Hydroxyzine hydrochloride (Atarax) is a prescription antihistamine for adults and children. It's used to treat anxiety and to ease itching from allergies. It's also used as a sleep aid (sedative) before and after general anesthesia. Hydroxyzine HCl (Atarax) comes as tablet and oral solution that are taken by mouth up to 4 times per day. Common side effects include sleepiness and dry mouth.
Itching from allergic skin conditions (e.g., hives, eczema, etc.)
Sleep aid (sedative) while receiving general anesthesia for surgery
Hydroxyzine HCl (Atarax) is a first-generation antihistamine. It treats itching by blocking a natural chemical in your body called histamine. Additionally, it treats anxiety by affecting another chemical in the brain called serotonin.
Source:Â DailyMed
Along with its needed effects, a medicine 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:
Less common or rare
Less common or rare with azatadine, cetirizine, clemastine, cyproheptadine, desloratadine, dexchlorpheniramine, diphenhydramine, or loratadine
Abdominal or stomach pain
burning
chills
clay-colored stools or dark urine
difficulty swallowing
dizziness
fast or irregular heartbeat
headache
prickly sensations
puffiness or swelling of the eyelids or around the eyes, face, lips or tongue
redness of skin
seizures
shortness of breath
skin rash
swelling
tightness in chest
tingling
unusual tiredness or weakness
Check with your doctor as soon as possible if any of the following side effects occur:
Symptoms of overdose
Clumsiness or unsteadiness
convulsions (seizures)
drowsiness (severe)
dryness of mouth, nose, or throat (severe)
feeling faint
flushing or redness of face
hallucinations (seeing, hearing, or feeling things that are not there)
shortness of breath or troubled breathing
trouble in sleeping
Some side effects 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:
More common
Drowsiness
dry mouth, nose, or throat
gastrointestinal upset, stomach pain, or nausea
headache
increased appetite and weight gain
thickening of mucus
Less common or rare
Acid or sour stomach
belching
blurred vision or any change in vision
body aches or pain
clumsiness or unsteadiness
confusion (not with diphenhydramine)
congestion
difficult or painful urination
difficulty in moving
difficult or painful menstruation
dizziness (not with brompheniramine or hydroxyzine)
drowsiness (with high doses of desloratadine and loratadine)
dryness of mouth, nose, or throat
early menstruation
fast heartbeat
hoarseness
increased sensitivity of skin to sun
increased sweating
indigestion
loss of appetite
joint pain
muscle aching or cramping
muscle pains or stiffness
nightmares (not with azatadine, chlorpheniramine, cyproheptadine, desloratadine, hydroxyzine, or loratadine)
ringing or buzzing in ears
skin rash
swollen joints
stomach discomfort, upset or pain
tender swollen glands in neck
unusual excitement, nervousness, restlessness, or irritability
vomiting
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Starts to work within 30 minutes
Available as a tablet and a liquid that are taken by mouth
Can use in children
Available by prescription only
Might need to take up to 4 times per day
Can rarely cause sexual side effects
Tell your care team about all of the medications you take before and during treatment with hydroxyzine HCl (Atarax). They can review your complete medication list to help you check for interactions. Hydroxyzine HCl (Atarax) can interact with many other medications, such as those that cause sleepiness or heart rhythm problems.
Antihistamines are commonly found in many over-the-counter products. Don't take other antihistamines while taking hydroxyzine HCl (Atarax). Doing so can raise your risk of taking too much medication (overdose). This can lead to severe side effects, including seizures and hallucinations (seeing things that aren't real).
Hydroxyzine HCl (Atarax) can cause dry mouth as a side effect. If this bothers you, sipping cool liquids, chewing gum, or rinsing your mouth with cold water can help. Also, ask your healthcare team about different forms of saliva substitutes, such as mouthwashes or sprays, that might help.
If you're pregnant or thinking of becoming pregnant, talk with your obstetrician-gynecologist(OB-GYN). Animal studies suggest that hydroxyzine HCl (Atarax) can cause harm during early pregnancy. Your OB-GYN can talk with you about safer options for your condition.
Talk to your prescriber about the risks and benefits of taking hydroxyzine HCl (Atarax) while breastfeeding. There's limited information about how hydroxyzine HCl (Atarax) might affect breast milk or nursing infants.
