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HydroxyzineSystematic (IUPAC) nameHydroxyzine:2-(2-{4-piperazin-1-yl}ethoxy)ethanolHydroxyzine pamoate:1-(p-chlorobenzhydryl) 4- diethylenediamine salt of 1,1'-methylene bis(2-hydroxy-3-naphthalene carboxylic acid)IdentifiersCAS number68-88-2 (hydroxyzine)ATC codeN05BB01PubChem3658DrugBankAPRD00688ChemSpider3531Chemical dataFormulaC21H27ClN2O2 Mol. mass374.904 g/molSMILESeMolecules & PubChemSynonymsHydroxyzine pamoate:VistarilHydroxyzine hydrochloride:Atarax (see Ataraxia) , Ucerax , Serecid , ANXPharmacokinetic dataBioavailabilityHigh in-vivoProtein binding93%MetabolismRenalHalf life20 to 25 hoursExcretionUrine, FecesTherapeutic considerationsPregnancy cat.A(AU) C(US)Legal status℞ Prescription onlyRoutesOral, intramuscular injectionHydroxyzine (pronounced /haɪˈdrɒksɨziːn/) is a first-generation antihistamine, of the piperazine class that is an H1 receptor antagonist. It was synthesized in the early 1950s and the medicinal formulation of this drug was announced in the 04 August 1956 issue of Chemistry Week. It is used primarily as an antihistamine for the treatment of itches and irritations, an antiemetic for the reduction of nausea, as a weak analgesic by itself and as an opioid potentiator, and as an anxiolytic '''for the treatment of anxiety'''.Its most common formulation is 25 mg small white, capsule-shaped and scored tablets of the hydrochloride salt made by UCB in the Netherlands. In the United States, a nearly-spherical dark green tablet is the most-commonly encountered version of it, with 25 and 100 mg capsules being available as well as a series of color-coded round tablets from Mallinkrodt (25 mg white, 50 mg orange, 100 mg blue). Hydroxyzine preparations usually require a doctor's prescription, as do other potent antihistamines in many countries; whereas some countries allow hydroxyzine and all or most other antihistamines to be sold over the counter.Even though it is an effective sedative, hypnotic, and tranquilizer, it shares almost none of the abuse, dependence, addiction, and toxicity potential of other drugs used for the same range of therapeutic reasons. The drug is available in two formulations, the pamoate and the dihydrochloride or hydrochloride salts. Vistaril, Equipose, Masmoran, Paxistil, and Vistaril Pamoate are preparations of the pamoate salt. Atarax, Alamon, Aterax, Durrax, Tran-Q, Orgatrax, Quiess, Vistaril Parenteral, and Tranquizine are hydroxyzine hydrochloride.Other drugs related to hydroxyzine are cyclizine (Marezine), buclizine, and meclizine (Dramamine II) and they share all or most of the benefits, indications, contraindications, cautions, and side effects of hydroxyzine. The second-generation antihistamine cetirizine is in fact one of the metabolites of hydroxyzine.// Prescription and useHydroxyzine is both an antihistamine and anxiolytic (see below) and its use as a mild tranquilizer is especially common in dentistry and it retains some popularity in obstetrics, where for many years it was especially preferred for its ability to boost the effectiveness of alphaprodine (Nisentil), a narcotic analgesic related to pethidine as well as permit later use of scopolamine or benzodiazepines better than other drugs might.Hydroxyzine hydrochloride is distributed by several manufacturers as tablets with strengths of 10, 25, 50, and 100 mg and hydroxyzine pamoate is distributed as capsules with strengths of 25, 50, and 100 mg. Oral liquids and ampules and multi-dose vials for injection are also available. Less commonly manufactured are tablet strengths of 5, 10, 20, and 30 mg , as are 25 mg suppositories. The latter four tablet strengths are used both in human medical and veterinary settings.Hydroxyzine is prescribed when the onset of an organic disease state manifests through anxiety, as general anxiety disorder, or in other more serious cases as psychoneurosis, and is therefore prescribed as a means of regulating normal function. Hydroxyzine has shown to be as effective as the benzodiazepine drug bromazepam in the treatment of generalised anxiety disorder. Hydroxyzine can also be used for the treatment of allergic conditions, such as chronic urticaria, atopic or contact dermatoses, and histamine-mediated pruritus. These have also been confirmed in both recent and past studies to have no adverse effects on the liver, blood, nervous system or urinary tract.In the case of both the pamoate and hydrochloride salts, use of hydroxyzine for premedication as a sedative has no effects on belladonna alkaloids, such as atropine, but may, following general anesthesia, potentiate meperidine and barbiturates, and use in pre-anesthetic adjunctive therapy should be modified depending upon the state of the individual. Hydroxyzine is also safe to use alongside other medications or cardiac agents derived from the digitalis plant, as it does not yield any side-effects, due to its effects on the sympathetic, rather than the central nervous system.Whilst the analgesic-sparing (potentiating) effect