Uses, Dosage, Side Effects, Interactions, Warning

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Vistaril (hydroxyzine) dosing, indications, interactions, adverse effects, and more

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.

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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.

New restrictions to minimise the risks of effects on heart rhythm with hydroxyzine-containing medicines

Use to be avoided in patients at greatest risk and doses to be kept low

The CMDh¹ has agreed by consensus new measures to minimise the risk of effects on heart rhythm with medicines containing the antihistamine hydroxyzine. The measures include restricting use of hydroxyzine in patients at high risk of heart rhythm problems and using the medicine at the lowest effective dose for as short a time as possible.

Hydroxyzine medicines are available in most EU countries. Their approved uses (indications) vary between countries and may include use to treat anxiety disorders, for relief of pruritus (itching), as premedication before surgery, and treatment of sleep disorders.

Recommendations for these new measures were originally made by EMA’s Pharmacovigilance Risk Assessment Committee (PRAC), which confirmed a previously known risk of QT interval prolongation and torsades de pointes, alterations in the electrical activity of the heart that can lead to abnormal heart rhythms and cardiac arrest (stopping of the heart). Having assessed the available evidence, including published studies and data from regular safety monitoring, the PRAC concluded that the risk did not differ between indications and that such events are most likely to occur in patients who have risk factors. The PRAC therefore recommended that the risk be managed by restricting hydroxyzine use in those most at risk of heart rhythm problems and reducing exposure to the medicine.

As the CMDh has now agreed the PRAC measures by consensus, the measures will be directly implemented by the Member States where the medicines are authorised, according to an agreed timetable. In particular, the product information of hydroxyzine-containing medicines will be updated with new dosing recommendations and warnings on use in patients who have risk factors for heart rhythm disturbances or who are taking certain other medicines.

Information to patients

• Medicines containing the antihistamine hydroxyzine are available in most EU countries. The approved uses are different in different countries, but may include treatment of anxiety, relief of itching, use as one of the medicines given before an operation (premedication) or treatment of sleep problems.
• There is a small risk of altered electrical activity of the heart when taking these medicines, which can lead to abnormal heart rhythm or even cause the heart to stop (cardiac arrest). The risk is mostly seen in patients who already have heart rhythm problems or have risk factors for these problems.
• To reduce the risk to a minimum, new measures have been agreed for these medicines to ensure they are used for as short a time as possible at the lowest effective dose, and that their use is avoided in those at higher risk.
• The dose in adults should not add up to more than a total of 100 mg a day. Elderly patients should not use these medicines, but if they do the maximum dose should be 50 mg a day.
• In countries where the medicines are approved for use in children, the maximum dose depends on their weight, and the daily total should not be more than 2 mg per kg of body weight in children weighing up to 40 kg (children over 40 kg should be given the adult dose).
• Hydroxyzine must not be taken by patients who already have disturbances of heart rhythm or are taking other medicines that can cause similar effects on the heart. It should be used with care if taking certain other medicines that slow the heart rate or decrease the level of potassium in the blood.
• The package leaflet and other product information for these medicines will be updated to take account of the new measures. In the meantime, patients who have any concerns should speak to their doctor or pharmacist.

Information to healthcare professionals

• Hydroxyzine has the potential to block hERG channels and other types of cardiac channels, resulting in a potential risk of QT interval prolongation and cardiac arrhythmia events. This potential risk was confirmed by clinical and post-marketing data. Most cases had other risk factors, electrolyte abnormalities or concomitant treatment that may have been contributory.
• The potential risk of QT interval prolongation and torsades de pointes can therefore be adequately minimised through measures targeting the identified risk factors and restricting the use of hydroxyzine to the lowest effective dose for the shortest possible duration.
• The maximum dose in adults should be a total of 100 mg daily; in the elderly, if use cannot be avoided the maximum daily dose should be 50 mg.
• The maximum daily dose in children up to 40 kg in weight should be 2 mg/kg/day; children over 40 kg should be given the adult dose.
• Use of hydroxyzine is contraindicated in patients with known acquired or congenital QT interval prolongation, or with a known risk factor for QT interval prolongation such as cardiovascular disease, significant electrolyte imbalance (hypokalaemia, hypomagnesaemia), family history of sudden cardiac death, significant bradycardia, or concomitant use of drugs known to prolong the QT interval and/or induce torsades de pointes.
• Use is not recommended in elderly patients, due to reduced elimination of hydroxyzine in these patients and greater vulnerability to anticholinergic effects and other adverse reactions. The medicine should be used with caution in patients with bradycardia, or who are taking hypokalaemia-inducing medicines. Care is also required when hydroxyzine is co-administered with drugs known to be potent inhibitors of alcohol dehydrogenase or CYP3A4/5.

The above risk minimisation measures were taken following an assessment of the available evidence, including published studies and data from regular safety monitoring. The data showed that the risk did not differ between indications. It was considered appropriate to restrict the maximum daily dose in adults, with corresponding changes in the paediatric and elderly populations based on pharmacokinetic data, in order to minimise exposure. For similar reasons, it was recommended that the treatment duration should be as short as possible.

