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At least 19 recordsLinked to original sources
PubMedDate not supplied

Conscious sedation of pediatric dental patients: an investigation of chloral hydrate, hydroxyzine pamoate, and meperidine vs. chloral hydrate and hydroxyzine pamoate.

This study evaluated two oral sedative regimens for the conscious sedation of pediatric dental patients (mean age 37.0 months) unmanageable by traditional behavior management techniques. Regimen A included chloral hydrate (Noctec--E.R. Squibb and Sons, Princeton, NJ) at 50 mg/kg with 25 mg hydroxyzine pamoate (Vistaril--Pfizer Laboratories, New York, NY), plus meperidine (Demerol--Winthrop-Breon, New York, NY) at 1.5 mg/kg. Regimen B included chloral hydrate at 50 mg/kg with 25 mg hydroxyzine pamoate. In a crossover research design, 10 patients were assigned randomly to receive one regimen, to be followed by the alternative regimen during the second appointment. The primary purpose of this study was to determine if meperidine would improve patient behavior, and increase the prevalence of respiratory compromise. A secondary purpose of the study was to develop an objective method to assess behavior during the conscious sedation of pediatric dental patients. Results revealed that the addition of oral meperidine to chloral hydrate and hydroxyzine pamoate resulted in improved behavior (P less than 0.01) during local anesthetic injection, rubber dam delivery, and the operative dental procedure. There was no increase in the prevalence of respiratory compromise with the addition of meperidine.

Anesthesia, Dental↗
PubMed1991

Objective antihistamine side effects are mitigated by evening dosing of hydroxyzine.

First-generation antihistamines have potency, pharmacokinetic, and cost advantages compared with nonsedating second-generation antihistamines. Bedtime dosing of hydroxyzine was investigated as a dosing strategy to minimize reaction time degradation and adverse subjective symptoms previously documented for hydroxyzine in divided doses. Hydroxyzine, 50 mg qhs, was compared with terfenadine, 60 mg bid, in this double-blind, placebo-controlled crossover study of 15 healthy, asymptomatic adults. Computer-based eye-hand reaction time tests of simple reaction time (SRT) and choice reaction time (CRT) were not statistically different among the three drugs. Drowsiness, dry mouth, and irritability were significant for hydroxyzine (P = .0001, .001 and .02, respectively) compared with terfenadine or placebo, but less than seen in a previous study of hydroxyzine, 25 mg bid. Symptom scores with terfenadine were comparable to placebo. Histamine skin test wheal and flare were both significantly and comparably suppressed by hydroxyzine and terfenadine (P = .0001). While wheal suppression by hydroxyzine was universal, four of the 15 subjects showed little or no suppression with terfenadine (P = .03). Although bedtime dosing of hydroxyzine did not eliminate subjective symptoms, it maintained skin H1-receptor antagonism the following morning and alleviated the prolongation of reaction times previously reported with hydroxyzine in divided doses. The significant adverse subjective symptoms and psychomotor performance degradations caused by first-generation antihistamines can be mitigated by creative dosing schedules.

Administration, Oral↗
PubMed1989

The pharmacokinetics and pharmacodynamics of hydroxyzine in patients with primary biliary cirrhosis.

Hydroxyzine, a potent H1-receptor antagonist often used for relief of pruritus in patients with hepatic dysfunction, was studied in eight patients, mean age 53.4 +/- SD 11.2 years, with primary biliary cirrhosis. The patients ingested a single dose of hydroxyzine, 0.7 mg/kg (mean dose 43.9 +/- 6.6 mg). Before the dose, then hourly for 6 hours, every 2 hours from 6-12 hours, at 24 hours, and every 24 hours for 6 days, serum hydroxyzine and cetirizine were measured and an intradermal injection of 0.01 mL of a 0.1 mg/mL solution of histamine phosphate was performed. Wheals and flares were traced at 10 minutes and the areas were calculated. Mean peak hydroxyzine levels of 116.5 +/- 60.6 ng/mL occurred at 2.3 +/- 0.7 hours and mean peak cetirizine levels of 500.4 +/- 302.0 ng/mL occurred at 4.8 +/- 2.8 hours. The mean serum elimination half-life of hydroxyzine was 36.6 +/- 13.1 hours, and the mean serum elimination half-life of cetirizine was 25.0 +/- 8.2 hours. The mean hydroxyzine clearance rate was 8.65 +/- 7.46 mL/min/kg, and the mean volume of distribution was 22.7 +/- 13.3 L/kg. The mean wheal area was suppressed (P less than 0.01) from 1 to 120 hours, with maximal suppression from 2 to 48 hours. The mean flare area was suppressed from 1 to 144 hours, with maximal suppression from 3 to 24 hours (P less than 0.01). All patients became sleepy from 0.5 to 6 hours. Blurred vision, dizziness and dry mouth each occurred in two patients. Hydroxyzine elimination is impaired in patients with primary biliary cirrhosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Pharmacokinetic and pharmacodynamic studies of the H1-receptor antagonist hydroxyzine in the elderly.

