Can a patient take Vistaril (hydroxyzine) and hydroxyzine together?

No, a patient should not take both Vistaril and hydroxyzine together—they are the same medication.

Vistaril is simply a brand name for hydroxyzine, so taking both would constitute dangerous medication duplication that could lead to overdose, excessive sedation, respiratory depression, cardiac arrhythmias, and potentially fatal outcomes. 1

Understanding the Medication Identity

• Vistaril and hydroxyzine are identical: Vistaril is the brand name for hydroxyzine pamoate, while hydroxyzine can also be dispensed as hydroxyzine hydrochloride (Atarax) or generic hydroxyzine 1
• Taking both simultaneously would double the intended dose, creating a serious overdose risk 1

Critical Safety Concerns with Duplication

Central Nervous System Depression

• The FDA explicitly warns that hydroxyzine potentiates CNS depressants, and when used with other CNS depressants, dosages should be reduced—not increased 1
• Excessive hydroxyzine causes profound sedation, confusion, impaired driving ability (1.5 times more likely to cause fatal automobile accidents), and performance impairment that persists even without subjective awareness of drowsiness 2, 3
• Recent driving under the influence investigations showed hydroxyzine caused incoordination, slurred speech, erratic driving, and crashes at therapeutic levels—duplication would dramatically worsen these effects 4

Cardiac Toxicity Risk

• The FDA warns that hydroxyzine can cause QT prolongation and Torsades de Pointes, particularly in patients with risk factors or taking other QT-prolonging medications 1
• Pediatric guidelines specifically list hydroxyzine among antihistamines that prolong the QT interval 5
• Doubling the dose through medication duplication would substantially increase the risk of life-threatening cardiac arrhythmias 1

Anticholinergic Toxicity

• Excessive hydroxyzine causes severe anticholinergic effects including urinary retention, constipation, dry mouth, confusion, and can precipitate narrow-angle glaucoma 2, 6
• In elderly patients, this duplication could trigger delirium, falls, fractures, and hepatic encephalopathy in those with liver disease 6

Common Clinical Scenarios Leading to This Error

Prescription from Multiple Providers

• A patient may receive hydroxyzine from one provider and Vistaril from another without either knowing about the duplicate prescription
• Always perform medication reconciliation and check both generic and brand names 1

Patient Confusion About Medication Names

• Patients may not recognize that their "anxiety medication" (Vistaril) and "allergy medication" (hydroxyzine) are identical
• Educate patients about both brand and generic names of their medications 1

Pharmacy Dispensing Errors

• Different pharmacies may dispense the same medication under different names
• Verify all antihistamines and anxiolytics in the patient's regimen before prescribing 1

What to Do If Duplication Has Occurred

• Immediately discontinue one of the duplicate medications 1
• Monitor for signs of overdose including excessive sedation, confusion, respiratory depression, hypotension, and cardiac arrhythmias 1
• Obtain an ECG if the patient has been taking duplicated doses, especially if they have cardiac risk factors or take other QT-prolonging medications 5, 1
• Assess for anticholinergic toxicity, particularly in elderly patients 6
• Consider hospitalization for observation if significant duplication has occurred or if the patient shows signs of toxicity 1

Appropriate Hydroxyzine Combinations (Not Duplication)

If the question was actually about combining hydroxyzine with different antihistamines:

• Combining hydroxyzine with a second-generation antihistamine like loratadine is appropriate: Use loratadine 10 mg during the day and hydroxyzine 10-50 mg at bedtime for conditions like urticaria with sleep disturbance 3
• This strategy provides daytime symptom control without sedation (loratadine) and nighttime symptom control with sleep aid (hydroxyzine) 3
• Never combine hydroxyzine with other first-generation antihistamines (diphenhydramine, promethazine) as this creates additive sedation and anticholinergic effects 5, 2