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Can Hydroxyzine Cause Muscle Pain? What You Need To Know

Can Hydroxyzine Cause Muscle Pain? What You Need To Know

If you grapple with insomnia, your quest for a good night’s sleep may lead you to hydroxyzine, an antihistamine often used off-label to treat sleeplessness. 

But, like all medications, it comes with potential side effects. One of the common concerns is: can hydroxyzine cause muscle pain? Learn about the specific unwanted reactions to this drug but also its benefits in our in-depth guide.

How Hydroxyzine Works

Hydroxyzine (brand names Atarax and Vistaril) is an antihistamine medication typically prescribed for conditions such as allergic reactions, anxiety, and tension. The medication binds to H1 receptors, reducing the release of pro-inflammatory cytokines and alleviating allergy symptoms like hives, sneezing, or skin irritations.

Hydroxyzine also suppresses activity in the part of the brain below the cerebral cortex. This dampening effect contributes to the drug’s sedative properties, making it viable for treating insomnia. Check out basic facts about this medicine in the table below:



FDA approval


Drug class

Histamine H1 antagonist

Key ingredient

Hydroxyzine dihydrochloride


Tablet, liquid, capsule


10 mg, 25 mg, 50 mg, 100 mg



Pregnancy risk

C (Risks can’t be ruled out)

Prescription or over-the-counter


Brand names

Atarax, Vistaril

Suitable for children

Yes (for allergic reactions—not used to treat insomnia)

Source: Polina Kovaleva

Can Hydroxyzine Cause Muscle Cramps?

Muscle cramps aren’t a commonly reported side effect of hydroxyzine. Still, the risks can’t be ruled out. This medicine can sometimes cause an electrolyte imbalance, potentially leading to muscle spasms.

Symptoms of muscle cramps may include the following:

  • Sudden, sharp muscle pain
  • Hardness or bulging in a muscle
  • Involuntary muscle contractions
  • Pain that worsens with movement

Other signs to watch out for include muscle stiffness, tingling, or weakness. 

If you have an electrolyte imbalance—such as excess potassium levels—you should inform your doctor before taking this medication. They’ll determine whether the drug is safe based on your condition and prescribe the optimum dose to reduce the risk of this side effect.

Is Hydroxyzine Effective for Sleep?

According to clinical studies, patients who took hydroxyzine reported improved sleep quality, while those who took the placebo didn’t notice any changes. While these results demonstrate that this medication can induce sleep, individual experiences may vary. 

Insomnia can arise from several factors that hydroxyzine alone may not solve, such as behavioral and environmental issues. To get comprehensive treatment, you should visit a sleep medicine expert.

With the acute shortage of sleep experts in the U.S., it may take a while before getting an appointment with a specialist. The rapid development of telehealth practices allows platforms like Kick to help you skip long waiting times and get a treatment plan personalized to your lifestyle, health history, and specific sleep issues almost instantly.

Source: Jep Gambardella

Kick—Bringing Restful Sleep 

Designed by Dr. Alex Dimitriu, a Stanford sleep expert, Kick’s comprehensive sleep program combines healthy sleep hygiene practices with gentle medications, such as:

  1. Hydroxyzine
  2. Cyclobenzaprine
  3. Ramelteon
  4. Gabapentin
  5. Doxepin
  6. Trazodone

How To Join Kick

Joining Kick is straightforward—follow these steps to get started:

  1. Head over to our signup page and kickstart your 15-minute consultation
  2. Fill us in on your sleep issues and medical history to help us tailor the treatment to your needs
  3. Decide whether you want your medication delivered to your doorstep or a local pharmacy

Our experienced sleep specialists will review your information within 24 hours and design a safe and effective treatment based on your case. The entire process is risk-free—according to our Doctor Guarantee, you won’t pay for the initial consultation if our team determines that we don’t have the best treatment for you.

Your designated expert will also offer ongoing cognitive behavioral therapy for insomnia (CBT-i) coaching. If the initial plan doesn’t yield the desired results within the first two weeks, our expert will adjust your treatment to ensure optimal results.

Kick’s sleep program has received excellent ratings on Trustpilot, which serve as a testament to its effectiveness.

