Hydroxyzine and Alcohol Interactions

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What is Hydroxyzine?

Hydroxyzine is a prescription-only antihistamine sold under the brand Vistaril. It's used for allergies, anxiety, and as a sedative.

Antihistamines block the action of histamine, a substance in the body that leads to allergic symptoms. They also decrease activity in the brain.

Hydroxyine comes in several forms:

  • Capsule
  • Tablet
  • Syrup
  • Oral suspension

An oral suspension consists of undissolved particles of one or more medicinal agents combined with liquid for oral administration. An injectable form is also available.

Hydroxyzine

People usually take hydroxyzine three or four times a day. Follow the directions, disclaimers, and drug information on your prescription label strictly, and ask your doctor to explain any sections you don't understand.

Take hydroxyzine exactly as directed. If you are taking it by suspension, shake it well before to ensure the medication mixes evenly.

Before taking hydroxyzine, tell your doctor if you're allergic to cetirizine, levocetirizine, or if you have any allergies. Hydroxyzine may contain inactive ingredients, which may lead to allergic reactions or other issues.

You should also speak to your doctor about your medical history, especially if you have any of the following health issues:

  • Irregular heartbeat, known as prolonged QT interval
  • Breathing problems, such as emphysema or asthma
  • Pressure in the eye or glaucoma
  • High blood pressure
  • Kidney problems
  • Liver issues
  • Seizures
  • Stomach or intestine problems, such as ulcers or blockage
  • Overactive thyroid (hyperthyroidism)
  • Difficulty urinating, for example, due to enlarged prostate

What Is Hydroxyzine Used For?

Adults and children may take hydroxyzine to reduce itching caused by allergic skin reactions such as hives. It is also used alone or combined with other medications to treat anxiety and tension in adults and children.

Hydroxyzine may be combined with anesthesia for some surgeries as sedation. This includes tooth extractions.

In some cases, hydroxyzine is prescribed to treat mental health issues, such as an anxiety disorder.

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Side Effects of Hydroxyzine

Taking hydroxyzine may lead to specific side effects. 

If any of the following symptoms are severe or persist, speak to your doctor for medical advice:

  • Drowsiness
  • Dry mouth
  • Constipation, especially in older adults
  • Confusion, especially in older adults
  • Dizziness
  • Headache

Some side effects of hydroxyzine can be severe. If you experience any of the following side effects or symptoms, call your doctor or healthcare provider immediately:

  • Unintentional trembling or shaking movements
  • Seizures

If you have any of the following symptoms of a severe skin condition, stop taking hydroxyzine, and speak to your doctor immediately:

  • Rash
  • Skin peeling
  • Pus-filled, blister-like lesions
  • Areas of swelling and redness on the skin
  • Fever

Hydroxyzine may cause other symptoms and side effects. Speak with your doctor for medical advice if you have any unusual issues while you are taking hydroxyzine.

If someone has overdosed on hydroxyzine and displays severe symptoms such as passing out or having difficulty breathing, call 911. 

Symptoms of a hydroxyzine overdose may include:

  • Severe sleepiness
  • Seizures
  • Dizziness
  • Hypersedation
  • Convulsions
  • Stupor (near-unconsciousness) 
  • Nausea
  • Vomiting
  • In children, mental or mood changes, such as restlessness and irritability

Hydroxyzine for Alcohol Withdrawal 

History

Hydroxyzine was once one of the drugs used to treat alcohol withdrawal syndrome (AWS) until the late 1960s. At the time, doctors did not know if the drug was better than others because there was not enough research to compare the drugs.

However, in 1969, a study showed that the best drug to treat alcohol withdrawal syndrome was Librium or chlordiazepoxide. Librium proved to work much more effectively than hydroxyzine in AWS patients.

Librium is a benzodiazepine, and it has a chemical structure that is vastly different from hydroxyzine. Today, benzodiazepines, including Librium, are now the drugs of choice when a doctor tries to treat someone with AWS.

Today

Nowadays, hydroxyzine is not prescribed as the primary drug for treating AWS. The medical guidelines for AWS don't recommend hydroxyzine for someone experiencing alcohol withdrawal syndrome.

The primary reason that hydroxyzine does not work effectively for AWS links with why AWS occurs in the first place. Two essential chemicals in your brain are glutamate and gamma-Aminobutyric acid (GABA).

