Can hydroxyzine be taken concurrently with metoprolol (beta blocker) and sertraline (selective serotonin reuptake inhibitor)?

From the Guidelines

It's generally safe to take hydroxyzine with metoprolol and sertraline, but caution is advised due to potential interactions and side effects. When considering the combination of these medications, it's essential to be aware of their individual mechanisms of action and potential interactions. Hydroxyzine, an antihistamine used for anxiety and itching, metoprolol, a beta-blocker for high blood pressure and heart conditions, and sertraline, an SSRI antidepressant, can be prescribed together, but careful monitoring is necessary 1.

Key Considerations

• Both hydroxyzine and sertraline can cause drowsiness, which may be intensified when taken together 1.
• There is a small theoretical risk of QT interval prolongation when combining hydroxyzine with sertraline, although this is generally not clinically significant in most patients 1.
• Metoprolol may enhance the blood-pressure-lowering effects of hydroxyzine.
• A discontinuation syndrome has been reported following missed doses or acute discontinuation of sertraline, which should be taken into consideration when prescribing or combining medications 1.

Recommendations

• Start with lower doses if your doctor approves this combination, and be cautious about activities requiring alertness until you know how these medications affect you together.
• Report any unusual side effects like extreme drowsiness, dizziness, confusion, or irregular heartbeat to your doctor immediately.
• Regular monitoring and assessment of treatment response using standardized symptom rating scales can help optimize the benefit-to-harm ratio and achieve remission 1.

From the FDA Drug Label

THE POTENTIATING ACTION OF HYDROXYZINE MUST BE CONSIDERED WHEN THE DRUG IS USED IN CONJUNCTION WITH CENTRAL NERVOUS SYSTEM DEPRESSANTS Caution is recommended during the concomitant use of drugs known to prolong the QT interval. These include Class 1A (e.g., quinidine, procainamide) or Class III (e.g., amiodarone, sotalol) antiarrhythmics, certain antipsychotics (e.g., ziprasidone, iloperidone, clozapine, quetiapine, chlorpromazine), certain antidepressants (e.g., citalopram, fluoxetine), Patients should also be advised against the simultaneous use of other CNS depressant drugs, and cautioned that the effects of alcohol may be increased

The use of hydroxyzine with metoprolol and sertraline requires caution.

• Metoprolol is a beta-blocker and does not directly interact with hydroxyzine in the label.
• Sertraline is an antidepressant that may prolong the QT interval, and its use with hydroxyzine requires caution due to the potential for QT prolongation. Hydroxyzine can be taken with metoprolol and sertraline, but patients should be monitored for signs of QT prolongation and CNS depression 2.

From the Research

Interaction between Hydroxyzine, Metoprolol, and Sertraline

• There is no direct evidence from the provided studies on the interaction between hydroxyzine, metoprolol, and sertraline 3, 4, 5, 6, 7.
• However, studies suggest that combining certain antidepressants with β-blockers like metoprolol can increase the risk of hemodynamic adverse events due to CYP2D6 drug interactions 4.
• Sertraline is an antidepressant that does not strongly inhibit CYP2D6, and its combination with metoprolol may not significantly increase the risk of bradycardia compared to other antidepressants that inhibit CYP2D6 5.
• The risk of emergent bradycardia associated with metoprolol is low and comparable to other β-blockers like carvedilol 6.
• Hydroxyzine is an antihistamine used to treat anxiety, and its interaction with metoprolol and sertraline is not well-studied in the provided evidence 3.

Clinical Considerations

• When combining hydroxyzine with metoprolol and sertraline, clinicians should be aware of the potential risks of CYP2D6 drug interactions and monitor patients for signs of hemodynamic adverse events 4.
• The evaluation and management of bradycardia should focus on assessing symptoms and disease states rather than solely relying on heart rate cutoffs 7.
• Further studies are needed to fully understand the interactions between hydroxyzine, metoprolol, and sertraline, and to provide guidance on their safe and effective use in clinical practice.