Hydroxyzine – Uses, Side Effects, Interactions

How does this medication work? What will it do for me?

Hydroxyzine belongs to the class of medications called antihistamines. It is used to relieve itching and other symptoms caused by allergic conditions. It can help to alleviate itching due to an adverse reaction to opioid medications. It works by blocking the actions of one of the body’s natural chemicals known as histamine. Histamine is responsible for many of the symptoms seen when an allergic reaction occurs. The calming effects of hydroxyzine result from its sedating side effect.

It is also used to manage anxiety and tension caused by situations such as dental procedures or acute emotional problems. Hydroxyzine is also used to control nausea and vomiting (except in pregnancy).

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

What form(s) does this medication come in?

Hydroxyzine is no longer being manufactured for sale in Canada. For brands that may still be available, search under hydroxyzine. This article is being kept available for reference purposes only. If you are using this medication, speak with your doctor or pharmacist for information about your treatment options.

How should I use this medication?

For adults and children weighing more than 40 kg, the recommended dose of hydroxyzine when taken by mouth is up to a maximum of 100 mg per day, divided into 3 or 4 doses.  For people over the age of 65 years, the maximum daily dose is 50 mg.

For adults and children weighing more than 40 kg, the recommended dose of hydroxyzine when taken by mouth is up to a maximum of 100 mg per day, divided into 3 or 4 doses.  For people over the age of 65 years, the maximum daily dose is 50 mg.

For children weighing less than 40 kg, the dose is based on body size, and is calculated as 2 mg per kilogram of body weight. This dose is then divided into 3 or 4 doses to be taken spaced out throughout the day. The maximum daily dose of hydroxyzine for this group is 80 mg per day.

Use an oral syringe to measure each dose of the liquid, as it gives a more accurate measurement than household teaspoons.

Hydroxyzine may be taken with or without food.

Many things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important to take this medication exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature, protect it from light and moisture, and keep it out of the reach of children.

For children weighing less than 40 kg, the dose is based on body size, and is calculated as 2 mg per kilogram of body weight. This dose is then divided into 3 or 4 doses to be taken spaced out throughout the day. The maximum daily dose of hydroxyzine for this group is 80 mg per day.

Use an oral syringe to measure each dose of the liquid, as it gives a more accurate measurement than household teaspoons.

Hydroxyzine may be taken with or without food.

Many things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important to take this medication exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature, protect it from light and moisture, and keep it out of the reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Who should NOT take this medication?

Do not take this medication if you:

• are allergic to hydroxyzine or any ingredients of the medication
• are in early pregnancy (first trimester)
• have had an allergic reaction to aminophylline or cetirizine
• have asthma and have had a breathing problem relating to histamine or allergies
• have a history of irregular heartbeat, other heart rhythm problems, or a family history of sudden cardiac death
• have untreated low levels of potassium or magnesium,
• have porphyria
• are taking certain medications that can affect heart rhythm, including:
• antidepressants (e. g., amitriptyline, citalopram, fluoxetine)
• ‘azole’ antifungals (e.g., itraconazole, ketoconazole, voriconazole)
• bronchodilators (e.g., formoterol, salmeterol)
• certain antibiotics (e.g., erythromycin, ciprofloxacin)
• medications for heart rhythm (e.g., flecainide, sotalol)
• medications to treat HIV/AIDS (e.g., atazanavir, ritonavir, saquinavir)
• domperidone
• ondansetron

What side effects are possible with this medication?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent. The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

• drowsiness
• dry mouth, nose, or throat
• flushing
• headache
• itching

Although most of these side effects listed below don’t happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

• hallucinations (seeing or hearing things that aren’t there)
• skin rash
• symptoms of irregular heartbeat (e.g., chest pain, dizziness, rapid, pounding heartbeat, shortness of breath)
• symptoms of too much medication (e.g., nausea, vomiting, slurred speech, excitement, restlessness, nervousness, irritability, or tremors)

Stop taking the medication and seek immediate medical attention if any of the following occur:

• seizures
• signs of an allergic reaction (e. g., rash, itching, or hives)
• signs of a severe skin reaction such as blistering, peeling, a rash covering a large area of the body, a rash that spreads quickly, or a rash combined with fever or discomfort

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Are there any other precautions or warnings for this medication?

