Is it safe to use hydroxyzine and meloxicam together?

Hydroxyzine and Meloxicam Interaction Safety

Hydroxyzine and meloxicam can be used together, but caution is warranted due to the potentiating action of hydroxyzine on CNS depressants, which may increase sedation risk. 1

Mechanism of Interaction

• Hydroxyzine is an antihistamine with sedative properties that can potentiate the effects of other central nervous system (CNS) depressants 1
• Meloxicam is a non-steroidal anti-inflammatory drug (NSAID) and COX-2 preferential inhibitor used for pain management 2, 3
• While meloxicam itself is not classified as a CNS depressant, the FDA label for hydroxyzine specifically mentions that its potentiating action must be considered when used with non-narcotic analgesics 1

Safety Considerations

Sedation Risk

• Hydroxyzine causes drowsiness as its most common side effect, which typically appears during the first week of treatment 4
• Patients should be warned about possible increased sedation when these medications are combined 1
• Elderly patients are at higher risk for sedation effects and should start with lower hydroxyzine doses (10 mg) 4

Cardiovascular Considerations

• Hydroxyzine has been associated with QT prolongation and Torsade de Pointes in post-marketing reports 1
• Meloxicam, like other NSAIDs, can cause peripheral edema and hypertension 3
• Monitor for cardiovascular effects, especially in patients with pre-existing heart conditions

Gastrointestinal Effects

• Meloxicam has been shown to have less gastrointestinal toxicity than non-selective NSAIDs, but still carries risk 3, 5
• High-dose meloxicam (20 mg/kg) has been associated with gastritis and fecal occult blood in animal studies 6
• Standard therapeutic doses (7.5-15 mg daily) have shown acceptable gastrointestinal safety profile 7, 2

Recommendations for Combined Use

1. Dosage Adjustment:

   • Consider reducing the hydroxyzine dose when used with meloxicam 1
   • Standard meloxicam dosing is 7.5-15 mg once daily 2
   • Standard hydroxyzine dosing is 25-50 mg daily for allergic conditions 4

2. Patient Monitoring:

   • Monitor for excessive sedation, especially during the first week of combined therapy
   • Watch for signs of cardiovascular effects (edema, blood pressure changes)
   • Be alert for gastrointestinal symptoms

3. Patient Education:

   • Warn patients about potential drowsiness and caution against driving or operating dangerous machinery 1
   • Advise against concurrent use of alcohol or other CNS depressants 4, 1
   • Instruct patients to report unusual symptoms promptly

4. Special Populations:

   • Use extra caution in elderly patients, starting with lower hydroxyzine doses (10 mg) 4
   • Use caution in patients with renal or hepatic impairment 4
   • Avoid in patients with known QT prolongation risk factors 1

Clinical Perspective

While there are no specific studies evaluating the interaction between hydroxyzine and meloxicam, the FDA label for hydroxyzine explicitly mentions potential interactions with non-narcotic analgesics 1. The combination is generally considered safe when appropriate precautions are taken, but clinicians should be vigilant about potential additive sedative effects.