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Drug Profile

The information on this site is intended to supplement and enhance, not replace, the advice of a physician who is familiar with your medical history. Decisions about your health should always be made ONLY after detailed conversation with your doctor.

Generic drug name: hydroxyzine (hy DROX i zeen)
Brand name(s): ATARAX, HY-PAM, VISTARIL
GENERIC: available FAMILY: Antihistamines
Find the drug label by searching at DailyMed.

Limited Use [what does this mean?]
Generic drug name: cetirizine (se TI ra zeen)
Brand name(s): CHILDREN'S ZYRTEC ALLERGY, CHILDREN'S ZYRTEC HIVES RELIEF, ZYRTEC, ZYRTEC ALLERGY, ZYRTEC HIVES RELIEF
GENERIC: not available FAMILY: Antihistamines
Find the drug label by searching at DailyMed.

Pregnancy and Breast-feeding Warnings [top]

Pregnancy Warning

Hydroxyzine caused fetal abnormalities in animal studies and is contraindicated in early pregnancy. There is limited data on effects of cetirizine in pregnant animals. Use during pregnancy only for clear medical reasons. Tell your doctor if you are pregnant or thinking of becoming pregnant before you take this drug.

Safety Warnings For This Drug [top]

Anticholinergic Effects

Warning: Special Mental and Physical Adverse Effects

Older adults are especially sensitive to the harmful anticholinergic effects of these drugs. Drugs in this family should not be used unless absolutely necessary.

Mental Effects: confusion, delirium, short-term memory problems, disorientation and impaired attention

Physical Effects: dry mouth, constipation, difficulty urinating (especially for a man with an enlarged prostate), blurred vision, decreased sweating with increased body temperature, sexual dysfunction and worsening of glaucoma

Non-Drug Approaches to Allergies

Avoid exposure to things that trigger your allergies or asthma, such as animals, bedding, chemicals, cosmetics, drugs, dust, mold, foods, pollens, or smoke. Wearing a mask reduces inhalation of drugs, pollens, and smoke. Many people with mildly red, itching eyes require no treatment. Cold compresses to the eyes may prove helpful. Using eye drops with vasoconstrictors whitens eyes for a while, but rebound redness can occur. Misuse of vasoconstrictors sets up a vicious cycle.

Facts About This Drug [top]

Cetirizine (ZYRTEC) is an antihistamine. Antihistamines relieve symptoms of seasonal allergies due to pollens; reduce sneezing and tearing due to dust mites, dander, and molds; and alleviate chronic hives and itching, but they do not cure any condition.

Cetirizine is the metabolic breakdown product of the older antihistamine hydroxyzine (ATARAX, VISTARIL). Although cetirizine does not cause as much drowsiness as hydroxyzine, it may cause more drowsiness than newer “nonsedating”...

Cetirizine (ZYRTEC) is an antihistamine. Antihistamines relieve symptoms of seasonal allergies due to pollens; reduce sneezing and tearing due to dust mites, dander, and molds; and alleviate chronic hives and itching, but they do not cure any condition.

Cetirizine is the metabolic breakdown product of the older antihistamine hydroxyzine (ATARAX, VISTARIL). Although cetirizine does not cause as much drowsiness as hydroxyzine, it may cause more drowsiness than newer “nonsedating” antihistamines. Small studies suggest cetirizine does not slow the heart rate, but studies on drug interactions are limited. Older adults and people with kidney and liver impairment should take no more than 5 milligrams a day. Older people are more apt to develop dry mouth, which can increase dental problems. Men are more apt to experience urinary retention. Cetirizine is not recommended in early pregnancy or during nursing.

Hydroxyzine is used to treat itching and hives caused by allergic reactions and to relieve drug withdrawal symptoms, nausea, and anxiety.

Antihistamines generally are used to treat hives and itching, which may suggest that an allergic reaction (rash and itching) to using these drugs orally would be rare. However, a review of international reports listed seven cases of urticaria (a type of rash) associated with the use of cetirizine and 10 cases associated with the use of hydroxyzine (ATARAX). Cross-reaction between the two drugs was reported in one patient.

Even though urticaria is a rare adverse effect, it is important to note that it can easily go unnoticed because it can mimic the underlying condition that the drug is being used to treat.

Hydroxyzine use is associated with a very small risk of QT interval prolongation and torsades de pointes (a fatal heart rhythm disturbance that can result in sudden death).[1],[2],[3],[4] The majority of reported cases of this adverse event occurred in patients with other risk factors for QT interval prolongation, such as pre-existing heart disease and low blood potassium or magnesium levels.[4]

Do not use these drugs to treat a cold. Colds and allergies have different causes, and these drugs are not effective against either the cause of a cold or its symptoms. In fact, they can make a cold or cough worse by thickening nasal secretions and drying mucous membranes.

These drugs can cause harmful adverse effects, most commonly in people older than 60. These effects include confusion; dizziness; fainting; difficult or painful urination; dry mouth, nose, or throat; nightmares; unusual excitement; nervousness; restlessness; and irritability.

