From the Guidelines
Hydroxyzine is contraindicated in patients with known hypersensitivity to hydroxyzine or cetirizine, as well as those with prolonged QT interval, due to the risk of further prolongation and potential dangerous arrhythmias like torsades de pointes. When considering the use of hydroxyzine, it is essential to evaluate the potential risks and benefits, particularly in patients with certain medical conditions.
- Patients with severe liver or kidney disease require caution due to impaired drug metabolism and elimination 1.
- Hydroxyzine should not be used in patients taking medications that also prolong QT intervals, as this creates a dangerous additive effect.
- The medication is contraindicated in patients with porphyria, as it may precipitate acute attacks.
- Elderly patients should use hydroxyzine with extreme caution due to increased anticholinergic effects, including confusion, sedation, and urinary retention.
- Additionally, patients with narrow-angle glaucoma, prostatic hypertrophy, or bladder neck obstruction should avoid hydroxyzine because its anticholinergic properties can worsen these conditions. It is crucial to note that hydroxyzine works by blocking H1 histamine receptors and has anticholinergic effects, which explains many of these contraindications 1. In clinical practice, the use of sedating antihistamines like hydroxyzine as monotherapy is now less common due to concerns about reduced concentration and performance, but they can be effective and well tolerated by some individuals 1. However, the primary concern is the potential for adverse effects, particularly in patients with certain underlying medical conditions, and hydroxyzine should be used with caution and under close medical supervision in these cases.
From the FDA Drug Label
Oral hydroxyzine hydrochloride is contraindicated in patients with known hypersensitivity to hydroxyzine hydrochloride products, and in patients with known hypersensitivity to cetirizine hydrochloride or levocetirizine hydrochloride. Hydroxyzine is contraindicated in patients with a prolonged QT interval. Hydroxyzine, when administered to the pregnant mouse, rat, and rabbit induced fetal abnormalities in the rat and mouse at doses substantially above the human therapeutic range. Clinical data in human beings are inadequate to establish safety in early pregnancy. Until such data are available, hydroxyzine is contraindicated in early pregnancy. Hydroxyzine is contraindicated for patients who have shown a previous hypersensitivity to any component of this medication. The contraindications for hydroxyzine are:
- Known hypersensitivity to hydroxyzine hydrochloride products
- Known hypersensitivity to cetirizine hydrochloride or levocetirizine hydrochloride
- Prolonged QT interval
- Early pregnancy due to inadequate clinical data to establish safety
- Previous hypersensitivity to any component of the medication 2
From the Research
Hydroxyzine Contraindications
- Hydroxyzine can cause systemic contact dermatitis, an underreported type of delayed hypersensitivity, as seen in a case where a patient was patch tested positive to ethylenediamine and repeated oral provocation with hydroxyzine reproduced her eczema 3.
- Hypersensitivity reactions to hydroxyzine can occur, including urticaria, anaphylaxis, contact dermatitis, and fixed drug eruption (FDE), with a wide range of manifestations and onset of reactions varying from a few minutes to several hours or longer 4.
- Antihistamines, including hydroxyzine, can cause hypersensitivity reactions, and reactions to one preparation are likely to occur, but not always, to other members of the same class, making diagnosis based on clinical suspicion and challenge testing necessary 4.
- Hydroxyzine has anticholinergic activity, which can interact with the micturition pathway and cause urinary retention, particularly in elderly patients with existing co-morbidities such as benign prostatic hyperplasia 5.