Hydroxyzine pamoate
Hydroxyzine pamoate (Vistaril)
Hydroxyzine
(hy-DROX-ih-zeen)
Vistaril (Rx)
Classification:
Nonbenzodiazepine antianxiety agent
Action/Kinetics:
Manifests anticholinergic, antiemetic, antispasmodic, local anesthetic, antihistaminic, and skeletal relaxant effects. Has mild antiarrhythmic activity and mild analgesic effects. High sedative and antiemetic effects and moderate anticholinergic activity. Onset: 15-30 min. t1/2: 3 hr. Duration: 4-6 hr. Metabolized by the liver and excreted through the urine. The pamoate salt is believed to be converted to the hydrochloride in the stomach.
Uses:
PO: Symptomatic relief of anxiety and tension associated with psychoneurosis. Anxiety observed in organic disease. Prior to dental procedures, in acute emotional problems, in alcoholism, allergic conditions with strong emotional overlay (e.g., chronic urticaria and pruritus). Beneficial to the cardiac client to allay anxiety and apprehension occurring with certain types of heart disease. Pruritus caused by allergic conditions. IM: Acute hysteria or agitation, withdrawal symptoms (including delirium tremens) in the acute or chronic alcoholic. Pre- and postoperative and pre- and postpartum adjunct to allay anxiety, to control emesis or to allow a decrease in dosage of narcotics.
Contraindications:
Pregnancy (especially early) or lactation; treatment of morning sickness during pregnancy or as sole agent for treatment of psychoses or depression. Hypersensitivity to drug. IV, SC, or intra-arterially.
Special Concerns:
Possible increased anticholinergic and sedative effects in geriatric clients.
Side Effects:
Low incidence at recommended dosages. Drowsiness, dryness of mouth, involuntary motor activity (rarely, tremors and convulsions), ECG abnormalities (e.g., alterations in T-waves), dizziness, urticaria, skin reactions, hypersensitivity. Worsening of porphyria. Marked discomfort, induration, and even gangrene at site of IM injection.
Overdose Management:
Symptoms: Oversedation. Treatment: Immediate induction of vomiting or performance of gastric lavage. General supportive care with monitoring of VS. Control hypotension with IV fluids and either norepinephrine or metaraminol (epinephrine should not be used).
Drug Interactions:
Additive effects when used with other CNS depressants. See Drug Interactions for Tranquilizers.
How Supplied:
Hydroxyzine hydrochloride: Injection: 25 mg/mL, 50 mg/mL; Syrup: 10 mg/5 mL; Tablet: 10 mg, 25 mg, 50 mg, 100 mg. Hydroxyzine pamoate: Capsule: 25 mg, 50 mg, 100 mg; Suspension: 25 mg/5 mL
Dosage
•Capsules, Oral Suspension, Syrup, Tablets. Hydroxyzine hydrochloride and hydroxyzine pamoate
Antianxiety.
Adults: 50-100 mg q.i.d.; pediatric under 6 years: 50 mg/day in divided doses; over 6 years: 50-100 mg/day in divided doses.
Pruritus.
Adults: 25 mg t.i.d.-q.i.d.; children under 6 years: 50 mg/day in divided doses; children over 6 years: 50-100 mg/day in divided doses.
Preoperative or post-general anesthetic sedative.
Adults: 50-100 mg; children: 0.6 mg/kg.
•IM. Hydroxyzine Hydrochloride
Acute anxiety, including alcohol withdrawal.
Adults: 50-100 mg q.i.d.
Antiemetic/analgesia, adjunctive therapy.
Adults: 25-100 mg; pediatric, 1.1 mg/kg. Switch to PO as soon as possible.
Pruritus.
Adults: 25 mg t.i.d. or q.i.d.
Sedative, as premedication and following general anesthesia.
Adults: 50-100 mg. Children: 0.6 mg/kg.
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