Hydroxyzine pamoate

VISTARIL

What it isH1, 5-HT2A, muscarinic, and alpha-1 antagonist; short-term anxiety and pruritus.

Why this oneIt offers rapid as-needed anxiolysis without controlled-substance status; pamoate is simply the capsule salt.

What limits itSedation and anticholinergic effects limit use; hERG blockade adds QT risk with other QT-prolonging drugs.

FDA-approved for

FDA dosing	Population	Start	Target	Max
Anxiety and tension (psychoneurosis; adjunct in organic disease with anxiety)	Adults
Pruritus due to allergic conditions (chronic urticaria, atopic/contact dermatoses, histamine-mediated pruritus)	General
Sedative (premedication and following general anesthesia)	General

Renal Undefined

Hepatic Undefined

Reduce dose of concomitant CNS depressants (narcotics, non-narcotic analgesics, barbiturates) when given with hydroxyzine
Start elderly at low end of dosing range and observe closely
Discontinue at first appearance of rash (risk of AGEP)

Potentiates CNS depressants (narcotics, analgesics, barbiturates) and alcohol — reduce their dosage
Drowsiness — caution with driving or operating machinery
QT prolongation/Torsade de Pointes — caution with cardiac risk factors, congenital long QT, and concomitant QT-prolonging drugs
Acute generalized exanthematous pustulosis (AGEP) — discontinue at first sign of rash or hypersensitivity
Geriatric: start low; increased sensitivity, decreased renal/hepatic/cardiac function

Drowsiness (usually transitory)
Dry mouth
Involuntary motor activity including tremor and convulsions (rare, usually at higher-than-recommended doses)
QT prolongation, Torsade de Pointes
Headache, hallucination
Pruritus, rash, urticaria; AGEP and fixed drug eruptions (post-marketing)

Pregnancy Contraindicated in early pregnancy; fetal abnormalities seen in animals; human safety data inadequate.

Lactation Not known whether excreted in human milk; should not be given to nursing mothers.

NO BOXED WARNINGS

Principal riskSedation and anticholinergic burden; QT at high dose