The new measures will now be implemented according to an agreed timetable in the individual EU countries. A letter explaining the changes will be sent to healthcare professionals. The SmPC and package leaflet of the affected medicines will be amended accordingly.

More about the medicine

Hydroxyzine-containing medicines have been authorised by national procedures in 22 Member States of the EU (Austria, Belgium, Bulgaria, Cyprus, Czech Republic, Denmark, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Luxembourg, Malta, Netherlands, Poland, Portugal, Slovakia, Spain, Sweden and United Kingdom) plus Norway and Iceland.

They are used generally by mouth or sometimes by injection. These medicines are available under various trade names including Atarax. Approved uses vary between countries, but may include treatment of anxiety disorders, relief of pruritus (itching) including that due to urticaria, premedication before surgery, and treatment of sleep disorders.

More about the procedure

The review of hydroxyzine was initiated on 25 April 2014 at the request of Hungary, under Article 31 of Directive 2001/83/EC.

The review was carried out by the Pharmacovigilance Risk Assessment Committee (PRAC), the Committee responsible for the evaluation of safety issues for human medicines, which made a set of recommendations. As hydroxyzine-containing medicines are all authorised nationally, the PRAC recommendation was forwarded to the Co-ordination Group for Mutual Recognition and Decentralised Procedures – Human (CMDh), for a position. The CMDh is a regulatory body representing EU Member States plus Iceland, Liechtenstein and Norway, and is responsible for ensuring harmonised safety standards for medicines authorised via national procedures across the EU.

On 25 March 2015 the CMDh adopted its position by consensus, so the measures recommended by the PRAC will be directly implemented by the Member States where the medicines are authorised, according to an agreed timetable.

¹ The CMDh is a medicines regulatory body representing the European Union (EU) Member States, Iceland, Liechtenstein and Norway.

Hydroxyzine: Pediatric Medication | Memorial Sloan Kettering Cancer Center

This information from Lexicomp^® explains what you need to know about this medication, including what it’s used for, how to take it, its side effects, and when to call your healthcare provider.

Brand Names: US

Vistaril

Brand Names: Canada

Atarax; NOVO-Hydroxyzin; PMS-HydrOXYzine HCl; PMS-HydrOXYzine [DSC]

What is this drug used for?

• It is used to treat itching.
• It is used to treat anxiety.
• It is used to put your child to sleep for surgery.
• It is used to treat mood problems.
• It is used to treat upset stomach and throwing up.
• It may be given to your child for other reasons. Talk with the doctor.

What do I need to tell the doctor BEFORE my child takes this drug?

• If your child is allergic to this drug; any part of this drug; or any other drugs, foods, or substances. Tell the doctor about the allergy and what signs your child had.
• If your child has ever had a long QT on ECG.

If your child is pregnant or breast-feeding a baby:

• Do not give this drug to your child during early pregnancy.
• Be sure your child does not breast-feed a baby while taking this drug.

This is not a list of all drugs or health problems that interact with this drug.

Tell the doctor and pharmacist about all of your child’s drugs (prescription or OTC, natural products, vitamins) and health problems. You must check to make sure that it is safe to give this drug with all of your child’s other drugs and health problems. Do not start, stop, or change the dose of any drug your child takes without checking with the doctor.

What are some things I need to know or do while my child takes this drug?

All products:

• Tell all of your child’s health care providers that your child is taking this drug. This includes your child’s doctors, nurses, pharmacists, and dentists.
• Have your child avoid tasks or actions that call for alertness until you see how this drug affects your child. These are things like riding a bike, playing sports, or using items such as scissors, lawnmowers, electric scooters, toy cars, or motorized vehicles.
• Alcohol may interact with this drug. Be sure your child does not drink alcohol.
• Talk with your child’s doctor before your child uses marijuana, other forms of cannabis, or prescription or OTC drugs that may slow your child’s actions.
• An unsafe heartbeat that is not normal (long QT on ECG) has happened with this drug. This may raise the chance of sudden death. Talk with the doctor.

If your child is pregnant:

• Tell the doctor if your child is pregnant or becomes pregnant. You will need to talk about the benefits and risks of your child using this drug while pregnant.

Injection:

• Unsafe heart problems and sometimes death have rarely happened when this drug was given with alcohol or certain other drugs that may slow your child’s actions. Talk with your child’s doctor.

What are some side effects that I need to call my child’s doctor about right away?

WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your child’s doctor or get medical help right away if your child has any of the following signs or symptoms that may be related to a very bad side effect:

All products:

• Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.
• Fast or abnormal heartbeat.
• Very bad dizziness or passing out.
• Trouble controlling body movements.
• Feeling confused.
• Rarely, a very bad skin reaction has happened with this drug. Signs include fever and many small skin spots within large areas of redness and swelling. Call your child’s doctor right away if your child has a rash or any of these signs.

