Can hydroxyzine be taken during the third trimester of pregnancy?

Hydroxyzine Use in Third Trimester of Pregnancy

Hydroxyzine should be avoided during the third trimester of pregnancy due to the risk of neonatal withdrawal syndrome. 1, 2

Safety Concerns

• Hydroxyzine has been associated with neonatal withdrawal syndrome when used at high doses throughout pregnancy 2
• Symptoms of neonatal withdrawal from hydroxyzine may include:
  • Tremors
  • Irritability
  • Hyperactivity
  • Jitteriness
  • Shrill cry
  • Myoclonic jerks
  • Hypotonia
  • Increased respiratory and heart rates
  • Feeding problems
  • Clonic movements 3
• These withdrawal symptoms can persist for up to 5 weeks after birth when treated with prescription medications 3

Risk Assessment

• While a 1997 prospective controlled study did not find increased teratogenic risk with hydroxyzine 4, this study primarily focused on first trimester exposure and malformations rather than third trimester use and withdrawal effects
• The risk of neonatal withdrawal is particularly concerning in the third trimester as drug exposure occurs closer to delivery, giving less time for clearance before birth

Alternative Options

If antihistamine therapy is necessary during the third trimester:

• First-line alternatives:

  • Chlorphenamine (chlorpheniramine) is preferred due to its longer safety record in pregnancy 1
  • Loratadine or cetirizine (FDA Pregnancy Category B) have potentially better safety profiles than hydroxyzine 1

• Non-pharmacological approaches should be considered first for symptom management:

  • Environmental allergen avoidance
  • Saline nasal irrigation for nasal congestion
  • Cool compresses for pruritus

Special Considerations

• If hydroxyzine must be used (when benefits clearly outweigh risks):
  • Use the lowest effective dose (10-25 mg per dose)
  • Do not exceed 50 mg total daily dose 1
  • Discontinue before delivery if possible to minimize risk of neonatal withdrawal effects
  • Monitor closely for maternal and fetal effects
  • Inform pediatricians about maternal hydroxyzine use so they can monitor the newborn for withdrawal symptoms

Monitoring Recommendations

If hydroxyzine was used in the third trimester:

• Newborns should be observed for at least 48-72 hours after birth for signs of withdrawal
• Symptoms typically appear within hours to days after birth
• Treatment may be required if significant withdrawal symptoms develop

In conclusion, while hydroxyzine has been used in pregnancy, the risk of neonatal withdrawal syndrome makes it an unfavorable choice during the third trimester. Alternative antihistamines with better safety profiles should be considered when medication is necessary.