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Abnormal heart rhythms: This medication can cause abnormal heart rhythms. Certain medications (e.g., sotalol, quinidine, thioridazine, chlorpromazine, pimozide, moxifloxacin, mefloquine, pentamidine, arsenic trioxide, tacrolimus) can increase the risk of a type of abnormal heart rhythm called QT prolongation and should not be used in combination with hydroxyzine. You are more at risk for this type of abnormal heart rhythm and its complications if you:

• are female
• are older than 65 years of age
• have a family history of sudden cardiac death
• have a history of heart disease or abnormal heart rhythms
• have a slow heart rate
• have congenital prolongation of the QT interval
• have diabetes
• have had a stroke
• have low potassium, magnesium, or calcium levels
• have nutritional deficiencies

If you have heart disease and abnormal heart rhythms, or people are taking certain medications , discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Alcohol and other medications that cause drowsiness: People taking this medication should not combine it with alcohol and avoid combining it with other medications, such as narcotic pain relievers or sedatives, that cause drowsiness. Doing so can cause additive drowsiness and reduced breathing, as well as other side effects, which can be dangerous.

Breathing problems: People with breathing problems such as asthma, emphysema, or chronic bronchitis may find that hydroxyzine makes breathing more difficult. It can dry the mucus in the lungs, making it more difficult to clear the lungs. If you experience difficulty breathing, stop taking the medication and contact your doctor.

Digestive system problems: Antihistamines, such as hydroxyzine, cause the passage of food though the digestive system to slow down. If you have any condition that already slows down the movement of food through the stomach and intestines, hydroxyzine may make this worse.

Drowsiness/reduced alertness: Hydroxyzine may cause drowsiness or dizziness, affecting your ability to drive or operate machinery. Avoid driving, operating machinery, or performing other potentially hazardous tasks until you have determined how you are affected by this medication.

Enlarged prostate and urinary difficulties: Hydroxyzine may worsen urinary difficulties. If you have an enlarged prostate or difficulty starting urination, including a blockage from the bladder, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Epilepsy: Hydroxyzine should be used with caution by people with epilepsy, as it may increase the risk for seizures. If you have a history of seizures, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Glaucoma: This medication may cause a slight increase in pressure in the eye and therefore should be used with caution by anyone with glaucoma. If you have glaucoma, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

If you notice vision changes while you are taking this medication, contact your doctor.

Kidney function: The kidneys are partially responsible for removing this medication from your body. Kidney disease or reduced kidney function may cause this medication to build up in the body, causing side effects. If you have reduced kidney function or kidney disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Liver function: Liver disease or reduced liver function may cause this medication to build up in the body, causing side effects. If you have liver problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Myasthenia gravis: Hydroxyzine may worsen the muscle weakness experienced by people with myasthenia gravis. This medication should be used with caution if you have myasthenia gravis.

Sedation: The sedating effect of hydroxyzine must be considered when the medication is used at the same time as other sedating medications such as narcotics, non-narcotic pain relievers, sleeping pills, sedatives, barbiturates, or alcohol.

Skin reactions: Rarely, people taking hydroxyzine experience a severe skin reaction that can be life-threatening. These reactions may start as a puffy, red skin rash that forms many small blisters, covering a large area of the body. If you experience these symptoms or worsening of an existing skin condition, contact your doctor immediately.

Thyroid disease: Hydroxyzine may cause symptoms of an overactive thyroid gland (hyperthyroidism). If you have thyroid problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Pregnancy: Hydroxyzine should not be used during early pregnancy. It may be used during later pregnancy only if the potential benefits outweigh the risks.

Breast-feeding: It is not known if hydroxyzine passes into breast milk. If you are a breast-feeding mother and are taking this medication, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Seniors: Seniors may be at increased risk for the sedating and impaired coordination effects of this medication. Seniors should use extra caution, for example, when getting up during the night.

What other drugs could interact with this medication?

There may be an interaction between hydroxyzine and any of the following:

• aclidinium
• alcohol
• amantadine
• amphetamines (e.g., dextroamphetamine, lisdexamfetamine)
• other antihistamines (e.g., azelastine, bilastine, cetirizine, doxylamine, diphenhydramine, loratadine, rupatadine)
• antiarrhythmic medications (e. g., amiodarone, flecainide, procainamide, quinidine, sotalol)
• anti-psychotics (e.g., chlorpromazine, clozapine, haloperidol, olanzapine, quetiapine, risperidone)
• atropine
• barbiturates (e.g., butalbital, pentobarbital phenobarbital)
• belladonna
• benzodiazepines (e.g., alprazolam, diazepam, lorazepam)
• benztropine
• betahistine
• botulinum toxin
• brimonidine
• buprenorphine
• cannabis
• chloral hydrate
• clidinium
• clonidine
• darifenacin
• dimenhydrinate
• diphenoxylate
• diuretics (water pills; e.g., amiloride, furosemide, hydrochlorothiazide)
• domperidone
• donepezil
• efavirenz
• eluxadoline
• entacapone
• esketamine
• fesoterodine
• galantamine
• glucagon
• glycopyrrolate
• grapefruit juice
• HIV protease inhibitors (e.g., atazanavir, ritonavir, saquinavir)
• ipratropium
• kava kava
• laxatives
• lemborexant
• long-acting beta 2 agonists (e. g., formoterol, salmeterol)
• macrolide antibiotics (e.g., clarithromycin, erythromycin)
• methadone
• methotrimeprazine
• metoclopramide
• metyrosine
• mifepristone
• mirabegron
• mirtazapine
• moclobemide
• muscle relaxants (e.g., baclofen, cyclobenzaprine, methocarbamol, orphenadrine)
• nabilone
• narcotic pain relievers (e.g., codeine, fentanyl, morphine, oxycodone, tapentadol, tramadol)
• nitroglycerin
• oxybutynin
• potassium chloride
• pramipexole
• pregabalin
• protein kinase inhibitors (e.g., lapatinib, pazopanib, sunitinib, vandetanib)
• quinine
• quinolone antibiotics (e.g., ciprofloxacin, ofloxacin, )
• rivastigmine
• ropinirole
• rotigotine
• scopolamine
• seizure medications (e.g., carbamazepine, clobazam, levetiracetam, phenobarbital, phenytoin, primidone, rufinamide, topiramate, valproic acid, zonisamide)
• selective serotonin reuptake inhibitors (SSRIs; e. g., citalopram, fluoxetine, paroxetine, sertraline)
• serotonin antagonists (anti-emetic medications; e.g., granisetron, ondansetron,)
• solifenacin
• stiripentol
• tacrolimus
• tetrabenazine
• thiazide diuretics (water pills; e.g., hydrochlorothiazide, indapamide, metolazone)
• tiotropium
• tizanidine
• tolterodine
• tranylcypromine
• trazodone
• tricyclic antidepressants (e.g., amitriptyline, clomipramine, desipramine, trimipramine)
• trospium
• umeclidinium
• valerian
• venlafaxine
• zolpidem
• zopiclone

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

All material copyright MediResource Inc. 1996 – 2023. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/drug/getdrug/Hydroxyzine

Differences, similarities, and which is better for you

Drug overview & main differences | Conditions treated | Efficacy | Insurance coverage and cost comparison | Side effects | Drug interactions | Warnings | FAQ

Vistaril and Xanax are two brand-name medications used for the treatment of short-term anxiety. Anxiety disorders affect approximately 40 million Americans, making it one of the most common mental illnesses. Unfortunately, statistics show only about 40% of patients seek treatment for their anxiety despite the fact that it is highly treatable.

There are a variety of types of treatment for anxiety. Cognitive-behavioral therapy focuses on identifying, understanding, and changing your thinking and behavioral patterns to help you better cope with your anxiety. Alternative treatments such as yoga, meditation, and acupuncture have proven effective for some in alleviating anxiety. Treatment with medication remains a predominant mode of treatment for anxiety.

There are several classes of medications indicated in the treatment of anxiety including selective serotonin reuptake inhibitors (SSRIs), selective norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants, and benzodiazepines. Your healthcare provider may recommend a combination of treatment types based on your symptoms.

What are the main differences between Vistaril and Xanax?

Vistaril (hydroxyzine pamoate) is a piperazine class sedating antihistamine used commonly in the treatment of transient anxiety symptoms. Vistaril is a prescription-only drug. It blocks the h2 histamine receptor. Its exact mechanism for relieving anxiety is unknown, though we do know that blocking the h2 receptor in the central nervous system leads to sedation, antiemetic, analgesic, and skeletal muscle relaxant effects. Vistaril (What is Vistaril?), and its generic form, are available in oral capsules in strengths of 25 mg, 50 mg, and 100 mg. It is also available in a liquid suspension of 25 mg/5 ml.

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Xanax (alprazolam) is a benzodiazepine used commonly in the treatment of short-term anxiety and generalized anxiety disorder. Other benzodiazepines include Ativan (lorazepam), Klonopin (clonazepam), and Valium (diazepam). Xanax is a prescription-only drug and is also categorized as a controlled substance by the Drug Enforcement Agency (DEA). Xanax works through the central nervous system (CNS) by inhibiting reticular pathways responsible for many types of emotional responses, including anxiety. Xanax (What is Xanax?), and its generic forms, are supplied on regular and orally disintegrating tablets in strengths of 0.25 mg, 0.5 mg, 1 mg, and 2 mg. An extended-release tablet is available in strengths of 0.5 mg, 1 mg, 2 mg, and 3 mg. There is also a concentrated liquid formulation in a concentration of 1 mg/ml.