Injection:

• Tissue damage has happened with this drug. Sometimes, this has led to surgery. Tell your child’s nurse if your child has any burning, color changes, pain, skin breakdown, or swelling where the shot was given.

What are some other side effects of this drug?

All drugs may cause side effects. However, many people have no side effects or only have minor side effects. Call your child’s doctor or get medical help if any of these side effects or any other side effects bother your child or do not go away:

• Feeling sleepy.
• Dry mouth.

These are not all of the side effects that may occur. If you have questions about side effects, call your child’s doctor. Call your child’s doctor for medical advice about side effects.

You may report side effects to your national health agency.

How is this drug best given?

Give this drug as ordered by your child’s doctor. Read all information given to you. Follow all instructions closely.

All oral products:

• Give this drug with or without food. Give with food if it causes an upset stomach.

Liquid:

• Measure liquid doses carefully. Use the measuring device that comes with this drug. If there is none, ask the pharmacist for a device to measure this drug.

Injection:

• It is given as a shot into a muscle.

What do I do if my child misses a dose?

All oral products:

• If your child takes this drug on a regular basis, give a missed dose as soon as you think about it.
• If it is close to the time for your child’s next dose, skip the missed dose and go back to your child’s normal time.
• Do not use 2 doses at the same time or extra doses.
• Many times this drug is given on an as needed basis. Do not give to your child more often than told by the doctor.

Injection:

• Call your child’s doctor to find out what to do.

How do I store and/or throw out this drug?

All oral products:

• Store at room temperature protected from light. Store in a dry place. Do not store in a bathroom.

Injection:

• If you need to store this drug at home, talk with your child’s doctor, nurse, or pharmacist about how to store it.

All products:

• Keep all drugs in a safe place. Keep all drugs out of the reach of children and pets.
• Throw away unused or expired drugs. Do not flush down a toilet or pour down a drain unless you are told to do so. Check with your pharmacist if you have questions about the best way to throw out drugs. There may be drug take-back programs in your area.

General drug facts

• If your child’s symptoms or health problems do not get better or if they become worse, call your child’s doctor.
• Do not share your child’s drug with others and do not give anyone else’s drug to your child.
• Some drugs may have another patient information leaflet. If you have any questions about this drug, please talk with your child’s doctor, nurse, pharmacist, or other health care provider.
• If you think there has been an overdose, call your poison control center or get medical care right away. Be ready to tell or show what was taken, how much, and when it happened.

Consumer Information Use and Disclaimer

This generalized information is a limited summary of diagnosis, treatment, and/or medication information. It is not meant to be comprehensive and should be used as a tool to help the user understand and/or assess potential diagnostic and treatment options. It does NOT include all information about conditions, treatments, medications, side effects, or risks that may apply to a specific patient. It is not intended to be medical advice or a substitute for the medical advice, diagnosis, or treatment of a health care provider based on the health care provider’s examination and assessment of a patient’s specific and unique circumstances. Patients must speak with a health care provider for complete information about their health, medical questions, and treatment options, including any risks or benefits regarding use of medications. This information does not endorse any treatments or medications as safe, effective, or approved for treating a specific patient. UpToDate, Inc. and its affiliates disclaim any warranty or liability relating to this information or the use thereof. The use of this information is governed by the Terms of Use, available at https://www.wolterskluwer.com/en/solutions/lexicomp/about/eula.

Last Reviewed Date

2020-08-04

Copyright

© 2021 UpToDate, Inc. and its affiliates and/or licensors. All rights reserved.

Hydroxyzine: Uses, Interactions, Mechanism of Action

Hydroxyzine – Drugs and Lactation Database (LactMed)

Last Revision: September 20, 2021.

Estimated reading time: 2 minutes

CASRN: 68-88-2

Drug Levels and Effects

Summary of Use during Lactation

Small occasional doses of hydroxyzine would not be expected to cause any adverse effects in breastfed infants. Larger doses or more prolonged use may cause drowsiness and other effects in the infant or decrease the milk supply, particularly in combination with a sympathomimetic such as pseudoephedrine or before lactation is well established. Other agents are preferred, especially while nursing a newborn or preterm infant.

Drug Levels

Maternal Levels. Relevant published information was not found as of the revision date.

Infant Levels. Relevant published information was not found as of the revision date.

Effects in Breastfed Infants

In one telephone follow-up study, mothers reported irritability and colicky symptoms 10% of infants exposed to various antihistamines and drowsiness was reported in 1.6% of infants. None of the reactions required medical attention.[1]

All adverse reactions in breastfed infants reported in France between January 1985 and June 2011 were compiled by a French pharmacovigilance center. Of 174 reports, hydroxyzine was reported to cause adverse reactions in 8 infants and to be one of the drugs most often suspected in serious adverse reactions, primarily sedation.[2]

Effects on Lactation and Breastmilk

Antihistamines in relatively high doses given by injection can decrease basal serum prolactin in nonlactating women and in early postpartum women[3,4] However, suckling-induced prolactin secretion is not affected by antihistamine pretreatment of postpartum mothers.[4] Whether lower oral doses of antihistamines have the same effect on serum prolactin or whether the effects on prolactin have any consequences on breastfeeding success have not been studied. The prolactin level in a mother with established lactation may not affect her ability to breastfeed.

