Vistaril

Primary Uses

Vistaril is an antihistamine that is used to treat several different conditions. It works by decreasing activity in the central nervous system and blocking histamine, a natural substance in the body that causes allergic symptoms.

Anxiety and Tension

Vistaril is used for the short-term relief of anxiety and tension. It may be prescribed for people experiencing anxiety related to emotional stress or as a supplement for anxiety associated with physical illnesses.

Allergic Skin Conditions

This medication is effective at relieving itching (pruritus) caused by various allergic skin conditions, including:

• Hives (Urticaria): Red, itchy welts on the skin.
• Eczema (Atopic Dermatitis): A chronic condition that makes the skin red and itchy.
• Contact Dermatitis: A skin rash caused by contact with a specific substance.

Sedation

Vistaril is frequently used as a sedative to help patients feel calm and relaxed before or after a surgical procedure. It can also be used as a premedication before general anesthesia.

Nausea and Vomiting

In some cases, healthcare providers may use Vistaril to help control nausea and vomiting, particularly when these symptoms occur after surgery.

Antihistamine Action

Vistaril is an antihistamine that works by blocking the action of histamine, a substance in the body that causes allergic symptoms such as itching, runny nose, and hives.

Central Nervous System Effects

The medication also affects the central nervous system. It is thought to suppress activity in specific subcortical regions of the brain. This action helps to provide several effects:

• Anxiety Relief: It helps decrease activity in the brain to reduce feelings of nervousness and tension.
• Sedation: It can cause drowsiness, which may help patients relax or sleep before a medical procedure.
• Nausea Control: It has antiemetic properties that help prevent or treat nausea and vomiting.

While it affects brain activity, it is not considered a cortical depressant and does not work the same way as habit-forming anti-anxiety medications like benzodiazepines.

Common Side Effects

The most common side effects of Vistaril are usually mild and may include:

• Drowsiness or sleepiness
• Dry mouth
• Dizziness
• Headache
• Blurred vision
• Constipation

Serious Side Effects

Contact your doctor immediately or seek emergency medical care if you experience any of the following serious symptoms:

• Fast, pounding, or irregular heartbeat
• Seizures
• Confusion or hallucinations
• Tremors or uncontrollable shaking
• Restless muscle movements in the eyes, tongue, jaw, or neck
• Severe skin reactions, such as a red or purple rash that spreads and causes blistering or peeling
• Difficulty breathing or swallowing
• Extreme fatigue

Drowsiness caused by this medication may impair your ability to drive or operate heavy machinery. This effect may be increased if you consume alcohol or take other medications that cause sedation.

Heart Rhythm Concerns

Vistaril has been associated with a risk of QT prolongation and Torsade de Pointes, which are serious heart rhythm conditions. This risk is higher in individuals with certain underlying factors, including:

• Pre-existing heart disease or a history of heart rhythm disorders.
• Low levels of potassium or magnesium in the blood (electrolyte imbalance).
• A slow heart rate (bradycardia).
• A family history of sudden cardiac death.

The risk may also increase when Vistaril is taken with other medications known to prolong the QT interval.

Central Nervous System Depression

This medication can cause significant drowsiness and may impair physical or mental abilities. Caution is advised when performing tasks that require alertness, such as driving or operating machinery. The sedative effects of alcohol and other central nervous system depressants, such as narcotics, sedatives, or barbiturates, may be increased when taken concurrently with Vistaril.

Serious Skin Reactions

In rare cases, hydroxyzine may cause serious skin conditions, such as acute generalized exanthematous pustulosis (AGEP). Symptoms often include fever and the sudden appearance of numerous small, fluid-filled bumps. If a skin rash or these symptoms occur, the medication should be stopped and a healthcare provider consulted immediately.

Contraindications and Precautions

Vistaril is contraindicated in the following situations:

• Early Pregnancy: Use is contraindicated during the first trimester of pregnancy.
• Hypersensitivity: It should not be used by individuals with a known allergy to hydroxyzine, cetirizine, or levocetirizine.
• Injection Safety: If administered by injection, it must be given intramuscularly. It should never be injected into a vein, under the skin, or into an artery, as this can cause severe tissue damage.

Caution is also recommended for individuals with certain medical conditions, including glaucoma, bladder neck obstruction, or an enlarged prostate, as the medication's anticholinergic effects may worsen these conditions. In elderly patients, lower doses are often recommended due to an increased sensitivity to side effects.

Pregnancy

Vistaril is typically contraindicated during the first trimester of pregnancy. Animal studies have shown that high doses of hydroxyzine can cause fetal abnormalities. While there are no adequate and well-controlled studies in humans, the potential risks to the developing fetus usually outweigh the benefits during early pregnancy.

If you are pregnant or planning to become pregnant, discuss the risks and benefits of this medication with your healthcare provider. They can help determine if the treatment is necessary or if there are safer alternatives available for your condition.

Breastfeeding

It is currently unknown whether Vistaril passes into human breast milk. Because many medications are excreted in breast milk and could potentially cause serious adverse reactions in a nursing infant, caution is advised.

Using antihistamines like Vistaril while breastfeeding may lead to:

• Drowsiness or unusual irritability in the nursing infant.
• A possible decrease in the mother's milk supply.

Consult your doctor to decide whether to continue breastfeeding or continue taking the medication based on your specific health needs and the importance of the drug to your treatment.

Oral Forms

Vistaril is available in the following oral preparations:

• Capsules: These are provided in various strengths for oral administration.
• Oral Suspension: This is a liquid form of the medication, often used for patients who have difficulty swallowing capsules.

Injectable Form

Vistaril is also available as a solution for intramuscular injection. This form is administered by a healthcare professional in a clinical setting and is not intended for intravenous or subcutaneous use.

FDA Approval and Indications

Vistaril (hydroxyzine pamoate) is a prescription medication approved by the U.S. Food and Drug Administration (FDA) for several specific uses:

• Anxiety: For the symptomatic relief of anxiety and tension associated with psychoneurosis and as an adjunct in organic disease states where anxiety is manifested.
• Pruritus: For the management of itching (pruritus) due to allergic conditions such as chronic urticaria, atopic dermatoses, and contact dermatoses.
• Sedation: For use as a sedative when used as premedication and following general anesthesia.

Safety Communications

While Vistaril does not have a boxed warning, the FDA has identified potential safety concerns. In 2016, the FDA included hydroxyzine in its list of potential signals of serious risks based on reports of QT interval prolongation and Torsade de Pointes. These are serious heart rhythm conditions that may require medical attention. Healthcare providers typically evaluate a patient's heart health and other medications before prescribing Vistaril to mitigate these risks.

Regulatory Classification

Vistaril is available only by prescription. It is not classified as a controlled substance under the Controlled Substances Act. The medication was originally approved by the FDA in 1956.

Withdrawal and Dependence

Vistaril (hydroxyzine) is not a controlled substance and is not known to cause physical dependence or addiction. Unlike other medications used for anxiety, such as benzodiazepines, Vistaril does not produce a physical "crash" or withdrawal syndrome when a person stops taking it.

Stopping the Medication

While there is no formal withdrawal process for Vistaril, there are a few factors to consider when discontinuing treatment:

• Return of Symptoms: The most common experience after stopping Vistaril is the return of the original symptoms the drug was treating, such as anxiety, itching, or insomnia.
• Consultation: It is always best to speak with a healthcare provider before stopping any prescribed medication. They can help determine if your symptoms are managed well enough to stop treatment safely.
• Tapering: Because Vistaril does not cause physical reliance, a gradual dose reduction (tapering) is usually not required, though your doctor may provide specific instructions based on your medical history.