Hydroxyzine oral tablet interactions: Alcohol, medications, and other factors

Hydroxyzine interactions with other medications

Before you start treatment with hydroxyzine, tell your doctor and pharmacist which prescription, over-the-counter, and other medications you take. By sharing this information with them, you may help prevent possible interactions. (To learn whether hydroxyzine interacts with supplements, herbs, or vitamins, see the “Hydroxyzine and other interactions” section.)

If you have questions about drug interactions that may affect you, such as what can you not take with hydroxyzine, ask your doctor or pharmacist.

Here’s a table of drugs that can interact with hydroxyzine. Keep in mind that this table doesn’t include all drugs that may interact with hydroxyzine. Some of these interactions are described in detail in “Drug interactions in depth.”

When to avoid Hydroxyzine

In some cases, factors or conditions could prevent your doctor from prescribing hydroxyzine due to the risk of harm. These are known as contraindications. The contraindications of hydroxyzine include:

Having long QT syndrome

Doctors typically won’t prescribe hydroxyzine for people with long QT syndrome. This is because hydroxyzine may cause long QT syndrome and can worsen the condition if you already have it. With long QT syndrome, your heart’s electrical system does not work correctly, which may cause life threatening arrhythmia.

If you have long QT syndrome, talk with your doctor before taking hydroxyzine. They’ll likely prescribe a treatment other than hydroxyzine for your condition.

During the first trimester of pregnancy

Doctors typically will not prescribe hydroxyzine during the first trimester of pregnancy. This is because animal studies showed hydroxyzine may cause harm if used during this period of pregnancy. It’s important to note that animal studies don’t always predict how a drug will affect humans.

For treating your condition during early pregnancy, your doctor can recommend a different treatment that’s safe for use in pregnancy.

Having had an allergic reaction to hydroxyzine or any of its ingredients, or certain other drugs

If you have had an allergic reaction to hydroxyzine or any of its ingredients, your doctor will likely not prescribe hydroxyzine. They’re also unlikely to prescribe hydroxyzine if you’ve had an allergic reaction to the medications cetirizine or levocetirizine. Taking these medications or hydroxyzine could cause another allergic reaction. You can ask your doctor about other treatments that may be better choices for you.

Note: Before you start treatment with hydroxyzine, it’s important to tell your doctor if these contraindications apply to you. They can determine whether to prescribe hydroxyzine.

Hydroxyzine interaction with alcohol

Your doctor will likely recommend that you do not drink alcohol or minimize alcohol consumption while taking hydroxyzine.

Consuming alcohol and taking hydroxyzine can increase the risk of CNS depression as a side effect of hydroxyzine and alcohol. Symptoms can include:

• lethargy
• slurred speech
• slowed breathing
• decreased awareness
• coma

If you have concerns about minimizing or avoiding alcohol while you’re taking hydroxyzine, talk with your doctor before starting treatment.

Drug interactions in depth

Here’s a closer look at certain drug interactions of hydroxyzine.

Benzodiazepines

Hydroxyzine can interact with benzodiazepines. These medications are prescribed for treating anxiety symptoms, providing sedation prior to surgery or another medical procedure, and other uses.

Interaction result: Taking hydroxyzine and a benzodiazepine together can increase the risk of CNS depression as a side effect of hydroxyzine and the benzodiazepine.

Interaction explained: Both hydroxyzine and benzodiazepines can cause CNS depression as a side effect when taken on their own. Combining these medications further raises the risk of this side effect and increases the risk of severe symptoms of CNS depression. With CNS depression, your nervous system slows down. This can cause slower breathing and a slower heart rate that can be life threatening.

Examples of benzodiazepine drugs: Here are some benzodiazepines that may interact with hydroxyzine:

• alprazolam (Xanax)
• clonazepam (Klonopin)
• diazepam (Valium, others)
• lorazepam (Ativan, Loreev XR)
• temazepam (Restoril)

Steps you or your doctor may take: Due to the risk of additive CNS depression, your doctor may suggest you don’t take hydroxyzine and a benzodiazepine together. Hydroxyzine and benzodiazepines are prescribed for some similar uses. So your doctor will likely suggest taking either hydroxyzine or the benzodiazepine to treat your condition, but not both.