The breastfeeding mother of a 5-week-old infant was diagnosed with bipolar disorder, panic attacks and anxiety disorder. She was started on hydroxyzine 50 mg at an unspecified interval and took it for 3 to 5 days with no effect on milk production. She was then started on aripiprazole 5 mg at an unspecified interval. After 5 days, she reported a decrease in milk production that required supplementation with formula. Nine days after stopping both drugs, her milk supply returned to normal. The decreased milk supply was possibly caused by the medications, with aripiprazole most likely.[5]

References

1.

Ito S, Blajchman A, Stephenson M, et al. Prospective follow-up of adverse reactions in breast-fed infants exposed to maternal medication. Am J Obstet Gynecol. 1993;168:1393–9. [PubMed: 8498418]

2.

Soussan C, Gouraud A, Portolan G, et al. Drug-induced adverse reactions via breastfeeding: A descriptive study in the French Pharmacovigilance Database. Eur J Clin Pharmacol. 2014;70:1361–6. [PubMed: 25183382]

3.

Pontiroli AE, De Castro e Silva E, Mazzoleni F, et al. The effect of histamine and h2 and h3 receptors on prolactin and luteinizing hormone release in humans: Sex differences and the role of stress. J Clin Endocrinol Metab. 1981;52:924–8. [PubMed: 7228996]

4.

Messinis IE, Souvatzoglou A, Fais N, et al. Histamine h2 receptor participation in the control of prolactin secretion in postpartum. J Endocrinol Invest. 1985;8:143–6. [PubMed: 3928731]

5.

Yskes R, Thomas R, Nagalla ML. A case of decreased milk production associated with aripiprazole. Prim Care Companion CNS Disord 2018;20:18l02303. PMID: 30549496. [PubMed: 30549496]

Substance Identification

Substance Name

Hydroxyzine

CAS Registry Number

68-88-2

Drug Class

Breast Feeding

Lactation

Antihistamines

Disclaimer: Information presented in this database is not meant as a substitute for professional judgment. You should consult your healthcare provider for breastfeeding advice related to your particular situation. The U.S. government does not warrant or assume any liability or responsibility for the accuracy or completeness of the information on this Site.

indications and contraindications, composition and dosage – Pharmacy Mos

Provision of medical care for myocardial infarction, alternative to drug treatment

Lesson 3

“Provision of medical care for myocardial infarction, an alternative to drug treatment”

In such a serious condition as myocardial infarction, emergency hospitalization is required, when trying to provide assistance at home, you can lose too much time, in this regard, with an attack of angina pectoris that does not stop within 30 minutes, an ambulance must be called urgently.

Treatment of myocardial infarction should be carried out only in a hospital in the intensive care unit. Moreover, the sooner the patient is delivered there, the more effective the result of subsequent treatment will be – it is important to focus the attention of patients on this.

Patients with myocardial infarction are transported on a stretcher or on a gurney to the intensive care unit of cardiology or to specialized units or intensive care units. With an uncomplicated course of the disease, the patient’s stay in the intensive care unit is 3 – 5 days.

Currently, the duration of treatment for a patient with uncomplicated myocardial infarction in a hospital is about three weeks, the duration of hospitalization is determined by the attending physician and depends on the course of the disease.

Treatment of myocardial infarction begins with pain management. The most effective drugs for quickly relieving an attack of angina pectoris are drugs belonging to the NITRATE group: tablets or in the form of aerosols.

NITROGLYCERIN is the international name for the drug.Different manufacturers release it under their own trade names, which are listed below.

How do nitroglycerin preparations work?

Nitrates dilate the arteries of the heart and improve the supply of oxygen to the heart. Also nitrates reduce the stress on the heart. In general, it helps to reduce the incidence and severity of chest pain.

What are the rules for taking nitroglycerin preparations?

Take your medicine as directed by your doctor.Do not stop taking nitroglycerin without first consulting your doctor.

Never take more nitroglycerin than prescribed by your doctor.

During treatment, carry the medicine pack with you, maintain a constant supply of the medicine.

This medicine has been prescribed for you only. Never give it to other people, even if you think they have a similar condition.

What to do if you miss a dose?

Take the missed dose of medication as soon as you remember.

If you have missed one dose of the drug, and the time has already come for the next dose, continue taking the drug in the recommended dose.

Do not take a double or extra dose of this medicine.

What is required for treatment to be effective and safe?

When standing up suddenly, you may feel dizziness, weakness, darkness in your eyes. To avoid this problem, try to get up slowly. If you still feel these symptoms, you must again take a horizontal position, then sit down slowly and, in the absence of these manifestations, slowly stand up.

Avoid drinking alcohol during treatment as it may worsen dizziness.

Before any surgical intervention, including dental care, tell your doctor that you are taking nitroglycerin.

