Hydroxyzine pamoate
VISTARIL
Pronunciation: hye-DROX-i-zeen
“Hydrozoan’s Vest roll”
What it isH1, 5-HT2A, muscarinic, and alpha-1 antagonist; short-term anxiety and pruritus.
Why this oneIt offers rapid as-needed anxiolysis without controlled-substance status; pamoate is simply the capsule salt.
What limits itSedation and anticholinergic effects limit use; hERG blockade adds QT risk with other QT-prolonging drugs.
FDA-approved for
- anxiety (~1956)
- pruritus (~1956)
Off-label
- insomnia
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Anxiety and tension (psychoneurosis; adjunct in organic disease with anxiety) | Adults | |||
| Pruritus due to allergic conditions (chronic urticaria, atopic/contact dermatoses, histamine-mediated pruritus) | General | |||
| Sedative (premedication and following general anesthesia) | General |
Renal Undefined
Hepatic Undefined
Instructions
- Reduce dose of concomitant CNS depressants (narcotics, non-narcotic analgesics, barbiturates) when given with hydroxyzine
- Start elderly at low end of dosing range and observe closely
- Discontinue at first appearance of rash (risk of AGEP)
Available strengths
- cap 25, 50, 100 mg
Contraindications
- Early pregnancy
- Prolonged QT interval
Cautions
- Potentiates CNS depressants (narcotics, analgesics, barbiturates) and alcohol — reduce their dosage
- Drowsiness — caution with driving or operating machinery
- QT prolongation/Torsade de Pointes — caution with cardiac risk factors, congenital long QT, and concomitant QT-prolonging drugs
- Acute generalized exanthematous pustulosis (AGEP) — discontinue at first sign of rash or hypersensitivity
- Geriatric: start low; increased sensitivity, decreased renal/hepatic/cardiac function
Adverse reactions
- Drowsiness (usually transitory)
- Dry mouth
- Involuntary motor activity including tremor and convulsions (rare, usually at higher-than-recommended doses)
- QT prolongation, Torsade de Pointes
- Headache, hallucination
- Pruritus, rash, urticaria; AGEP and fixed drug eruptions (post-marketing)
Pregnancy Contraindicated in early pregnancy; fetal abnormalities seen in animals; human safety data inadequate.
Lactation Not known whether excreted in human milk; should not be given to nursing mothers.
Cost
NO BOXED WARNINGS
Principal riskSedation and anticholinergic burden; QT at high dose
Classes and tags
Clinical profile
Active metabolites
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