Chemistry:Hydroxyzine

From HandWiki
Short description: Antihistamine drug
Hydroxyzine
Hydroxyzine.svg
Hydroxyzine-3d-sticks.png
Clinical data
Pronunciation/haɪˈdrɒksɪziːn/
Trade namesAtarax,[1] Vistaril,[2] others
Other namesUCB-4492
AHFS/Drugs.comMonograph
MedlinePlusa682866
License data
Dependence
liability		None [3]
Routes of
administration		By mouth, intramuscular injection
Drug classFirst generation antihistamine[4]
ATC code
Legal status
Legal status
  • AU: S4 (Prescription only)
  • CA: ℞-only
  • UK: POM (Prescription only)
  • US: ℞-only
  • EU: Rx-only
  • In general: ℞ (Prescription only)
Pharmacokinetic data
BioavailabilityHigh
Protein binding93%
MetabolismLiver
MetabolitesCetirizine, others
Elimination half-lifeAdults: 20.0 hours[5][6]
Elderly: 29.3 hours[7]
Children: 7.1 hours[5]
ExcretionUrine, feces
Identifiers
CAS Number
PubChem CID
IUPHAR/BPS
DrugBank
ChemSpider
UNII
KEGG
ChEBI
ChEMBL
Chemical and physical data
FormulaC21H27ClN2O2
Molar mass374.91 g·mol−1
3D model (JSmol)
  (verify)

Hydroxyzine, sold under the brand names Atarax and Vistaril among others, is an antihistamine medication.[8] It is used in the treatment of itchiness, insomnia, anxiety, and nausea, including that due to motion sickness.[8] It is used either by mouth or injection into a muscle.[8]

Common side effects include sleepiness, headache, and a dry mouth.[8][9] Serious side effects may include QT prolongation.[9] It is unclear if use during pregnancy or breastfeeding is safe.[8] Hydroxyzine works by blocking the effects of histamine.[9] It is a first-generation antihistamine in the piperazine family of chemicals.[8][4]

It was first made by Union Chimique Belge in 1956 and was approved for sale by Pfizer in the United States later that year.[8][10] In 2021, it was the 58th most commonly prescribed medication in the United States, with more than 11 million prescriptions.[11][12]

Medical uses

Hydroxyzine is used in the treatment of itchiness, anxiety, and nausea due to motion sickness.[8]

A systematic review concluded that hydroxyzine outperforms placebo in treating generalized anxiety disorder. Insufficient data were available to compare the drug with benzodiazepines and buspirone.[13]

Hydroxyzine can also be used for the treatment of allergic conditions, such as chronic urticaria, atopic or contact dermatoses, and histamine-mediated pruritus. These have also been confirmed in both recent and past studies to have no adverse effects on the liver, blood, nervous system, or urinary tract.[14][better source needed]

Use of hydroxyzine for premedication as a sedative has no effects on tropane alkaloids, such as atropine, but may, following general anesthesia, potentiate meperidine and barbiturates, and use in pre-anesthetic adjunctive therapy should be modified depending upon the state of the individual.[14]

Hydroxyzine is used as a non-barbiturate tranquilizer[15][better source needed] and for the treatment of neurological disorders, such as psychoneurosis and other forms of anxiety or tension states.[15]

Doses of hydroxyzine hydrochloride used for sleep range from 25 to 100 mg.[16][17][18] As with other antihistamine sleep aids, hydroxyzine is usually only prescribed for short term or "as-needed" use since tolerance to the CNS effects of hydroxyzine can develop in as little as a few days.[19][non-primary source needed] A major systematic review and network meta-analysis of medications for the treatment of insomnia published in 2022 found little evidence to inform the use of hydroxyzine for insomnia.[20] A 2023 meta-review concludes that hydroxyzine is effective for inducing sleep onset but less effective for maintaining sleep for eight hours.[21]