In 2015, a study published in JAMA Internal Medicine showed that strong anticholinergic drugs such as hydroxyzine were associated with an increased risk of dementia in older adults.[5],[6]

In 2016, Prescrire International published an article showing a small increased risk of oral clefts in children when hydroxyzine was used during the first trimester of pregnancy. When hydroxyzine was used toward the end of pregnancy, it was associated with bradycardia (abnormally slow heart rate), seizures, and withdrawal symptoms in newborns.[7]

Regulatory actions surrounding these drugs

2004: In December, the Food and Drug Administration (FDA) added urticaria to the adverse reactions section of the product label of hydroxyzine pamoate (VISTARIL).

2016: The FDA updated the drug product label of hydroxyzine to state that the drug is associated with a serious skin reaction, acute generalized exanthematous pustulosis (AGEP). Signs of AGEP include fever and pus-filled bumps on the skin.[8]

Before You Use This Drug [top]

Tell your doctor if you have or have had:

  • allergies to drugs
  • glaucoma
  • kidney problems
  • pregnancy or are breast-feeding
  • prostate problems
  • urinary retention

Tell your doctor about any other drugs you take, including aspirin, herbs, vitamins, and other nonprescription products.

When You Use This Drug [top]

  • Do not drink alcohol or use other drugs that can cause drowsiness.
  • Until you know how you react to this drug, do not drive or perform other activities that require alertness.
  • Protect yourself from sunburn, using a sunscreen or wearing protective clothing (cetirizine).
  • Do not breast-feed.
  • Use sugarless gum, ice, or saliva substitutes if dry mouth develops.
  • If you plan to have any surgery, including dental surgery, tell your doctor that you take this drug.

How to Use This Drug [top]

  • If you miss a dose, take it as soon as you remember, but skip it if it is almost time for the next dose. Do not take double doses.
  • Do not share your medication with others.
  • Take the drug at the same time(s) each day.
  • Take with food, water, or milk.
  • Swallow tablets whole. If you become drowsy, take at bedtime.
  • Store at room temperature with lid on tightly. Do not store in the bathroom. Do not expose to heat, moisture, or strong light. Keep out of reach of children.

Interactions with Other Drugs [top]

The following drugs, biologics (e.g., vaccines, therapeutic antibodies), or foods are listed in Evaluations of Drug Interactions 2003 as causing “highly clinically significant” or “clinically significant” interactions when used together with any of the drugs in this section. In some sections with multiple drugs, the interaction may have been reported for one but not all drugs in this section, but we include the interaction because the drugs in this section are similar to one another. We have also included potentially serious interactions listed in the drug’s FDA-approved professional package insert or in published medical journal articles. There may be other drugs, especially those in the families of drugs listed below, that also will react with this drug to cause severe adverse effects. Make sure to tell your doctor and pharmacist the drugs you are taking and tell them if you are taking any of these interacting drugs:

Central nervous system (CNS) depressant drugs, including alcohol, antidepressants, antihistamines, antipsychotics, some blood pressure medications (reserpine, methyldopa, beta-blockers), motion sickness medications, muscle relaxants, narcotics, sedatives, sleeping pills, and tranquilizers.

Adverse Effects [top]

Call your doctor immediately if you experience:

  • unusual bleeding or bruising
  • cough
  • difficulty swallowing
  • dizziness
  • fast or irregular heartbeat (cetirizine)
  • chills
  • convulsions or seizures
  • tightness in chest
  • puffiness or swelling of eyelids or around eyes, face, lips, or tongue
  • shortness of breath
  • skin rash, hives, or itching
  • unusual tiredness or weakness
  • wheezing
  • abdominal or stomach pain
  • clay-colored stools or dark urine
  • diarrhea
  • fever
  • headache

Call your doctor if these symptoms continue:

  • confusion (cetirizine)
  • dizziness
  • headache
  • dryness of mouth, nose, or throat (cetirizine)
  • increased sweating (cetirizine)
  • loss of appetite (cetirizine)
  • nightmares (cetirizine)
  • unusual excitement, nervousness, or irritability (cetirizine)
  • ringing or buzzing in ears (cetirizine)
  • skin rash (cetirizine)
  • upset or painful stomach or nausea (cetirizine)
  • constipation
  • diarrhea
  • change in menstrual cycle
  • tremor
  • drowsiness
  • fast heartbeat (cetirizine)
  • clumsiness or unsteadiness
  • sunburn (cetirizine)
  • tiredness
  • difficult or painful urination (cetirizine)
  • changes in vision (cetirizine)
  • increased appetite or weight gain (cetirizine)

Signs of overdose:

  • clumsiness or unsteadiness
  • severe dry mouth, nose, or throat
  • flushed or red face
  • shortness of breath
  • trouble breathing
  • fast or irregular heartbeat
  • severe drowsiness
  • seizures
  • hallucinations
  • trouble sleeping
  • faintness or lightheadedness

If you suspect an overdose, call this number to contact your poison control center: (800) 222-1222.

last reviewed February 28, 2021