Can you take hydroxyzine and trazodone together?

In this article:

• Can you take hydroxyzine and trazodone together?
• Risks and interactions
• What medications should you not mix with hydroxyzine or trazodone?
• Can you take hydroxyzine with other anxiety medications?

In this article

• Can you take hydroxyzine and trazodone together?
• Risks and interactions
• What medications should you not mix with hydroxyzine or trazodone?
• Can you take hydroxyzine with other anxiety medications?

Hydroxyzine (brand name Vistaril) is a first-generation antihistamine prescription medication that healthcare providers prescribe to treat nausea, anxiety disorders, and allergic reactions. Trazodone (brand names Desyrel, Oleptro, Trazodone D) is an antidepressant drug that is used to treat depression, anxiety, and sleep disorders. According to medical experts, taking hydroxyzine and trazodone together can increase the risks of irregular heart rhythm and excessive sedation, so this combination of drugs should be avoided. 

Although it’s not advised to use these prescription drugs together, it’s still important to understand the potential risks, including side effects and drug interactions or contraindications, and when to seek help from your healthcare provider.

Can you take hydroxyzine and trazodone together?

When it comes to combining hydroxyzine and trazodone, Claudia Cometa, PharmD, a pharmacist, CEO, and executive healthcare consultant of Peace Advocacy Group in Clearwater, Florida, says that because of the potential drug interactions, taking these medications together is not worth the risk. 

“Using these medications together would increase the risk for cardiac arrhythmias, sedation, confusion, and cognitive impairment,” she says. “This combination of medications is not recommended in the general population and should definitely be avoided in anyone with existing heart conditions. Additive central nervous system (CNS) depression would be especially concerning for the elderly.” 

Heart conditions

If you have been diagnosed with a serious heart disease, Dr. Cometa says this combination of medications should be avoided to reduce your risk of life-threatening complications. “Both of these medications can cause cardiac arrhythmias, and using them together is not recommended,” she says. Cardiac arrhythmia is a problem with the rate or rhythm of the heartbeat.

Symptoms of cardiac arrhythmias can include:

• Anxiety
• Confusion
• Chest pain or discomfort
• Difficulty breathing or gasping while asleep
• Dizziness or fainting
• Tiredness or weakness

Additionally, Ozan Toy, MD, chief medical officer at Telepsychiatry and PsychTMS in Clifton, New Jersey, says that the combination of hydroxyzine and trazodone can lead to oversedation or excessive sedation. 

Oversedation can cause symptoms like:

• Excessive drowsiness
• Hearing troubles
• Inappropriate movement
• Visual disturbances
• Sweating
• Nausea
• Loss of response to verbal command

As an antihistamine medication, hydroxyzine blocks the effects of receptors in the brain, which causes drowsiness and sleepiness. People who take hydroxyzine together with trazodone can feel even sleepier. Please seek medical advice from your healthcare provider to ensure the combination of these medications is tolerable for you.

Hydroxyzine and trazodone risks and interactions

It could possibly be safe to combine hydroxyzine and trazodone. However, in most cases, it is not recommended, as the combination can increase the risk of life-threatening side effects. “Any potential benefits of helping with sleep disturbances as well as depression and anxiety would be outweighed by the potential risk for side effects,” Dr. Cometa says. 

Both hydroxyzine and trazodone have depressant effects on the central nervous system that can cause drowsiness and dizziness. In addition, hydroxyzine may produce a stronger effect on sedation and heart health. That being said, it’s important to seek medical advice for this drug interaction and notify your healthcare provider if you’re experiencing symptoms of seizures, prolonged QT interval (heart rhythm problems), and low blood pressure. 

Before taking this medication combination, please notify your healthcare provider if you have the following medical conditions:

• Heart problems or have had a recent heart attack
• Heart rhythm problems
• Bipolar disorder
• Liver disease
• Kidney problems
• Glaucoma or high eye pressure
• Asthma
• Seizures

In addition to the contraindications or drug interactions, it’s important to look at the individual risk of side effects of hydroxyzine and trazodone.

