Can Atarax (hydroxyzine) and Gabapentin be taken together?

Can Atarax (Hydroxyzine) and Gabapentin Be Taken Together?

Yes, Atarax (hydroxyzine) and gabapentin can be taken together, as there are no documented pharmacokinetic interactions or contraindications to their concurrent use, though caution is warranted due to additive sedative effects and increased risk of falls, particularly in elderly or frail patients.

Key Safety Considerations

Additive Central Nervous System Depression

• Both hydroxyzine (a first-generation antihistamine) and gabapentin cause sedation and CNS depression, which can be additive when combined 1
• The combination may result in enhanced drowsiness, dizziness, and impaired psychomotor performance 1
• Patients should be counseled about avoiding activities requiring alertness (driving, operating machinery) until they understand how the combination affects them 1

Specific Risk Populations

Elderly and Frail Patients:

• Hydroxyzine carries an 80% sedation rate and significant anticholinergic effects that can worsen cognitive impairment 1
• Gabapentin in renal impairment (common in elderly) increases risk of altered mental status by 50%, falls by 55%, and fractures by 38% at doses >300 mg/day 2
• Use the lowest effective doses in older adults and titrate gradually 1

Patients with Renal Impairment:

• Gabapentin requires careful dose adjustment in renal dysfunction due to nonlinear pharmacokinetics and risk of life-threatening drug accumulation 2
• Hydroxyzine is metabolized hepatically but its sedative effects may be prolonged in renal failure 1

Anticholinergic Burden

• Hydroxyzine has significant anticholinergic properties that can cause urinary retention, constipation, dry mouth, and confusion 1
• Avoid this combination in patients with prostatic hypertrophy, elevated intraocular pressure, cognitive impairment, or dementia 1
• The anticholinergic effects may be particularly problematic when combined with gabapentin's CNS effects 1

Clinical Monitoring Recommendations

When prescribing this combination:

• Start with the lowest doses of each medication 1
• Monitor closely for excessive sedation, confusion, and falls risk during the first few weeks 2
• Assess for orthostatic hypotension, particularly in elderly patients 1
• Avoid concurrent use with other CNS depressants (benzodiazepines, opioids, alcohol) due to compounded sedation risk 1

Dosing Guidance

Hydroxyzine:

• Standard adult dose: 25 mg four times daily 1
• In elderly or when combined with gabapentin: consider starting at 10-25 mg at bedtime and titrate cautiously 1

Gabapentin:

• When used with sedating medications, consider lower starting doses and slower titration 2
• In renal impairment (CrCl <60 mL/min), mandatory dose reduction is required 2

Common Pitfalls to Avoid

• Do not assume gabapentin is "safe" in elderly patients—it requires renal dose adjustment and carries significant fall risk 2
• Do not overlook hydroxyzine's anticholinergic burden, which can precipitate delirium in vulnerable patients 1
• Do not combine with benzodiazepines without careful consideration, as this creates triple CNS depression 1