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Key takeaways
It is not generally recommended for buspirone and hydroxyzine to be taken together as they can cause an increase in unwanted side effects.
In certain cases, a healthcare provider may prescribe buspirone and hydroxyzine together for quick, short-term relief of anxiety symptoms.
Extreme caution should be used when taking buspirone and hydroxyzine together, as adverse effects such as extreme drowsiness or impaired motor function can be dangerous, particularly for older patients.
If you need to take buspirone and hydroxyzine together, you should not drive or operate heavy machinery, and you should notify your healthcare provider of any other medications you’re currently taking.
Buspirone (brand-name BuSpar) is a prescription medication used in the treatment of medical conditions like anxiety disorders. Another potential treatment option for anxiety is hydroxyzine, which is often sold under the names Atarax and Vistaril. Buspirone is an anxiolytic, which works by balancing the levels of serotonin and dopamine in your brain. Hydroxyzine is an antihistamine that is frequently used to treat allergic reactions by blocking histamine receptors associated with immune responses to allergies such as hay fever, and inflammation such as hives and insect bites. Hydroxyzine is also used to treat anxiety. The two drugs can be safely taken together, but healthcare providers do not typically recommend it.
A treatment involving both medications should only take place under the supervision of a healthcare provider, as taking buspirone with hydroxyzine causes an increase in serious side effects. If you take these medications simultaneously, it’s important to know their side effects and potential interactions beforehand.
Can you take buspirone and hydroxyzine together?
While medical experts say that it is possible to take buspirone and hydroxyzine together when necessary for quick anxiety relief, it is not a recommended course of treatment, especially in the long term. “There is an increased risk of side effects if they’re taken together,” says Taylor McDaniel, PharmD, a pharmacy manager at VIGILINT in Fuquay-Varina, North Carolina.
Benefits of taking buspirone and hydroxyzine at the same time
In certain situations, buspirone and hydroxyzine may be taken together under the supervision of a healthcare provider. Both drugs are used to treat anxiety, and taking both together can help to quickly reduce symptoms, particularly in the interim, while your healthcare provider is working to determine the best treatment plan for your long-term health.
Ankur Bindal, MD, a board-certified psychiatrist and CEO of KAB Medical Group Inc. in California, says that the drugs can safely be taken together, but he recommends proceeding with caution.
“In specific situations where a doctor carefully monitors dosage and potential side effects, [taking buspirone and hydroxyzine together] might be considered safe for short-term use, particularly for individuals experiencing mild anxiety symptoms with occasional bouts of severe itching or allergic reactions where the sedative effect of hydroxyzine is necessary for symptom management,” he explains. “However, if your physician approves this combination, the medications need to be started at a lower dose, with close monitoring, special caution to be taken in older patients, and avoidance of driving or operating machinery.”
Individually, buspirone and hydroxyzine have different benefits in treating anxiety. Hydroxyzine is a faster-acting drug used for more immediate treatment needs. Buspirone, on the other hand, takes longer to build up in your system and become effective and is often used for chronic anxiety.
Because it can take three to four weeks to begin to see a change in your anxiety symptoms from taking buspirone, hydroxyzine may be used in the meantime to help ease immediate anxiety symptoms such as severe panic attacks or anxiety attacks. This provides short-term relief of the symptoms of anxiety while you work with a healthcare provider to find the buspirone dosage that is right for you.
As the effects of hydroxyzine are much more short-lived, buspirone is the better choice of the two for the long-term treatment of anxiety disorders. However, hydroxyzine may be used for temporary periods of anxiety or emotional stress, as the use of this medicine can also treat physical symptoms of anxiety, such as nausea, vomiting, or hives.
Buspirone and hydroxyzine risks and interactions
As mentioned, many healthcare providers don’t recommend taking buspirone and hydroxyzine together due to the increased risk of certain side effects.