Conditions treated by Vistaril and Xanax

Vistaril is indicated in the treatment of anxiety, tension, and psychomotor agitation in conditions of emotional distress. Due to its actions on histamine receptors, Vistaril is also indicated in treating pruritus (itching) due to conditions of chronic urticaria, contact dermatitis, and atopic dermatitis. Vistaril is used in the treatment of nausea and vomiting due to both pregnancy and post-operative causes. It is also approved to provide sedation for procedures.

Vistaril is also used off-label for some indications. Off-label use refers to drugs being used for indications not approved by the Food and Drug Administration (FDA). Vistaril is used off-label for the temporary treatment of insomnia due to its somnolence effects. It is also used off-label to treat seasonal allergic rhinitis (season allergies).

Xanax is indicated in the treatment of transient symptoms of anxiety as well as generalized anxiety disorder (GAD). It is also indicated in the treatment of panic disorder. Xanax can be used off-label to relieve anxiety and mood disorders related to premenstrual dysphoric disorder (PMDD).

Is Vistaril or Xanax more effective?

A double-blind, controlled clinical study compared the anxiolytic, sedative, amnesia, and safety effects of the ingredients of Vistaril and Xanax on pre-procedural patients. This study found that Vistaril produced essentially no effect on anxiety for these patients, compared to a moderate effect produced by Xanax. The two drugs were comparable in regards to effects in somnolence and memory, but the effects of hydroxyzine lead to a more pronounced decrease in blood pressure. While they are both effective pre-procedural drugs, Xanax may be preferred due to its more pronounced effect on anxiety and adverse event profile.

Only your doctor can decide which anxiety treatment is best for you. If you are experiencing anxiety or other symptoms of a mental health disorder, seek medical advice. Do not attempt to self-medicate or take over-the-counter medications.

Coverage and cost comparison of Vistaril vs. Xanax

Vistaril is a prescription medication that is typically covered by both Medicare and commercial insurance plans. Brand name Vistaril can cost as much as $92 out-of-pocket. With a coupon from SingleCare, you could pay as little as $4 for a 30-day supply of the generic, hydroxyzine pamoate 25 mg.

Xanax is a prescription medication that is typically covered by commercial insurance plans. Medicare drug plans may or may not cover Xanax. It is excluded from some plans. The out-of-pocket price for Xanax is an average of about $63. With a coupon from SingleCare, you could pay less than $10 for a 30-day supply of the 1 mg generic.

Use the SingleCare discount card

Common side effects of Vistaril vs. Xanax

Anticholinergic side effects are common with both Vistaril and Xanax (forms of arrhythmia). Drowsiness, or somnolence, is a side effect of both drugs. Drowsiness can affect daily productivity and should be weighed against the benefits of treatment. Dry mouth also affects patients taking either Vistaril or Xanax. While there are remedies for dry mouth such as gum and mouth rinse, it may be very bothersome for some.

Vistaril is known to cause QT prolongation and Torsade de Pointes (forms of arrhythmia). Vistaril should be avoided in patients with a known history of QT prolongation or risk factors such as pre-existing cardiac disease, electrolyte imbalances, and drug use.

The following list is not intended to be a comprehensive list of adverse events. Consult your healthcare provider for a complete list of potential side effects.

Source: Vistaril (DailyMed) Xanax (DailyMed)

Drug interactions of Vistaril vs. Xanax

Vistaril should be avoided with both long- and short-acting beta agonists, such as albuterol or formoterol. Beta agonists are linked to the incidence of QT prolongation and Torsade de Pointes, and concurrent use with Vistaril increases the risk of these adverse events.

Vistaril and Xanax combined with opioid agonists may greatly increase the risk of severe drowsiness and somnolence. Xanax combined with opioid agonists may lead to severe respiratory depression and hypotension (low blood pressure). This can be life-threatening. Combined use with drugs such as codeine or hydrocodone can be dangerous and should be avoided.

Vistaril and Xanax should be used cautiously in patients on other antihistamines that may be sedating, such as diphenhydramine or chlorpheniramine. The additive drowsiness of these medications can cause harm to the patient.