What problems can nitrates cause?

Along with their benefits, all medicines can cause unwanted (adverse) reactions. They usually disappear or diminish after your body gets used to the medication.

Consult a physician if any of the following side effects occur: throbbing headache, facial flushing, hot flashes, dizziness, heart problems, palpitations.

Any other sensations that bother you that you think are related to taking this medicine, you can discuss with your doctor.

If chest pain cannot be relieved with nitroglycerin or other nitrates, narcotic analgesics are administered intravenously.The pain must be removed, because it can lead to cardiogenic shock from which the patient is very difficult to remove.

There are three ways to improve the condition of coronary blood flow:

1. Dissolve the blood clot formed in the artery. This is the most modern method of treatment and it is called thrombolysis. The earlier the drug is injected to dissolve the blood clot, the better the result. The maximum effect is achieved within the first hour after the onset of myocardial infarction. This hour is even called “golden”.When the blood clot dissolves after 6 hours, only about 5% of the affected heart muscle can be saved. Used drugs belonging to the FIBRINOLITICS group (alteplase, streptokinase, tenecteplase, urokinase).

How does the drug work?

dissolve the clot formed in the artery.

What problems can fibrinolytics cause?

Along with their benefits, all medicines can cause unwanted (adverse) reactions.

Bleeding from injection sites (does not require premature discontinuation of therapy) is the most common complication when using the drug.

Cardiac arrhythmias

Any other sensations that bother you that you think are related to taking this medicine, you can discuss with your doctor.

2. Reduce the workload on the heart. Prescribed drugs that lower the pressure, reduce the volume of circulating blood, slow down the heart rate and thereby reduce the need for oxygen in the heart muscle and prolong the life of starving cells in the heart attack zone.

This group includes β-ADRENO BLOCKERS.

This group has an active anti-angina, antiarrhythmic effect. High efficiency is achieved by regulating the needs of your heart and the capabilities of your coronary arteries, i.e. transfers the work of your heart to a more economical mode.

If you are prescribed this group of drugs, you must monitor your heart rate and blood pressure. They reduce the heart rate (preferably 55-60 beats per minute at rest), dilate the heart vessels, lower blood pressure (should be less than 140/90 mm Hg).Art.).

Remember that this group of drugs is used for a long time, you can not skip and stop taking the drug without the knowledge of the doctor, if you cancel it, you must gradually reduce the dose over several days. The use of β-blockers reduces mortality after MI during the first year by 25%.

BISOPROLOL is the international name for the drug. Different manufacturers release it under their own trade names, which are listed below.

Aritel, Bidop, Biprol, Bisokard, Bisoprolol hemifumarate, Bisoprolol fumarate, Concor, Concor Cor, Corbis, Coronal

CARVEDILOL is the international name for the drug.Different manufacturers release it under their own trade names, which are listed below.

Acridilol, Atram, Vedicardol, Dilatrend, Carvedigamma, Carvedilol, Carvedilol Obolenskoe, Carvetrend, Carvedil, Cardivas, Coriol, Talliton

METOPROLOL is the international name for the drug. Different manufacturers release it under their own trade names, which are listed below.

Betalok, Vasokardin, Vasokardin retard, Corvitol 100, Corvitol 50, Metoprolol, Metoprolol Acri, Metoprolol Ratiopharm, Metoprolol tartrate, Egilok, Egilok retard

How does the drug work?

Bisoprolol, metoprolol, carvedilol reduce the intensity of the heart, its oxygen demand, lower blood pressure, and also restore the impaired function of the heart muscle.

What to do if you miss a dose?

Take the missed dose of medication as soon as you remember.

If you have missed one dose of the drug, and it is already time for the next dose, continue taking the same schedule.

Do not take a double or extra dose of this medicine.

What is required for treatment to be effective and safe?

If you have diabetes mellitus, regularly measure your blood glucose concentration.

Before any surgery, including dental care, tell your doctor that you are taking bisoprolol.

Follow your healthcare provider’s dietary advice.

What problems can beta blockers cause?

Along with their benefits, all medicines can cause unwanted (adverse) reactions.

Consult a doctor if any of the following side effects occur: dizziness, increased fatigue, chilliness of the limbs, sleep disturbances, nightmares, shortness of breath, skin rash, dry eyes, sexual problems, urinary problems, chilliness or excessive sweating, the appearance or intensification of shortness of breath, the appearance or intensification of edema, nasal congestion, sleep disturbance.

Any other concerns you feel that you think are related to taking this medicine, you can discuss with your doctor.

INHIBITORS OF ANGIOTENSIN – A CONVERSING ENZYME (captopril, enalapril, lisinopril, fosinopril, perindopril, etc.) also protect the heart and blood vessels from pathological changes leading to the development of heart failure. ENALAPRIL is the international name of the drug. Different manufacturers release it under their own trade names, which are listed below.

