As is the case with any medication, there may be some cases where hydroxyzine use is not recommended, or its usage will have to be altered, in order to reduce the risk of negative side effects from interacting with other drugs, medical conditions, or even foods.
Drug Interactions
Drugs that may interact with hydroxyzine include the following:
- Zoloft (sertraline)
- Xanax (alprazolam)
- Lexapro (escitalopram)
- Zyrtec (cetirizine)
- Prozac (fluoxetine)
- Opioids like codeine and hydrocodone
Please note that this list may not be complete, and other interactions with drugs not listed here may occur.
Hydroxyzine and Zoloft
Using Zoloft together with hydroxyzine may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. In some people, especially in the elderly, the combination of the two medicines may cause impairment in thinking, judgment, and motor coordination. It is, therefore, important to avoid activities requiring mental alertness such as driving or operating hazardous machinery until patients know how these medications affect them.
Hydroxyzine and Xanax
Taking Xanax and hydroxyzine together may increase the risk of serious side effects such as slow and shallow breathing, severe dizziness, and drowsiness.
Hydroxyzine and Lexapro
Lexapro interactions with hydroxyzine can cause serious and potentially life-threatening side effects. Using Lexapro and hydroxyzine together can, in fact, increase the risk of an irregular heart rhythm. The risk may increase for those who have congenital long QT syndrome (a heart condition that causes the heart to take longer to recharge between beats), other cardiac diseases, conduction abnormalities, or electrolyte disturbances (for example, magnesium or potassium loss due to severe or prolonged diarrhea or vomiting).
Those who take these medications together and experience sudden dizziness, light-headedness, fainting, shortness of breath, or heart palpitations should seek immediate medical attention.
Hydroxyzine and Zyrtec
Using Zyrtec together with hydroxyzine may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. In some people, especially in the elderly, the combination of the two medicines may cause impairment in thinking, judgment, and motor coordination. It is, therefore, important to avoid activities requiring mental alertness such as driving or operating hazardous machinery until patients know how these medications affect them.
Hydroxyzine and Prozac
Using Prozac together with hydroxyzine may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. In some people, especially in the elderly, the combination of the two medicines may cause impairment in thinking, judgment, and motor coordination. It is, therefore, important to avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how these medications affect you.
Hydroxyzine and Opioids
Opioids such as codeine and hydrocodone, which are generally used as painkillers, also have antidepressant properties. Hydroxyzine may increase the antidepressant action of opioids; it is therefore recommended to reassess opioids dosage when taken in conjunction with hydroxyzine.
Food Interactions
Sometimes the foods we eat and the beverages we drink can also interact with our medications.
Food and drink that may interact with hydroxyzine include:
Please note that this list may not be complete, and there may be other foods and beverages that interact with this drug.
Hydroxyzine and Alcohol
For more information, please visit our page regarding hydroxyzine and alcohol interactions.
Condition & Disease Interactions
Sometimes certain medications can increase the risk of negative side effects for patients with certain diseases or other medical conditions.
Disease and medical conditions that are known to negatively interact with hydroxyzine include:
- Depression
- QT prolongation
- Anticholinergic effects
- Glaucoma
- Asthma
- Cardiovascular disease
- Renal/liver disease
Please note that this list may not be complete, and there may be other diseases and medical conditions where patients should not take hydroxyzine.
Hydroxyzine and Depression
Hydroxyzine may affect thinking and behavior. Specifically, it may decrease inhibition and aggressiveness, as well as cause agitation and hallucinations.
Hydroxyzine can cause or exacerbate mental depression and stimulate suicidal thoughts. Patients therefore should tell their doctor if they have a history of depression or other psychiatric disorders before taking hydroxyzine. Patients who notice any changes in mood or behaviour should ask their doctor for medical advice.
Hydroxyzine and QT Prolongation
Hydroxyzine may cause QT prolonged intervals, particularly in cases of pre-existing heart disease/ irregular heartbeat/ atrial fibrillation, electrolyte imbalances, or anti-arrhythmogenic drug use. Patients should tell their doctor if they have risk factors for QT prolongation, such as congenital long QT syndrome, family history of long QT syndrome or other predisposing conditions, as well as myocardial infarction (heart attacks), uncompensated heart failure, and bradyarrhythmias (slow heart rates).
Hydroxyzine and Anticholinergic effects
Hydroxyzine may have anticholinergic activity (Ex. constipation, drowsiness, decrease saliva, blurry vision, decreased ability to urinate,etc.) that may be especially dangerous for elderly people. Patients should tell their doctor if they have urinary retention or obstruction, angle-closure glaucoma, untreated intraocular hypertension (ocular hypertension resulting from high pressure within the eye), or uncontrolled primary open-angle glaucoma, and gastrointestinal obstructive disorders. Unfortunately, these conditions are likely to be exacerbated by anticholinergic activity.
Hydroxyzine and Glaucoma
Hydroxyzine may have anticholinergic activity that may be especially dangerous for elderly people with glaucoma and trouble urinating due to retention or enlarged prostate. Patients should tell their doctor if they have any of these conditions, as they are likely to be exacerbated by anticholinergic activity.
Hydroxyzine and Asthma
Respiratory anticholinergic effects of hydroxyzine may obstruct the respiratory tract by reducing its volume and thickening bronchial secretions. Patients should tell their doctor if they have asthma or chronic obstructive pulmonary disease (COPD) because these may worsen when taking this drug.
Hydroxyzine and Cardiovascular Disease
Although rare and usually caused by overdose, anticholinergic activity of hydroxyzine may cause cardiovascular side effects such as tachycardia (fast heart rate), palpitation, and ECG changes. Patients should therefore tell their doctor if they have cardiovascular disease, hypertension (high blood pressure), or hyperthyroidism (overactive thyroid).
Hydroxyzine and Renal and Liver Disease
Hydroxyzine may have increased side effects on people with renal (kidney) or liver disease due to drug and metabolite accumulation in the kidneys and liver. People with pre-existing renal and liver conditions may consider taking a lower dose of hydroxyzine.
Hydroxyzine and Pregnancy
For more information, please visit our page on hydroxyzine and pregnancy interactions.
Disclaimer: this article does not constitute or replace medical advice. If you have an emergency or a serious medical question, please contact a medical professional or call 911 immediately. To see our full medical disclaimer, visit our Terms of Use page.