This is not intended to be a comprehensive list of interactions for Vistaril and Xanax. Please consult your pharmacist or other healthcare professional for a complete list of interactions.

Warnings of Vistaril and Xanax

It is unknown if Vistaril crosses into breast milk, and therefore should be avoided or used cautiously in nursing mothers.

Concomitant use of Xanax with opioid agonists can cause life-threatening respiratory depression and hypotension. In some cases, it may lead to coma and/or death. If it is determined that the combination cannot be avoided, patients must be advised on the adverse events. Patients should not drive or operate heavy machinery while on these medications.

Xanax is a controlled substance and could be habit-forming. The use of Xanax carries the risk of physical dependence and substance abuse, even after a relatively short-term treatment. Your doctor may limit the amount of Xanax prescribed to reduce this risk.

Withdrawal symptoms, including seizures, may occur with dose decrease or discontinuation of Xanax. This medication should be tapered with the advice of a medical professional while they monitor the patients for signs and symptoms of withdrawal.

Frequently asked questions about Vistaril vs. Xanax

What is Vistaril?

Vistaril is a prescription histamine-1 blocker used in the short-term treatment of transient anxiety symptoms. It may also be used to treat symptoms of insomnia, itching, and allergic reaction. It is available as an oral capsule, oral suspension, and injection.

What is Xanax?

Xanax is a prescription anxiety medication used for both short-term anxiety as well as generalized anxiety disorder. It is a benzodiazepine and considered a controlled substance that has the potential to be addicting. It is available as an oral, orally disintegrating, and extended-release tablet. It is also available as a concentrated oral liquid.

Are Vistaril and Xanax the same?

Vistaril and Xanax are both used to treat short-term symptoms of anxiety, but they are not the same type of medication. Vistaril is a type of antihistamine, while Xanax is a benzodiazepine and considered a controlled substance.

Is Vistaril or Xanax better?

Xanax has been shown to have a more pronounced effect at decreasing anxiety in transient symptom situations. The somnolence and amnesia tendencies tend to be comparable between the drugs. Vistaril appears to cause low blood pressure to a larger extent than Xanax, so therefore Xanax may be preferred in many instances of transient, short-term anxiety situations.

Can I use Vistaril or Xanax while pregnant?

Vistaril is considered pregnancy category C by the Food and Drug Administration. This means there are not enough studies to establish its safety in pregnancy, and it should only be used when benefits clearly outweigh any risks. Xanax is considered pregnancy category D. This means that studies have proven that harm can come to the fetus with use during pregnancy, and its use during pregnancy is not recommended.

Can I use Vistaril or Xanax with alcohol?

Due to alcohol’s potential to cause drowsiness and slow respiratory rate, the concurrent use of alcohol with Vistaril or Xanax is not recommended.

Does Vistaril help with anxiety?

Vistaril is approved to treat short-term, transient symptoms of anxiety. Due to some of the adverse events it may cause, your doctor may choose another type of therapy for daily anti-anxiety treatment.

How long does it take for Vistaril to work?

The effects of Vistaril begin just 15 to 60 minutes after taking the dose and can last up to four to six hours.

Is Vistaril a controlled substance?

Vistaril is not a controlled substance. It does not have a significant potential for abuse or physical dependence.

How we are treated: Atarax – Indicator

Medicine

22:55, April 23, 2020

Soothe my anxiety

How to turn the side effect of the drug into its main advantage, which GAD poisons our daily life and how histamine “distraction” helps us to calm down, will tell the new issue of the heading “How they treat us.”

Spring exacerbation this year is likely to await those suffering from anxiety disorders and panic attacks. Even normally calm people have more than enough reasons to worry. Nervous, many will think not only about proper nutrition, the distribution of rest and activity and sleep patterns, but also about medications that can come to the rescue in such a state. We have already discussed many popular anti-anxiety drugs, both Phenazepam from the benzodiazepine group, and their analogues, such as Stresam or Afobazol. Today we will talk about Atarax, which is considered by pharmacists as a mild tranquilizer and anti-anxiety agent.

From what, from what

Benzodiazepine drugs for anxiety, as we have already written more than once, are famous for a diverse bunch of undesirable effects – from memory and attention impairment to withdrawal syndrome. But our hero today does not belong to this common group. In contrast, hydroxyzine (namely, the name of the active ingredient of Atarax) is the first generation of antihistamines, which we usually treat allergic rhinitis, swelling or rashes. But inhibition of the nervous system and drowsiness – a side effect that drugs like Suprastin or even Zodak becomes a real curse – manufacturers have adopted. As a result, the side effect of Atarax (in which the same derivative, cetirizine, is formed in the body as the active ingredient in Zodak) won and is used as the main one.

