Hydroxyzine	(high-DROX-ih-zeen)
Trade Name(s):	Hydroxyzine Hydrochloride   ·Tablets 10 mg   ·Tablets 25 mg   ·Tablets 50 mg   ·Tablets 100 mg   ·Syrup 10 mg per 5 mL   ·Injection 25 mg/mL   Vistaril   ·Capsules 25 mg (as pamoate)   ·Capsules 50 mg (as pamoate)   ·Capsules 100 mg (as pamoate) Apo-Hydroxyzine Indicates Canadian Trade Name.
Class:	Antianxiety Piperazine, nonselective
Action:	May be caused by suppression of activity in subcortical areas of CNS. Absorption: Hydroxyzine is readily absorbed in the GI tract. T max is approximately 3 h and C max is 82 ng/mL.
	Metabolism: Hydroxyzine is metabolized by the liver.
	Excretion: The mean t ½ is 3 h (reported to be up to 20 h; may be longer in elderly).
	Onset: Onset is 15 to 30 min (oral).
	Peak: Time to peak is 1 to 2 h.
	Duration: Duration is 4 to 6 h.
Indications:	Symptomatic relief of anxiety and tension associated with psychoneurosis; adjunct therapy in organic disease states with anxiety; management of pruritus caused by allergic conditions; sedative before and after general anesthesia (PO, IM).
Contraindications:	Early pregnancy; hypersensitivity to hydroxyzine or cetirizine.
Interactions:
	Alcohol and CNS depressants CNS depressant effects may be increased.
Lab Test Interferences:	None well documented.
Adverse Reactions:
	cardiovascular: Chest tightness.
	cns: Transitory drowsiness; involuntary motor activity, including tremor and convulsions.
	gi: Dry mouth.
	respiratory: Hypersensitivity reactions (eg, wheezing, shortness of breath).
Precautions:
	Pregnancy: Category C .
	Lactation: Cetirizine, a metabolite of hydroxyzine, has been detected in breast milk. Therefore, hydroxyzine is not recommended.
	ECG abnormalities Particularly alterations in T-waves have been associated with anxiolytic doses.
	Porphyria Clinical exacerbations have occurred.
Overdosage:	Signs & symptoms Oversedation.
Patient/Family Education:	Advise patient that medication is usually started at a low dose and then gradually increased until max benefit is obtained. Caution patient to take as prescribed and not to stop taking or change the dose unless advised by health care provider. Advise patient to take as prescribed without regard to meals but to take with food if stomach upset occurs. Advise patient or caregiver using syrup to measure and administer prescribed dose using dosing syringe, dosing spoon, or dosing cup. Advise patient that if a dose is missed, to take it as soon as possible, unless it is nearing time for the next scheduled dose. Then, skip the missed dose and take the next dose at the regularly scheduled time. Caution patient not to double the dose to catch up. Advise patient that if symptoms are not controlled, not to increase the dose of medication or frequency of use, but to inform health care provider. Caution patient that larger doses or more frequent dosing does not increase effectiveness and may cause excessive drowsiness or other adverse reactions. Instruct patient to contact health care provider if symptoms do not appear to be getting better, are getting worse, or if bothersome adverse reactions (eg, drowsiness, dizziness) occur. Caution patient not to take any OTC antihistamines while taking this medication unless advised by health care provider. Caution patient that alcohol and other CNS depressants (eg, sedatives) will have additional sedative effects if taken with hydroxyzine. Caution patient that drug may cause drowsiness and to use caution driving or performing other tasks requiring mental alertness until tolerance is determined. Advise patient to take frequent sips of water, suck on ice chips or sugarless hard candy, or chew sugarless gum if dry mouth occurs. If patient is to have allergy skin testing, advise patient not to take the medication for at least 4 days before skin testing.