Gabasync

Gabasync, a treatment consisting of a combination of hydroxyzine and two other medications (gabapentin and flumazenil) as well as therapy, is an ineffective treatment promoted for methamphetamine addiction, though it had also been claimed to be effective for dependence on alcohol or cocaine.[22] It was marketed as PROMETA. While the individual drugs had been approved by the FDA, their off-label use for addiction treatment has not.[23] Gabasync was marketed by Hythiam, Inc. which is owned by Terren Peizer, a former bond salesman who has since been indicted for securities fraud relative to another company.[24][25] Hythiam charges up to $15,000 per patient to license its use (of which half goes to the prescribing physician, and half to Hythiam).[26]

In November 2011, the results of a double-blind, placebo-controlled study (financed by Hythiam and carried out at UCLA) were published in the peer-reviewed journal Addiction. It concluded that Gabasync is ineffective: "The PROMETA protocol, consisting of flumazenil, gabapentin and hydroxyzine, appears to be no more effective than placebo in reducing methamphetamine use, retaining patients in treatment or reducing methamphetamine craving."[27]

Contraindications

The administration of hydroxyzine in large amounts by ingestion or intramuscular administration during the onset of pregnancy can cause fetal abnormalities. When administered to pregnant rats, mice and rabbits, hydroxyzine caused abnormalities such as hypogonadism with doses significantly above that of the human therapeutic range.[28][better source needed]

In humans, a significant dose has not yet been established in studies and, by default, the Food and Drug Administration (FDA) has introduced contraindication guidelines in regard to hydroxyzine.[28] Use by those at risk for or showing previous signs of hypersensitivity is also contraindicated.[28] Hydroxyzine is contraindicated for intravenous (IV) injection, as it has shown to cause hemolysis.

Other contraindications include the administration of hydroxyzine alongside depressants and other compounds which affect the central nervous system;[28] if absolutely necessary, it should only be administered concomitantly in small doses.[28] If administered in small doses with other substances, as mentioned, then patients should refrain from using dangerous machinery, motor vehicles or any other practice requiring absolute concentration, in accordance with safety laws.[28]

Studies have also been conducted which show that long-term prescription of hydroxyzine can lead to tardive dyskinesia after years of use, but effects related to dyskinesia have also anecdotally been reported after periods of 7.5 months,[29] such as continual head rolling, lip licking and other forms of athetoid movement. In certain cases, elderly patients' previous interactions with phenothiazine derivatives or pre-existing neuroleptic treatment may have contributed to dyskinesia at the administration of hydroxyzine due to hypersensitivity caused by prolonged treatment,[29] and therefore some contraindication is given for short-term administration of hydroxyzine to those with previous phenothiazine use.[29]

Side effects

Several reactions have been noted in manufacturer guidelines—deep sleep, incoordination, sedation, calmness, and dizziness have been reported in children and adults, as well as others such as hypotension, tinnitus, and headaches.[30] Gastrointestinal effects have also been observed, as well as less serious effects such as dryness of the mouth and constipation caused by the mild antimuscarinic properties of hydroxyzine.[30]

Two packages of Atarax, a brand name for hydroxyzine, in Suomi. Four foil packages of pills sit in front of two boxes, one labeled as having 25 pills and the other labeled for 100.
Atarax

Central nervous system effects such as hallucinations or confusion have been observed in rare cases, attributed mostly to overdosage.[31][30] Such properties have been attributed to hydroxyzine in several cases, particularly in patients treated for neuropsychological disorders, as well as in cases where overdoses have been observed. While there are reports of the "hallucinogenic" or "hypnotic" properties of hydroxyzine, several clinical data trials have not reported such side effects from the sole consumption of hydroxyzine, but rather, have described its overall calming effect described through the stimulation of areas within the reticular formation. The hallucinogenic or hypnotic properties have been described as being an additional effect from overall central nervous system suppression by other CNS agents, such as lithium or ethanol.[32]

