Can Vistaril Cause Facial Tingling?
Facial tingling is not a recognized or documented adverse effect of Vistaril (hydroxyzine) based on available clinical evidence and guidelines.
Known Adverse Effects of Hydroxyzine
The documented side effects of hydroxyzine are well-characterized and do not include facial tingling or paresthesias:
- Central nervous system effects are the most common, including sedation (80% rate), fatigue, impaired memory, impaired concentration, and cognitive impairment 1, 2
- Anticholinergic effects include dry mouth, blurred vision, urinary retention (particularly problematic in prostatic hypertrophy), and elevated intraocular pressure 1, 3
- Psychomotor impairment manifests as incoordination, slow and slurred speech, difficulty following instructions, and prolonged reaction times 2
- Cardiovascular effects can occur, including abnormal ventricular repolarization when given in substantial doses or to susceptible individuals 4
Dermatologic Reactions (Not Facial Tingling)
While hydroxyzine can cause skin reactions, these are allergic/hypersensitivity phenomena rather than neurologic sensations:
- Maculopapular eruptions have been reported as generalized rashes appearing shortly after drug administration 5
- Contact sensitivity is very rare with hydroxyzine compared to other antihistamines, but documented cases exist with positive patch testing 5
- These reactions represent allergic responses, not neurologic symptoms like tingling 5
Clinical Interpretation
If a patient reports facial tingling while taking hydroxyzine:
- Consider alternative causes including anxiety (which hydroxyzine is prescribed to treat), hyperventilation, electrolyte disturbances, or other medications the patient may be taking 1, 3
- Review concomitant medications, as 74% of hydroxyzine users also take antidepressants, 44% take opioids, and 38% take anticonvulsants—any of which could cause paresthesias 2
- Evaluate for allergic reaction if accompanied by rash, though tingling alone would be atypical for hydroxyzine hypersensitivity 5
Important Caveat
The absence of documented facial tingling in the literature does not definitively prove it cannot occur, but it is not a recognized adverse effect of this medication that has been in clinical use for over 30 years with extensive safety data 1, 3, 2.