From the FDA Drug Label
The most common manifestation of hydroxyzine overdosage is hypersedation. Other reported signs and symptoms were convulsions, stupor, nausea and vomiting. As in the management of overdosage with any drug, it should be borne in mind that multiple agents may have been taken. If vomiting has not occurred spontaneously, it should be induced. Immediate gastric lavage is also recommended General supportive care, including frequent monitoring of the vital signs and close observation of the patient, is indicated. Hypotension, though unlikely, may be controlled with intravenous fluids and levarterenol or metaraminol. Do not use epinephrine as hydroxyzine counteracts its pressor action. Hydroxyzine overdose may cause QT prolongation and Torsade de Pointes ECG monitoring is recommended in cases of hydroxyzine overdose. There is no specific antidote. It is doubtful that hemodialysis would be of any value in the treatment of overdosage with hydroxyzine. However, if other agents such as barbiturates have been ingested concomitantly, hemodialysis may be indicated There is no practical method to quantitate hydroxyzine in body fluids or tissue after its ingestion or administration.
Hydroxyzine is unlikely to be dialyzable. The drug label states that "it is doubtful that hemodialysis would be of any value in the treatment of overdosage with hydroxyzine" 1. This suggests that hydroxyzine is not effectively removed by hemodialysis.
From the Research
Introduction to Hydroxyzine Dialyzability
Hydroxyzine is a medication used to treat various conditions, including pruritus and interstitial cystitis. The question of whether hydroxyzine is dialyzable is crucial for healthcare providers, especially when treating patients with end-stage renal disease.
Factors Affecting Dialyzability
The dialyzability of a drug depends on several factors, including its physical, chemical, and pharmacokinetic properties, as discussed in 2. These properties include water solubility, molecular weight, protein binding, volume of distribution, and the fraction, route, and rate of drug elimination.
Hydroxyzine Properties and Dialyzability
While the provided evidence does not directly address the dialyzability of hydroxyzine, it discusses the medication's properties and uses. For instance, 3 examines the pharmacokinetics and pharmacodynamics of hydroxyzine in patients with primary biliary cirrhosis, highlighting its elimination half-life, clearance rate, and volume of distribution. However, these properties are not explicitly linked to dialyzability.
Clinical Uses and Implications
Hydroxyzine has been used to treat pruritus in patients on dialysis, as shown in 4, where it was compared to gabapentin. The study found that both medications significantly improved and controlled pruritus, but it did not address the dialyzability of hydroxyzine. Other studies, such as 5, discuss the use of hydroxyzine in treating interstitial cystitis, but again, do not provide information on its dialyzability.
Treatment Considerations
When treating patients with hydroxyzine, especially those on dialysis, healthcare providers should consider the following:
- Dosage: Typical dosages range from 25 mg/day to 100 mg/day, as seen in 4.
- Duration: Treatment duration may vary depending on the condition being treated and the patient's response.
- Differentials: Healthcare providers should be aware of potential side effects, such as drowsiness, blurred vision, and dry mouth, as reported in 3.
- Caveats: The lack of direct evidence on hydroxyzine's dialyzability means that healthcare providers should exercise caution when prescribing this medication to patients with end-stage renal disease.
Conclusion
In conclusion, while the provided evidence does not directly answer the question of whether hydroxyzine is dialyzable, it highlights the importance of considering a drug's properties and clinical uses when treating patients with end-stage renal disease. Healthcare providers should be aware of the potential implications of using hydroxyzine in these patients and take necessary precautions to ensure safe and effective treatment, as discussed in 2 and 4.