The pharmacokinetics and pharmacodynamics of the antipruritic H1-receptor antagonist hydroxyzine hydrochloride were studied in nine healthy, fasting subjects (mean age 69.5 +/- 3.7 years) who ingested a single dose of hydroxyzine syrup, 0.7 mg/kg (mean dose 49.0 +/- 6.7 mg). Blood samples were collected hourly for 6 hours, every 2 hours from 6 to 12 hours, at 24 hours, and then every 24 hours for 144 hours. At these times an intradermal injection of 0.01 ml of a 0.1 mg/ml histamine phosphate solution was performed, and wheal and flare areas were computed. The serum elimination t1/2 of hydroxyzine was 29.3 +/- 10.1 hours; the volume of distribution was 22.5 +/- 6.3 L/kg; the clearance rate was 9.6 +/- 3.2 ml/min/kg, and the AUC was 1383.1 +/- 1039.0 ng.hr/ml. The mean serum elimination t1/2 of cetirizine, the active metabolite of hydroxyzine generated in vivo, was 24.8 +/- 7.7 hours, not significantly different from that of the parent compound (p = 0.05). After a single dose of hydroxyzine the mean wheal and flare areas were significantly suppressed from 1 to 144 hours, compared with the mean predose wheal and flare sizes (p less than 0.01). Maximum wheal suppression, compared with all other wheals measured during the study, occurred from 4 to 10 hours, inclusive, and maximum flare suppression occurred from 2 to 72 hours, inclusive (p less than 0.01). Hydroxyzine has a long t1/2 and a large volume of distribution in the elderly. The suppressive effect on the wheal and flare after a single dose of hydroxyzine is also extremely prolonged, suggesting the possibility of enhanced H1-receptor activity in old age.

Age Factors↗
PubMed1990

Interactive effect of ethanol administration on blood hydroxyzine levels in rabbits.

Mechanism of a rise of blood hydroxyzine concentrations (BHC) due to ethanol administration was investigated used rabbits. When 10 mg/kg hydroxyzine dihydrochloride were orally administered together with 10 ml/kg of 1 to 15% ethanol solution, BHC raised in all rabbits given ethanol solution more than 10%. When 10 ml/kg of 15% ethanol solution were orally administered at 1, 2 or 3 hours before oral administration of hydroxyzine, BHC raised markedly in all cases. BHC raised little or a little when hydroxyzine were orally administered immediately after intravenous administration of 5 ml/kg of 20% ethanol solution. It was considered that the main mechanism of a rise of BHC was not metabolic interaction between hydroxyzine and ethanol, but an enhancement of intestinal absorption of hydroxyzine due to ethanol. It was also found that hydroxyzine in blood distributed rapidly into bodily tissues.

Animals↗
PubMed1986

Cimetidine increases the plasma concentration of hydroxyzine.

The combination of hydroxyzine and cimetidine is reported to be more effective than hydroxyzine alone in chronic urticaria. The plasma concentration of hydroxyzine was studied in seven patients treated both with the hydroxyzine 25 mg t.i.d. and the combinations of hydroxyzine 25 mg and cimetidine 200 mg t.i.d. Hydroxyzine plasma concentrations were definitely higher during the combination treatment than during hydroxyzine alone. This may explain the effectiveness of the combination treatment.

Chronic Disease↗
PubMed1991

Peripheral antihistamine and central sedative effects of single and continuous oral doses of cetirizine and hydroxyzine.

