Can Atarax (hydroxyzine) and Trazodone be taken together?

Concurrent Use of Atarax (Hydroxyzine) and Trazodone

Yes, Atarax (hydroxyzine) and trazodone can be taken together, but caution should be exercised due to potential additive sedative effects. Both medications are used in different clinical contexts and have different mechanisms of action, making their combination pharmacologically reasonable in certain situations.

Pharmacological Properties and Clinical Uses

Hydroxyzine (Atarax)

• Mechanism: First-generation antihistamine with sedating properties
• Clinical uses:
  • Management of pruritus (itching) 1
  • Anxiety
  • Sedation

Trazodone

• Mechanism: Atypical antidepressant with 5-HT2A/1C receptor antagonist properties 2
• Clinical uses:
  • Depression
  • Insomnia 1
  • Agitation in Alzheimer's disease 1

Safety of Combination

1. No contraindication exists for combining these medications

   • Unlike MAOIs, which are contraindicated with trazodone, hydroxyzine does not have a specific contraindication with trazodone 3

2. Potential additive effects:

   • Both medications have sedating properties
   • Combined use may enhance sedation, which could be beneficial for insomnia but problematic during daytime activities

3. No significant pharmacokinetic interactions:

   • Unlike some SSRIs that might interact with trazodone, hydroxyzine is not known to significantly alter trazodone metabolism 4

Clinical Considerations

Benefits of Combination

• May be useful for patients with:
  • Insomnia plus anxiety or depression
  • Pruritus with sleep disturbance
  • Agitation in dementia requiring multiple approaches 1

Risks to Monitor

1. Excessive sedation:

   • May impair cognitive function and psychomotor skills
   • Particular concern in elderly patients

2. Respiratory depression:

   • While uncommon with these medications alone, the risk increases with combination

3. Cardiac effects:

   • Trazodone should be used with caution in patients with premature ventricular contractions 1
   • Monitor for QT prolongation with combined use

Practical Recommendations

1. Start with lower doses of both medications when using in combination

   • For trazodone: Consider starting at 25mg rather than 50mg 1
   • For hydroxyzine: Consider reducing the standard dose

2. Timing considerations:

   • If used for sleep, administer both medications at bedtime
   • If hydroxyzine is needed for daytime symptoms, consider using trazodone only at night

3. Patient monitoring:

   • Assess for excessive daytime sedation
   • Monitor for cognitive impairment
   • Evaluate therapeutic benefit versus side effects

Special Populations

Elderly Patients

• Higher risk of adverse effects
• Start with lower doses
• Monitor more frequently for sedation and falls

Patients with Comorbid Conditions

• Respiratory disorders: Use with caution due to potential respiratory depression
• Cardiac conditions: Monitor for cardiac effects, especially with trazodone

Conclusion

While hydroxyzine and trazodone can be safely used together, the combination should be approached with careful consideration of the potential for additive sedation. Proper dosing, timing, and monitoring can help maximize benefits while minimizing risks.