Can Atarax (hydroxyzine) be given with propranolol?

Co-administration of Atarax (Hydroxyzine) with Propranolol

Atarax (hydroxyzine) can be safely administered with propranolol, but careful monitoring for enhanced sedative effects and potential additive hypotensive effects is necessary. This combination does not have any absolute contraindications in the guidelines, but requires awareness of potential interactions.

Pharmacological Considerations

Mechanism of Action

• Hydroxyzine: First-generation antihistamine with sedative properties
• Propranolol: Non-selective beta-blocker that blocks both β1 and β2 receptors

Potential Interaction Concerns

1. Sedation Risk

   • Hydroxyzine has sedative properties
   • When combined with propranolol, which can cause fatigue, the sedative effect may be enhanced

2. Hypotensive Effects

   • Both medications can lower blood pressure
   • Propranolol through beta-blockade 1
   • Hydroxyzine through mild anticholinergic and central effects

3. Cardiovascular Effects

   • Propranolol can cause bradycardia and hypotension 1, 2
   • The combination may potentially enhance these effects

Clinical Recommendations

Monitoring Parameters

• Blood pressure: Monitor for excessive hypotension, especially when initiating therapy
• Heart rate: Watch for symptomatic bradycardia (heart rate <50 bpm)
• Mental status: Assess for excessive sedation or dizziness
• Orthostatic changes: Check for postural hypotension, particularly in elderly patients

Dosing Considerations

• Consider starting with lower doses of both medications when used concurrently
• Propranolol dosing typically ranges from 80-240 mg daily in divided doses 1
• Adjust doses based on patient response and tolerance

Precautions

Absolute Contraindications to This Combination

• None specifically listed in guidelines

Use With Caution In:

• Elderly patients (increased risk of sedation and falls)
• Patients with pre-existing hypotension
• Patients with cardiac conduction disorders
• Patients operating machinery or driving
• Patients with decompensated heart failure 2

Special Populations

Cardiovascular Disease

• In patients with cardiovascular disease, monitor more closely for:
  • Bradycardia
  • Hypotension
  • Worsening heart failure symptoms 2

Respiratory Disease

• Use with caution in patients with reactive airway disease, as propranolol is non-selective and can cause bronchospasm 1
• Consider cardioselective beta-blockers as alternatives if respiratory concerns exist

Patient Education

• Advise patients about potential increased sedation
• Caution against activities requiring mental alertness until response to the combination is known
• Instruct patients to report dizziness, excessive drowsiness, or significant drops in blood pressure
• Recommend rising slowly from sitting or lying positions to minimize orthostatic effects

Conclusion

While there are no specific contraindications to using hydroxyzine with propranolol in the guidelines, clinicians should be vigilant about potential additive sedative and hypotensive effects. With proper monitoring and dose adjustments, this combination can be used safely in most patients.