The main mechanism of action is that hydroxyzine is an inverse agonist of the h2-histamine receptor, that is, a protein that, after binding to histamine, triggers a series of reactions. Behind these terrible words is just that hydroxyzine binds to the same protein as histamine (one of the main “conductors” in allergic reactions and inflammation), and “distracts” this protein from interactions with its “believing”. As a result, real histamine binds to the receptor protein worse, which should lead to the desired effect of the drug.

But how does reducing the effect of histamine affect the brain? Cetirizine from a single 30 mg dose of hydroxyzine not only penetrates the brain, despite the blood-brain barrier protecting it from unwanted substances. Positron emission tomography images show that it binds to 67.6% of the brain’s histamine receptors. This calms patients and makes them sleepy, while binding 20% ​​of the receptors is not enough for this effect. In addition, hydroxyzine acts (albeit weaker) on other receptors, including dopamine and serotonin. The same principle is based on the action of some drugs for depression and other mental disorders. But on muscarinic receptors, unlike many antihistamines, it does not show an effect, so it should pose less of a danger to people with heart disease.

You can learn how to understand medicines on your own in the author’s online course “How we are being treated” by the editor of Indicator.Ru Ekaterina Mishchenko: https://clck.ru/Pnmtk

The processing of hydroxyzine in the body is mainly done by the liver, and even our old friend alcohol dehydrogenase is involved in the process. The highest concentration of the drug in the blood (and the main effect) can be expected 2 hours after application, and it is excreted by half after 20 hours in adults, and after seven in children. In the elderly, these figures may differ, but the effect of the drug on them is poorly understood, so for them it may even have potentially dangerous side effects.

Closer to the body

All of these diverse mechanisms sound great, but do they work in large patient populations or just change elusive biochemistry in limited human and animal experiments? The reasons for increased anxiety can be no less diverse, so let’s deal with the indications, and clinical trials will help us in this.

Atarax is prescribed for the treatment of itching, for the symptomatic control of anxiety before an upcoming operation (this is called premedication), for generalized anxiety disorder, psychomotor agitation, irritability, and even for chronic alcoholism. Since the drug has entered its seventh decade, it has been studied in great detail. In some areas, a lot of material has accumulated, and it has been systematized in reviews of the Cochrane Collaboration.

The Cochrane Library is a database of the Cochrane Collaboration, an international non-profit organization involved in the development of World Health Organization guidelines. The name of the organization comes from the name of its founder, the 20th-century Scottish medical scientist Archibald Cochrane, who championed the need for evidence-based medicine and the conduct of competent clinical trials and wrote the book Efficiency and Efficiency: Random Reflections on Public Health. Medical scientists and pharmacists consider the Cochrane Database one of the most authoritative sources of such information: the publications included in it have been selected according to the standards of evidence-based medicine and report the results of randomized, double-blind, placebo-controlled clinical trials.

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The fight against itching in skin diseases caused by irritation or raging immunity (urticaria, dermatitis, eczema) is the work of Atarax in its original, antihistamine direction. And here it is used as a systemic medicine (by mouth, usually in the form of tablets). According to the conclusion of the authors of the Cochrane review, cetirizine (as we remember, hydroxyzine is converted into it in the body) in a standard dosage completely removes urticaria if you drink it in a short or medium course. The studies focused on redness and irritation (which is also itchy) that appeared spontaneously (for no apparent reason) and did not disappear for about six weeks without treatment.

Eczema can become an even more unpleasant skin disease. The affected areas not only redden and itch, but also swell, can get wet and become covered with flaky crusts. For eczema, the benefit of antihistamines alone is not yet clear: they were usually used as part of complex treatment, so their effect is questionable. However, the authors urge not only to conduct new tests, but also not to refuse the use of antihistamines in the ensemble – it is likely that something will help.

How gross is this anxiety of yours

Anxiety can be caused not only by external factors (like the current pandemic and the accompanying “infodemic”, as well as events in one’s own life — for example, the illness of a loved one), but also by mental disorders. Distinguishing causes, effects and making a diagnosis without medical help is quite difficult, so we will only briefly describe the options for which Atarax is prescribed.

