Can you take hydroxyzine and trazodone (antidepressant) together?

Hydroxyzine and Trazodone Combination Safety

Yes, hydroxyzine and trazodone can generally be taken together, but caution should be exercised due to their additive sedative effects which may increase the risk of excessive drowsiness and impaired coordination. 1

Mechanism of Action and Effects

• Hydroxyzine: An antihistamine with anxiolytic properties used for anxiety and pruritus 2

  • Acts primarily as an H1-receptor antagonist
  • Has sedating properties that can help with sleep

• Trazodone: A serotonin antagonist and reuptake inhibitor (SARI) antidepressant 1

  • Used for depression at higher doses (150-300mg)
  • Commonly prescribed at lower doses (25-100mg) for insomnia
  • Has significant sedative properties

Safety Considerations

Additive Sedation

• Both medications have sedative effects that can compound when taken together
• May cause excessive drowsiness, dizziness, and impaired coordination
• Particularly concerning for:
  • Elderly patients
  • Those operating machinery or driving
  • Patients with respiratory conditions

Dosing Recommendations

• If combining these medications:
  • Take at bedtime to minimize daytime sedation
  • Start with lower doses of each medication
  • Adjust doses based on response and tolerance
  • Consider using trazodone at 25-50mg initially when combining with hydroxyzine

Special Populations

• Elderly patients:

  • More sensitive to sedative effects
  • Start with reduced doses (half the standard adult dose) 1
  • Monitor closely for confusion, falls, and cognitive impairment

• Renal impairment:

  • Hydroxyzine dose should be halved in moderate renal impairment 2
  • Avoid hydroxyzine in severe renal impairment (creatinine clearance <10 mL/min) 2

• Hepatic impairment:

  • Hydroxyzine should be avoided in severe liver disease due to inappropriate sedating effects 2

Monitoring

When taking this combination:

• Watch for excessive sedation, dizziness, confusion
• Monitor for morning grogginess or "hangover" effects
• Be cautious with activities requiring alertness until individual response is known
• Avoid alcohol and other CNS depressants which would further increase sedation

Clinical Considerations

• This combination may be particularly useful for patients with both anxiety and insomnia
• Trazodone has been shown to have fewer anticholinergic effects than tricyclic antidepressants 3
• Hydroxyzine can be taken three times daily for anxiety but is often used at night for sleep 2
• The combination may provide synergistic benefits for sleep in some patients, though formal studies on this specific combination are limited

Alternatives

If the sedation from combining these medications is problematic:

• Consider non-sedating alternatives for daytime anxiety management
• Reserve the combination for nighttime use only
• Explore cognitive behavioral therapy for insomnia (CBT-I) as a non-pharmacological approach 1

Remember to inform your healthcare provider about all medications you are taking to ensure appropriate monitoring and dosing adjustments.