From the Guidelines
Oral prednisone and hydroxyzine should be taken together with caution, as hydroxyzine, a first-generation antihistamine, can cause significant sedation, performance impairment, and anticholinergic effects, which may be exacerbated by the concurrent use of prednisone, a corticosteroid that can have various side effects 1. When considering the use of oral prednisone and hydroxyzine together, it is essential to weigh the potential benefits against the risks, particularly the sedative and anticholinergic effects of hydroxyzine.
- Typical adult dosing for prednisone ranges from 5-60 mg daily, depending on the condition being treated.
- Hydroxyzine is commonly prescribed at 25-100 mg 3-4 times daily for allergic reactions or anxiety.
- However, due to the potential for sedation and performance impairment associated with hydroxyzine, as highlighted in the study 1, it is crucial to exercise caution when taking these medications together, especially in older adults or individuals who operate heavy machinery or drive.
- Additionally, the concomitant use of other CNS-active substances, such as alcohol, sedatives, hypnotics, or antidepressant medication, may further enhance performance impairment from antihistamines like hydroxyzine 1.
- To minimize potential adverse effects, patients should be advised to follow their prescribed dosages carefully, take prednisone with food to minimize stomach irritation, and avoid abrupt discontinuation of prednisone to prevent withdrawal symptoms.
- Furthermore, patients should be aware of the potential for increased sedation and anticholinergic effects when taking hydroxyzine, and avoid combinations with other medications or alcohol that may exacerbate these effects 1.
From the Research
Oral Prednisone and Hydroxyzine
- The combination of oral prednisone and hydroxyzine has been studied in various contexts, including the treatment of acute urticaria and cutaneous drug eruptions 2, 3.
- In a study on acute urticaria, patients who received a 4-day "burst" course of prednisone in addition to standard treatment with H1 antihistamines, such as hydroxyzine, showed significant improvement in symptoms and clinical response compared to those who received placebo 3.
- However, there is also evidence that hydroxyzine can cause cutaneous drug eruptions, and patients who experience worsening skin conditions after treatment with antihistamines should be assessed for potential allergic reactions 2.
- In pediatric patients with idiopathic anaphylaxis, prednisone and hydroxyzine have been used to control symptoms and induce remission, with no reported deaths during treatment 4.
- Hydroxyzine has also been investigated for its potential analgesic effects, with one case report showing a 50% reduction in reported pain in a patient with lumbar spinal stenosis 5.
- The use of prednisone has been compared to other steroidal drugs, such as vamorolone, which shows promise in reducing side effects associated with chronic glucocorticoid use 6.