Hydroxyzine exhibits anxiolytic and sedative properties in many psychiatric patients. One study showed that patients reported very high levels of subjective sedation when first taking the drug, but that levels of reported sedation decreased markedly over 5–7 days, likely due to CNS receptor desensitization. Other studies have suggested that hydroxyzine acts as an acute hypnotic, reducing sleep onset latency and increasing sleep duration — also showing that some drowsiness did occur. This was observed more in female patients, who also had greater hypnotic response.[33] The use of sedating drugs alongside hydroxyzine can cause oversedation and confusion if administered at high doses—any form of hydroxyzine treatment alongside sedatives should be done under supervision of a doctor.[15][31]

Because of the potential for more severe side effects, this drug is on the list to avoid in the elderly.[34]

Pharmacology

Pharmacodynamics

Site Ki (nM) Species Ref
5-HT2A 170 (IC50) Rat [35]
5-HT2C ND ND ND
α1 460 (IC50) Rat [35]
D1 >10,000 Mouse [36]
D2 378
560 (IC50)		 Mouse
Rat		 [36]
[35]
H1 2.0–19
6.4
100 (IC50)		 Human
Bovine
Rat		 [37][38][39]
[40]
[35]
H2 ND ND ND
H3 ND ND ND
H4 >10,000 Human [38]
VDCC ≥3,400 (IC50) Rat [35]
Values are Ki (nM), unless otherwise noted. The smaller the value, the more strongly the drug binds to the site.

Hydroxyzine's predominant mechanism of action is as a potent and selective histamine H1 receptor inverse agonist.[41][42] This action is responsible for its antihistamine and sedative effects.[41][42] Unlike many other first-generation antihistamines, hydroxyzine has a lower affinity for the muscarinic acetylcholine receptors, and in accordance, has a lower risk of anticholinergic side effects.[40][42][43][44] In addition to its antihistamine activity, hydroxyzine has also been shown to act more weakly as an antagonist of the serotonin 5-HT2A receptor, the dopamine D2 receptor, and the α1-adrenergic receptor.[35][41] The weak antiserotonergic effects of hydroxyzine likely underlie its usefulness as an anxiolytic,[45] as other antihistamines without such properties have not been found to be effective in the treatment of anxiety.[46]

Hydroxyzine crosses the blood–brain barrier easily and exerts effects in the central nervous system.[41] A positron emission tomography (PET) study found that brain occupancy of the H1 receptor was 67.6% for a single 30 mg dose of hydroxyzine.[47] In addition, subjective sleepiness correlated well with the brain H1 receptor occupancy.[47] PET studies with antihistamines have found that brain H1 receptor occupancy of more than 50% is associated with a high prevalence of somnolence and cognitive decline, whereas brain H1 receptor occupancy of less than 20% is considered to be non-sedative.[48]

Hydroxyzine also acts as a functional inhibitor of Acid sphingomyelinase.[49]

Pharmacokinetics

Hydroxyzine can be administered orally or via intramuscular injection. When given orally, hydroxyzine is rapidly absorbed from the gastrointestinal tract. Hydroxyzine is rapidly absorbed and distributed with oral and intramuscular administration, and is metabolized in the liver; the main metabolite (45%), cetirizine, is formed through oxidation of the alcohol moiety to a carboxylic acid by alcohol dehydrogenase, and overall effects are observed within one hour of administration. Higher concentrations are found in the skin than in the plasma. Cetirizine, although less sedating, is non-dialyzable and possesses similar antihistamine properties. The other metabolites identified include a N-dealkylated metabolite, and an O-dealkylated 1/16 metabolite with a plasma half-life of 59 hours. These pathways are mediated principally by CYP3A4 and CYP3A5.[50][51] The N-dealykylated metabolite, norchlorcyclizine, bears some structural similarities to trazodone, but it has not been established whether it is pharmacologically active.[52][53] In animals, hydroxyzine and its metabolites are excreted in feces primarily through biliary elimination.[54][55] In rats, less than 2% of the drug is excreted unchanged.[55]

