From the Research
Hydroxyzine should be used with extreme caution after cardiac bypass surgery due to its potential to cause QT interval prolongation, which may increase the risk of arrhythmias in patients with recent cardiac surgery. While it can be prescribed for anxiety or pruritus in post-operative patients, careful consideration of the patient's current cardiac status, electrolyte levels, and concurrent medications is necessary. The most recent study on the topic, 1, found that hydroxyzine initiation decreased in the UK after safety advisories on cardiac arrhythmias, suggesting a trend towards caution with its use in patients at risk for QT prolongation.
Some key points to consider when deciding to use hydroxyzine after cardiac bypass surgery include:
- Lower initial doses (such as 10-25mg every 6-8 hours) are recommended with careful monitoring of cardiac parameters.
- Alternative medications like lorazepam (0.5-1mg every 6-8 hours) for anxiety or diphenhydramine (25mg every 6 hours) for pruritus may be safer options in the immediate post-bypass period.
- Hydroxyzine's anticholinergic properties can also cause dry mouth, urinary retention, and constipation, which may complicate post-operative recovery.
- Any signs of cardiac irregularities during hydroxyzine administration should prompt immediate medication reassessment.
It's also important to note that the current evidence on the use of hydroxyzine after cardiac bypass surgery is limited, and more studies are needed to fully understand its risks and benefits in this population, as highlighted by studies such as 2 and 3. However, based on the available evidence, caution is advised when using hydroxyzine in patients after cardiac bypass surgery.