From the Guidelines
Hydroxyzine is a suitable option for managing anxiety in a patient with alcohol withdrawal, and it can be administered at a dose of 25-50 mg orally every 6 hours as needed for anxiety symptoms. When treating alcohol withdrawal, hydroxyzine is particularly useful because it provides anxiolytic effects without the risk of respiratory depression or dependence associated with benzodiazepines, as noted in the management of agitated patients 1. However, ensure the patient is also receiving appropriate alcohol withdrawal protocol medications (typically benzodiazepines based on CIWA-Ar scoring) as hydroxyzine alone is insufficient for withdrawal management.
For acid reflux, consider adding famotidine 20 mg twice daily or pantoprazole 40 mg once daily, as these medications can provide symptomatic relief for GI symptoms common during withdrawal. It's essential to note that the use of antireflux medications should be based on the presence of symptoms of GERD or esophagitis, rather than as empiric therapy for dysphonia alone, as suggested by the clinical practice guideline on hoarseness (dysphonia) 1. Monitor the patient for sedation when combining hydroxyzine with other CNS depressants.
Key considerations for the patient's treatment plan include:
- Hydroxyzine dosing: 25-50 mg orally every 6 hours as needed for anxiety symptoms
- Acid reflux management: famotidine 20 mg twice daily or pantoprazole 40 mg once daily, based on symptoms of GERD or esophagitis
- Monitoring for sedation and respiratory depression when combining hydroxyzine with other CNS depressants
- Ensuring the patient receives appropriate alcohol withdrawal protocol medications, typically benzodiazepines based on CIWA-Ar scoring.
From the FDA Drug Label
For symptomatic relief of anxiety and tension associated with psychoneurosis and as an adjunct in organic disease states in which anxiety is manifested. The patient is requesting anxiety medication, and hydroxyzine can be used for the symptomatic relief of anxiety and tension.
- Hydroxyzine is not indicated for acid reflux. However, it is essential to exercise caution when using hydroxyzine, especially in patients with a history of substance abuse, as it may potentiate the effects of central nervous system depressants 2 2.
From the Research
Medication for Anxiety and Acid Reflux in ETOH Withdrawal
- The patient is requesting anxiety medication and something for acid reflux while being treated for ETOH withdrawal.
- Hydroxyzine is an antihistamine that can be used for anxiety, but its use in ETOH withdrawal is not directly addressed in the provided studies.
- For anxiety in ETOH withdrawal, benzodiazepines such as lorazepam, chlordiazepoxide, oxazepam, and diazepam are commonly used 3, 4.
- Diazepam is suggested as a preferred benzodiazepine for moderate to severe alcohol withdrawal due to its rapid onset of action and long elimination half-life, allowing for a smoother withdrawal 3.
- However, the provided studies do not specifically address the use of hydroxyzine in ETOH withdrawal or its combination with medications for acid reflux.
Treatment of ETOH Withdrawal
- The treatment of ETOH withdrawal typically involves benzodiazepines, anticonvulsants, beta-blockers, and antihypertensives 4.
- Symptom-triggered dosing of benzodiazepines is often preferred over fixed-schedule dosing 4.
- The Clinical Institute Withdrawal Assessment for Alcohol scoring system is a useful tool for assessing and managing alcohol withdrawal 4.
Benzodiazepine Withdrawal Management
- The management of benzodiazepine withdrawal, which may be relevant for patients with a history of benzodiazepine use, includes gradual dosage reduction, psychological interventions, and occasional prescription of concomitant medication 5.
- However, this is not directly relevant to the patient's current request for anxiety medication and acid reflux treatment during ETOH withdrawal.