Bagopril, Berlipril 5, Berlipril 10, Berlipril 20, Vasopren, Vero-Enalapril, Invoril, Renipril, Renitek, Ednit, Enalapril, Enalapril-ICN, Enalapril-Acri, Enalapril Hexal, Enalapril-Rospri, Enalapril, Epalapril Enam, Enan NM, Enap, Enarenal, Enapharm, Envas

LISINOPRIL is the international name for the drug. Different manufacturers release it under their own trade names, which are listed below.

Diroton, Irumed, Lizacard, Lizigamma, Lisinopril, Lisinopril Stada, Lisinopril dihydrate, Lisinoton, Lizoril, Listril, Litan, Sinopril

PERINDOPRIL is the international name for the medicine.Different manufacturers release it under their own trade names, which are listed below.

Hypernik, Coverex, Perindopril, Perindopril erbumin, Perinpress, Prenessa, Prestarium

How does the drug work?

Angiotensin-converting enzyme inhibitors dilate blood vessels, lower blood pressure, and increase the efficiency of the heart.

Along with their benefits, all medicines can cause unwanted (adverse) reactions.

Consult a doctor if any of the following side effects occur: cough, dizziness, headache, insomnia or drowsiness, severe weakness, skin rash, itchy skin, fever, facial flushing, cough, nasal congestion, sore throat, pain in the abdomen, loose stools, constipation, palpitations, unusual taste in the mouth.

It is necessary to draw the attention of patients that the most common side effect of an ACE inhibitor is cough – it occurs in up to 20% of cases in women:

Important! See your doctor immediately if you experience sudden swelling of your tongue, lips or eyelids.

Any other sensations that bother you that you think are related to taking this medicine, you can discuss with your doctor.

3. To improve the rheological properties of blood – to reduce the ability of blood to form clots (anticoagulants, antiplatelet agents).

You will be prescribed DIRECT-ACTION ANTICOAGULANTS in the form of injections (sodium heparin, sodium enoxaparin, sodium dolteparin, calcium nadroparin). SODIUM HEPARIN is the international name of the medicine.Different manufacturers release it under their own trade names, which are listed below.

Heparin, Heparin “Biochemi”, Heparin BS, Heparin Lechiva, Heparin sodium, Heparin – Richter, Heparin – Ferein

ENOXAPARIN SODIUM – international drug name

DALTEPARIN SODIUM is the international name of the medicine.

NADROPARIN CALCIUM is the international name of the drug.

How does the drug work?

Direct anticoagulants reduce the ability of the blood to form blood clots (thrombi).

Rules for the introduction of the solution.

The solution is injected subcutaneously into the anterolateral region of the abdominal wall at the waist level.

The patient must lie down during the injection.

When injected, the needle is inserted vertically to its full length into the thickness of the skin, clamped in the fold.

The skin fold is not straightened until the end of the injection.

Do not rub the injection site after injection.

What problems can the drug cause?

Along with their benefits, all medicines can cause unwanted (adverse) reactions.

After sc injection, pain at the injection site, bruising (hematoma) at the injection site may occur. In some cases, the formation of solid inflammatory seals (infiltrates) containing the drug is possible, which dissolve after a few days, without the need to discontinue the drug.

Possible bleeding from mucous membranes and wounds

Important! See your doctor immediately if you have the following symptoms: rhinitis, urticaria, lacrimation, fever, bronchospasm.

Any other sensations that bother you that you think are related to taking this medicine, you can discuss with your doctor.

To prevent the formation of blood clots in the blood vessels of the heart, you need to constantly take medicines that reduce blood clotting – ANTI-AGGREGANTS, usually acetylsalicylic acid at 125 mg / day and clopidogrel 75 mg / day. ACETYL SALICYLIC ACID is the international name of the drug. Different manufacturers release it under their own trade names, which are listed below.

ASK-cardio, Ascopirin, Aspivatrin, Aspikor, Aspinat, Aspinat 300, Aspinat Alco, Aspinat Cardio, Aspirin 1000, Aspitrin, Asprovit, Acecardol, Acetylsalicylic acid, Acetylsalicylic acid, Yorkali acetyl acid, Acetyl-acetyl acid acid-UBF, Atsbirin, CardiASK, Cardiopyrin, Nextrim Fast, Taspir, Terapin, Thrombo ASS, Upsarin Upsa, Fluspirin

How does the drug work?

Acetylsalicylic acid reduces the severity of inflammation, pain and lowers body temperature.In addition, acetylsalicylic acid reduces the formation of blood clots (thrombi).

What to do if you miss a dose?

Take the missed dose of medication as soon as you remember.

If you have missed one dose of the drug, and it is already time for the next dose, continue taking the same schedule.

Do not take a double or extra dose of this medicine.

What is required for treatment to be effective and safe?

Take your medicine at the same time of day.

If you need to take acetylsalicylic acid with other medicines, ask your doctor about the safety of this combination.

Try to avoid bumps, cuts or any other damage, as acetylsalicylic acid reduces blood clotting.

What problems can acetylsalicylic acid cause?