Certain antipsychotics

Hydroxyzine oral tablet can interact with certain antipsychotics, which are prescribed to treat certain mental health conditions, such as schizophrenia.

Interaction result: Taking hydroxyzine with certain antipsychotics can increase the risk of long QT syndrome as a side effect of hydroxyzine and certain antipsychotics.

Interaction explained: Taken on their own, hydroxyzine and certain antipsychotics can cause long QT syndrome as a side effect. Taking these medications together can raise the risk of this side effect, including the risk of severe symptoms. With long QT syndrome, your heart’s electrical system doesn’t work correctly, which may cause life threatening arrhythmia.

Examples of antipsychotic drugs: Here are some antipsychotics that may interact with hydroxyzine:

• asenapine (Secuado, Saphris)
• pimozide
• quetiapine (Seroquel)
• thioridazine
• ziprasidone (Geodon)

Steps you or your doctor may take: There are different antipsychotic medications available, and they have different effects. Differences include in the risk of causing long QT syndrome. Depending on the antipsychotic medication you take, your doctor may:

• suggest a different treatment for your condition besides hydroxyzine
• prescribe a lower hydroxyzine dose and closely monitor your heart rhythm if you take it with an antipsychotic
• prescribe hydroxyzine, but suggest switching to a different antipsychotic with a lower risk of long QT syndrome

Certain antifungals

Hydroxyzine can interact with certain antifungal drugs. These medications are prescribed to treat infections caused by fungus.

Interaction result: Taking hydroxyzine together with certain antifungal drugs can increase the risk of long QT syndrome as a side effect of hydroxyzine and certain antifungals.

Interaction explained: Both hydroxyzine and certain antifungals can cause long QT syndrome as a side effect when taken on their own. Combining these medications can raise your risk of long QT syndrome. It can also raise your risk of developing severe symptoms or complications of this side effect.

Examples of antifungal drugs: Here are some antifungal drugs that may interact with hydroxyzine:

• fluconazole (Diflucan)
• itraconazole (Sporanox, Tolsura)
• ketoconazole
• posaconazole (Noxafil)
• voriconazole (Vfend)

Steps you or your doctor may take: There are several possible steps your doctor may take regarding this interaction. They may:

• closely monitor you for signs of long QT syndrome if you take hydroxyzine and the interacting antifungal together short-term
• prescribe a different antifungal that doesn’t have this interaction with hydroxyzine
• suggest a different treatment besides hydroxyzine if you need to take an interacting antifungal drug for a long time

Hydroxyzine and other interactions

Hydroxyzine may have other interactions, such as with supplements, foods, vaccines, or even lab tests. You’ll find details below. Keep in mind that the following information does not include all other possible interactions with hydroxyzine.

Hydroxyzine interactions with supplements

It’s possible for drugs to interact with supplements such as vitamins and herbs.

Hydroxyzine interactions with vitamins

There are no specific reports of vitamins interacting with hydroxyzine. However, that doesn’t mean vitamin interactions won’t occur or be recognized in the future. Because of this, you should talk with your doctor or pharmacist before taking any vitamin product with hydroxyzine.

Hydroxyzine interactions with herbs

There are no specific reports of herbs interacting with hydroxyzine. However, that doesn’t mean herbal interactions won’t occur or be recognized in the future. Because of this, it’s important to check with your doctor or pharmacist before taking any of these products during hydroxyzine treatment.

Hydroxyzine interactions with food

There were no reports of food interactions with hydroxyzine. If you’d like to learn more about eating certain foods during treatment with hydroxyzine, talk with your doctor.

Hydroxyzine interactions with vaccines

There aren’t any known interactions between hydroxyzine and vaccines. Talk with your doctor or pharmacist to see whether you’re due for any vaccines.

Hydroxyzine interactions with lab tests

Hydroxyzine isn’t known to interact with any lab tests. If you have concerns about this medication interacting with lab tests, talk with your doctor.

