Can You Take Lexapro And Hydroxyzine Together?
In our latest question and answer, the pharmacist discusses combining Lexapro and hydroxyzine.
I was recently put on hydroxyzine pamoate 25 mg to help me sleep at night. I was also given Lexapro 10 mg for anxiety. I was told by my doctor I could take both at night, but I'm scared honestly. I thought about just taking the Lexapro at night and my normal sleep aid ZzzQuil. Is that ok?
Jul 02, 2021- Lexapro and hydroxyzine are generally safe to take together for most people, though those with heart conditions should use this combination only under close medical supervision.
- Both medications can cause a heart rhythm change called QT prolongation, so watch for dizziness, palpitations, or shortness of breath.
- Lexapro takes 4 to 12 weeks to start working, and the combination may cause additive side effects like drowsiness and dry mouth that tend to improve over time.
Hi ERG and thank you for your question. I’m glad that you turned to your physician to help manage your mental health.
I understand the hesitation combining two new drugs! The good news is that in most instances, it is safe to take Lexapro and hydroxyzine pamoate (generic for Vistaril) together. I say 'in most instances' since there are some precautions, particularly in those with pre-existing heart conditions, where the combination should be avoided, or at the very least, used under the close supervision of your physician.
Both drugs (Lexapro and hydroxyzine) can cause what is known as QT prolongation (i.e. a change in heart rhythm). This adverse reaction is relatively rare, but the risk is increased in those with heart problems already.
If you do take both drugs together, be sure to look out for the following side effects:
- Dizziness
- Palpitations
- Shortness of breath
As mentioned, this combination is generally considered safe for most individuals, but it is important to be aware of potential issues.
I want to point out that ZzzQuil, which contains diphenhydramine, has the same precaution. Both hydroxyzine pamoate and diphenhydramine are antihistamines (although they have slightly different properties), so you wouldn't necessarily be avoiding a drug interaction substituting ZzzQuil for hydroxyzine pamoate.
Lastly, although not an interaction per se, Lexapro and hydroxyzine do have some additive side effects, like drowsiness and dry mouth. These would tend to decrease over time, however.
Below, I give some additional insight into your specific situation.
Lexapro For Anxiety
Lexapro (or under the generic name, escitalopram) is a selective serotonin reuptake inhibitor (SSRI) approved for use nearly 20 years ago, so we have nearly two decades of research and outcomes that we can look to.
When it comes to escitalopram, most side effects tend to occur when the medication is started for the first time. Generally, these side effects gradually resolve and you’ll start to experience the positive antidepressant effects of the medication after being on the medication for 4-12 weeks.
When it comes to SSRI’s, the best advice that I can give to anyone starting is patience!
Escitalopram is a very effective treatment for generalized anxiety, but it does not work right away. Again, it will probably take from 4-12 weeks for you to see the benefits of the medication.
ZzzQuil Vs. Hydroxyzine For Sleep
In the meantime, I would recommend stopping the ZzzQuil and starting to take the hydroxyzine pamoate instead.
Hydroxyzine pamoate has been shown to be a more effective treatment for insomnia than diphenhydramine (the active ingredient of ZzzQuil) and it helps to reduce anxiety as well.
I think that the combination of escitalopram and hydroxyzine is a good choice to treat your anxiety, but I think that you have a better chance at success if you stop the ZzzQuil and use the hydroxyzine instead.
Good luck, and just remember that the medication is effective, it just takes a while to help. Additionally, if you do make any changes to your drug regimen, be sure to let your doctor know.
References & sources
- Lexapro prescribing information — FDA
- Vistaril prescribing information — FDA
- Hydroxyzine: Rational Choice for Inpatients with Insomnia — Current Psychiatry
- What are the clinical implications of new onset or worsening anxiety during the first two weeks of SSRI treatment for depression? — Depression and Anxiety
Glossary — Terms in This Answer
- QT prolongation
- A change in the electrical rhythm of the heart that can potentially cause irregular heartbeats.
- Palpitations
- A sensation of feeling your heart beating irregularly or unusually fast in your chest.
- Antihistamines
- Medications that block the effects of histamine in the body, commonly used to treat allergies and sleep problems.
- Selective serotonin reuptake inhibitor (SSRI)
- A class of antidepressant medications that work by increasing levels of the chemical serotonin in the brain.
- Escitalopram
- The generic name for Lexapro, a medication used to treat depression and anxiety.
- Hydroxyzine pamoate
- The generic name for Vistaril, a medication used to treat anxiety and insomnia.
- Diphenhydramine
- The active ingredient in ZzzQuil and other over-the-counter sleep aids that causes drowsiness.
- Insomnia
- A sleep disorder characterized by difficulty falling asleep or staying asleep.
Dr. Brian Staiger, PharmD
Doctor of Pharmacy, board certified clinical pharmacist (BCPS), American Herbalist Guild, Medication Therapy Management certified
Brian Staiger, PharmD, BCPS, is a licensed pharmacist with more than 13 years of experience across retail pharmacy, clinical pharmacy, medication safety, pharmacy program development, and healthcare administration. He is the founder of HelloPharmacist.com, where he helps patients...
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