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- Hydroxyzine vs. hydralazine: What's the difference?
- What are hydroxyzine and hydralazine?
- What are the side effects of hydroxyzine and hydralazine?
- What is the dosage of hydroxyzine vs. hydralazine?
- What drugs interact with hydroxyzine and hydralazine?
- Are hydroxyzine and hydralazine safe to use while pregnant or breastfeeding?
Hydroxyzine vs. hydralazine: What's the difference?
- Hydroxyzine is an antihistamine with anticholinergic (drying) and sedative properties that is used to treat itching caused by various allergic reactions. Hydroxyzine is also used to treat anxiety and tension, to induce sedation prior to or after anesthesia, and to treat nausea, vomiting, and alcohol withdrawal.
- Hydralazine is used to treat hypertension (high blood pressure), alone or in combination with other blood pressure medications. It is also used to treat hypertensive crisis and congestive heart failure.
- A brand name for hydroxyzine is Vistaril.
- A brand name for hydralazine is Apresoline.
- Side effects of hydroxyzine and hydralazine that are similar include loss of appetite and nausea.
- Side effects of hydroxyzine that are different from hydralazine include drowsiness, tiredness, sleepiness, dizziness, problems with coordination, drying and thickening of oral and other respiratory secretions, upset stomach, confusion, dry mouth, nervousness, irritability, blurred or double vision, tremors, and seizures.
- Side effects of hydralazine that are different from hydroxyzine include headache, vomiting, diarrhea, palpitations, rapid heartbeat, and chest pain (angina).
What are hydroxyzine and hydralazine?
Hydroxyzine is an antihistamine with anticholinergic (drying) and sedative properties used to treat itching caused by allergic reactions. It is also used to treat anxiety and tension, and for inducing sedation prior to or after anesthesia. Hydroxyzine also is used to treat nausea, vomiting, and alcohol withdrawal.
Hydralazine is an antihypertensive medication used to treat high blood pressure. It is a peripheral arterial vasodilator that causes relaxation of blood vessels, which carry blood away from the heart and toward the organs and tissues. Hydralazine has shown to be beneficial for the treatment of congestive heart failure (CHF) when used in combination with isosorbide dinitrate (Isordil, Isordil Titradose, Dilatrate-SR) as an alternative for patients who cannot tolerate ACE inhibitors.
What are the side effects of hydroxyzine and hydralazine?
Common side effects of hydroxyzine are:
- Disturbed coordination
- Drying and thickening of oral and other respiratory secretions
- Stomach distress
Other important side effects include:
- Dry mouth
- Blurred vision
- Double vision
- Loss of appetite
Hydroxyzine should be used with caution (if at all) in persons with narrow-angle glaucoma, prostatic hypertrophy (enlarged prostate gland), hyperthyroidism, cardiovascular disease, hypertension, and asthma.
Common side effects of hydralazine are:
- Tachycardia (rapid heartbeat)
- Angina pectoris (chest pain)
Other less commonly reported side effects include:
- Paralytic ileus
- Low blood pressure
- Paradoxical pressor response
- Dyspnea (shortness of breath)
- Peripheral neuritis
- Muscle cramps
- Psychotic reactions
- Difficulty urinating
- Blood disorders
- Hypersensitivity type reactions
- Nasal congestion
- Abnormal tear production (lacrimation)
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What is the dosage of hydroxyzine vs. hydralazine?
- Hydroxyzine has its maximal effect about 30 to 60 minutes after it is taken. Its effects last for 4 to 6 hours.
- The recommended dose for treating itching (pruritus) is 25 mg given 3 or 4 times daily by mouth or by intramuscular injection.
- When used for sedation, the recommended dose is 50 to 100 mg orally or 25 to 100 mg by intramuscular injection.
- Anxiety and tension are managed with 50 to 100 mg in 4 divided doses or 50 to 100 mg intramuscular injection in 4 or 6 divided doses.
- Alcohol withdrawal is treated with a 50 to 100 mg injection and may be repeated every 4 to 6 hours as needed.
- The dose for nausea and vomiting is 25 to 100 mg by injection.
- Hydroxyzine can be taken with or without food.
Hypertension in adult patients:
- Start treatment at a low dose and increase gradually based on individual patient response. The usual recommended starting regimen is 10 mg orally four times daily for the first 2 to 4 days, increase to 25 mg four times daily for the remainder of the first week.
- For the second and subsequent weeks, increase dosage to 50 mg four times daily (increase dose by 10 to 25 mg/dose gradually every 2 to 5 days).
- The maximum daily dose used in clinical studies is 300 mg.
Congestive heart failure:
- The initial dose for treating heart failure is 10 to 25 mg orally 3 to 4 times daily.
- The usual dose is 225 to 300 mg daily in 3 to 4 divided doses.
For pediatric hypertensive emergencies, the dose is 0.5 mg/Kg IV every 4 hours.
What drugs interact with hydroxyzine and hydralazine?
