Vistaril

Contraindications

Documented hypersensitivity or related product including cetirizine and levocetirizine and components of the formulation

Prolonged QT interval

SC, intra-arterial, or IV administration

Cautions

Nursing mothers

May cause CNS depression resulting in drowsiness; avoid driving or operating dangerous machinery

May cause oversedation and confusion in elderly patients; start on lower doses and monitor closely; avoid use

IM only for parenteral use; switch to PO ASAP

Use caution in patients with narrow-angle glaucoma, prostatic hyperplasia, or respiratory disease (asthma or COPD)

Hydroxyzine may rarely cause acute generalized exanthematous pustulosis (AGEP), a serious skin reaction characterized by fever and numerous small, superficial, non-follicular, sterile pustules, arising within large areas of edematous erythema; if signs or symptoms suggest AGEP, do not resume use of hydroxyzine and consider alternative therapy; avoid cetirizine or levocetirizine in patients who have experienced AGEP or other hypersensitivity reactions with hydroxyzine, due to risk of cross-sensitivity

Drug interaction interview

• Caution recommended during concomitant use of drugs known to prolong QT interval including Class 1A (e.g., quinidine, procainamide) or Class III (e.g., amiodarone, sotalol) antiarrhythmics, certain antipsychotics (e.g., ziprasidone, iloperidone, clozapine, quetiapine, chlorpromazine), certain antidepressants (e.g., citalopram, fluoxetine), certain antibiotics (e.g., azithromycin, erythromycin, clarithromycin, gatifloxacin, moxifloxacin); and others (e.g., pentamidine, methadone, ondansetron, droperidol)

• Hydroxyzine has its maximal effect about 30 to 60 minutes after it is taken. Its effects last for 4 to 6 hours.
• The recommended dose for treating itching (pruritus) is 25 mg given 3 or 4 times daily by mouth or by intramuscular injection.
• When used for sedation, the recommended dose is 50 to 100 mg orally or 25 to 100 mg by intramuscular injection.
• Anxiety and tension are managed with 50 to 100 mg in 4 divided doses or 50-100 mg intramuscular injection in 4 or 6 divided doses.
• Alcohol withdrawal is treated with a 50-100 mg injection and may be repeated every 4 to 6 hours as needed.
• The dose for nausea and vomiting is 25 to 100 mg by injection.
• Hydroxyzine can be taken with or without food.

Common Side Effects of Vistaril

The side effects of Vistaril are generally mild and don't last long. They include:

• Drowsiness
• Fixed drug eruptions, or isolated red or purple lesions on the skin that reappear in the same spots whenever the drug is taken
• Headache
• Pruritus, rash, and urticaria (hives)
• Dry mouth

Severe Side Effects of Vistaril

On rare occasions, Vistaril may cause serious side effects. Call your doctor if you experience:

• Involuntary motor activity, such as movement in your eyes, tongue, jaw, or neck
• Tremor (uncontrolled shaking)
• Hallucinations
• Convulsions (seizures)
• Respiratory problems, such as labored breathing

• It is used to treat itching.
• It is used to treat anxiety.
• It is used to put you to sleep for surgery.
• It may be given to you for other reasons. Talk with the doctor.

If you think there has been an overdose, call your poison control center or get medical care right away. Be ready to tell or show what was taken, how much, and when it happened.

Hydroxyzine pamoate is designated chemically as 1-(p-chlorobenzhydryl) 4- [2-(2-hydroxyethoxy) ethyl] diethylenediamine salt of 1,1′-methylene bis (2 hydroxy- 3-naphthalene carboxylic acid).

Inert ingredients for the capsule formulations are: hard gelatin capsules (which may contain Yellow 10, Green 3, Yellow 6, Red 33, and other inert ingredients); magnesium stearate; sodium lauryl sulfate; starch; sucrose.

Inert ingredients for the oral suspension formulation are: carboxymethylcellulose sodium; lemon flavor; propylene glycol; sorbic acid; sorbitol solution; water.

The most common manifestation of overdosage of Vistaril is hypersedation. Other reported signs and symptoms were convulsions, stupor, nausea and vomiting. As in the management of overdosage with any drug, it should be borne in mind that multiple agents may have been taken.

If vomiting has not occurred spontaneously, it should be induced. Immediate gastric lavage is also recommended. General supportive care, including frequent monitoring of the vital signs and close observation of the patient, is indicated. Hypotension, though unlikely, may be controlled with intravenous fluids and vasopressors (do not use epinephrine as hydroxyzine counteracts its pressor action.) Caffeine and Sodium Benzoate Injection, USP, may be used to counteract central nervous system depressant effects.

Hydroxyzine overdose may cause QT prolongation and Torsade de Pointes. ECG monitoring is recommended in cases of hydroxyzine overdose.