More serious side effects of hydroxyzine include:

• Allergic reactions, such as itching, rash, hives, trouble breathing, swelling or tingling in your mouth or throat, chest tightness, or swelling in your face and hands
• Increased or unsafe heart rate
• Hallucinations
• Confusion
• Priapism (an erection that lasts more than four hours)
• Acute generalized exanthematous pustulosis (AGEP), a type of skin rash
• Serotonin syndrome (a life-threatening drug reaction that occurs from having too much serotonin in your body)

Taking trazodone can also cause side effects, some of which include:

• Dry mouth
• Nervousness
• Headache
• Weight changes
• Drowsiness
• Dizziness
• Fatigue
• Blurred vision
• Nausea or vomiting

In very rare cases, trazodone can cause more serious adverse effects as well, such as:

• Suicidal thoughts and behaviors
• Worsening of depression
• High or low blood pressure
• Heart attack
• Serotonin syndrome 
• Heart rhythm problems (QT prolongation)
• Eye problems and vision changes
• Low sodium levels
• Bleeding and bruising
• Seizures

If you’re experiencing any adverse side effects from either of the medications, please seek immediate medical attention. It’s recommended that you don’t discontinue these medications without your healthcare provider’s guidance, as you may need to taper off them gradually. 

What medications should you not mix with hydroxyzine or trazodone? 

According to Dr. Toy, you should exercise caution when taking additional sedatives with the combination of hydroxyzine and trazodone. This includes sedatives used for the short-term treatment of insomnia or benzodiazepine medications, which exert effects on benzodiazepine receptors, a class of agents that work in the central nervous system to slow it down.

“Additional sedating medications, such as opioids, anti-anxiety medications, additional antihistamines, and insomnia medications, should not be mixed with hydroxyzine or trazodone,” Dr. Cometa says. 

Individually, hydroxyzine has its own potential drug interactions. These include:

• CNS depressants (oxycodone, morphine, and hydrocodone-acetaminophen)
• Benzodiazepines (alprazolam, lorazepam, diazepam)
• Muscle relaxants (cyclobenzaprine, metaxalone, and methocarbamol)
• Anticonvulsants (gabapentine and pregabalin)
• Hypnotics
• Antidepressants 

Trazodone also has its own drug interactions to be aware of. “Trazodone should be used cautiously with any serotonin-modulating medications, such as tricyclic antidepressants (TCAs), MOA inhibitors, serotonin selective reuptake inhibitors (SSRIs), and serotonin-norepinephrine reuptake inhibitors (SNRIs),” Dr. Cometa says.

If you have questions about the drug interaction or dosing guidelines, please contact your healthcare provider for additional guidance.

Can you take hydroxyzine with other anxiety medications?

Despite the potential drug interactions, you might be able to take hydroxyzine with other anxiety medications following the advice of your healthcare provider. According to Dr. Cometa, there are other anxiety medications, such as buspirone and benzodiazepines, that could potentially be taken with hydroxyzine under the supervision of your healthcare provider.

Buspirone is also a prescription drug used to treat anxiety disorder or temporarily relieve symptoms of anxiety or tension, and benzodiazepines are CNS depressant medications that treat several conditions, including anxiety disorders, insomnia, agitation, and muscle spasms. 

But, with any drug combination, there’s a possibility for some unwanted side effects. “Most anti-anxiety medications cause sedation, so any combination regimens to treat anxiety would pose safety concerns,” Dr. Cometa says. “However, some individuals, under supervision and decreased dosage, may be able to combine hydroxyzine with buspirone or short-term use of benzodiazepines safely.”

Taking multiple antidepressants together could increase your risk of developing long-term, life-threatening medical conditions like cardiac arrhythmias, serotonin syndrome, and prolonged QT conditions. Before starting this treatment regimen, please seek guidance from your healthcare professional to discuss safer alternatives for managing your medical conditions.