The time to reach maximum concentration (Tmax) of hydroxyzine is about 2.0 hours in both adults and children and its elimination half-life is around 20.0 hours in adults (mean age 29.3 years) and 7.1 hours in children.[5][6] Its elimination half-life is shorter in children compared to adults.[5] In another study, the elimination half-life of hydroxyzine in elderly adults was 29.3 hours.[7] One study found that the elimination half-life of hydroxyzine in adults was as short as 3 hours, but this may have just been due to methodological limitations.[56] Although hydroxyzine has a long elimination half-life and acts, in-vivo, as an antihistamine for as long as 24 hours, the predominant CNS effects of hydroxyzine and other antihistamines with long half-lives seem to diminish after 8 hours.[57]

Administration in geriatrics differs from the administration of hydroxyzine in younger patients; according to the FDA, there have not been significant studies made (2004), which include population groups over 65, which provide a distinction between elderly aged patients and other younger groups. Hydroxyzine should be administered carefully in the elderly with consideration given to possible reduced elimination.[31][better source needed]

Chemistry

Hydroxyzine is a member of the diphenylmethylpiperazine class of antihistamines.

Hydroxyzine is supplied mainly as a dihydrochloride salt (hydroxyzine hydrochloride) but also to a lesser extent as an embonate salt (hydroxyzine pamoate).[58][59][60] The molecular weights of hydroxyzine, hydroxyzine dihydrochloride, and hydroxyzine pamoate are 374.9 g/mol, 447.8 g/mol, and 763.3 g/mol, respectively.[4] Due to their differences in molecular weight, 1 mg hydroxyzine dihydrochloride is equivalent to about 1.7 mg hydroxyzine pamoate.[61]

Analogues

Analogues of hydroxyzine include buclizine, cetirizine, cinnarizine, cyclizine, etodroxizine, meclizine, and pipoxizine among others.

Society and culture

Brand names

Hydroxyzine preparations require a doctor's prescription. The drug is available in two formulations, the pamoate and the dihydrochloride or hydrochloride salts. Vistaril, Equipose, Masmoran, and Paxistil are preparations of the pamoate salt, while Atarax, Alamon, Aterax, Durrax, Tran-Q, Orgatrax, Quiess, and Tranquizine are of the hydrochloride salt.