Along with their benefits, all medicines can cause unwanted (adverse) reactions.

Consult your doctor if any of the following side effects occur: abdominal pain, heartburn, nausea.

Important! See your doctor immediately if you have the following symptoms: swelling of the face, mouth, neck, skin rash; shortness of breath or choking; black or bloody stools and red urine; deafness.

Any other sensations that bother you that, in your opinion, are associated with taking this medicine, you can discuss with your doctor. CLOPIDOGREL is the international name for the medicine. Different manufacturers release it under their own trade names, which are listed below.

Zylt, Clopidogrel hydrogen sulfate, Plavix

How does the drug work?

Clopidogrel inhibits the ability of platelets (platelets) to bind to each other, which prevents blood clots (blood clots) from forming in blood vessels.

What to do if you miss a dose?

Take the missed dose of medication as soon as you remember.

If you have missed one dose of the drug, and the time has already come for the next dose, continue taking the drug in the recommended dose.

Do not take a double or extra dose of this medicine.

What is required for treatment to be effective and safe?

Before taking any over-the-counter medicine, talk to your doctor about how safe it is to combine with clopidogrel.

Do not take aspirin or other medicines containing acetylsalicylic acid unless prescribed by your doctor.

Clopidogrel may cause dizziness.

What problems can clopidogrel cause?

Along with their benefits, all medicines can cause unwanted (adverse) reactions.

Talk to your doctor if any of the following side effects occur: abdominal discomfort or pain, fatigue, loose stools, constipation, headache, dizziness, poor motor coordination, tingling sensations in the limbs, skin rash or itching.

Important! Seek medical attention immediately if bruising, bleeding, blood in the urine, or blackening of the stool appear for no apparent reason.

Any other sensations that bother you that you think are related to taking this medicine, you can discuss with your doctor.

Medicines that lower the concentration of cholesterol in the blood – STATINS are very important. They reduce the size of existing atherosclerotic plaques and prevent the formation of new ones. The risk of death with continuous use of statins is reduced by 30-40%.

SIMVASTATIN, ATORVASTATIN, ROSUVASTATIN

International drug name.Various manufacturers release it under their own trade names.

How do drugs work?

Reduce the formation of cholesterol in the liver, which further leads to a decrease in blood cholesterol.

What to do if you miss a dose?

Take the missed dose of medication as soon as you remember.

If you have missed one dose of the drug, and the time has already come for the next dose, continue taking the drug in the recommended dose.

Do not take a double or extra dose of this medicine.

What is required for treatment to be effective and safe?

Refrain from drinking alcohol, as this may reduce the effectiveness of treatment.

Remember that smoking has a negative effect on the condition of your body and reduces the positive effect of the drug.

Do not take the medicine with grapefruit juice, as this may increase the level of atorvastatin in the blood.

During treatment with the drug and at least one month after stopping it, women should use effective methods of contraception.

Before any surgery, including dental care, tell your doctor that you are taking the drug.

What problems can statins cause?

Along with their benefits, all medicines can cause unwanted (adverse) reactions.

Consult a doctor if any of the following side effects occur: headache, abdominal pain, bloating, diarrhea or constipation, sleep disturbance, loss of appetite, tingling or numbness in the limbs, dizziness, skin rash, sexual problems, chest pain cage.

Important! Seek medical attention immediately if: severe weakness, muscle pain, yellowing of the skin.

Any other sensations that bother you that you think are related to taking this medicine, you can discuss with your doctor.

The above drugs are used, as a rule, for a long time, therefore they require medical supervision and an individual approach. Do not forget that if you feel better, in no case should you stop taking the drugs or reduce their dose yourself.

Reducing the risk of side effects of drug therapy for arterial hypertension with ACE inhibitors and calcium antagonists

Authors: M.S. Soboleva , Lecturer, Department of Pharmacology and Clinical Pharmacology, Far Eastern State Medical University, Khabarovsk;

E.V. Slobodenyuk , Doctor of Biological Sciences, Head of the Department of Pharmacology and Clinical Pharmacology, Far Eastern State Medical University, [email protected];

O.P. Gnatyuk , MD, DSc, Head of the Department of Roszdravnadzor in the Khabarovsk Territory;

I.F. Bukatova , cardiologist, GUZ KKB No., [email protected];

Z.V. Kalagina , cardiologist, GUZ KKB No. 1.

Results of a prospective study (n = 60) of the efficacy and safety of 6-month therapy for arterial hypertension with the appointment of an angiotensin-converting enzyme inhibitor (ACE inhibitor) and a calcium antagonist ( AK ) in the form of a fixed combination (Equator) and two monocomponent drugs (Listril “+” Stamlo M “) showed that in the” Equator “group, the prescribed treatment was canceled in 10% of patients due to the appearance of peripheral edema and in 3% due to dry cough.30% of patients in the Listril and Stamlo M groups dropped out of the study due to the development of peripheral edema and 27% of patients with the appearance of a dry cough. At the same time, in order to achieve therapeutic equivalence in patients receiving therapy in the form of a combination of two drugs, due to the variety of release forms, an increase in daily doses of drugs was more often used, and in patients taking a fixed combination – additional prescription of diuretics and β-blockers.

