Can Hydroxyzine Help Treat Insomnia? What You Should Know

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What is hydroxyzine?

Hydroxyzine is an antihistamine used to treat allergic skin reactions, anxiety, and tension. It works by reducing activity in the central nervous system.

This also means there is the possibility of it being used to help induce sleep, and, in fact, it is sometimes given during and after general anesthesia.

When is hydroxyzine prescribed for insomnia?

The first-line treatment for insomnia is cognitive behavior therapy (CBT). Hydroxyzine might be prescribed to help with anxiety symptoms, although it does not work well for generalized anxiety disorder.

Hydroxyzine is, however, used as a go-to treatment for sleep disturbances in people suffering from post-traumatic stress disorder (PTSD). It doesn't work quite as well as prazosin but can be used for patients who don't tolerate that drug.

In this context, it helps treat insomnia and reduces the incidence of nightmares. It has also been shown to improve sleep in patients with cirrhosis (scarring of the liver caused by long-term liver damage).

In other words, hydroxyzine is generally prescribed for insomnia caused by certain other conditions, including anxiety. It is not approved as a first-line treatment for insomnia.

What are the side effects of hydroxyzine?

Hydroxyzine is not recommended for long-term use, and you should not take it for longer than four months. Side effects include:

  • Impaired thinking and reaction times

  • Tremors

  • Confusion

  • Seizures

  • Restless muscle movements in the eyes, tongue, jaw, or neck

  • Constipation

  • Dry mouth

  • Sleepiness

  • Headache

  • Fatigue

  • Potential heart problems

  • Hallucinations

  • Low blood pressure

  • Weakness

These side effects can be worsened if you drink alcohol. Hydroxyzine may also make restless leg syndrome worse. Hydroxyzine should not be taken while pregnant or breastfeeding.

While it has not been definitively linked to birth defects in humans, animal studies¹ have shown adverse effects. While you are taking hydroxyzine, you should use a reliable method of birth control (hydroxyzine does not interact with oral contraceptives), as the fetus might be affected before you know you are pregnant.

You should not take hydroxyzine if you:

  • Have long QT syndrome² (LQTS), a heart condition that affects how your heart beats. Hydroxyzine can worsen LQTS and potentially cause life-threatening complications.

  • Are allergic to cetirizine or levocetirizine

You should talk to your doctor if you have:

  • Personal or family history of LQTS

  • Electrolyte imbalance

  • Recent history of heart attack

  • Heart disease

  • Glaucoma

  • Obstruction of the bladder

  • A blockage in your digestive tract

Hydroxyzine is a strong antihistamine that tends to have side effects. However, if your doctor has prescribed it, they have determined that the benefits outweigh the risks.

What medications interact with hydroxyzine?

Several other medications can interact with hydroxyzine. Talk to your doctor and pharmacist about the medications you are taking, including any over-the-counter medications, vitamins, herbs, and other supplements. Hydroxyzine can interact with:

  • Antiarrhythmics, including amiodarone and sotalol. As both drugs affect your QT interval (a measurement on your ECG reading), this can cause dangerous changes to your heart rhythm.

  • Citalopram and similar antidepressants that affect the QT interval.

  • Haloperidol and similar drugs

  • Levofloxacin antibiotics

  • Methadone

  • Monoamine oxidase inhibitors, which can increase your risk of breathing problems or low blood pressure

  • Central nervous system depressants including opioids, sleep medications, and benzodiazepines. These medications can slow down the nervous system too much and cause breathing problems

  • Phenytoin, as hydroxyzine interferes with the action of this drug

  • Drugs metabolized by the enzyme CYP2D6. Hydroxyzine interferes with the action of the enzyme CYP2D6, which can cause certain drugs to be metabolized more slowly and increase their side effects. This includes fluoxetine (e.g., Prozac) and codeine.

  • Blood pressure medications, which can increase the sedative effect of hydroxyzine, including ACE inhibitors, angiotensin receptor blockers, beta-blockers, calcium channel blockers, and diuretics.

Hydroxyzine does not appear to interact with any herbs, supplements, or foods, although you should not consume alcohol as it can increase side effects from hydroxyzine.

How long does hydroxyzine take to work?

Hydroxyzine is fast-acting, and the sedative effects begin about 30 to 45 minutes after you take it. Its effects only last a few hours, although it can stay in your system for up to 60 hours. If you are using hydroxyzine to help with sleep issues caused by anxiety or stress, take it right before bedtime for maximum effect.

The medication can be taken with or without food.

Can you overdose on hydroxyzine?

It is possible to overdose on hydroxyzine, so you should never take more than the recommended dosage. Mild overdose symptoms include:

  • Tachycardia (fast heart rate)

  • Fever

  • Sleepiness

  • Nausea

At a high dose, though, hydroxyzine can cause serious symptoms including:

  • Breathing problems

  • Low blood pressure

  • Convulsions

  • Abnormal heart rhythm

  • Coma

A severe hydroxyzine overdose should be considered a medical emergency, and you should call 911 or go to the nearest emergency room immediately.

The lowdown

Hydroxyzine can have a sedative effect and help you sleep. However, it is not typically prescribed to treat primary insomnia. It may be used to treat anxiety, which can cause insomnia and is known to help with sleep disturbances caused by PTSD or cirrhosis. It is not prescribed for more than four months due to potential concerns about long-term safety.

Hydroxyzine is a strong medication that can have side effects, but it can be very effective in a subset of people with sleep difficulties.

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