References

  1. ↑ "Atarax: FDA-Approved Drugs". https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm?event=overview.process&ApplNo=010392. 
  2. ↑ "Vistaril: FDA-Approved Drugs". https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm?event=overview.process&ApplNo=011459. 
  3. ↑ Substance Abuse in the Mentally and Physically Disabled. CRC Press. 2001. p. 26. ISBN 9780824744977. https://books.google.com/books?id=MY1kFYk98mQC&pg=PA26. 
  4. ↑ 4.0 4.1 4.2 "Hydroxyzine". United States National Library of Medicine (NLM). https://pubchem.ncbi.nlm.nih.gov/compound/Hydroxyzine. 
  5. ↑ 5.0 5.1 5.2 5.3 "Clinical pharmacokinetics of H1-receptor antagonists (the antihistamines)". Clinical Pharmacokinetics 10 (6): 477–497. 1985. doi:10.2165/00003088-198510060-00002. PMID 2866055. 
  6. ↑ 6.0 6.1 "The pharmacokinetics and antihistaminic of the H1 receptor antagonist hydroxyzine". The Journal of Allergy and Clinical Immunology 73 (1 Pt 1): 69–75. January 1984. doi:10.1016/0091-6749(84)90486-x. PMID 6141198. 
  7. ↑ 7.0 7.1 "Pharmacokinetic and pharmacodynamic studies of the H1-receptor antagonist hydroxyzine in the elderly". Clinical Pharmacology and Therapeutics 45 (1): 9–14. January 1989. doi:10.1038/clpt.1989.2. PMID 2562944. 
  8. ↑ 8.0 8.1 8.2 8.3 8.4 8.5 8.6 8.7 "Hydroxyzine Hydrochloride Monograph for Professionals". American Society of Health-System Pharmacists. https://www.drugs.com/monograph/hydroxyzine-hydrochloride.html. 
  9. ↑ 9.0 9.1 9.2 British national formulary : BNF 74 (74 ed.). British Medical Association. 2017. p. X. ISBN 978-0857112989. 
  10. ↑ Before Prozac: the troubled history of mood disorders in psychiatry. Oxford [Oxfordshire]: Oxford University Press. 2009. ISBN 9780195368741. https://books.google.com/books?id=8VaYF8pIPxgC&q=hydroxyzine%201956&pg=PR13. 
  11. ↑ "The Top 300 of 2021". https://clincalc.com/DrugStats/Top300Drugs.aspx. 
  12. ↑ "Hydroxyzine - Drug Usage Statistics". https://clincalc.com/DrugStats/Drugs/Hydroxyzine. 
  13. ↑ "Hydroxyzine for generalised anxiety disorder". The Cochrane Database of Systematic Reviews (12): CD006815. December 2010. doi:10.1002/14651858.CD006815.pub2. PMID 21154375. 
  14. ↑ 14.0 14.1 United States Food & Drug Administration, (2004), p1
  15. ↑ 15.0 15.1 15.2 "Management of emotional disturbances; use of hydroxyzine (atarax) in general practice". California Medicine 88 (6): 443–444. June 1958. PMID 13536863. 
  16. ↑ "Pharmacotherapy for Insomnia in Primary Care". The Primary Care Companion for CNS Disorders 18 (2). 2016. doi:10.4088/PCC.16br01930. PMID 27486547. 
  17. ↑ "Insomnia: Pharmacologic Therapy". American Family Physician 96 (1): 29–35. July 2017. PMID 28671376. 
  18. ↑ "Problems with sleep: what should the doctor do?". Comprehensive Therapy 29 (1): 18–27. 2003. doi:10.1007/s12019-003-0003-x. PMID 12701339. 
  19. ↑ "Peripheral antihistamine and central sedative effects of single and continuous oral doses of cetirizine and hydroxyzine". European Journal of Clinical Pharmacology 41 (5): 435–439. 1 September 1991. doi:10.1007/BF00626365. PMID 1684750. 
  20. ↑ "Comparative effects of pharmacological interventions for the acute and long-term management of insomnia disorder in adults: a systematic review and network meta-analysis". Lancet 400 (10347): 170–184. July 2022. doi:10.1016/S0140-6736(22)00878-9. PMID 35843245. 
  21. ↑ "Efficacy and safety of hydroxyzine for sleep in adults: Systematic review". Human Psychopharmacology 38 (2): e2864. March 2023. doi:10.1002/hup.2864. PMID 36843057. 
  22. ↑ "Prescription For Addiction". 60 Minutes (CBS News). 9 December 2007. http://www.cbsnews.com/stories/2007/12/07/60minutes/main3590535.shtml.. 
