hydroxyzine Nursing Considerations & Management

Drug Name

Generic Name :hydroxyzine , hydroxyzine hydrochloride , hydroxyzine pamoate

Brand Name:

  • Oral preparations: Apo-Hydroxyzine (CAN), Novo-Hydroxyzine (CAN), Vistaril
  • Parenteral preparations: Vistaril
  • Oral preparations: Vistaril

Classification: Anxiolytic, Antihistamine, Antiemetic

Pregnancy Category C

Dosage & Route

Available forms : Tablets—10, 25, 50, 100 mg; syrup—10 mg/5 mL; capsules—25, 50, 100 mg; oral suspension—25 mg/5 mL; injection—25, 50 mg/mL

Dosages : Start patients on IM therapy when indicated; use oral therapy for maintenance. Adjust dosage to patient’s response.



  • Symptomatic relief of anxiety: 50–100 mg qid.
  • Management of pruritus: 25 mg tid–qid.
  • Sedative (preoperative and postoperative): 50–100 mg.


  • Psychiatric and emotional emergencies, including alcoholism: 50–100 mg immediately and q 4–6 hr as needed.
  • Nausea and vomiting: 25–100 mg.
  • Preoperative and postoperative, prepartum and postpartum: 25–100 mg.


  • Anxiety, pruritus:
    • < 6 yr: 50 mg/day in divided doses.
    • > 6 yr: 50–100 mg/day in divided doses.
  • Sedative: 0.6 mg/kg.


  • Nausea, preoperative and postoperative: 1.1 mg/kg (0.5 mg/lb).
Therapeutic actions
  • Hydroxyzine blocks histamine H1-receptors on effector cells of the GI tract, blood vessels and respiratory tract; a sedating anihistamine with antimuscarinic and significant sedative properties. It also possesses skeletal muscle relaxing, bronchodilator, antiemetic and analgesic properties.
  • Symptomatic relief of anxiety and tension associated with psychoneurosis; adjunct in organic disease states in which anxiety is manifested; alcoholism and asthma; before dental procedures
  • Management of pruritus due to allergic conditions, such as chronic urticaria, atopic and contact dermatosis, and in histamine-mediated pruritus
  • Sedation when used as premedication and following general anesthesia
  • Control of nausea and vomiting and as adjunct to analgesia preoperatively and postoperatively (parenteral) to allow decreased opioid dosage
  • IM administration: Management of the acutely disturbed or hysterical patient; the acute or chronic alcoholic with anxiety withdrawal symptoms or delirium tremens; as preoperative and postoperative and prepartum and postpartum adjunctive medication to permit reduction in opioid dosage, allay anxiety, and control emesis
Adverse effects
  • CNS depression, paradoxical CNS stimulation, dry mouth, thickened respiratory secretions, constipation, blurring of vision, tachycardia, GI disturbances, headache, hypotension, tinnitus.
  • Porphyria, neonates, pregnancy, lactation.
Nursing considerations
  • History: Allergy to hydroxyzine or cetirizine, uncomplicated vomiting in children, lactation, pregnancy
  • Physical: Skin color, lesions, texture; orientation, reflexes, affect; R, adventitious sounds
  • WARNING: Determine and treat underlying cause of vomiting. Drug may mask signs and symptoms of serious conditions, such as brain tumor, intestinal obstruction, or appendicitis.
  • Do not administer parenteral solution subcutaneously, IV, or intra-arterially; tissue necrosis has occurred with subcutaneous and intra-arterial injection, and hemolysis with IV injection.
  • Give IM injections deep into a large muscle: In adults, use upper outer quadrant of buttocks or midlateral thigh; in children use midlateral thigh muscles; use deltoid area only if well developed.
Teaching points
  • Take this drug as prescribed. Avoid excessive dosage.
  • You may experience these side effects: Dizziness, sedation, drowsiness (use caution if driving or performing tasks that require alertness); avoid alcohol, sedatives, sleep aids (serious overdosage could result); dry mouth (frequent mouth care, sucking on sugarless lozenges may help).
  • Report difficulty breathing, tremors, loss of coordination, sore muscles, or muscle spasms.