Generalized Anxiety Disorder (known in English as Generalized Anxiety Disorder, or GAD) refers to anxiety and worries that haunt a person constantly and sometimes for no particular reason, disrupting daily life. The patient may experience many symptoms: difficulty swallowing, difficulty sleeping, sweating, fearfulness, always feeling tired, constantly irritated, worrying about little things, trembling, or complaining of headaches. According to the Cochrane Review, hydroxyzine cannot be the number one drug candidate to fight GAD. Although it outperforms placebo in clinical trials, articles do not always provide detailed treatment results and the risk of misinterpretation of results is high. There are few studies, and the sample size in them is not very large. Although the review was published in 2010, little new data has been added since then. Nevertheless, he did not succumb to other anxiolytics (from English anxiety – anxiety).

Double-blind, randomized, placebo-controlled method is a method of clinical drug research in which subjects are not privy to important details of the study being conducted. “Double-blind” means that neither the subjects nor the experimenters know who is being treated, “randomized” means that the distribution into groups is random, and the placebo is used to show that the effect of the drug is not based on self-hypnosis and that this medicine helps better than a pill without an active substance. This method prevents subjective distortion of the results. Sometimes the control group is given another drug with already proven efficacy, rather than a placebo, to show that the drug not only treats better than nothing, but also outperforms analogues.

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Another review (albeit dedicated to another drug) mentions hydroxyzine as a worthy competitor: it helps calm children before neurodiagnostic procedures. Hydroxyzine can also relieve pain during contractions, but there is very little data on this topic.

PubMed’s database of English-language articles also contains many articles on hydroxyzine and anxiety. True, they do not help dispel all doubts. Whether Atarax reduces anxiety before surgery is debatable. So, competing with alprazolam, hydroxyzine lost in reducing anxiety, but had the same sedative (calming, suppressing) effect. However, in all studies it is tested either in combination with other drugs (so which of them we owe the action is not clear), or compared with drugs that themselves may not be very effective for this indication. When compared with placebo, alas, the result turns into a pumpkin. Although the sample is small here too, so these results can be refuted if desired.

Indicator.Ru recommends: for urticaria – yes, for anxiety – as an alternative

For generalized anxiety disorder, Atarax is recommended if psychotherapy is not enough, and antidepressants did not work out. Nevertheless, it proved to be no worse than other anti-anxiety drugs in terms of efficacy, tolerability and safety. In other types of anxiety disorders or anxiety caused by real causes of anxiety, Atarax has been little studied.

It is usually used either against allergic reactions, itching and hives (where it is, by the way, effective), or as a premedication – a sedative before surgery or other difficult medical intervention (where it is not very effective). While it is true that anxiety can exacerbate skin problems, continually creating new causes for concern, it is considered here as an antihistamine, but as a cure for anxiety is not in the first line of defense. It is not a barbiturate but is calming, not a benzodiazepine derivative but may help with anxiety. In addition, it is devoid of some of the side effects characteristic of antihistamines.

At the same time, the drug has been poorly studied in a sample of older people, and it has not been studied at all for alcohol dependence. But since anxiety can be increased during exacerbation of the withdrawal syndrome and many other conditions, and the mechanisms for its suppression are the same, Atarax often becomes the drug of choice in all these cases.

Our recommendation is not the same as a doctor’s prescription. Before you start taking this or that drug, be sure to consult a specialist.

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Author: Ekaterina Mishchenko

Tags #How we are treated

Confirmatory analysis of urine for the content of specific narcotic drugs, psychotropic and potent substances (GC-MS method) in the Optimum laboratory in Sochi (Adler)

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* Collection of biomaterial is paid separately

Urinalysis for specific narcotic drugs, psychotropic substances and potent substances

There is a fairly wide variety of rapid tests in the form of test strips, etc. , but this type of analysis is only a preliminary measure for the detection of drugs in urine . The use of the Gas Chromatography/Mass Spectrometry method will allow a professional judgment to be applied to any result drug test .

Gas chromatography – mass spectroscopy is a universal method that allows you to qualitatively and quantitatively identify many substances: from the hormonal components of the blood to medicinal and potent substances. In laboratory diagnostics , the GC-MS method plays an exceptional role in the detection of intoxicants in the tested biomaterials. GC-MS is a combination of two analytical tools that complement each other: gas chromatography, which separates complex mixtures into individual components in a gas environment, and mass spectrometry, which identifies spectrometrically detected components.

Sampling

Urine must be collected within the first five days (120 hours) of the discovery of drug intoxication. Although many substances (described in the table below) can be eliminated before the expiration of five days, some substances remain at low concentrations.

