HYDROXYZINE

(hye drox' i zeen)

hydroxyzine hydrochloride

Oral preparations: Apo-Hydroxyzine (CAN), Atarax, Novo-Hydroxyzine (CAN), Vistaril
Parenteral preparations: Multipax (CAN), Vistaril

hydroxyzine pamoate

Oral preparations: Vistaril
Pregnancy Category C

Drug classes
Therapeutic actions
Indications
Contraindications and cautions
Available forms
Dosages
  Adults
  Pediatric patients
Pharmacokinetics
Adverse effects
Nursing considerations Assessment
Interventions
Teaching points

 

Drug classes

Antianxiety drug
Antihistamine
Antiemetic

Therapeutic actions

Mechanisms of action not understood; actions may be due to suppression of subcortical areas of the CNS; has clinically demonstrated antihistaminic, analgesic, antispasmodic, antiemetic, mild antisecretory, and bronchodilator activity

Indications

• Symptomatic relief of anxiety and tension associated with psychoneurosis; adjunct in organic disease states in which anxiety is manifested; alcoholism and asthma; prior to dental procedures
• Management of pruritus due to allergic conditions, such as chronic urticaria, atopic and contact dermatosis, and in histamine-mediated pruritus
• Sedation when used as premedication and following general anesthesia
• Control of nausea and vomiting and as adjunct to analgesia pre- and post-op (parenteral) to allow decreased narcotic dosage
• Management of the acutely disturbed or hysterical patient; the acute or chronic alcoholic with anxiety withdrawal symptoms or delirium tremens; as preoperative and postoperative and prepartum and postpartum adjunctive medication to permit reduction in narcotic dosage, allay anxiety, and control emesis (IM administration)

Contraindications and cautions

• Allergy to hydroxyzine; uncomplicated vomiting in children (may contribute to Reye's syndrome or unfavorably influence its outcome; extrapyramidal effects may obscure diagnosis of Reye's syndrome); pregnancy; lactation.

Available forms

Tablets—10, 25, 50, 100 mg; syrup—10 mg/5 mL; capsules—25, 50, 100 mg; oral suspension—25 mg/5 mL; injection—25, 50 mg/mL

Dosages

Start patients on IM therapy when indicated; use oral therapy for maintenance. Adjust dosage to patient's response.

Adults

Oral
•  Symptomatic relief of anxiety: 50–100 mg qid.
•  Management of pruritus: 25 mg tid–qid.
•  Sedative (preoperative and postoperative): 50–100 mg.

IM
•  Psychiatric and emotional emergencies, including alcoholism: 50–100 mg immediately and q 4–6 hr as needed.
•  Nausea and vomiting: 25–100 mg.
•  Preoperative and postoperative, prepartum and postpartum: 25–100 mg.

Pediatric patients

Oral
•  Anxiety, pruritus:

> 6 yr: 50–100 mg/day in divided doses. < 6 yr: 50 mg/day in divided doses.

•  Sedative: 0.6 mg/kg.

IM
•  Nausea, preoperative and postoperative: 1.1 mg/kg (0.5 mg/lb).

Pharmacokinetics


Route Onset Peak Duration
Oral, IM 15–30 min 3 hr 4–6 hr

Metabolism: Hepatic; T ½: 3 hr

Distribution: Crosses placenta; may enter breast milk

Excretion: Urine

Adverse effects

Adverse effects in Italics are most common; those in Bold are life-threatening.

•  CNS: Drowsiness, involuntary motor activity, including tremor and convulsions
•  GI: Dry mouth
•  Hypersensitivity: Wheezing, dyspnea, chest tightness

Nursing considerations Assessment

•  History: Allergy to hydroxyzine, uncomplicated vomiting in children, lactation, pregnancy
•  Physical: Skin color, lesions, texture; orientation, reflexes, affect; R, adventitious sounds

Interventions

• Determine and treat underlying cause of vomiting. Drug may mask signs and symptoms of serious conditions, such as brain tumor, intestinal obstruction, appendicitis.
• Do not administer parenteral solution SC, IV, or intra-arterially; tissue necrosis has occurred with SC and intra-arterial injection, hemolysis with IV injection.
• Give IM injections deep into a large muscle: Adults: upper outer quadrant of buttocks or midlateral thigh; Children: midlateral thigh muscles; use deltoid area only if well developed.

Teaching points

• Take this drug as prescribed. Avoid excessive dosage.
• These side effects may occur: dizziness, sedation, drowsiness (use caution if driving or performing tasks that require alertness); avoid alcohol, sedatives, sleep aids (serious overdosage could result); dry mouth (frequent mouth care, sucking sugarless lozenges may help).
• Report difficulty breathing, tremors, loss of coordination, sore muscles, or muscle spasms.


Copyright © 2004 Lippincott Williams & Wilkins
Amy M. Karch
2004 Lippincott's Nursing Drug Guide