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Drug Info Maternal Matters

Can you take hydroxyzine during pregnancy?

There is not enough research in humans to say this antihistamine is risk-free
Wendy Wisner
By | Sep. 12, 2024 Medically reviewed by Kimberly Bowman, MD
Three pregnant women holding their bellies - Can you take hydroxyzine while pregnant?

Key takeaways

  • Hydroxyzine is an antihistamine used to treat allergies and manage anxiety. There is not enough research in humans during pregnancy to say it is risk-free.

  • Animal studies show that hydroxyzine increases the risk of congenital disorders when taken in early pregnancy, and there are known risks when taken during labor.

  • The use of hydroxyzine while expecting should be a shared decision between a healthcare provider and patient after considering the potential risks of fetal exposure versus the benefits of treatment.

In this article:

Hydroxyzine, also known by its brand names Vistaril and Atarax, is a first-generation antihistamine used to treat anxiety, insomnia, and allergy symptoms such as skin rash, hives, and itchiness. It has been FDA approved for use in the U.S. since 1957. Yet, there are no human studies establishing its safety during pregnancy. Because of the lack of data, some providers don’t prescribe hydroxyzine during pregnancy—especially during the first trimester and during labor. Luckily, there are safe alternatives to treat allergies and anxiety when you’re expecting.

Can you take hydroxyzine while pregnant?

Hydroxyzine is contraindicated in the first trimester of pregnancy and during labor. “It increases the risk of fetal defects,” says Kecia Gaither, MD, MPH, an OB-GYN and the director of Perinatal Services at NYC Health + Hospitals/Lincoln. This is based on research in pregnant mice, rabbits, and rats that found the medication caused fetal abnormalities in high doses. Because it is unknown if the same applies to humans, hydroxyzine is an FDA Category C drug. This means that its safety during pregnancy hasn’t been established yet.

However, antihistamines are generally considered safe during pregnancy, especially later in gestation. The National Alliance on Mental Illness (NAMI) and the American College of Obstetricians and Gynecologists (ACOG) list hydroxyzine as an antihistamine that may be safe during the second and third trimesters. The ACOG also states that hydroxyzine can be useful as a supportive treatment for patients with anxiety-related insomnia due to the medication’s sedating effects. Regardless, you should always check with your obstetrician before taking any medication during pregnancy.

What are the risks of taking hydroxyzine while pregnant?

Hydroxyzine is known to cross the placental barrier, says Dr. Gaither. When taken during the first trimester, the potential risks include:

  • Congenital disorders in the fetus
  • Hypotension (low blood pressure)
  • Myoclonus (muscle jerks)
  • Neonatal hypoxia (when not enough oxygen reaches your body tissues)
  • Central nervous system (CNS) depression
  • A potentially fatal maternal heart rhythm  (torsade de pointes) if combined with the medication ondansetron, commonly used for nausea/vomiting in pregnancy

In late pregnancy and when used during labor, the adverse effects include:

  • Seizures in newborns
  • Decreased fetal heart rate

These are especially likely when used in combination with narcotics.

It’s unknown whether hydroxyzine is excreted in breast milk or safe during breastfeeding, so you should always seek medical advice from a healthcare professional before taking hydroxyzine if you are a nursing mother.

What can I take instead of hydroxyzine during pregnancy?

If you and your prescribing provider determine that hydroxyzine isn’t right for you during pregnancy, several other treatment options may be more effective or safer for you to take, says Sazan Sylejmani, Pharm.D., a pharmacist at Westmont Pharmacy in Westmont, Illinois.

Allergies

For allergy symptoms, second-generation over-the-counter antihistamines are considered safer, such as:

These are less likely to have side effects, such as drowsiness and sedation, than medications like hydroxyzine. The ACOG warns strongly against taking the decongestant pseudoephedrine to treat allergy symptoms during pregnancy because it’s associated with a small increased risk of abdominal wall birth defects.

Anxiety

For treating anxiety, antidepressants may be a safer choice. “Low-dose selective serotonin reuptake inhibitors (SSRIs) like sertraline are often used for anxiety,” says Dr. Sylejmani. The American College of Obstetricians and Gynecologists (ACOG) notes that SSRIs do not increase the risk of congenital disorders when taken during pregnancy. Other antidepressants may be safe as well. Work with your provider or a psychiatrist to determine the best anxiety medication for you.

Additionally, natural remedies for anxiety can be very effective, such as:

  • Psychotherapy, such as cognitive behavior therapy (CBT)
  • Exercise, such as yoga
  • Deep breathing exercises
  • Pregnancy massage
  • Acupuncture

In addition to these, Dr. Sylejmani suggests that staying well hydrated, eating healthy, and spending time with loved ones can also help create a sense of well-being during pregnancy. “The most important thing is for pregnant women to take good care of themselves and discuss any health concerns with their doctor,” emphasizes Dr. Sylejmani.

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