Vistaril (Hydroxyzine) is NOT Used for Pain Management in Pregnant Women
Vistaril (hydroxyzine) is contraindicated in early pregnancy and is not an analgesic—it has no role in pain management for pregnant women. 1
Why Hydroxyzine is Inappropriate
Contraindication in Pregnancy
- Hydroxyzine is explicitly contraindicated in early pregnancy due to fetal abnormalities demonstrated in animal studies (rats and mice) at doses above the human therapeutic range 1
- The FDA drug label states that clinical data in humans are inadequate to establish safety in early pregnancy 1
- Hydroxyzine is also contraindicated in patients with prolonged QT interval 1
Not an Analgesic
- Hydroxyzine is an antihistamine with anxiolytic and antiemetic properties—it has no direct analgesic effect 1
- It is not mentioned in any pregnancy pain management guidelines as a treatment option 2, 3
Appropriate Pain Management Options in Pregnancy
First-Line Treatment
- Paracetamol (acetaminophen) is the recommended first-line analgesic for pain during pregnancy at any stage 3
- Dosing: 975 mg every 8 hours or 650 mg every 6 hours orally 3
- Use the lowest effective dose for the shortest possible time 4, 5
Second-Line Options
- NSAIDs (ibuprofen) can be used during the second trimester only 2
- NSAIDs must be avoided after 28 weeks gestation due to risk of premature ductus arteriosus closure and oligohydramnios 3
- Ibuprofen 600 mg every 6 hours can be considered when appropriate 3
Severe Pain Management
- For severe pain unresponsive to non-opioids, short-course low-dose opioids may be necessary 3
- Morphine is the opioid of choice if strong analgesia is required 3
- Use the lowest effective dose for the shortest duration 2
Labor and Postpartum Pain
- Neuraxial analgesia (epidural) is the most effective method for labor pain and should be encouraged 3
- Postpartum: multimodal approach with scheduled acetaminophen and NSAIDs (safe during breastfeeding) 3
Critical Caveats
- Severe pain after vaginal delivery is unusual and should prompt evaluation for complications 3
- Women with opioid use disorder require specialized multidisciplinary pain management 2
- Avoid meperidine during pregnancy due to poor efficacy and toxicity risk 3
- Any medication use during pregnancy should balance maternal benefit against potential fetal risk 2