Hydroxyzine withdrawal
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Hydroxyzine Withdrawal: Insights from Recent Research
Hydroxyzine Withdrawal Symptoms and Management
Overview of Hydroxyzine Use and Withdrawal
Hydroxyzine, a first-generation antihistamine, is commonly prescribed for its anxiolytic effects in treating anxiety and tension. It acts on multiple receptors, including histamine (H1), serotonin (5-HT2), muscarine, dopamine (D1/D2), and adrenergic receptors3. Despite its efficacy, abrupt withdrawal from hydroxyzine can lead to significant withdrawal symptoms, including the potential for brief psychotic disorders3.
Hydroxyzine in Benzodiazepine Withdrawal
A study involving 154 outpatients with generalized anxiety disorder (GAD) evaluated the use of hydroxyzine in facilitating lorazepam withdrawal. The study found that hydroxyzine, whether administered at 25 mg or 50 mg, significantly improved anxiety levels and reduced withdrawal symptoms compared to placebo. Progressive withdrawal was preferred over abrupt withdrawal due to fewer dropouts and better patient satisfaction1. This suggests that hydroxyzine can be an effective support in benzodiazepine withdrawal, particularly in managing anxiety and withdrawal symptoms.
Hydroxyzine in Opioid Withdrawal
Hydroxyzine has also been studied for its role in opioid withdrawal. A double-blind, placebo-controlled study demonstrated that co-administration of hydroxyzine with a 5-HT3-receptor antagonist (palonosetron) significantly reduced the severity of opioid withdrawal symptoms. The combination was more effective than palonosetron alone, indicating that hydroxyzine can enhance the treatment effect in opioid withdrawal2. Another study supported these findings, showing that a protocol including hydroxyzine, tizanidine, and gabapentin was effective in managing opioid withdrawal and facilitating transition to relapse prevention strategies5.
Hydroxyzine in Alcohol Withdrawal
In the context of alcohol withdrawal, hydroxyzine was compared with other medications such as chlordiazepoxide, chlorpromazine, and thiamine. The study concluded that chlordiazepoxide was more effective in preventing delirium tremens and convulsions, suggesting that hydroxyzine may not be the best choice for managing severe alcohol withdrawal symptoms6.
Side Effects and Tolerance
Hydroxyzine is generally well-tolerated, with common side effects including sleepiness, weight gain, dry mouth, loss of concentration, and insomnia. These side effects are typically transient and diminish over time4. However, abrupt discontinuation of hydroxyzine can lead to withdrawal symptoms, emphasizing the need for a gradual tapering approach3.
Conclusion
Hydroxyzine is a versatile medication with applications in managing anxiety, benzodiazepine withdrawal, and opioid withdrawal. Its efficacy in reducing withdrawal symptoms and anxiety makes it a valuable tool in these contexts. However, its role in alcohol withdrawal appears limited compared to other medications. Gradual tapering is recommended to minimize withdrawal symptoms and ensure patient comfort.
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Most relevant research papers on this topic
[Comparison of 6 different methods for lorazepam withdrawal. A controlled study, hydroxyzine versus placebo].
Lorazepam withdrawal is feasible and effective, with progressive withdrawal being preferred for patient comfort and sleep improvement.
RCTPalonosetron and hydroxyzine pre-treatment reduces the objective signs of experimentally-induced acute opioid withdrawal in humans: a double-blinded, randomized, placebo-controlled crossover study
Pretreatment with palonosetron and hydroxyzine significantly reduces opioid withdrawal symptoms, suggesting potential benefits for treating opioid withdrawal.
RCTBrief psychotic disorder after abrupt withdrawal of hydroxyzine hydrochloride.
Hydroxyzine hydrochloride is a first-generation antihistamine used for treating allergic states, anesthesia-related nausea, and psychiatric disorders, with no serious adverse effects.
[Value of hydroxyzine in generalized anxiety disorder: controlled double-blind study versus placebo].
Hydroxyzine at 50 mg/day significantly reduces anxiety in patients with generalized anxiety disorder, with the most common side effect being transient sleepiness.
RCTA novel non-opioid protocol for medically supervised opioid withdrawal and transition to antagonist treatment
A novel non-opioid and benzodiazepine-free protocol is feasible for medically supervised opioid withdrawal and transition to relapse prevention strategies, including injectable extended release naltrexone.
Observational StudyTreatment of the acute alcohol withdrawal state: a comparison of four drugs.
Chlordiazepoxide is the most effective drug for treating alcohol withdrawal symptoms, preventing delirium tremens and convulsions, with a 2-percent incidence in the chlordiazepoxide group.
Reduction of opioid-withdrawal symptoms with quetiapine.
Quetiapine effectively reduces opioid withdrawal symptoms and is generally well-tolerated in patients undergoing opioid cessation.
Observational StudyDuration of inhibition of immediate skin test reactivity by hydroxyzine hydrochloride in dogs.
Hydroxyzine hydrochloride effectively suppresses immediate skin reactions in dogs with flea allergy, lasting 3 to 5 days after withdrawal.
Non-RCT
Animal StudyNeonatal seizures associated with maternal hydroxyzine hydrochloride in late pregnancy.
Neonatal seizures may be a rare neurological complication of maternal hydroxyzine treatment (150 mg/day) in late pregnancy.
Case ReportHydroxyzine-Induced Torsade De Pointes: A Case Report and a Literature Review
Hydroxyzine use can lead to torsade de pointes, highlighting the need for cautious prescribing practices and monitoring to minimize this risk.
Case Report