8 Hydroxyzine (Vistaril) Interactions You Should Know About

Hydroxyzine (Vistaril) is an antihistamine that’s prescribed for allergies, itching, and anxiety. There are two forms of hydroxyzine: hydroxyzine hydrochloride and hydroxyzine pamoate. Both forms work the same way in the body to help treat symptoms. This means they also have similar risks, including drug interactions.

Interactions can affect the way a medication works in your body or increase your risk of certain side effects. For instance, one of the most common side effects of hydroxyzine is drowsiness. And many hydroxyzine interactions can make this side effect worse. But more serious hydroxyzine interactions are also possible.

So which hydroxyzine interactions should you know about? Below, we’ll discuss eight of the most notable and how you might manage them.

1. Opioids

Opioids are a group of medications used to treat pain. They can cause drowsiness and confusion. Hydroxyzine can also cause these side effects. So taking an opioid with hydroxyzine can make drowsiness more severe. And this can raise your risk of accidental injury or falls.

Combining an opioid and hydroxyzine isn’t typically recommended. But there may be times when taking both is necessary. If this is the case for you, your prescriber may lower the dosage of one or both medications. They may also suggest taking your doses at different times of the day.

Be cautious of the side effects you experience if you’re taking hydroxyzine and an opioid. You shouldn’t drive while taking this combination if you can avoid it. If you ever notice extreme drowsiness or trouble breathing, seek immediate help.

Promotion disclosure

Hydroxyzine Hydrochloride

Avg retail price

$14.93(Save 44.14%)

GoodRx discount

$8.34

See all discounts

How it works

Use GoodRx to find medications, pharmacies, and discounts.

GoodRx discounts can help you pay less for your prescription.

Bring your free coupon or savings card to the pharmacy.

2. Other medications that cause drowsiness

As mentioned above, feeling drowsy or sleepy after taking hydroxyzine is common. For this reason, you should avoid other medications that also cause drowsiness (sedatives) if possible. Taking hydroxyzine with a sedative can cause severe drowsiness.

Sedatives include many medications, including:

• Barbiturates such as phenobarbital

• Benzodiazepines such as alprazolam (Xanax) and clonazepam (Klonopin)

• Sleeping medications such as zolpidem (Ambien) and eszopiclone (Lunesta)

But these aren’t the only medications to be aware of with this hydroxyzine interaction. Many prescription and over-the-counter (OTC) medications cause drowsiness as a side effect. Examples include melatonin and muscle relaxers such as cyclobenzaprine.

Discuss this hydroxyzine interaction with your prescriber. They’ll let you know if the benefit of combining these medications outweighs the risk of increased drowsiness for you.

If they say it’s OK to take hydroxyzine and another sedating medication, be extra careful. You should avoid driving or performing other activities that require focus until you know how the combination affects you. And report any excessive drowsiness to your prescriber.

3. Alcohol

Drinking alcohol has many effects on the body. This includes making you feel sleepy and causing coordination problems. Hydroxyzine can also cause these side effects. Because of this, it’s best to avoid alcohol when taking hydroxyzine. The risk of severe drowsiness and falls goes up when the two are combined.

Discuss your alcohol use with your prescriber if you also take hydroxyzine. Some people only take hydroxyzine as needed for symptoms instead of every day. Your prescriber can let you know if you’re safely able to consume alcohol if you take hydroxyzine this way.

4. Amiodarone

There are reports that hydroxyzine can cause a potentially dangerous irregular heart rhythm called QT prolongation. Taking it with other medications that affect the heart’s rhythm may raise the risk of this side effect. One example is amiodarone (Pacerone) — a medication that’s prescribed to treat and prevent certain abnormal heart rhythms (arrhythmias). This combination of medications should be used cautiously.

Make sure your prescriber knows if you take both hydroxyzine and amiodarone. If they give you the green light to take both, they may want to see you more frequently for check-ups.

Let them know right away if you experience any new or worsening heart-related side effects. This may include unexplained dizziness or blurry vision. If you experience shortness of breath, heart palpitations, or sudden fainting, call 911 or seek immediate help.

5. Certain antibiotics

Antibiotics are a useful tool for fighting bacterial infections. They can, however, cause a number of side effects, such as affecting the heart’s rhythm. Some antibiotics can lead to QT prolongation. And since hydroxyzine also carries this warning, taking it with these antibiotics may raise the risk of this side effect.

