Yes, hydroxyzine is on the Beers list
Hydroxyzine is explicitly included in the American Geriatrics Society Beers Criteria® as a potentially inappropriate medication for older adults and should generally be avoided in patients 65 years and older. 1, 2
Why Hydroxyzine is Problematic in Older Adults
Hydroxyzine is a first-generation antihistamine with strong anticholinergic properties that pose significant risks in the geriatric population:
- Central nervous system effects: Causes sedation, confusion, and increased fall risk
- Anticholinergic burden: Can worsen cognitive function and precipitate delirium
- Cardiac risks: The FDA label warns of QT prolongation and Torsade de Pointes, particularly concerning in older adults with pre-existing cardiac conditions 3
- Drug interactions: Potentiates other CNS depressants (opioids, benzodiazepines, barbiturates), requiring dose reductions when used together 3
Clinical Context
Research demonstrates hydroxyzine is commonly prescribed despite being on the Beers list - it was the 5th most commonly prescribed potentially inappropriate medication (5.4% of older outpatients) at a major medical center 1. More concerning, when clinicians attempt to deprescribe other CNS-active medications, hydroxyzine is sometimes inappropriately used as a "substitute," representing 26.2% of substitutions to potentially inappropriate medications 2.
Key Prescribing Considerations
The 2023 AGS Beers Criteria® update reinforces that hydroxyzine should be avoided in older adults 4. The FDA label specifically warns that:
- Elderly patients should be started on low doses and observed closely due to increased risk of confusion and over-sedation 3
- Caution is needed in patients with decreased renal function (common in older adults) 3
- Avoid in patients with risk factors for QT prolongation 3
When you encounter hydroxyzine prescribed to an older adult, strongly consider deprescribing or switching to safer alternatives rather than continuing this potentially inappropriate medication.