Hydroxyzine also adds to the sedating effects of the narcotic class of pain medications and its derivatives, for example:
- oxycodone/acetaminophen (Percocet)
- hydrocodone/acetaminophen (Vicodin)
- hydromorphone (Dilaudid)
- propoxyphene (Darvon)
Hydroxyzine also adds to the effects of the tricyclic class of antidepressants, for example:
Hydroxyzine also adds to the effects of certain antihypertensive medications, for example:
Hydroxyzine can also intensify the drying effects of other medications with anticholinergic properties, for example:
- dicyclomine (Bentyl)
- bethanechol (Urecholine)
- propantheline (Pro-Banthine)
- amitriptyline (Elavil, Endep)
- chlorpromazine (Thorazine)
When using these drugs, the dose of hydroxyzine may require reduction.
Sympathomimetics may decrease the effectiveness of hydralazine, for example:
- dobutamine (Dobutrex)
- dopamine (Intropin)
- norepinephrine (Levophed)
- epinephrine (Adrenalin)
- metaraminol (Aramine)
- phenylephrine, (NeoSynephrine, Neofrin)
- ephedra (Ma Huang)
Co-administration of these agents may block the antihypertensive benefits of hydralazine treatment.
Are hydroxyzine and hydralazine safe to use while pregnant or breastfeeding?
- A limited number of studies of hydroxyzine in pregnant women suggests that there may be a relationship between its use in the first trimester of pregnancy and congenital abnormalities in the fetus. Therefore, hydroxyzine should be avoided during the first trimester of pregnancy.
- It is not known whether hydroxyzine is excreted into breast milk. In general, antihistamines are not recommended for use during breastfeeding because they can cause stimulation or seizures in newborns.
Hydralazine should be used in pregnancy only if the potential benefit justifies the potential risk to the fetus. Hydralazine is classified as FDA pregnancy risk category C (Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks). It is used for treating high blood pressure during pregnancy.
Hydralazine is excreted in breast milk. Hydralazine should be used cautiously in females who are breastfeeding if treatment is necessary.
Hydroxyzine (Vistaril) is an antihistamine with anticholinergic (drying) and sedative properties that is used to treat itching caused by allergies, to treat anxiety and tension, to induce sedation prior to or after anesthesia, and to treat nausea, vomiting, and alcohol withdrawal. Hydralazine (Apresoline) is an antihypertensive used to treat hypertension (high blood pressure) alone or in combination with other blood pressure medications and to treat hypertensive crisis and congestive heart failure.
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Related Disease Conditions
High Blood Pressure (Hypertension)
High blood pressure (hypertension) is a disease in which pressure within the arteries of the body is elevated. About 75 million people in the US have hypertension (1 in 3 adults), and only half of them are able to manage it. Many people do not know that they have high blood pressure because it often has no has no warning signs or symptoms. Systolic and diastolic are the two readings in which blood pressure is measured. The American College of Cardiology released new guidelines for high blood pressure in 2017. The guidelines now state that blood normal blood pressure is 120/80 mmHg. If either one of those numbers is higher, you have high blood pressure. The American Academy of Cardiology defines high blood pressure slightly differently. The AAC considers 130/80 mm Hg. or greater (either number) stage 1 hypertension. Stage 2 hypertension is considered 140/90 mm Hg. or greater. If you have high blood pressure you are at risk of developing life threatening diseases like stroke and heart attack.REFERENCE: CDC. High Blood Pressure. Updated: Nov 13, 2017.
Itch (Itching or Pruritus)
Itching can be a common problem. Itches can be localized or generalized. There are many causes of itching to include: infection (jock itch, vaginal itch), disease (hyperthyroidism, liver or kidney), reactions to drugs, and skin infestations (pubic or body lice). Treatment for itching varies depending on the cause of the itch.
Anxiety is a feeling of apprehension and fear characterized by symptoms such as trouble concentrating, headaches, sleep problems, and irritability. Anxiety disorders are serious medical illnesses that affect approximately 19 million American adults. Treatment for anxiety may incorporate medications and psychotherapy.
Pulmonary hypertension is elevated pressure in the pulmonary arteries that carry blood from the lungs to the heart. The most common symptoms are fatigue and difficulty breathing. If the condition goes undiagnosed, more severe symptoms may occur. As pulmonary hypertension worsens, some people with the condition have difficulty performing any activities that require physical exertion. While there is no cure for pulmonary hypertension, it can be managed and treated with medications and supplemental oxygen to increase blood oxygen levels.
Preeclampsia (Pregnancy Induced Hypertension)
Preeclampsia is related to increased blood pressure and protein in the mother's urine. Preeclampsia typically begins after the 20th week of pregnancy. When preeclampsia causes seizures, it is termed "eclampsia" and is the second leading cause of maternal death of in the US. Preeclampsia is the leading cause of fetal complications. Risk factors for preeclampsia include high blood pressure, obesity, multiple births, and women with preexisting medical conditions such as diabetes, kidney disease, rheumatoid arthritis, lupus, or scleroderma. Pregnancy planning and lifestyle changes may reduce the risk of preeclampsia during pregnancy.
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