Glutamate enhances activity in the brain, while GABA calms it. Alcohol boosts the effects of GABA. When you consume a lot of alcohol, there is not a lot of glutamate present. Because of this, your brain becomes very sensitive to glutamate.

When you stop drinking alcohol suddenly, your brain becomes overexcited from all the glutamate present because no GABA blocks it. Drugs like benzodiazepines are effective because they fit the GABA receptors in your brain and help calm it down.

Hydroxyzine, on the other hand, does not affect the GABA or glutamate receptors in your brain. Therefore, it cannot counteract the effect of glutamate in your brain, which is the main result of AWS symptoms.

Because of this, hydroxyzine does not work effectively in AWS patients.

Can You Drink Alcohol While Taking Hydroxyzine?

You should avoid drinking alcohol while taking hydroxyzine, including beer and wine. Consuming alcohol with the drug can increase some of the side effects of the medicine.

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Hydroxyzine and Alcohol Interaction & Risks

The drug interactions between hydroxyzine and alcohol can increase the nervous system side effects of hydroxyzine. These side effects include dizziness, drowsiness, and difficulty concentrating.

Some people may also suffer from impairment in thinking and judgment. To reduce the risks of these drug interactions, do not drink alcohol while taking hydroxyzine, and do not use more than the recommended dose.

Other Hydroxyzine Interactions

You should not use hydroxyzine if you:

  • Are allergic to levocetirizine (Xyzal) or cetirizine (Zyrtec)
  • Are pregnant
  • Have long QT syndrome

Inform your doctor if you're taking other drugs that cause drowsiness. These include:

  • Opioids such as hydrocodone or codeine
  • Anxiety and sleep medications, including alprazolam, lorazepam, or zolpidem
  • Muscle relaxers such as cyclobenzaprine or carisoprodol
  • Antihistamines, including diphenhydramine, loratadine or promethazine

Other drugs that are known to have serious adverse effects when interacting with hydroxyzine include, but are not limited to:

  • Amiodarone
  • Citalopram
  • Clozapine
  • Droperidol
  • Eluxadoline
  • Fluoxetine
  • Iloperidone
  • Isocarboxazid
  • Procainamide
  • Quetiapine
  • Quinidine
  • Sodium Oxybate
  • Sotalol
  • Tranylcypromine
  • Ziprasidone

This is not a complete list of hydroxyzine drug interactions. Speak with your healthcare professional so they can provide medical advice when taking hydroxyzine.

Hydroxyzine interacts with alcohol and other drugs. Talk to your doctor about your alcohol consumption and medication history before taking Hydroxyzine.

How to Find Treatment for Alcohol Withdrawal

Some people are worried about quitting drinking due to withdrawal symptoms, but alcohol detox is essential as the first step in treating alcohol use disorder (AUD).

Due to the severity of some withdrawal symptoms, detox should be supervised and monitored by a medical professional.

This is especially important for people who have a history of lung or heart problems or other medical conditions. Withdrawal symptoms can rapidly worsen.

During medical detox, your treatment provider tracks your blood pressure and heart rate to ensure your health condition does not worsen. You can also speak with them about any symptoms you are experiencing and if you are in any pain. 

When alcohol detox occurs in an inpatient rehab facility, different medications may be used to help reduce specific withdrawal symptoms. Medicines can also help keep a person's body chemicals in balance, reducing the risk for severe complications.

In some cases, medication can cause unwanted side effects or interfere with the detox process. In these circumstances, other remedies are used.

If you or a loved one needs professional help with alcoholism, reach out to an addiction specialist for more information about treatment.

Updated on January 17, 2022
6 sources cited
  1. MedlinePlus. "Hydroxyzine: Medlineplus Drug Information."
  2. DailyMed. "Hydroxyzine hydrochloride tablet." U.S. National Library of Medicine.
  3. RxList. "Vistaril (hydroxyzine): Uses, dosage, side effects, interactions, warning." October 27, 2020. 
  4. Reus, Victor I et al. “The American Psychiatric Association Practice Guideline for the Pharmacological Treatment of Patients With Alcohol Use Disorder.” The American journal of psychiatry vol. 175,1 : 86-90.
  5. Kattimani, Shivanand, and Balaji Bharadwaj. “Clinical management of alcohol withdrawal: A systematic review.” Industrial psychiatry journal vol. 22,2 : 100-8.
  6. Center for Substance Abuse Treatment. "Detoxification and Substance Abuse Treatment. Rockville (MD): Substance Abuse and Mental Health Services Administration." 2006. 

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