If it is not possible to donate urine directly to the laboratory, you can take it yourself. At least 50 ml of urine should be collected in two sterile containers, samples can be stored in a refrigerator at 2-8°C. If samples cannot be submitted for analysis before 24 hours have elapsed, they can be placed in a freezer. Unused samples are allowed to be stored for up to 12 months (at t = -18°С) in case the need for additional research arises.

Please note! The specified terms of detection of stupefying substances in the urine are indicative, and it will be impossible to detect many of them 4-5 days after their intake.

Content limit

The list is exhaustive, laboratory technicians are testing those substances, the consumption of which is most common in their region.

Benzodiazepines:

• Alprazolam and alpha-OH-alprazolam – 10 µg/l
• Bromazepam and OH-bromazepam – 10 µg/l
• Diazepam 10 µg/L
• Clobazam 10 µg/L
• Clonazepam and 7-aminoclonazepam 5 µg/L
• Clotiazepam 10 µg/L

90 096 Loprazolam 10 µg/L

• Lorazepam 10 µg/L
• Lormetazepam 10 µg/L
• Midazolam 10 µg/L
• Nitrazepam and 7-aminonitrazepam — 5 mcg/l
• Nordiazepam — 10 mcg/l
• Oxazepam — 10 mcg/l
• Prazepam — 10 mcg/l
• Temazepam — 10 mcg/l
• Tetrazepam 10 µg/L
• Triazolam and 4-OH-triazolam 5 µg/L
• Phenazepam 5 µg/L
• Flunitrazepam and 7-aminoflunitrazepam 5 µg/L 90 097
• Chlordiazepoxide – 10 µg/l
• Estazolam – 10 µg/l

Hypnotics:

• Zaleplon – 10 µg/l
• Zol pidem and metabolites — 10 µg/l
• Zopiclone and metabolites — 10 µg/l

Antihistamines and other drugs:

• Alimemazine — 10 µg/l
• Amitriptyline and nortriptyline – 10 µg/l
• Aceprometazine – 10 µg/l
• Brompheniramine and desmethyl-B – 10 µg/l
• Valproic acid – 5 0 µg/l
• Haloperidol – 10 µg/l
• Hydroxysine – 10 µg/l
• Desipramine – 10 µg/l
• Dextromethorphan – 10 µg/l
• Diphenhydramine – 10 µg/l
• Doxepin and desmethyldoxepin – 10 µg/l
• Doxylamine and desmethyldoxylamine – 10 µg/l
• Imipramine – 10 µg/l
• Carisoprodol and meprobamate – 50 µg/l
• Clonidine – 10 µg/l
• Niaprazine – 10 µg/l

9 0096 Oxomemazine – 20 µg/l

• Sertraline and norsertraline – 10 µg/l
• Fluoxetine and norfluoxetine – 10 µg/l
• Chlorpheniramine and desmethyl-C – 10 µg
• Cetirizine 10 µg/L
• Cyamemazine 10 µg/L
• Cyclobenzaprine 10 µg/L
• Citalopram and desmethylcitalopram 10 µg /l

Barbiturates:

• Amobarbital – 25 mcg/l
• Butalbital – 25 mcg/l
• Pentobarbital – 25 mcg/l
• Secobarbital – 25 µg/l
• Phenobarbital – 25 µg/l

Narcotics and non-narcotic analgesics:

• Hydrocodone – 10 µg/l 9009 7
• Hydromorphone – 10 µg/l
• Dextromethorphan – 10 µg/l
• Dihydrocodeine – 10 µg/l
• Codeine – 10 µg/l
• Meperidine (pet idine) — 10 mcg/l
• methadone – 10 μg/l
• morphine – 10 μg/l
• oxicodon – 10 μg/l
• Petidin – 10 mcg/l
• pro -Polopoxifen and norpropoxifen – 10 μg/l
• fondeline – 10 μg/l

90 90 90 90 90 195

“Street” drugs and other psychoactive drugs:

• TNS SOON-10 μg/l
• 6-monoacetylmorphin (mothers)-10 μg/l
• Morphine-10 μg Ekgonin – 50 μg/l
• Cocaetilelene – 50 μg/l
• Methylecgonine – 50 µg/l
• Amphetamine – 10 µg/l
• MBDB – 10 µg/l
• MDA – 10 µg/l
• MDMA – 10 µg/L
• MDEA – 10 µg/L
• Methamphetamine – 10 µg/L
• Ketamine and norketamine – 1 µg/L
• Lysergic acid (LSD) – 1 µg/L
• Phencyclidine – 10 µg/l
• Piperazine group – 10 µg/l
• Scopolamine – 10 µg/l
• Ethanol – 0.