Withdrawal From Alcohol Using Hydroxyzine

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When a person is dependent on alcohol and abruptly quits drinking, they may experience many unpleasant symptoms, such as increased anxiety and agitation. During medical detox, certain medications are used to treat these mood-related symptoms to help make the alcohol withdrawal process more manageable.

Please contact Guardian Recovery today if you are struggling to quit drinking and are concerned about the detox process. We offer medication-assisted treatment to reduce the uncomfortable withdrawal symptoms so you can focus on recovery and taking your next steps in treating your addiction. 

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What Is Hydroxyzine?

Hydroxyzine (brand name Vistaril or Atarax) is an anti-allergy medication used for the short-term treatment of certain psychiatric disorders, such as anxiety and dementia. It was formerly the primary drug used in medical detox to help control mood-related withdrawal symptoms, such as anxiety and agitation.

Hydroxyzine works to reduce brain activity, which is the reason for its positive effect on anxiety-related issues. It also blocks histamines that the body produces in association with allergic reactions

Can Hydroxyzine Help With Alcohol Withdrawal?

Hydroxyzine was one of the medications used to address alcohol withdrawal syndrome (AWS) and was the first-line treatment until 1969. At that time, a published study revealed that Librium (chlordiazepoxide) was the best drug to treat AWS. Moreover, researchers found that Librium was more effective at reducing withdrawal symptoms than hydroxyzine

Librium is a benzodiazepine, a class of drugs known to help with anxiety, insomnia, and seizures. After its identification as a better remedy for AWS, Librium and other benzodiazepines became the go-to medication to address alcohol withdrawal symptoms. The main reason for the shift in thinking was that hydroxyzine does not interact with GABA (gamma-aminobutyric acid).

GABA is a neurochemical that reduces activity in the central nervous system (CNS), and alcohol amplifies its effects. If you stop drinking abruptly, your CNS will become hyper-excited because GABA is suddenly unavailable to block excitatory chemicals (e.g., glutamate).  Benzodiazepines work to calm the CNS because they bind to GABA brain receptors, whereas hydroxyzine does not.

What Does Hydroxyzine Treat?

As noted, hydroxyzine is an antihistamine also approved to treat anxiety and its related symptoms, such as fear, worry, irritability, and difficulty concentrating.

Uses For Hydroxyzine Include:

  • Reducing allergy-related itching and rashes
  • Lessening nervousness before and after surgery
  • Relieving anxiety during childbirth
  • Increasing the effectiveness of opioid analgesics, such as meperidine
  • Promoting sleep
  • Easing nausea and vomiting 

Risks of Combining Alcohol and Hydroxyzine

Hydroxyzine is not technically a depressant, but it does have tranquilizing effects related to reduced activity in the CNS. Alcohol is, in fact, a CNS depressant and can also cause sedation. Therefore, alcohol compounds the effects of hydroxyzine in the nervous system and vice versa, resulting in drowsiness, unconsciousness, impaired cognition, coordination issues, and respiratory depression. 

Hydroxyzine has been associated with a mild risk of QT interval prolongation. This condition can predispose a person to “a potentially fatal polymorphic ventricular tachycardia called torsades de pointes (TdP),” which may “degenerate into ventricular fibrillation and cause sudden death.”

Prolongation of QT interval has been reported in long-term alcoholics, leading to cardiac arrhythmia.  Arrhythmias have also been found among otherwise healthy individuals following excessive alcohol use or chronic consumption. As a result, using hydroxyzine while drinking heavily may compound your risk of sudden coronary death.

Possible Accidents and Injuries

The issues involved with experiencing these potentially incapacitating effects are similar to those of being extremely drunk. Therefore, if you take hydroxyzine with any amount of alcohol, you should not drive or engage in any potentially risky activities. In fact, your ability to perform even relatively simple tasks, including navigating stairs, may become severely compromised.

Severe mental impairments due to drinking while using hydroxyzine can result in impaired judgment, impulsivity, and a propensity to make poor decisions. When motor skills and coordination are also compromised, this can lead to car crashes or heavy machinery accidents. 

Injuries related to accidents like these can be severe, catastrophic, or fatal. Even something as seemingly minor as a fall can cause broken bones, leg and hip fractures, and traumatic brain injuries.

Overdose

Using hydroxyzine, especially in high doses or in combination with heavy drinking, increases the risk of overdose caused by sedation and CNS depression.

