THERAPEUTICS

Brands

• Atarax
• Marax
• Vistaril
• see index for additional brand names

Generic?

• Yes

Class

• Antihistamine (anxiolytic, hypnotic, antiemetic)

Commonly Prescribed For

• (bold for FDA approved)
• Anxiety and tension associated with psychoneurosis
• Adjunct in organic disease states in which anxiety is manifested
• Pruritus due to allergic conditions
• Histamine-mediated pruritus
• Premedication sedation
• Sedation following general anesthesia
• Acute disturbance/hysteria (injection)
• Anxiety withdrawal symptoms in alcoholics or patients with delirium tremens (injection)
• Adjunct in pre/postoperative and pre/postpartum patients to allay anxiety, control emesis, and reduce narcotic dose (injection)
• Nausea and vomiting (injection)
• Insomnia

How The Drug Works

• Blocks histamine 1 receptors

How Long Until It Works

• 15–20 minutes (oral administration)
• Some immediate relief with first dosing is common; can take several weeks with daily dosing for maximal therapeutic benefit in chronic conditions

If It Works

• For short-term symptoms of anxiety – after a few weeks, discontinue use or use on an “as-needed” basis
• For chronic anxiety disorders, the goal of treatment is complete remission of symptoms as well as prevention of future relapses
• For chronic anxiety disorders, treatment most often reduces or even eliminates symptoms, but not a cure since symptoms can recur after medicine stopped
• For long-term symptoms of anxiety, consider switching to an SSRI or SNRI for long-term maintenance
• If long-term maintenance is necessary, continue treatment for 6 months after symptoms resolve, and then taper dose slowly
• If symptoms reemerge, consider treatment with an SSRI or SNRI, or consider restarting hydroxyzine

If It Doesn’t Work

• Consider switching to another agent or adding an appropriate augmenting agent

Best Augmenting Combos for Partial Response or Treatment-Resistance

• Hydroxyzine can be used as an adjunct to SSRIs or SNRIs in treating anxiety disorders

Tests

• None for healthy individuals
• Hydroxyzine may cause falsely elevated urinary concentrations of 17-hydroxycorticosteroids in certain lab tests (e.g., Porter-Silber reaction, Glenn-Nelson method)