is most marked with pethidine and relatives in certain cases such as post-operative pain, the effect can be noticed and used with most or all opioid analgesics and other centrally-acting analgesics which are not opioids such as orphenadrine and nefopam and may also help reduce muscle spasm and set the stage for ibuprofen, naproxen, other NSAIDs, aspirin and paracetamol to work better for the patient, especially if used in conjunction with diphenhydramine (Tylenol PM, Percogesic Extra-Strength and its aspirin, naproxen, diclofenac, and ibuprofen analogues) or phenyltoloxamine (Percogesic original forumla, some extra-strength backache remedies like Momentum and Doan's Pills)One of the more common regimens for moderate to moderately-severe pain -- be it acute, recurring acute or chronic -- prescribed in the United States and Canada and some European and Asian countries is a prescription for plain codeine tablets or combination products containing paracetamol, aspirin, ibuprofen, or similar drug with codeine (Tylenol With Codeine No. 1, 2, 3 & 4, the Emprin With Codeine and 222-292-293-294 series, and many other trade names) and instructions to combine an anti-inflammatory pain reliever like ibuprofen or naproxen with it and to combine this with a prescription for hydroxyzine to be taken in dosages of 12.5 to 100 mg either along with the codeine or at a fixed schedule of its own. In the case of sports injuries, other injuries, severe sinus infections and others, another part is added to the regimen in the form of a centrally-acting non-benzodiazepine muscle relaxant such as orphenadrine (Norflex), cyclobenzaprine (Flexeril), chlorzoxazone (Parafon), baclofen (Lioresal) and others. Of course, the narcotic can be changed to hydrocodone, dihydrocodeine, ethylmorphine, tramadol, pentazocine, nicodicodeine, propiram, oxycodone, benzylmorphine, thebacon, nicocodeine, dextropropoxyphene, tilidine, meptazinol or others; they can be found alone or in preparations which contain the narcotic along with aspirin, ibuprofen, or other similar drugs with or without paracetamol. The selection of carisoprodol (Soma) as the muscle relaxant often yields a particularly powerful combination and the doses of the narcotic as well as the hydroxyzine must be cut down substantially to start the careful titration of the dose. Such cases may produce enough somnolence to require the elimination of the hydroxyzine or replacement of it with cyclizine and/or addition of caffeine to the regimen by itself or as an ingredient in the narcotic combination product.In other cases, the usage of hydroxyzine is as a form of non-barbiturate tranquilliser used in the pre-operative sedation and treatment of neurological disorders, such as psychoneurosis and other forms of anxiety or tension states. The trade name Atarax for the hydrochloride points to this ataractic (anti-anxiety) effect and Tranquizine and Tran-Q are trade names which point to a similar spectrum of actions. Physicians and patients both often prefer hydroxyzine to benzodiazepines, babiturates, and meprobamate-glutethemide type depressants as first-line treatments for insomnia and daytime anxiety as hydroxyzine is safer, clears out of the system more quickly than many depressants like diazepam, phenobarbital, chloral hydrate and others, and does not cause physical dependence nor does it generate a morbid seek orientation for the drug in the patient.It has been suggested through pharmacological trials that the usage of hydroxyzine on dogs reduced the incidence and duration of ventricular arrythmias, and that it is able to block the spasmogenic actions associated with other substances such as serotonin, reserpine, histamine, acetylcholine and the effect of pituitary extract on the duodenum. Similarly, in experiments conducted on the ileum of small rabbits, hydroxyzine was found to inhibit hypermotility caused by the presence of barium chloride.For dentistry and obstetrics as well as other surgeries and procedures and acute pain situations like accidents, hydroxyzine is useful as a first line anxiolytic and opioid adjunct because it lacks both antagonism and synergy with benzodiazepines and scopolamine, allowing either of these agents to be used simultanteously or later in the procedure if need be.Hydroxyzine is one of the least anticholinergic first-generation antihistamines at about 8-10 per cent of the antimuscarinic power of atropine. It is also, along with its relatives cyclizine, buclizine, meclizine, and others as well as phenindamine (Thephorin, Nolahist) and cyproheptadine (Periactin) (the prototype of the piperidine chemical class of first-generation antihistamines), and the phenothiazines, part of a small number of antihistamines to have clinically significant antiserotonergic effects as well.Hydroxyzine has beneficial effects listed in this article but stands out in this pharmacotherapeutic category for its virtually non-existent addiction liability. The piperazine
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