The peripheral histamine-inhibiting and central sedative effects of single oral doses (SOD) and of repeated administration for one week (steady state, SS), of 20 mg hydroxyzine HCL and 10 mg cetirizine have been assessed in 12 healthy volunteers, in a double-blind placebo-controlled cross-over study. Peripheral H1-receptor antagonism was estimated as the reduction in the area of the flare and the duration of the itch after intradermal injection of histamine 0.1 and 1.0 micrograms. CNS effects were assessed by a battery of computerized neuropsychological tests and seven visual analogue scales. Drug compliance was ascertained by plasma level determinations. Cetirizine 10 mg (SOD) produced a more pronounced peripheral effect than 20 mg hydroxyzine, whereas hydroxyzine but not cetirizine, showed a significant sedative action in the relevant rating scales. These effects vanished during steady state, suggesting adaptation to the initial sedative effect of hydroxyzine in most of the subjects. No sedative effect of cetirizine was demonstrated. There was no impairment at group level in the neuropsychological tests after the SOD or SS treatment. However, six subjects who showed sedation in the analogue ratings after hydroxyzine, displayed significantly impaired performance after hydroxyzine SOD. The findings are discussed in relation to the individual characteristics of the study groups.

Administration, Oral↗
PubMed1979

Suppression of seasonal allergic rhinitis symptoms with daily hydroxyzine.

The effectiveness of hydroxyzine in the suppression of allergic rhinitis symptoms was evaluated using a double-blind, parallel study design during the 1977 ragweed season. Forty-three subjects with positive ragweed skin tests and a history of an exacerbation of symptoms during August and September of the previous two years were randomly assigned to receive either hydroxyzine or placebo. Subjects scored the severity and duration of symptoms in a daily diary and adverse effects were evaluated from a structured interview at two-week intervals. Although drowsiness and dry mouth were frequent initially among the hydroxyzine-treated patients, these minor side effects rapidly disappeared as the dose was slowly increased, and all but one subject tolerated 150 mg/day. Subsequently, during the period of the highest ragweek pollen counts, the hydroxyzine-treated group spent significantly more days free of symptoms or with only mild sneezing, rhinorrhea, and eye symptoms than subjects who took placebo (p less than 0.05). Thus, hydroxyzine appeared to be well tolerated on a continuous daily basis and was effective in suppressing most of the symptoms of seasonal allergic rhinitis. Comparison of hydroxyzine with antihistamines more traditionally used for allergic rhinitis appears warranted.

Adult↗
PubMed1989

Prolongation of simple and choice reaction times in a double-blind comparison of twice-daily hydroxyzine versus terfenadine.

Newer, nonsedating antihistamines provide a therapeutic alternative for the patient with allergy whose work is impaired by the side effects of traditional H1 antihistamines. To assess the differential effect of these antihistamines on reaction times and subjective symptoms, we compared terfenadine, 60 mg twice daily, to hydroxyzine, 25 mg twice daily, in a double-blind, placebo-controlled, crossover study of 16 healthy, asymptomatic adults. Simple reaction time and choice reaction time were measured with a computer-based, eye-hand, reaction-time testing apparatus. Reaction times and symptom scores were assessed 90 minutes after the fourth and tenth doses of each drug. Hydroxyzine, but not terfenadine, significantly prolonged both simple and choice reaction time (p less than or equal to 0.0001). However, decision time, the time to process one bit of spatial information, was not prolonged by either antihistamine. Therefore, hydroxyzine prolonged the interpretation and response to stimuli of the central nervous system without increasing single-bit processing time. Although terfenadine was not different from placebo for any symptom assessed, hydroxyzine produced significant drowsiness (p = 0.001), dry mouth (p = 0.022), and irritability (p = 0.021). During the 5 days of hydroxyzine administration, neither objective nor subjective symptoms demonstrated the development of tolerance. No correlation was found between subjective symptoms and prolongation of reaction times by hydroxyzine, suggesting that side effect symptoms of traditional antihistamines are unreliable predictors of objective performance. Terfenadine provides a promising therapeutic alternative to traditional antihistamines for individuals performing critical tasks.

Adult↗
PubMedDate not supplied

Relative efficacy and safety of loratadine, hydroxyzine, and placebo in chronic idiopathic urticaria and atopic dermatitis.

The subjects of this double-blind study were 59 patients with chronic idiopathic urticaria or atopic dermatitis randomly assigned to receive 10 mg of loratadine once daily and placebo twice daily (n = 20), 25 mg of hydroxyzine thrice daily (n = 20), or placebo thrice daily (n = 19). The patients (15 men, 44 women) were aged 18 to 65 years. Among the 18 patients with urticaria and 41 with atopic dermatitis, daily symptom scores decreased 43% and 57% in those receiving loratadine, 47% and 38% in those receiving hydroxyzine, and 0% and 33% in the placebo patients. The difference between the treated and placebo patients was significant among the urticaria patients. According to a global evaluation of treatment effects, more treated than placebo patients reported marked or complete symptom relief; among the patients with atopic dermatitis, the difference was significant between the loratadine and placebo patients. Somnolence or sedation during treatment was reported by one of the patients receiving loratadine, by eight of the hydroxyzine patients, and by two of the placebo patients; the difference between the loratadine and hydroxyzine patients was significant. It was concluded that loratadine is as effective as hydroxyzine in the treatment of urticaria and demonstrates a significant antipruritic effect in atopic dermatitis, but does not have the central nervous system effects of hydroxyzine.