Overdose Symptoms May Include:

  • Confusion and disorientation
  • Shallow, slow, or stopped breathing
  • Fatigue and lethargy
  • Headache
  • Dizziness
  • Nausea and vomiting
  • High or low blood pressure
  • Fast or abnormal heart rhythms
  • Pinpoint pupils
  • Abnormal breathing sounds, such as whistling or crackling
  • Tremors
  • Seizures
  • Unresponsiveness or stupor
  • Coma
  • Death

Dependence and Addiction

Intentionally consuming alcohol while on hydroxyzine to increase intoxication has both immediate and long-term risks. This is also known as polysubstance abuse, a pattern of substance use that can lead to many adverse consequences, including dependence and addiction.

The development of physical dependence can make it challenging to stop drinking and use other drugs. A drug- or alcohol-dependent person will experience withdrawal symptoms if they try to quit using because their system needs to restabilize to a renewed, altered way of functioning.

Dependence is also closely associated with tolerance, which develops over time as the body becomes accustomed to a substance upon repeated use and thereby reduces its response. When this happens, many individuals will be forced to continue increasing their substance use to experience desired effects.

Addiction encompasses both conditions, as well as a compulsive need to seek and use alcohol or another drug of choice.

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How Does Alcohol Affect the Body?

Due to alcohol’s inebriating and toxic impact on many brain and bodily systems and organs, excessive drinking can result in many short-term effects and long-term physical and mental health conditions.

Short-Term Effects of Alcohol Include:

  • Relaxation and drowsiness
  • Euphoric feelings
  • Mood changes
  • Reduced inhibitions and impulsivity
  • Slurred or slowed speech
  • Nausea, vomiting, and diarrhea
  • Headache and dehydration
  • Impaired vision
  • Altered perception
  • Loss of coordination and balance
  • Reduced ability to focus and make decision
  • Blackouts, or gaps in memory
  • Dehydration

Although these effects are temporary, they can be very impactful and life-altering in severe cases. As noted, mood, judgment, and behavior impairments can have far-reaching effects. Indeed, they can lead to drinking and driving, injuries, and regrettable decisions that have personal and social repercussions.

Long-Term Effects of Alcohol Use Include:

  • Ongoing mood and emotional changes
  • Ongoing personality changes
  • Chronic depression and suicidal thoughts
  • Reduced impulse control
  • Insomnia and other sleep disturbances
  • Compromised immune system
  • Adverse libido and sexual changes, such as reduced fertility
  • Appetite and weight changes
  • Memory, concentration, and focusing difficulties

Increased Risks Include:

  • Several cancers, including breast, mouth, throat, larynx, colon, and rectum
  • Brain-related disorders, such as dementia and stroke
  • Cardiovascular issues, such as heart disease and high blood pressure
  • Liver damage and cirrhosis
  • Pancreatitis

Problematic drinking can affect overall mental health. This is because alcohol use can worsen existing mental health disorders and also trigger symptoms closely resembling these disorders. For example, the DSM-5 a manual that mental health professionals use to diagnose psychiatric conditions, recognizes criteria for alcohol-induced disorders, including anxiety, depression, and others.

With alcohol-induced conditions, symptoms will primarily occur during intoxication and tend to improve rapidly when alcohol use is discontinued.

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The Importance of Seeking Professional Help

Excessive alcohol use is always dangerous, but when combined with other drugs that cause sedation, the effects can be more severe and even life-threatening. Although hydroxyzine is no longer commonly used for alcohol withdrawal, more effective remedies are available. At Guardian Recovery, we administer Librium and other medications to help ease alcohol withdrawal symptoms to promote safe and comfortable recovery.

Overcoming addiction is challenging and should not be attempted alone. If you need help with alcohol use disorder or polysubstance disorder, please contact Guardian Recovery today for a free, no-obligation health insurance check

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Disclaimer: Does not guarantee specific treatment outcomes, as individual results may vary. Our services are not a substitute for professional medical advice or diagnosis; please consult a qualified healthcare provider for such matters.

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Reviewed professionally for accuracy by:

Ryan Soave

L.M.H.C.

Ryan Soave brings deep experience as a Licensed Mental Health Counselor, certified trauma therapist, program developer, and research consultant for Huberman Lab at Stanford University Department of Neurobiology. Post-graduation from Wake Forest University, Ryan quickly discovered his acumen for the business world. After almost a decade of successful entrepreneurship and world traveling, he encountered a wave of personal and spiritual challenges; he felt a calling for something more. Ryan returned to school and completed his Master’s Degree in Mental Health Counseling. When he started working with those suffering from addiction and PTSD, he found his passion. He has never looked back.

Written by:

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Cayla Clark

Cayla Clark grew up in Santa Barbara, CA and graduated from UCLA with a degree in playwriting. Since then she has been writing on addiction recovery and psychology full-time, and has found a home as part of the Guardian Recovery team.

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