Hydroxyzine HCl (Atarax) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Risk factors: Alcohol use | Taking other medications that cause sleepiness | Age 65 or older
Hydroxyzine HCl (Atarax) can make you very sleepy, which can affect your ability to focus, think, or react. This side effect is more likely to happen or be more intense if you're 65 years or older, drink alcohol while taking this medication, or take other medications that cause sleepiness (e.g., opioids, benzodiazepines, sleep medications, alcohol). Don't drive or operate machinery until you know how hydroxyzine HCl (Atarax) affects you.
Risk factors: Low blood potassium or magnesium levels | Older age | Kidney problems | Heart or heart rhythm problems | Taking other medications that can cause heart rhythm problems
Though rare, people who took hydroxyzine HCl (Atarax) have reported heart rhythm problems, like QT prolongation. In most cases, they were already at higher risk for this problem because of existing heart conditions or conditions that affected their electrolyte levels. Your healthcare team might check in with you more often if you're taking other medications that can affect your heart rhythm, such as certain antipsychotics or certain antibiotics. Most of the time, people who have QT prolongation don't experience any symptoms. But get medical help right away if you feel your chest pounding, have shortness of breath or chest pain, or feel faint or lightheaded.
People aged 65 years and older experience more side effects when taking antihistamine medications like hydroxyzine HCl (Atarax). Because of this, your healthcare team will have you start with a lower dose of hydroxyzine HCl (Atarax) and raise your dose slowly over time. Watch out for changes in vision, severe dry mouth, trouble urinating, or constipation. Also, feelings of drowsiness can leave you unsteady on your feet, which can lead to accidental falls and injuries. Talk with your primary care provider about your risk for side effects before taking hydroxyzine HCl (Atarax).
Risk factors: Allergy to cetirizine (Zyrtec) or levocetirizine (Xyzal)
Some people have experienced a severe allergic reaction to hydroxyzine HCl (Atarax). These reactions can be life-threatening and include facial swelling, hives, and anaphylaxis (e.g., closing of the throat). If you notice dizziness; fast heartbeat; a choking sensation; difficulty breathing; swelling around your eyes, lips, or tongue; or any signs of a severe skin reaction after taking hydroxyzine HCl (Atarax), get medical attention right away.
In addition, although rare, hydroxyzine HCl (Atarax) can cause a serious skin reaction that looks like a rash and small blisters usually on the face or on skin folds. It can sometimes occur with a fever. If you notice a rash or worsening of other skin reactions that you're using hydroxyzine HCl (Atarax) to treat, stop this medication and contact your prescriber right away. They might ask you to consider other options to treat your condition.
Hydroxyzine HCl (Atarax) comes as a tablet and an oral solution.
Anxiety
Age 18 years and older: The typical dose is 50 mg to 100 mg by mouth four times daily.
Age 6 years and older: The typical dose is 50 mg to 100 mg by mouth per day, split up into smaller doses and taken throughout the day.
Age under 6 years: The typical dose is 50 mg by mouth per day, split up into smaller doses and taken throughout the day.
Itching
Age 18 years and older: The typical dose is 25 mg by mouth three to four times per day.
Age 6 years and older: The typical dose is 50 mg to 100 mg by mouth per day, split up into smaller doses and taken throughout the day.
Age under 6 years: The typical dose is 50 mg by mouth per day, split up into smaller doses and taken throughout the day.
Sedative
Age 18 years and older: The typical dose is 50 mg to 100 mg, as directed by the healthcare team.
Age under 18 years: Your healthcare team will determine the dose based on body weight. The typical dose is 0.6 mg/kg by mouth, as directed by the care team.
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking any of these medicines, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using medicines in this class with any of the following medicines is not recommended. Your doctor may decide not to treat you with a medication in this class or change some of the other medicines you take.
Using medicines in this class with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
Allergy to cetirizine (Zyrtec) or levocetirizine (Xyzal)
Heart rhythm condition called prolonged QT interval or long QT syndrome
Early pregnancy
Itching from allergic skin conditions (e.g., hives, eczema, etc.)
Sleep aid (sedative) while receiving general anesthesia for surgery
Allergies
Common cold symptoms
Trouble sleeping for people 12 years and older
Short-term relief of allergy symptoms (e.g., runny nose; sneezing; itching of the nose or throat; itchy, watery eyes)
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Apozeal Pharmaceuticals Inc. (2024). Hydroxyzine hydrochloride solution [package insert]. DailyMed.
Chartwell RX, LLC. (2024). Hydroxyzine hydrochloride tablet, film coated [package insert]. DailyMed.
Drug and Lactation Database (LactMed®). (2024). Hydroxyzine. National Institute of Child Health and Human Development.
Moore, M. J., et al. (2023). Acute generalized exanthematous pustulosis. StatPearls.
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