HYDROXYZINE INTERACTION WITH CANNABIS OR CBD

Cannabis (often called marijuana) and cannabis products, such as cannabidiol (CBD), have been specifically reported to interact with hydroxyzine. Taking hydroxyzine and using cannabis can increase the risk of CNS depression as a side effect of hydroxyzine and cannabis.

Before you start treatment with hydroxyzine, tell your doctor and pharmacist if you use cannabis. By sharing this information with them, you may help prevent possible interactions.

Note: Cannabis is illegal at a federal level but is legal in many U.S. states to varying degrees.

Hydroxyzine and health-related interactions

Certain medical conditions and other factors may increase the risk of interactions with hydroxyzine. Before you take this drug, be sure to talk with your doctor about your health history. Hydroxyzine may not be the right treatment option if you have certain medical conditions or other factors affecting your health.

Health conditions or factors that might interact with hydroxyzine include:

• Age: Older adults (age 65 years and above) should avoid taking hydroxyzine if possible. This group has a higher risk of experiencing certain hydroxyzine side effects, including CNS depression. If your doctor prescribes you hydroxyzine, they’ll likely prescribe the lowest dose for the shortest time needed to treat your symptoms.
• Dementia: People with dementia may have a higher risk of certain hydroxyzine side effects, including confusion and difficulty paying attention. Due to this, doctors often avoid prescribing hydroxyzine to people with dementia when possible. Instead, they may recommend a different treatment for your condition.
• Kidney or liver problem: If you have a kidney problem, such as chronic kidney disease, or a liver problem, such as cirrhosis, you may have a higher risk of having hydroxyzine side effects. Your kidneys and liver play a role in breaking down and getting rid of hydroxyzine after you take a dose. Having a kidney or liver problem could cause the level of hydroxyzine in your system to increase. This can raise your risk of side effects, including CNS depression. Your doctor may prescribe you a lower hydroxyzine dose. Or they may prescribe a different treatment for your condition.
• Lactose intolerance: Hydroxyzine oral tablets contain lactose. If you have lactose intolerance, your doctor may prescribe you a different form of hydroxyzine.
• Long QT syndrome or other heart arrhythmia: Hydroxyzine can cause long QT syndrome as a side effect. If you already have long QT syndrome or another arrhythmia, taking hydroxyzine could worsen your condition. To learn more, see the “When to avoid hydroxyzine” section.
• Allergic reaction: If you’ve had an allergic reaction to hydroxyzine or any of its ingredients, your doctor will likely not prescribe hydroxyzine. Taking the drug could cause another allergic reaction. You can ask them about other treatments that may be better choices for you.
• Breastfeeding: The manufacturer of hydroxyzine recommends against breastfeeding if you’re taking the medication. If you’re breastfeeding or planning to, talk with your doctor before taking hydroxyzine. They can discuss treatment options and ways to feed your child.
• Pregnancy: Hydroxyzine should not be taken during early pregnancy. To learn more, see the “When to avoid hydroxyzine” section. If you’re pregnant or planning to become pregnant, tell your doctor before starting hydroxyzine treatment. They can advise the right treatment plan for you.

Preventing interactions

You can take certain steps to help prevent interactions with hydroxyzine. Your doctor and pharmacist are key resources, so reaching out to them before starting treatment is an important first step. For example, it’s necessary that you plan to do the following:

• Let them know if you drink alcohol or use cannabis.
• Tell them about any other medications you take, as well as any supplements, herbs, and vitamins.
• Create a medication list, which your doctor and pharmacist can help you fill out.

It’s also important to read the hydroxyzine label and other paperwork that may come with the drug. The label may have colored stickers that mention an interaction. And the paperwork, sometimes called the medication guide or patient package insert, may contain details about interactions.

If hydroxyzine doesn’t come with paperwork, you can ask your pharmacist to print a copy. If you need help reading or understanding this information, ask your doctor or pharmacist.

You can also help prevent interactions with hydroxyzine by taking it exactly as your doctor prescribes.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.