From the Guidelines
Hydroxyzine can affect the heart by potentially causing QT interval prolongation, which may increase the risk of irregular heartbeats, particularly at higher doses or in individuals with pre-existing heart conditions, electrolyte abnormalities, or when taking other medications that also affect the QT interval. This effect is a concern because it can lead to serious cardiac complications, including torsades de pointes and sudden cardiac death 1. The mechanism behind this effect involves hydroxyzine's interference with potassium channels in heart cells, which affects the repolarization phase of the cardiac action potential.
Key Considerations
- Most healthy individuals taking standard doses (25-50 mg 3-4 times daily for adults) are unlikely to experience significant cardiac issues, but caution is still necessary, especially in elderly patients, those with heart disease, or patients taking other QT-prolonging medications.
- Symptoms of heart-related side effects may include palpitations, dizziness, or fainting.
- If prescribed hydroxyzine and having heart concerns, it is crucial to discuss them with a healthcare provider, who may recommend ECG monitoring or an alternative medication.
- Recent guidelines and studies emphasize the importance of careful consideration of the potential for QT interval prolongation when prescribing medications like hydroxyzine, especially in high-risk patients 1.
Recommendations for Use
- Use hydroxyzine with caution in patients with heart conditions or those taking other medications that may prolong the QT interval.
- Monitor patients for signs of QT interval prolongation, such as palpitations or dizziness.
- Consider alternative medications for patients at high risk of QT interval prolongation or cardiac complications.
- Always consult with a healthcare provider before starting or stopping any medication, especially if there are concerns about heart health.
From the FDA Drug Label
QT Prolongation/Torsade de Pointes (TdP): Cases of QT prolongation and Torsade de Pointes have been reported during post-marketing use of hydroxyzine. Therefore, hydroxyzine should be used with caution in patients with risk factors for QT prolongation, congenital long QT syndrome, a family history of long QT syndrome, other conditions that predispose to QT prolongation and ventricular arrhythmia, as well as recent myocardial infarction, uncompensated heart failure, and bradyarrhythmias Caution is recommended during the concomitant use of drugs known to prolong the QT interval. Hydroxyzine overdose may cause QT prolongation and Torsade de Pointes ECG monitoring is recommended in cases of hydroxyzine overdose.
Hydroxyzine can affect the heart, particularly in relation to QT prolongation and Torsade de Pointes.
- It should be used with caution in patients with risk factors for QT prolongation.
- ECG monitoring is recommended in cases of hydroxyzine overdose. 2 2
From the Research
Hydroxyzine's Effect on the Heart
- Hydroxyzine, a first-generation sedating antihistamine, has been linked to cardiac safety concerns, including QT prolongation and torsade de pointes (TdP) 3, 4, 5.
- Studies have shown that hydroxyzine can inhibit human ether-a-go-go-related gene (hERG) potassium ion channels, which can lead to QT prolongation and TdP 3, 5.
- The risk of TdP associated with hydroxyzine use is increased in patients with underlying medical conditions or concomitant medications that constitute at least one additional risk factor for such events 3, 4.
- Healthcare providers should conduct personalized risk assessments, monitor electrolyte levels, and perform regular electrocardiograms to minimize the risk of TdP associated with hydroxyzine therapy 4.
Risk Factors for QT Prolongation and TdP
- Underlying cardiovascular disorders and concomitant treatment with drugs known to induce arrhythmia are significant risk factors for QT prolongation and TdP associated with hydroxyzine use 3.
- Patients with a history of polysubstance abuse, opioid withdrawal, or underlying repolarization abnormalities are also at increased risk of TdP associated with hydroxyzine use 4, 5.
- Genetic mutations, such as the A614V-HERG mutation, can also increase the risk of QT prolongation and TdP associated with hydroxyzine use 5.
Regulatory Advisories and Prescribing Practices
- Regulatory advisories on hydroxyzine and the risk of QT prolongation and TdP have been issued in the UK and Canada 6.
- Studies have shown that hydroxyzine initiation decreased in the UK following the advisories, but not in Canada 6.
- Healthcare providers should exercise caution when prescribing hydroxyzine, especially in patients with risk factors for QT prolongation and TdP, and consider alternative treatments when possible 4, 6.