There is no specific antidote. It is doubtful that hemodialysis would be of any value in the treatment of overdosage with hydroxyzine. However, if other agents such as barbiturates have been ingested concomitantly, hemodialysis may be indicated. There is no practical method to quantitate hydroxyzine in body fluids or tissue after its ingestion or administration.

Usual Adult Dose of Vistaril for Anxiety:

-Oral: 50 to 100 mg 4 times a day
-IM: 50 to 100 mg immediately, then every 4 to 6 hours as needed

Uses:
-Oral: Provides symptomatic relief of anxiety and tension associated with psychoneurosis; an adjunct treatment in organic disease states in which anxiety is manifested.
-IM: Treatment for psychiatric and emotional emergencies, including acute alcoholism.

Usual Adult Dose for Pruritus:

Oral: 25 mg 3 or 4 times a day

Use: Management of pruritus due to allergic conditions such as chronic urticaria and atopic and contact dermatoses, and in histamine-mediated pruritus.

Usual Adult Dose for Sedation:

-Oral: 50 to 100 mg orally
-IM: 25 to 100 mg

Uses:
-Oral: As a sedative when used as premedication and following general anesthesia.
-IM: Pre- and postoperative and pre- and postpartum adjunctive treatment.

Usual Adult Dose for Nausea/Vomiting:

IM: 25 to 100 mg

Use: Treatment of nausea and vomiting, excluding nausea and vomiting of pregnancy.

Usual Pediatric Dose for Sedation:

-Oral: 0.6 mg/kg
-IM: 0.5 mg/lb of body weight

Uses:
-Oral: As a sedative when used as premedication and following general anesthesia.
-IM: Pre- and postoperative adjunctive treatment.

Usual Pediatric Dose for Anxiety:

Under Age 6:
Oral: 50 mg/day in divided doses

Age 6 and Over:
Oral: 50 to 100 mg per day in divided doses

Uses:
-Provides symptomatic relief of anxiety and tension associated with psychoneurosis; an adjunct treatment in organic disease states in which anxiety is manifested.
-Management of pruritus due to allergic conditions such as chronic urticaria and atopic and contact dermatoses, and in histamine-mediated pruritus.

Usual Pediatric Dose for Pruritus:

Under Age 6:
Oral: 50 mg/day in divided doses

Age 6 and Over:
Oral: 50 to 100 mg per day in divided doses

Uses:
-Provides symptomatic relief of anxiety and tension associated with psychoneurosis; an adjunct treatment in organic disease states in which anxiety is manifested.
-Management of pruritus due to allergic conditions such as chronic urticaria and atopic and contact dermatoses, and in histamine-mediated pruritus.

Usual Pediatric Dose for Nausea/Vomiting:

IM: 0.5 mg/lb of body weight

Use: Treatment of nausea and vomiting.

Applies to hydroxyzine: oral capsule, oral suspension, oral syrup, oral tablet

Other dosage forms:

• intramuscular solution

Along with its needed effects, hydroxyzine (the active ingredient contained in Vistaril) may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur while taking hydroxyzine:

• Chest pain or discomfort
• cough
• difficulty with swallowing
• dizziness
• fainting
• fast heartbeat
• hives, itching, or skin rash
• irregular or slow heart rate
• puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
• shortness of breath
• tightness in the chest
• unusual tiredness or weakness

Get emergency help immediately if any of the following symptoms of overdose occur while taking hydroxyzine:

• Decreased awareness or responsiveness
• drowsiness
• nausea
• seizures
• severe sleepiness
• vomiting

Some side effects of hydroxyzine may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

• Shakiness in the legs, arms, hands, or feet
• trembling or shaking of the hands or feet

• Dry mouth
• headache
• seeing, hearing, or feeling things that are not there

• May be used to relieve anxiety and tension associated with psychoneurosis.
• May also be used as add-on therapy to relieve anxiety that manifests as a result of other mental health conditions.
• Effective at relieving itching due to allergies, chronic urticaria, histamine-mediated itch or dermatitis (eczema).
• May be used as premedication and following general anesthesia for its calming and sedating effect.

This medicine may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert.

Drinking alcohol with this medicine can cause side effects.

Taking this medicine with other drugs that make you sleepy can worsen this effect. Ask your doctor before taking hydroxyzine with a sleeping pill, narcotic pain medicine, muscle relaxer, or medicine for anxiety, depression, or seizures.

Hydroxyzine can cause a serious heart problem, especially if you use certain medicines at the same time, including antibiotics, antidepressants, heart rhythm medicine, antipsychotic medicines, and medicines to treat cancer, malaria, HIV or AIDS. Tell your doctor about all medicines you use, and those you start or stop using during your treatment with hydroxyzine.

Other drugs may interact with hydroxyzine, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed here. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.