Vistaril 50mg Capsules

Hydroxyzine is a first-generation antihistamine that acts as a potent antagonist of histamine H1 receptors in the periphery and central nervous system. Its anxiolytic and sedative effects are primarily due to its central nervous system depression, likely related to its H1 antagonism and possibly its anticholinergic and anti-serotonergic activities. It also possesses antiemetic and mild bronchodilator properties.

Urgent Side Effects: Seek Medical Help Right Away

While rare, some people may experience severe and potentially life-threatening side effects when taking this medication. If you notice any of the following symptoms, contact your doctor or seek immediate medical attention:

Signs of an allergic reaction, such as:
+ 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
+ Swelling of the mouth, face, lips, tongue, or throat
Abnormal or rapid heartbeat
Severe dizziness or fainting
Difficulty controlling body movements
Confusion
A rare but serious skin reaction, characterized by:
+ Fever
+ Multiple small skin spots within large areas of redness and swelling
If you experience a rash or any of these symptoms, contact your doctor immediately.

Other Possible Side Effects

Like all medications, this drug can cause side effects. While many people may not experience any side effects or only minor ones, it's essential to discuss any concerns with your doctor. If you experience any of the following side effects or any other symptoms that bother you or persist, contact your doctor or seek medical help:

Dry mouth
Drowsiness

This is not an exhaustive list of possible side effects. If you have questions or concerns about side effects, consult your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.

Before Taking This Medication: Important Information to Share with Your Doctor

It is essential to inform your doctor about the following:

Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the symptoms you experienced.
If you have a history of prolonged QT interval on an electrocardiogram (ECG).
If you are in the early stages of pregnancy. Note that this medication should not be taken during early pregnancy.
If you are breastfeeding. You should not breastfeed while taking this medication.

This list is not exhaustive, and it is crucial to discuss all your medications (including prescription, over-the-counter, natural products, and vitamins) and health issues with your doctor and pharmacist. They will help determine if it is safe for you to take this medication with your other medications and health conditions. Never start, stop, or change the dosage of any medication without first consulting your doctor.

It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication.

Before operating a vehicle or engaging in any activity that requires your full attention, wait until you understand how this medication affects you. It is also crucial to discuss the use of alcohol, marijuana, or other forms of cannabis, as well as prescription or over-the-counter (OTC) medications that may cause drowsiness, with your doctor beforehand.

This medication has been associated with an abnormal and potentially life-threatening heart rhythm known as long QT interval on an electrocardiogram (ECG), which may increase the risk of sudden death. Therefore, it is vital to consult with your doctor about this risk.

If you are 65 years or older, exercise caution when using this medication, as you may be more susceptible to experiencing side effects.

If you are pregnant or planning to become pregnant, notify your doctor. It is necessary to have a discussion with your doctor about the potential benefits and risks of using this medication during pregnancy to make an informed decision.

• Drugs known to prolong the QT interval (e.g., Class IA and III antiarrhythmics, certain antipsychotics, macrolide antibiotics, fluoroquinolone antibiotics, certain antifungals, methadone, citalopram, escitalopram)
• Patients with known acquired or congenital QT prolongation

• CNS depressants (e.g., alcohol, opioids, benzodiazepines, barbiturates, other sedating antihistamines): Increased sedation and respiratory depression.
• Anticholinergic drugs (e.g., tricyclic antidepressants, atropine, benztropine): Increased anticholinergic side effects (dry mouth, blurred vision, urinary retention, constipation).

• Beta-blockers (e.g., metoprolol, propranolol): May increase hydroxyzine levels due to shared metabolic pathways (minor).
• CYP3A4/5 inhibitors (e.g., ketoconazole, ritonavir): May slightly increase hydroxyzine levels, but not clinically significant for most patients.

• Not available

• Drowsiness
• Dizziness
• Dry mouth
• Blurred vision
• Urinary retention
• Constipation
• Confusion (especially in elderly)
• Tremor
• Seizures (rare)
• Palpitations or irregular heartbeat (seek immediate medical attention)

Generally not recommended during pregnancy, especially in the first trimester, due to limited human data and some animal studies showing fetal abnormalities at high doses. Use only if the potential benefit justifies the potential risk to the fetus.

Not recommended during breastfeeding. Hydroxyzine and its active metabolite, cetirizine, are excreted into breast milk. Potential for sedation, anticholinergic effects (e.g., dry mouth, urinary retention), and irritability in the infant.

Used in children for pruritus, anxiety, and sedation. Dosing is weight-based. Children may be more susceptible to paradoxical excitation or excessive sedation. Use with caution and monitor closely.

Use with extreme caution due to increased sensitivity to anticholinergic effects (e.g., confusion, urinary retention, constipation, dry mouth) and sedative effects. Elderly patients are at higher risk for falls and cognitive impairment. Included in the Beers Criteria as a medication to avoid in older adults due to its strong anticholinergic properties and risk of sedation. Start with the lowest effective dose and titrate slowly.

• Hydroxyzine is a first-generation antihistamine with significant sedative and anticholinergic properties, making it useful for short-term anxiety, pruritus, and pre-operative sedation.
• It is NOT recommended for long-term management of generalized anxiety disorder due to its side effect profile and the availability of safer, more effective long-term treatments.
• Due to the risk of QT prolongation, especially with higher doses or in patients with pre-existing cardiac conditions or on other QT-prolonging drugs, an ECG may be warranted before initiation.
• The active metabolite, cetirizine (Zyrtec), is a second-generation antihistamine with less CNS penetration and fewer sedative/anticholinergic effects.
• Patients should be warned about additive CNS depression with alcohol and other sedatives.
• Often used as a non-benzodiazepine alternative for acute anxiety or insomnia, but its anticholinergic burden limits its utility, especially in the elderly.

• For anxiety: Benzodiazepines (e.g., lorazepam, alprazolam - short-term), SSRIs/SNRIs (e.g., escitalopram, sertraline, duloxetine - long-term), Buspirone, Gabapentin, Propranolol.
• For pruritus: Second-generation antihistamines (e.g., cetirizine, loratadine, fexofenadine), topical corticosteroids, doxepin (topical or oral at low doses).
• For sedation: Diphenhydramine, melatonin, zolpidem (for insomnia).

If your symptoms or health issues persist or worsen, it's essential to contact your doctor for further guidance. To ensure your safety, never share your medication with others or take someone else's medication. Some medications may come with an additional patient information leaflet, so be sure to check with your pharmacist for more information. If you have any questions or concerns about this medication, don't hesitate to reach out to your doctor, nurse, pharmacist, or other healthcare provider. In the event of a suspected overdose, immediately call your local poison control center or seek emergency medical attention. When seeking help, be prepared to provide details about the overdose, including the medication taken, the amount, and the time it occurred.