Reducing the risk of side effects of drug therapy for arterial hypertension with ACE inhibitors and calcium antagonists

Arterial hypertension (AH) is one of the most significant medical and social problems in Russia.According to a study carried out within the framework of the target federal program “Prevention and treatment of arterial hypertension in the Russian Federation”, 59.4% of hypertensive patients are taking antihypertensive drugs (AHP), of which 21.5% of patients are effectively treated [1]. Modern standards recommend the appointment of combination therapy using angiotensin-converting enzyme (ACE) inhibitors with diuretics or calcium antagonists (AC).



Materials and methods

Prospective study of the efficacy and safety of various combinations of therapy for hypertension with the appointment of an ACE inhibitor and AK was carried out on the basis of the cardiotherapy department of the Khabarovsk Regional Clinical Hospital No. 1 named.Professor S.I. Sergeeva.

The study used drugs registered on the territory of the Russian Federation, entered in the State Register of Medicines, passed preclinical, clinical trials, undergoing post-registration control, widely used in medical practice. The administration of the drug was carried out in accordance with the indications included in the instructions for use. The conclusion of the expert committee on medical ethics was received for the study.Before the start of the study, each patient signed an informed consent to participate.

Criteria for the inclusion of patients in the study: age 18–87 years; diagnosis of grade I – III arterial hypertension with 0–4 risk factor, established earlier or for the first time in life; ineffectiveness of previous therapy or its absence.

The study involved 60 patients randomized into 2 groups (n = 30), who can be prescribed drug therapy in the form of a fixed combination of Equator (lisinopril 10 mg + amlodipine 5 mg) or using two monocomponent drugs Listril ( Lisinopril 10 mg) + Stamlo M (Amlodipine 5 mg).During the study, it was allowed to titrate the dose of basic drugs, add other antihistamines if the therapy was ineffective, and also take drugs for the treatment of concomitant diseases that do not significantly affect blood pressure.

The main parameters of the effectiveness of therapy were:

1. The level of systolic and diastolic blood pressure (SBP, DBP) and pulse rate (HR) – before the start of therapy; after a week of therapy; at the time of the patient’s discharge from the hospital; after 1, 2, 3, 4, 5, 6 months of therapy (9 control points in total).
2. Development of adverse reactions or complications of hypertension during drug therapy.

The obtained data were processed using Microsoft Office Excel 2007 (descriptive statistics), IBM SPSS Statistics 19. When evaluating the results of work, the Mann-Whitney test was used to compare quantitative indicators (blood pressure, age, etc.) of several groups , the χ2 test was used to compare qualitative indicators. In the case of evaluating the studied parameters in the dynamics of the study (SBP, DBP, heart rate, etc.)within one group, the Wilcoxon test was used. Differences were considered significant at p <0.05. The relationship of the studied indicators was determined using the Spearman's rank correlation coefficient. Correlation was considered significant at p <0.05.


Results and discussion

Patient groups are comparable in all main parameters (Table 1). Statistically significant differences were observed according to the criterion for the development of left ventricular hypertrophy – a greater number of patients with these pathologies in the fixed combination group.

During the study, as a result of dose titration and the appointment of combination therapy, the target blood pressure (BP) was achieved in the fixed combination group in 19.16 ± 4.39 days, and in the group of two mono-drugs – in 13.9 ± 1.34 days … The period of reaching the target BP is comparable in both groups (p = 0.645).

When both regimens were prescribed, an increase in the dose to 20 mg of lisinopril and 10 mg of amlodipine was required in 26.67% of patients. In the group of two drugs, the dose of amlodipine to 10 mg was increased by 6.67% of patients (at a dose of 10 mg lisinopril) and another 6.67% of patients, while maintaining the dose of a calcium antagonist of 5 mg, doubled the dose of lisinopril to 20 mg.

The results of the study showed that, despite the high frequency of adding a third drug, side effects were relatively rare in patients who took Equator. In the second group, by the end of the study, complications of pharmacotherapy were observed in almost half of the patients. During the study, one patient, while using Listril and Stamlo M, experienced a hypertensive crisis, which served as the basis for hospitalization, an additional visit to the doctor and his exclusion from the study.


Conclusions

1. As a result of dose titration and prescription of combination therapy, there were practically no statistically significant differences in the criterion of effectiveness (SBP, DBP, heart rate) in the group of the fixed combination and two monocomponent drugs.

2. Side effects in the form of peripheral edema and dry cough developed significantly more often in the group of two monocomponent drugs, which led to a high frequency of cancellation and changes in the treatment regimen.
3. In the group of patients who received therapy in the form of a fixed combination, there was good tolerance and rare cases of side effects.

4. The use of a fixed combination when prescribing drug therapy in the form of a combination of ACE inhibitors and AK is one of the possible ways to reduce the risk of adverse effects.