Hydroxyzine interactions to avoid

In this article:

• Hydroxyzine drug interactions
• Hydroxyzine food interactions
• Other hydroxyzine interactions
• How to minimize hydroxyzine interactions
• When to talk to a healthcare provider about hydroxyzine interactions

In this article

• Hydroxyzine drug interactions
• Hydroxyzine food interactions
• Other hydroxyzine interactions
• How to minimize hydroxyzine interactions
• When to talk to a healthcare provider about hydroxyzine interactions

Likely due to its sedating nature, hydroxyzine hydrochloride (generic Vistaril) is an antihistamine that may be preferable to newer options like Zyrtec (cetirizine), Claritin (loratadine), Allegra (fexofenadine), and Xyzal (levocetirizine) for the treatment of pruritus (itching), anxiety, and nausea than non-drowsy antihistamines. However, drowsiness can be a big problem with hydroxyzine, and combining hydroxyzine with other meds that cause sleepiness, like central nervous system (CNS) depressants, is particularly risky. Other medications can also cause adverse effects when taken with hydroxyzine. To keep yourself safe, you should be aware of the prescription drugs, nonprescription medications, and foods that interact with hydroxyzine. 

Hydroxyzine drug interactions

The potential for adverse effects with hydroxyzine alone is noteworthy. Drowsiness and dizziness are fairly common, along with anticholinergic effects like dry mouth, urinary retention, and constipation. Less common but much more serious is the potential for cardiac QT-prolongation, which can precipitate serious heart rhythm problems. The risk of these issues is raised by taking medications with similar side effects.

CNS depressants

Drugs that cause drowsiness are called CNS depressants. Hydroxyzine falls within that broad category, and coupling it with other medications creates more concern for falls and accidents. CNS depressants that interact with hydroxyzine include:

• Opiate analgesics, such as Oxaydo (oxycodone), morphine, and hydrocodone-acetaminophen
• Benzodiazepines, such as Xanax (alprazolam), Ativan (lorazepam), and Valium (diazepam)
• Muscle relaxants, like Fexmid (cyclobenzaprine), metaxalone, and Robaxin (methocarbamol)
• Anticonvulsants, such as Neurontin (gabapentin) and Lyrica (pregabalin)
• Hypnotics, such as Ambien and Lunesta
• Antidepressants, like Prozac and trazodone

Symptoms of combining hydroxyzine with CNS depressants could range from mild sleepiness to difficulty waking up or unsteadiness with walking. Severe symptoms are reasons to seek care immediately. Your healthcare provider may not prescribe hydroxyzine if you take another CNS depressant, or they may prescribe a low dose in order to avoid over-sedation. Your healthcare provider will consider your age and any other medical conditions you have before they prescribe hydroxyzine with a CNS depressant. 

QT-prolonging drugs

QT prolongation amounts to slowing down the electrical reset after heartbeats. This delay increases the chance of a life-threatening heart arrhythmia developing. Besides hydroxyzine, many different types of medications can prolong the QT interval. A few examples include:

• Macrolide antibiotics, like Zithromax (azithromycin) and clarithromycin
• Quinolone antibiotics, such as levofloxacin and moxifloxacin
• Antipsychotics, including Seroquel (quetiapine) and Risperdal (risperidone)
• Antidepressants like Celexa (citalopram), Remeron (mirtazapine), and doxepin

With so many types of QT-prolonging drugs, this issue is more common than patients may realize, particularly because mental health medications are often used concurrently. If you take multiple medications, make sure to mention them to your healthcare provider before they prescribe hydroxyzine. They’ll assess the risk of QT prolongation and may end up recommending an electrocardiogram (EKG), a simple in-office test, to measure the QT interval.

Anticholinergics

Anticholinergics are a category of drugs from many different classes that inhibit the action of the neurotransmitter acetylcholine, which plays a large role in various bodily functions. When the neurotransmitter can’t operate as it should, it can result in anticholinergic side effects, such as blurred vision, difficulty urinating, constipation, confusion, and agitation. Examples of anticholinergics that may react with hydroxyzine include:

• Antihistamines, both sedating (hydroxyzine and diphenhydramine) and non-drowsy (cetirizine and loratadine) varieties
• Antipsychotics, such as Seroquel, Zyprexa (olanzapine), and Risperdal
• Bladder antimuscarinics, like trospium, Ditropan XL (oxybutynin XL), and Detrol (tolterodine)
• Inhaled antimuscarinics, including Spiriva Respimat (tiotropium), Atrovent HFA (ipratropium), and Incruse Ellipta (umeclidinium)
• Tricyclic antidepressants, such as doxepin, amitriptyline, and nortriptyline

Higher doses of hydroxyzine and anticholinergics result in more severe side effects, and older adults are more susceptible. If you are experiencing adverse effects and are taking hydroxyzine with or without another anticholinergic, contact your healthcare provider immediately for instructions.

Hydroxyzine food interactions

Fortunately, hydroxyzine does not have serious interactions with most foods. You can take it with or without a meal. However, do not take hydroxyzine and grapefruit together. Grapefruit and grapefruit juice can slow the way the drug metabolizes in the body, resulting in higher levels of hydroxyzine that can cause an increased risk of QT-prolongation.

Other hydroxyzine interactions

Drinks are a different story, and unlike foods, certain drinks can have a notable interaction with this antihistamine.

Hydroxyzine interactions with alcohol 

Without a doubt, alcohol is a CNS depressant. Drinking with hydroxyzine can compound your risk of drowsiness, increase your risk of falls, and affect your judgment. 

Hydroxyzine and caffeine

The effects of combining hydroxyzine and caffeine depend on your reason for taking the medication. For example, taking hydroxyzine for anxiety and drinking caffeinated beverages doesn’t make much sense; by taking hydroxyzine for its sedating effects, you counteract it with the stimulation from caffeine. On the other hand, if you are taking hydroxyzine for itching, caffeine may offset the tiredness side effect well.

Hydroxyzine, cannabis, and illicit drugs

The concern about combining hydroxyzine, cannabis, and illicit drugs is similar to the concern about taking it with alcohol. Combining CNS depressants worsens their effects, especially in regard to increased sedation.

Hydroxyzine and herbal supplements

Plant-based products can fall under CNS depressants like kratom, anticholinergics like Jimson weed, or QT-prolongers like berberine. Just because they are found in nature does not mean that herbs cannot harm you or interact with drugs like hydroxyzine.

How to minimize hydroxyzine interactions

Awareness and communication are your biggest allies in staying safe during medical treatment. Please be aware of the risks of drug interactions anytime you take a new pill, whether prescribed or over the counter. Review your complete medication list with your healthcare provider and discuss any concerns about additive side effects.

When to talk to a healthcare provider about hydroxyzine interactions

Asking about drug interactions when you are first prescribed hydroxyzine is wise. You and your healthcare provider can review your medication list for any concerns. If you have been taking hydroxyzine and are about to start a new prescription or nonprescription pill, stop and ask your healthcare provider or pharmacist for medical advice about any interactions. They’ll be glad you asked, and as a result, you will be safer.