Adolescent↗
PubMed1989

Effect of hydroxyzine and meperidine on arterial blood gases in healthy human volunteers.

Because hydroxyzine hydrochloride is frequently used to tranquilize patients, who are receiving narcotic analgesics for pain relief, its effect alone and in combination with meperidine on arterial blood gases and ventilation in patients at rest was evaluated in 65 healthy volunteers, who gave informed consent. Hydroxyzine hydrochloride, 1.5 mg/kg IV given over 30 seconds, caused no decrease but rather a significant (P less than .001) increase in PaO2 and no increase in PaCO2 and/or pH at 5, 10, 20, 30, and 60 minutes (N = 29; mean age = 47.0 years). Meperidine, 1.5 mg/kg IV given over 30 seconds, caused a significant (P less than .01) reduction in PaO2 at 5 minutes indicating ventilatory depression but no increase in PaCO2 and/or pH (N = 19; mean age = 32.4 years). The combination of the same doses of hydroxyzine with meperidine IV caused a significantly greater decrease in PaO2 only at 10 minutes but a greater increase in PaCO2 and pH at all times for 60 minutes than did meperidine alone (N = 17; mean age = 39.5 years), which indicates greater ventilatory depression with the combination than with hydroxyzine alone. However, PaO2, PaCO2 and pH remained within the awake normal ranges for PaO2, PaCO2, and pH for the age group of volunteers even at 10 minutes after IV injection of the drug combination when most of the volunteers were asleep. In conclusion, hydroxyzine even when given IV in excess of the maximum IM therapeutic doses caused no changes in PaO2, PaCO2 or pH, which would indicate clinically important ventilatory depression.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1979

Comparison of pirbuterol and pirbuterol and hydroxyzine in patients with reversible airway obstruction.

The effects of single oral doses of pirbuterol 10 mg plus hydroxyzine 10 mg, and of pirbuterol 10 mg plus placebo, were compared in a single-blind cross-over trial in 17 adult patients with reversible airway obstruction. The initial bronchodilator response after the two treatments was similar, but mean specific airway conductance at 3, 4, 6 and 8 h, and mean FEV1 and FVC after 3 and 4 hours, were significantly higher after pirbuterol + hydroxyzine than after pirbuterol + placebo. The mean thoracic gas volume measured at 3 and 4 h was lower after pirbuterol + hydroxyzine. Heart rate, blood pressure and a continuous ECG record did not differ after the two treatments. The findings suggest that the combination of pirbuterol and hydroxyzine brings about more prolonged bronchodilatation in patients with reversible airway obstruction than does pirbuterol alone.

Adult↗
PubMed1989

A double-blind, placebo-controlled, crossover trial of ketotifen versus hydroxyzine in the treatment of pediatric mastocytosis.

To asses the efficacy of ketotifen (Zaditen; Sandoz Pharmaceuticals, Basel, Switzerland) for the treatment of pediatric mastocytosis, eight children who exhibited symptoms as a result of mastocytosis were enrolled in a 12-week, double-blind, placebo-controlled, crossover trial of ketotifen versus hydroxyzine (Atarax; Roerig, New York, N.Y.). Efficacy of each drug was assessed by daily symptom scores and plasma- and 24-hour urine-histamine levels. After completion of the study, symptom scores revealed that seven of the eight children exhibited a greater reduction in symptoms while they were receiving hydroxyzine (p less than 0.05). The symptoms most likely to improve with treatment with hydroxyzine were flushing and abdominal pain. Analysis of plasma- and 24-hour urine-histamine levels at the beginning and end of each trial period of each drug revealed no significant differences (p greater than 0.20). Changes in 24-hour urine-histamine levels, but not plasma-histamine levels, correlated with changes in symptom scores. We conclude that ketotifen offers no advantage over hydroxyzine in the treatment of pediatric mastocytosis.

Child↗
PubMed1990

Urticaria: clinical efficacy of cetirizine in comparison with hydroxyzine and placebo.