Some antibiotics that can affect the heart’s rhythm include:

• Azithromycin (Zithromax)

• Ciprofloxacin (Cipro)

• Clarithromycin

• Erythromycin (Ery-Tab)

• Levofloxacin

• Moxifloxacin (Avelox)

These may not be the only antibiotics that raise the risk of QT prolongation. If you’ve been prescribed an antibiotic, make sure your prescriber knows if you take hydroxyzine. They may prefer to prescribe another antibiotic if an alternative is available.

6. Antipsychotic medications

Antipsychotic medications can help treat mental health conditions such as bipolar disorder and schizophrenia. While they can be effective treatment options, they may affect the heart’s rhythm. Antipsychotics can cause QT prolongation. Hydroxyzine is also reported to cause this side effect. So the risk of QT prolongation may be higher if you take both.

Some examples of antipsychotics include:

• Aripiprazole (Abilify)

• Chlorpromazine

• Clozapine (Clozaril)

• Haloperidol

• Olanzapine (Zyprexa)

• Quetiapine (Seroquel)

• Thioridazine

• Ziprasidone (Geodon)

This isn’t a full list of antipsychotic medications. But nearly all antipsychotics carry a risk of QT prolongation.

Discuss this hydroxyzine interaction with your prescriber. They may just have you follow up more frequently to watch for heart rhythm changes. But they might prefer to change one of your prescriptions to avoid this interaction. Don’t make any changes to either medication without your prescriber’s OK first.

7. Other antihistamines

Antihistamines are widely available, and many are available OTC, such as diphenhydramine (Benadryl). They’re often a go-to choice for seasonal allergies and cold symptoms. But if you’re taking hydroxyzine, you should avoid taking other antihistamines without your prescriber’s OK.

That’s because hydroxyzine is also an antihistamine. And mixing antihistamines together can make side effects more likely. In mild cases, you may experience dry mouth or excessive drowsiness. In severe cases, taking multiple antihistamines can cause cardiac arrest and seizures.

Common antihistamines include:

• Cetirizine (Zyrtec)

• Chlorpheniramine

• Diphenhydramine

• Fexofenadine (Allegra)

• Loratadine (Claritin)

• Levocetirizine (Xyzal)

If you’re picking out an OTC allergy or cold medication, ask your pharmacist for help. They can make sure you purchase a medication that doesn’t interact with hydroxyzine.

8. Lexapro and Celexa

Escitalopram (Lexapro) and citalopram (Celexa) are two commonly prescribed antidepressants. While rare, they can cause QT prolongation. And as mentioned above, hydroxyzine can also cause this side effect. Taking both hydroxyzine and escitalopram or citalopram raises your risk of abnormal heart rhythms.

What’s more, both escitalopram and citalopram can cause drowsiness as a side effect. You may be more likely to feel sleepy if you’re also taking hydroxyzine. Drowsiness could also be more intense than it is with just one medication.

It’s possible that you may need to take both hydroxyzine and one of these antidepressants. But your prescriber may choose to avoid this interaction if they can. There are other antidepressants that work similarly to escitalopram and citalopram that don’t cause QT prolongation. There are also other hydroxyzine alternatives they might suggest.

When should you contact your prescriber about a hydroxyzine interaction?

It’s best to prevent hydroxyzine interactions before they happen. You should share a complete medication list with your prescriber and pharmacist when starting hydroxyzine. You should also review this list with them any time medication or dosage changes happen. Be sure to include all prescription and OTC medications, as well as vitamins and supplements.

If you believe you may be experiencing interaction symptoms, contact your prescriber. A hydroxyzine interaction could lead to new or worse side effects, such as drowsiness or balance problems. A dosage or medication change may help relieve these side effects.

If you experience severe side effects, such as heart palpitations or sudden chest pain, seek medical help right away. These can be symptoms of more serious complications, such as QT prolongation. And they require immediate medical attention.

Why trust our experts?

Written by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

Reviewed by:

Stacia Woodcock, PharmD

Stacia Woodcock, PharmD, is a pharmacy editor for GoodRx. She earned her Doctor of Pharmacy degree from the University of Kentucky and is licensed in New York and Massachusetts.

Our editorial standards

Meet our experts