On its own, the most common side effects of buspirone include:
- Dizziness
- Headache
- Nausea
- Nervousness
- Excitement
- Drowsiness
- Insomnia
- Heart problems, specifically QT prolongation
Side effects of hydroxyzine include:
- Dry mouth
- Confusion
- Weakness
- Tremor
- Urinary retention
- Drowsiness
- Headache
- Blurred vision
Individually, both anxiety medications have unpleasant side effects that can be exacerbated when taken together. With this in mind, if you’re taking these two drugs simultaneously, you should avoid driving or operating heavy machinery.
According to Dr. Bindal, side effects of taking buspirone and hydroxyzine together include:
- Extreme drowsiness
- Sedation
- Confusion
- Impaired concentration
- Impaired motor coordination
If you’re experiencing any extreme side effects while taking buspirone and hydroxyzine together or individually, please seek medical attention from your healthcare provider.
Dr. McDaniel notes that there are factors outside of other medications to consider when planning ahead for potential interactions. “Avoid taking buspirone with grapefruit juice, as it increases the chance for more side effects due to the increase of concentration of buspirone in the body,” she explains. You should also avoid consuming alcohol while taking buspirone and hydroxyzine.
Older adults or patients who have been diagnosed with kidney or liver problems should consult with a healthcare provider before taking buspirone with hydroxyzine.
How long after taking buspirone can you take hydroxyzine?
When taking buspirone with hydroxyzine, it’s best to wait a few hours after taking buspirone before taking hydroxyzine to reduce the chances of unwanted side effects.
Buspirone doses start at 5-15 milligrams (mg) and will be prescribed to take two to three times daily, depending on the dose. Your healthcare provider will prescribe the recommended dosage and medication schedule. Consistency is key, as buspirone works best when it has had the chance to build up in your system.
Buspirone is only available as an oral tablet, with 7.5 mg tablets being the most common for those new to the prescription medication.
Hydroxyzine doses generally start at 25 mg and can be increased as needed with the recommendation of your healthcare provider. You may take hydroxyzine up to four times daily, depending on your medical needs. “Hydroxyzine has its maximal effect about 30 to 60 minutes after it is taken, and its effects last for 4 to 6 hours,” Dr. Bindal says.
Hydroxyzine can be taken in several different forms. You could be prescribed hydroxyzine oral tablets, oral solution (syrup), or injections. Oral administration is the most common, but ultimately, you should follow your prescription.
What medications should you not take with buspirone or hydroxyzine?
If you are taking or plan to take buspirone or hydroxyzine, you should use caution when taking other medications. Anxiety medications come with several possible interactions, so you should discuss all medications that you take with your healthcare provider before beginning either buspirone or hydroxyzine.
According to Dr. Bindal, prescription drugs that should not be taken with buspirone include:
- Anticonvulsants such as carbamazepine (Tegretol) and phenytoin (Dilantin)
- Antibiotics such as erythromycin, ciprofloxacin (Cipro), and clarithromycin
- MAOIs such as isocarboxazid (Marplan), phenelzine (Nardil), tranylcypromine (Parnate), and procarbazine (Matulane)
- Trazodone (Desyrel), an antidepressant that can increase the risk of serotonin syndrome (occurs when there’s too much serotonin in your body)
- Calcium channel blockers such as diltiazem and verapamil
- Rifampin (Rimactane), an antibiotic used mostly commonly to treat tuberculosis. Dexamethasone, a steroid medicine that can make buspirone less effective
- CNS depressants, such as benzodiazepines (Xanax, Valium, Klonopin, Ativan)
The following medicines should also be avoided when taking hydroxyzine:
- Amiodarone
- Escitalopram (Lexapro)
- Citalopram (Celexa)
- Antipsychotic medications such as pimozide (Orap) and thioridazine (Mellaril)
- Other antihistamines such as diphenhydramine (Benadryl) and cetirizine (Zyrtec)
Sources
- Buspirone, National Alliance on Mental Illness (2016)
- Serotonin syndrome, Cleveland Clinic (2022)
- Taylor McDaniel, PharmD, a pharmacy manager at VIGILINT