Can Atarax (hydroxyzine) be given to someone with a Small Bowel Obstruction (SBO)?

Hydroxyzine (Atarax) Use in Small Bowel Obstruction

Hydroxyzine (Atarax) should be avoided in patients with small bowel obstruction due to its anticholinergic properties which can worsen the obstruction by decreasing gastrointestinal motility.

Pathophysiology and Concerns

Small bowel obstruction (SBO) presents several challenges that make hydroxyzine use problematic:

1. Anticholinergic Effects: Hydroxyzine has anticholinergic properties that can:

   • Decrease gastrointestinal motility
   • Reduce secretions
   • Potentially worsen or mask symptoms of obstruction 1

2. Risk of Complications: In SBO, medications that slow intestinal motility can:

   • Increase intraluminal pressure
   • Exacerbate distention
   • Potentially increase risk of ischemia and perforation 1

Preferred Management for SBO

Initial Management

• Nasogastric tube decompression
• IV fluid resuscitation
• Electrolyte correction
• Close monitoring of vital signs and abdominal examination 1

Medication Considerations

Medications to Avoid in SBO:

• Anticholinergics (including hydroxyzine)
• Opioids (in complete obstruction)
• Prokinetic agents like metoclopramide (in complete obstruction) 1

Appropriate Medications for Symptom Management:

1. For Nausea/Vomiting:

   • Ondansetron or other 5-HT3 antagonists (preferred)
   • Low-dose haloperidol
   • Scopolamine (only in palliative settings with inoperable obstruction) 1

2. For Pain Management:

   • Non-opioid analgesics when possible
   • Careful use of opioids when necessary (with close monitoring)

3. For Secretion Management (in palliative/inoperable cases only):

   • Octreotide has been shown to be superior to hyoscine butylbromide for controlling gastrointestinal symptoms in malignant inoperable bowel obstruction 2

Special Considerations

Malignant Bowel Obstruction

In palliative care settings with inoperable malignant bowel obstruction:

• Octreotide is recommended early due to its efficacy and tolerability 1
• Anticholinergics may be considered only when gut function is no longer possible 1

Partial vs. Complete Obstruction

• In partial obstruction: Even more caution with anticholinergics as they may convert a partial to complete obstruction
• In complete obstruction: Focus on decompression rather than medication management 1

Alternative Anxiolytics/Antiemetics for SBO Patients

If a patient with SBO requires anxiolytic or antiemetic effects:

• Low-dose benzodiazepines (for anxiety)
• Ondansetron (for nausea/vomiting)
• Haloperidol (for nausea/delirium)

Conclusion

The management of SBO requires careful consideration of medication effects on gastrointestinal motility. Hydroxyzine should be avoided in patients with SBO due to its anticholinergic properties that can potentially worsen the obstruction and mask important clinical symptoms.