose

If you take it on a regular schedule, take the missed dose as soon as you remember, unless it is almost time for the next one; then skip it and continue as usual. Do not take a double dose.

Storage

At room temperature in the original, tightly closed container, away from light, excess heat and moisture (not in the bathroom), out of reach of children; do not freeze the syrup. Do not flush it; use a take-back program.

Interactions to know about

Opioids, barbiturates, other sedatives and alcohol add to drowsiness, and their doses may need lowering. Drugs that prolong the QT interval, including some antiarrhythmics, antipsychotics, antidepressants and antibiotics, methadone and ondansetron, add to heart rhythm risk. Avoid cetirizine and levocetirizine after a skin reaction or allergy to hydroxyzine.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Hydroxyzine differs from pharmacy to pharmacy

Hydroxyzine is sold only as generics, and the tablets have many makers. Tablets, syrup and capsules are separate products, and a pharmacist can fill only the one prescribed, so quotes for capsules and tablets at the same dose can differ.

Each pharmacy sets its own cash price, including its dispensing fee, which applies to every fill whatever its size, so the quantity written matters. The 100 mg capsule is listed for a single maker.

Ways to pay less for Hydroxyzine without insurance

• Ask whether hydroxyzine is on the pharmacy’s flat-price generic list, and compare more than one pharmacy.
• Ask the prescriber whether tablets or capsules suit you, and have each pharmacy quote the exact product and quantity written.
• If you take it every day on a settled dose, ask for a ninety-day supply.
• If the syrup is prescribed for someone who can swallow tablets, ask the prescriber whether tablets would suit.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Hydroxyzine

1. 1.Is my prescription for the hydrochloride tablets, the syrup or the pamoate capsules?
2. 2.Do any of my heart, antibiotic, antidepressant or nausea medicines affect my heart rhythm with it?
3. 3.How drowsy will it make me, and is it safe with alcohol or my pain or sleep medicines?
4. 4.Which rash or other symptoms mean I should stop it and call?

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