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hydroxyzine hydrochloride / pamoate
Atarax (discontinued; generic) · Vistaril (pamoate capsules)
Antihistamine / anxiolytic⚠ Unverified beta content
At a glance
- Class
- First-generation H1 antihistamine with sedative/anxiolytic effect
- Black box
- None listed
- Key monitoring
- ECG / QTc
- Sedation / mental status / falls
- Usual adult dose
- Anxiety (label, oral): 50–100 mg four times daily
- Call provider / escalate if
- Fainting, racing/irregular heartbeat (QT prolongation) • Severe drowsiness or confusion, falls • Unable to urinate, severe constipation
Built-in explanation — generated offline from this app’s structured data (no AI, no network). Still unverified beta content.
What it is
- hydroxyzine hydrochloride / pamoate (Atarax (discontinued; generic), Vistaril (pamoate capsules)) — first-generation H1 antihistamine with sedative/anxiolytic effect.
- Used for: Symptomatic relief of anxiety and tension associated with psychoneurosis; Pruritus due to allergic conditions; Sedation as premedication / after general anesthesia.
Usual adult dosing
- Anxiety (label, oral): 50–100 mg four times daily (Many clinicians use lower PRN doses (e.g., 25–50 mg) – follow orders.)
- Pruritus (label): 25 mg three or four times daily
- Premedication/sedation (label): 50–100 mg
- Older adults: Use lowest effective dose; avoid when possible (Beers criteria)
Boxed warning
- None listed in this entry — still review serious warnings.
Monitor
- ECG / QTc [If cardiac/QT risk factors or other QT-prolonging drugs]
- Sedation / mental status / falls [Every contact]
Nursing priorities
- Baseline ECG/QTc if cardiac disease, electrolyte abnormality, or other QT-prolonging drugs.
- Age (older adults higher risk), glaucoma, BPH/urinary retention, constipation.
- Fall precautions; sedation can persist.
- Reduce doses of concurrent opioids/CNS depressants per provider.
- Monitor for anticholinergic effects (urinary retention, constipation, confusion).
Major interactions
- Opioids, non-narcotic analgesics, barbiturates, alcohol, other CNS depressants: Potentiated CNS depression – reduce the other drug’s dose (label).
- QT-prolonging drugs (haloperidol, ondansetron, methadone, macrolides, antiarrhythmics, citalopram): Additive QT prolongation / torsades.
Key teaching
- It can make you sleepy and dizzy. Do not drive until you know how it affects you.
- Do not mix it with alcohol, sleeping pills, or pain medicines unless your provider says it is OK.
- It can dry your mouth and make it harder to pee or have bowel movements. Tell us if this is a problem.
Optional: AI explanation
Off by default. To enable, add your own API key in Settings (stored only on this device).
Other serious warnings
- QT prolongation / torsades de pointes (contraindicated with prolonged QT; use caution with risk factors)
- Additive CNS depression with narcotics, non-narcotic analgesics, barbiturates, alcohol – reduce their doses
- Anticholinergic effects (urinary retention, narrow-angle glaucoma, BPH, delirium in older adults)
- Contraindicated in early pregnancy (label); not recommended in nursing mothers
- Severe cutaneous reactions (AGEP, SJS/TEN – rare)
- Falls and cognitive impairment in older adults
Sources: FDA label (DailyMed): HYDROXYZINE HYDROCHLORIDE TABLET, FILM COATED [N
- ECG / QTcWhen: If cardiac/QT risk factors or other QT-prolonging drugs
- Sedation / mental status / fallsWhen: Every contact
- Anticholinergic effects (urine, bowel, vision, confusion)
- Potassium / magnesiumIf QT risk
Sources: FDA label (DailyMed): HYDROXYZINE HYDROCHLORIDE TABLET, FILM COATED [N
Assessment
- Baseline ECG/QTc if cardiac disease, electrolyte abnormality, or other QT-prolonging drugs.
- Age (older adults higher risk), glaucoma, BPH/urinary retention, constipation.
- Pregnancy status; sedating medications and alcohol.
- Allergy to cetirizine/levocetirizine (contraindicated).