Chronic urticaria is a problem for both physician and patient. In an effort to avoid the risks associated with corticosteroid treatment, many first-generation H1-receptor antagonists have been tried and found to induce undesirable levels of sedation when given in amounts sufficient to control urticaria. Cetirizine, a pharmacologically active oxidized metabolite of hydroxyzine, was developed to provide selective H1-receptor inhibition without depression of the central nervous system. In a 4-week, multicenter, double-blind, placebo-controlled safety and efficacy study, cetirizine, in a once-a-day dose (5 to 20 mg), was equivalent in efficacy to hydroxyzine in divided doses (25 to 75 mg/day). The incidence of somnolence in the cetirizine group was not significantly different from that of the placebo group. However, in the hydroxyzine group, the incidence of somnolence was significantly higher than that in the placebo group (p = 0.001). The results of this study demonstrate that cetirizine has a greater safety margin over the older parent drug hydroxyzine.

Adolescent↗
PubMed1992

Comparative randomized double-blind study of hydroxyzine versus placebo as premedication before injection of iodinated contrast media.

The use of ionic contrast media in radiologic examinations may cause a wide variety of anaphylactoid reactions. The aim of this double-blind randomized study was to determine whether a simple and inexpensive premedication based on an antihistamine could reduce the number of idiosyncratic reactions in 400 patients (251 men and 149 women) without a clinical history of allergy who were to receive an intravenous injection of a low-osmolality iodinated contrast medium. Twelve hours before examination, a group of 200 patients was given one 100-mg tablet of hydroxyzine; another group of 200 was given a placebo tablet under the same conditions. Results in the two groups were comparable at the .05 level of significance. Twenty-five patients in the placebo group had a reaction (mainly urticaria); only two patients in the hydroxyzine group had a reaction (P less than .0001; odds ratio, 14.1). No severe reaction occurred in either group. Because hydroxyzine and placebo were allocated at random, it is concluded that hydroxyzine reduces the frequency of minor anaphylactoid reactions in patients at low risk.

Aged↗
PubMed1990

Potentiation of pain relief with hydroxyzine: a therapeutic myth?

Opioid analgesics are among the oldest known medications. In spite of long usage, clinical success in controlling pain in many settings appears to be limited by a lack of understanding of the clinical pharmacology of these agents. Efforts to achieve better outcomes often focus on the use of adjunctive agents, such as hydroxyzine, in an attempt to control postoperative pain with a minimum of toxicity. Although such combined therapies are exceedingly common, clinical data supporting a hypothesis of an "opioid-sparing" effect of hydroxyzine are marked by serious methodologic flaws, including lack of placebo control, lack of statistical analyses, and use of subjective assessments, all of which compromise the validity of such conclusions. In doses that may contribute to pain relief, hydroxyzine demonstrates a significant potential for causing respiratory depression which is additive to that of opioids, but not reversible with naloxone. In total, the data do not confirm the purported clinical benefits of hydroxyzine-opioid combinations in comparison with appropriate regimens of opioids alone.

Drug Synergism↗
PubMed1992

Simulated assembly line performance following ingestion of cetirizine or hydroxyzine.

Twelve healthy subjects participated in three daytime work periods, in a double-blind repeated measures Latin square design. Subjects received cetirizine (10 mg), hydroxyzine (25 mg), or placebo at 0800. Performance was measured each day during eight 50-minute test periods on a simulated assembly line task between 0830 and 1700. Before entry into the study, subjects were trained to a minimum 80% correction rate on the performance task. Performance decrements were consistently associated with hydroxyzine but not with cetirizine. Subjects made fewer correct responses with hydroxyzine compared with both cetirizine and placebo. Subjectively, participants reported feeling sleepier and performing worse during the hydroxyzine condition than following placebo. Cetirizine, however, did not differ from the other two conditions on self-assessments of alertness or performance. These findings support the hypothesis that objective measures of human functioning are more specific than are subjective measures.

Adult↗
PubMedDate not supplied

Evaluation of the effect of nitrous oxide and hydroxyzine in controlling the behavior of the pediatric dental patient.

This study evaluated and compared the effect of three different sedation combinations on the young dental patient: hydroxyzine alone, hydroxyzine with nitrous oxide, and nitrous oxide alone. Nineteen uncooperative children with mean age of 37 months needing at least three restorative visits were selected for this study. Crying, alertness, and general behavior were evaluated during the dental procedure. The combination of hydroxyzine and nitrous oxide was more effective than the others for the majority of the sessions in terms of controlling crying and alertness. The results in the present study indicate that the sedative effect of hydroxyzine on children's behavior is enhanced by the addition of nitrous oxide.

Analysis of Variance↗