Hydroxyzine IM

VISTARIL IM

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Pronunciation: hye-DROX-i-zeen

Hydroxyzine IM ballicule: receptor binding, kinetics and half-life diagram — Mechanism of action: Hydroxyzine IM ballicule

Hydroxyzine IM ATARAX mascot mnemonic cartoon — Visual mnemonic: Hydroxyzine IM mascot
**“Hydrozoan’s Atari”**

What it isInjectable H1 antagonist with antimuscarinic, alpha-1, and serotonin blockade; acute anxiety, nausea, and perioperative sedation.

Why this oneNon-controlled acute anxiolytic on agitation order sets; IM only among the parenteral routes.

What limits itIM ONLY — SC, IV, and intra-arterial injection cause tissue damage (hemolysis with IV). QTc caution at high doses.

Hydroxyzine IM molecular structure (skeletal formula) — Molecular structure: Hydroxyzine IM

FDA-approved for

anxiety/tension (acute) (~1958)
nausea/vomiting; pre/post-op adjunct (~1958)

Principal riskSedation and anticholinergic burden; QT at high dose

Classes and tags

Clinical profile

Therapeutic safety burden2 / 4

Overdose danger2 / 4

Weight-gain liability1 / 4

Sedation liability3 / 4

QT / Torsades1 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk2 / 4

Legacy pregnancy categoryC

Defining liabilitySedation, falls, dependence and additive respiratory depression with opioids or other CNS depressants.

FDA label

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NO BOXED WARNINGS

FDA dosing	Population	Start	Target	Max
Anxiety/tension/psychomotor agitation; acutely disturbed patient; alcohol withdrawal/delirium tremens	Adults
Pre-/postoperative and pre-/postpartum adjunct (reduce narcotic dose, allay anxiety, control emesis)	Adults
Nausea and vomiting (excluding nausea/vomiting of pregnancy)	Adults

Renal Undefined.

Hepatic Undefined.

Instructions

For intramuscular administration only; never SC, intra-arterial, or IV
Give deep IM; may start IM then maintain on oral therapy when practicable

Available strengths

inj 25, 50 mg/mL
tab 10, 25, 50 mg
sol 10 mg/5 mL

Contraindications

Prolonged QT interval
Early pregnancy

Cautions

Severe injection-site reactions (tissue damage, necrosis, gangrene) requiring surgical intervention
Drowsiness
Acute generalized exanthematous pustulosis (AGEP)

Adverse reactions

Drowsiness
Dry mouth (higher doses)
Injection-site reactions
Tremor/convulsions (high doses)

Pregnancy Contraindicated in early pregnancy (animal fetal abnormalities; human safety not established).

Lactation Undefined.

Cost

Hydroxyzine IM (VISTARIL IM)

Strength		#/mo	generic $/unit	CostPlus
25 mg/mL	inj	per unit		not offered
50 mg/mL	inj	per unit		not offered

NADAC is a voluntary CMS survey of what retail community pharmacies pay for the drugs they stock. Hydroxyzine IM is administered under clinical supervision and dispensed outside retail pharmacies, so it rarely appears on surveyed invoices.

Other forms: Hydroxyzine HCl (ATARAX)