While hydroxyzine is effective for allergic conditions, there are important safety considerations and situations where it should not be used. Understanding these contraindications and potential drug interactions helps ensure your child receives safe, appropriate treatment.
Hydroxyzine contraindications center around cardiac safety, respiratory depression risk, and central nervous system interactions. Recent research has highlighted concerns about neurodevelopmental effects in preschool children, leading to more cautious prescribing practices. The medication's multiple receptor interactions create potential for significant drug interactions, particularly with other CNS depressants.
Even mild previous reactions can progress to severe reactions with re-exposure
Can lead to potentially fatal arrhythmias (torsades de pointes)
Risk of congenital malformations
Higher risk of excessive sedation and respiratory depression
Risk of respiratory depression, especially during sleep
Increased risk of toxicity and prolonged sedation
Accumulation of active metabolites, prolonged effects
This medication is generally considered safe during pregnancy and breastfeeding when used as directed. However, if you're pregnant or breastfeeding and need to give this medication to your child, it's always a good idea to discuss this with your healthcare provider to ensure it's the best choice for your specific situation.
Specific drugs: See description
Effect: Unknown effect
How it happens: Additive CNS depression
Management: Consult healthcare provider
Specific drugs: See description
Effect: Unknown effect
How it happens: Additive anticholinergic effects
Management: Consult healthcare provider
Specific drugs: See description
Effect: Unknown effect
How it happens: Additive QT prolongation
Management: Consult healthcare provider
Specific drugs: See description
Effect: Unknown effect
How it happens: Reduced hydroxyzine metabolism
Management: Consult healthcare provider
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The 2 mg/kg/day limit is an absolute cardiac safety ceiling - never exceed for any indication
Recent population studies suggest limiting use in preschoolers due to potential neurodevelopmental concerns
Hydroxyzine converts to cetirizine, so avoid combining with Zyrtec to prevent overdose
CNS depression risk is highest when combined with opioids - this combination should be avoided