  23. ↑ Prometa Founder's Spotty Background Explored, 3 November 2006, http://www.drugfree.org/join-together/prometa-founders-spotty-background-explored/
  24. ↑ "UNITED STATES V. TERREN S. PEIZER". 1 March 2023. https://www.justice.gov/criminal-vns/case/united-states-v-terren-s-peizer. 
  25. ↑ Prescription For Addiction, 60 Minutes' Scott Pelley Reports On A New Addiction Treatment, 7 December 2007, http://www.cbsnews.com/news/prescription-for-addiction/
  26. ↑ "Prometa under fire in Washington drug court program". Alcoholism & Drug Abuse Weekly 20 (3). 21 January 2008. doi:10.1002/adaw.20121. https://onlinelibrary.wiley.com/doi/abs/10.1002/adaw.20121. 
  27. ↑ "Double-blind placebo-controlled evaluation of the PROMETA™ protocol for methamphetamine dependence". Addiction 107 (2): 361–369. February 2012. doi:10.1111/j.1360-0443.2011.03619.x. PMID 22082089. 
  28. ↑ 28.0 28.1 28.2 28.3 28.4 28.5 United States Food & Drug Administration, (2004), p2
  29. ↑ 29.0 29.1 29.2 "Hydroxyzine-associated tardive dyskinesia". Annals of Neurology 11 (4): 435. April 1982. doi:10.1002/ana.410110423. PMID 7103423. 
  30. ↑ 30.0 30.1 30.2 UCB South-Africa, et al., (2004)
  31. ↑ 31.0 31.1 31.2 United States Food & Drug Administration, (2004), p3
  32. ↑ Handbook of Clinical Drug Data. 128 (10th ed.). New York: McGraw-Hill Medical. 2002. 794–796]. ISBN 9780071363624. https://archive.org/details/handbookofclinic00ande/page/794. 
  33. ↑ "Acute effects of hydroxyzine on nocturnal sleep and sleep tendency the following day: A C-EEG study". Human Psychopharmacology 7 (1): 25–35. 1992. doi:10.1002/hup.470070104. 
  34. ↑ "NCQA's HEDIS Measure: Use of High Risk Medications in the Elderly". 2008. http://www.ncqa.org/Portals/0/Newsroom/SOHC/Drugs_Avoided_Elderly.pdf. 
  35. ↑ 35.0 35.1 35.2 35.3 35.4 35.5 Cite error: Invalid <ref> tag; no text was provided for refs named pmid1979798
  36. ↑ 36.0 36.1 "Prediction of drug-induced catalepsy based on dopamine D1, D2, and muscarinic acetylcholine receptor occupancies". Drug Metabolism and Disposition 25 (6): 675–684. June 1997. PMID 9193868. http://dmd.aspetjournals.org/cgi/pmidlookup?view=long&pmid=9193868. 
  37. ↑ "Binding characteristics of cetirizine and levocetirizine to human H(1) histamine receptors: contribution of Lys(191) and Thr(194)". Molecular Pharmacology 61 (2): 391–399. February 2002. doi:10.1124/mol.61.2.391. PMID 11809864. http://pdfs.semanticscholar.org/1c73/c896c9b25e9a529643851696f51672f07640.pdf. 
  38. ↑ 38.0 38.1 "Evaluation of histamine H1-, H2-, and H3-receptor ligands at the human histamine H4 receptor: identification of 4-methylhistamine as the first potent and selective H4 receptor agonist". The Journal of Pharmacology and Experimental Therapeutics 314 (3): 1310–1321. September 2005. doi:10.1124/jpet.105.087965. PMID 15947036. 
  39. ↑ "Biochemical characterization of desloratadine, a potent antagonist of the human histamine H(1) receptor". European Journal of Pharmacology 449 (3): 229–237. August 2002. doi:10.1016/s0014-2999(02)02049-6. PMID 12167464. 
  40. ↑ 40.0 40.1 Cite error: Invalid <ref> tag; no text was provided for refs named pmid2884340
  41. ↑ 41.0 41.1 41.2 41.3 Itch - Management in Clinical Practice. Current Problems in Dermatology. 50. Karger Medical and Scientific Publishers. 2016. pp. 1–80. ISBN 9783318058895. https://books.google.com/books?id=IlgDDQAAQBAJ&pg=RA1-PA80. 
  42. ↑ 42.0 42.1 42.2 Psychiatry and Pedopsychiatry. Charles University in Prague, Karolinum Press. 2017. pp. 364. ISBN 9788024633787. https://books.google.com/books?id=bD9UDgAAQBAJ&pg=PA364. 
  43. ↑ "The chemistry and mode of action of tranquilizing drugs". Annals of the New York Academy of Sciences 67 (10): 685–700. May 1957. doi:10.1111/j.1749-6632.1957.tb46006.x. PMID 13459139. Bibcode: 1957NYASA..67..685B. 