Interventions
- Fall precautions; sedation can persist.
- Reduce doses of concurrent opioids/CNS depressants per provider.
- Monitor for anticholinergic effects (urinary retention, constipation, confusion).
- Check K/Mg and QTc with other QT drugs.
- IM injection (hydroxyzine HCl): deep IM only, never subcutaneous or IV (tissue damage).
Sources: General nursing drug reference conventions (e.g., Davis Drug Guide / L
- Fainting, racing/irregular heartbeat (QT prolongation)
- Severe drowsiness or confusion, falls
- Unable to urinate, severe constipation
- Rash with fever, blisters or skin peeling
- Eye pain/vision change
- Allergic reaction (swelling, trouble breathing)
Sources: FDA label (DailyMed): HYDROXYZINE HYDROCHLORIDE TABLET, FILM COATED [N · General nursing drug reference conventions (e.g., Davis Drug Guide / L
- Drowsiness / sedation
- Dry mouth
- Dizziness
- Headache
- Blurred vision
- Constipation, urinary retention (anticholinergic)
- Confusion in older adults
Sources: FDA label (DailyMed): HYDROXYZINE HYDROCHLORIDE TABLET, FILM COATED [N
- Opioids, non-narcotic analgesics, barbiturates, alcohol, other CNS depressants MajorPotentiated CNS depression – reduce the other drug’s dose (label).
- QT-prolonging drugs (haloperidol, ondansetron, methadone, macrolides, antiarrhythmics, citalopram) MajorAdditive QT prolongation / torsades.
- Other anticholinergic drugs (benztropine, TCAs, diphenhydramine, clozapine/olanzapine)Additive anticholinergic burden.
- EpinephrineHydroxyzine may counteract pressor effect of epinephrine (label: use norepinephrine/metaraminol if pressor needed).
Sources: FDA label (DailyMed): HYDROXYZINE HYDROCHLORIDE TABLET, FILM COATED [N
- It can make you sleepy and dizzy. Do not drive until you know how it affects you.
- Do not mix it with alcohol, sleeping pills, or pain medicines unless your provider says it is OK.
- It can dry your mouth and make it harder to pee or have bowel movements. Tell us if this is a problem.
- Tell your provider about any heart rhythm problem, fainting, or medicines that affect the heart.
- Tell your provider right away if you could be pregnant.
- Get up slowly to avoid falls.
Sources: General nursing drug reference conventions (e.g., Davis Drug Guide / L
Indications
- Symptomatic relief of anxiety and tension associated with psychoneurosis
- Pruritus due to allergic conditions
- Sedation as premedication / after general anesthesia
- Common psychiatric use: PRN anxiety, insomnia, adjunct in agitation
Dosing
- Anxiety (label, oral): 50–100 mg four times dailyMany clinicians use lower PRN doses (e.g., 25–50 mg) – follow orders.
- Pruritus (label): 25 mg three or four times daily
- Premedication/sedation (label): 50–100 mg
- Older adults: Use lowest effective dose; avoid when possible (Beers criteria)
Sources: FDA label (DailyMed): HYDROXYZINE HYDROCHLORIDE TABLET, FILM COATED [N
Prescriber-oriented details; limited in this beta.
geriatric
- Beers criteria: avoid in older adults (strongly anticholinergic).
pregnancy Lactation
- Label: contraindicated in early pregnancy; not recommended in nursing mothers.
Sources: FDA label (DailyMed): HYDROXYZINE HYDROCHLORIDE TABLET, FILM COATED [N
- Verified
- No – unverified beta
- Last reviewed
- 2026-10-29 (drafted; not clinician-reviewed)
- FDA label (DailyMed): HYDROXYZINE HYDROCHLORIDE TABLET, FILM COATED [NUCARE PHARMACEUTICALS, INC]
- General nursing drug reference conventions (e.g., Davis Drug Guide / Lexicomp nursing) - summarized from standard practice; NOT line-by-line verified
Reviewer notes – please double-check
- Source label used was a generic (repackager) label.
- Typical PRN psychiatric doses (25–50 mg) are practice patterns, not label dosing.