  44. ↑ Essentials of Medical Pharmacology. JP Medical Ltd. 2013. pp. 165. ISBN 9789350259375. https://books.google.com/books?id=FfG8AQAAQBAJ&pg=PA165. 
  45. ↑ Textbook of Anxiety Disorders. American Psychiatric Publishing, Inc. 2009. pp. 196. ISBN 9781585622542. https://books.google.com/books?id=quQY1R8vsZcC&q=hydroxyzine%20serotonin&pg=PA196. 
  46. ↑ "Hydroxyzine prevents isolation-induced vocalization in guinea pig pups: comparison with chlorpheniramine and immepip". Pharmacology, Biochemistry, and Behavior 79 (1): 119–124. September 2004. doi:10.1016/j.pbb.2004.06.015. PMID 15388291. 
  47. ↑ 47.0 47.1 "Dose dependency of brain histamine H(1) receptor occupancy following oral administration of cetirizine hydrochloride measured using PET with [11C]doxepin". Human Psychopharmacology 24 (7): 540–548. October 2009. doi:10.1002/hup.1051. PMID 19697300. 
  48. ↑ "The physiological and pathophysiological roles of neuronal histamine: an insight from human positron emission tomography studies". Pharmacology & Therapeutics 113 (1): 1–15. January 2007. doi:10.1016/j.pharmthera.2006.06.008. PMID 16890992. 
  49. ↑ "Hydroxyzine Use and Mortality in Patients Hospitalized for COVID-19: A Multicenter Observational Study". Journal of Clinical Medicine 10 (24): 5891. December 2021. doi:10.3390/jcm10245891. PMID 34945186. 
  50. ↑ "Ucerax (hydroxyzine hydrochloride) 25 mg film-coated tablets. Summary of product characteristics". Irish Medicines Board. 2013. http://www.imb.ie/images/uploaded/swedocuments/LicenseSPC_PA0891-005-001_16082013162208.pdf. 
  51. ↑ Foye's principles of medicinal chemistry (7th ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. 2013. ISBN 978-1-60913-345-0. OCLC 748675182. https://www.worldcat.org/oclc/748675182. 
  52. ↑ "Prolonged penile erections induced by hydroxyzine: possible mechanism of action". Neuropsychobiology 30 (1): 4–6. 1994. doi:10.1159/000119126. PMID 7969858. 
  53. ↑ "Hydroxyzine and Possible Metabolites". Canadian Society of Forensic Science Journal 27 (2): 87–92. January 1994. doi:10.1080/00085030.1994.10757029. 
  54. ↑ "Vistaril (hydroxyzine pamoate) Capsules and Oral Suspension". 2006. http://www.pfizer.com/pfizer/download/uspi_vistaril.pdf. "This paper says "The extent of renal excretion of Vistaril has not been determined"" 
  55. ↑ 55.0 55.1 "Comparative studies on distribution, excretion, and metabolism of hydroxyzine-3H and its methiodide-14C in rats". Journal of Pharmaceutical Sciences 63 (10): 1527–1532. October 1974. doi:10.1002/jps.2600631008. PMID 4436782. 
  56. ↑ Drug Toxicity & Metabolism In Pediatrics. CRC Press. 1989. pp. 257. ISBN 9780849345647. https://books.google.com/books?id=3eruIjPYbC8C&pg=PA257. 
  57. ↑ "H1-receptor antagonists. Comparative tolerability and safety". Drug Safety 10 (5): 350–380. May 1994. doi:10.2165/00002018-199410050-00002. PMID 7913608. 
  58. ↑ The Dictionary of Drugs: Chemical Data: Chemical Data, Structures and Bibliographies. Springer. 14 November 2014. pp. 671–. ISBN 978-1-4757-2085-3. https://books.google.com/books?id=0vXTBwAAQBAJ&pg=PA671. 
  59. ↑ Index Nominum 2000: International Drug Directory. Taylor & Francis. 2000. pp. 532–. ISBN 978-3-88763-075-1. https://books.google.com/books?id=5GpcTQD_L2oC&pg=PA532. 
  60. ↑ Concise Dictionary of Pharmacological Agents: Properties and Synonyms. Springer Science & Business Media. 6 December 2012. pp. 147–. ISBN 978-94-011-4439-1. https://books.google.com/books?id=tsjrCAAAQBAJ&pg=PA147. 
  61. ↑ "Hydroxyzine Pamoate 5 mg/ML Oral Suspension". https://www.uspharmacist.com/article/hydroxyzine-pamoate-5-mgml-oral-suspension. 



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