Source: Los Muertos Crew

Hydroxyzine Side Effects—Tips for Safe Dosing

Source: ธันยกร ไกรสร

While hydroxyzine carries the risk of side effects, they rarely occur when patients follow their doctor’s instructions. Here are some tips for using this drug safely:

  • Follow the prescribed dosage—You should take the medication as instructed to avoid the risk of taking too much, which can enhance the side effects
  • Consider the potential interactions with food and drinks—Hydroxyzine may interact with caffeine, alcohol, and grapefruit juice, reducing its potency or enhancing the risk of side effects
  • Don’t stop the medication abruptly—To minimize the risk of unwanted reactions, consult your doctor before discontinuing this medication
  • Don’t use the medication beyond the prescribed period—If you use hydroxyzine for more than four months, you may develop tolerance and psychological dependence
  • Don’t use the drug if planning to get pregnant—There’s not enough information to claim that the drug is safe for babies, so you should avoid it when pregnant, breastfeeding, or planning to get pregnant

Hydroxyzine can interact with other drugs, enhancing the risk of side effects. Check out the potential interactions between hydroxyzine and other medications in the table below:


Interaction With Hydroxyzine


Can enhance the risk of cognitive impairment


Can contribute to drowsiness, dry mouth, and blurry vision


Can enhance the risk of side effects


Can raise the risk of impaired coordination


Can cause additive effects


Can enhance the sedative effects


Can contribute to the risk of low blood pressure


Can raise the risk of irregular heart rhythm 


Can contribute to the sedative effects


Can enhance the risk of severe drowsiness


Can contribute to the side effects

If you experience an unwanted reaction, you should inform your healthcare provider about your health history and the substances you’ve been using to identify its exact cause.

Can Hydroxyzine Cause Chest Pain?

Hydroxyzine carries the risk of exacerbating chest pain, especially among individuals with high blood pressure and QT prolongation—a condition that affects heart rhythm. These patients may experience the following when using hydroxyzine:

Individuals with QT prolongation shouldn’t use hydroxyzine. If you experience chest pain while on hydroxyzine, inform your healthcare provider immediately.

Can Hydroxyzine Make Your Nose Bleed?

While nosebleeds aren’t a common side effect of hydroxyzine, they’ve been reported in some cases. According to a phase IV clinical study of FDA data, out of 47,188 patients who reported unwanted reactions when taking this medication, 234 (0.5%) experienced nosebleeds. If you experience nosebleeds while taking hydroxyzine, you should stay calm and take these three steps:

  1. Sit upright—This reduces blood pressure in the veins around the nose, minimizing further bleeding
  2. Lean forward—This prevents swallowing blood, which may cause stomach discomfort
  3. Pinch your nostrils—Using your thumb and index finger, pinch your nostrils and breathe through your mouth for about ten minutes

If your nosebleed persists for more than 20 minutes or it’s accompanied by other symptoms, such as dizziness and breathlessness, you should seek immediate medical attention.

Why Does My Hydroxyzine Smell Weird?

The smell of hydroxyzine is influenced by the chemical substances it contains. Still, changes in storage conditions, such as temperature and humidity, can affect this drug’s smell. 

If your hydroxyzine smells unusual, you shouldn’t ignore it—a weird smell may indicate that the medication is contaminated or has expired. You should always check the expiry date before using this medicine and store it as directed by the pharmacist or the instructions on the bottle.

Does Hydroxyzine Affect the Sense of Smell or Taste?

Hydroxyzine isn’t specifically known to affect the sense of smell or taste. Still, some medications can alter these senses.

These changes can be caused by the drug’s ingredients or the way it alters chemicals, nerve sensations, or enzymes in the body. This can affect your appetite and weight, especially if you’re using the drug beyond the typical maximum period of 3–4 months.

You should notify your healthcare provider if you notice a change in your sense of smell or taste after taking hydroxyzine.

Can Hydroxyzine Cause Shortness of Breath?

Hydroxyzine can potentially cause shortness of breath. This isn’t a common side effect, but it has been reported in some cases. Symptoms include trouble breathing, unusual tiredness, or weakness.

If you experience difficulty breathing while on hydroxyzine, follow these steps:

  1. Stop taking the medication immediately
  2. Stay calm and try to take slow, deep breaths
  3. Find a comfortable place to sit down and rest
  4. Call your health provider or local emergency services
  5. Avoid taking similar drugs or other medications until you’ve consulted your healthcare provider

Can Hydroxyzine Cause Bad Breath?

Hydroxyzine doesn’t typically cause bad breath, but it may cause dry mouth as a side effect. Dry mouth—also called xerostomia—can cause an increase in bacteria in the mouth, leading to bad breath (halitosis).

Patients who experience halitosis while on hydroxyzine should maintain good oral hygiene by:

  • Staying hydrated
  • Brushing and flossing regularly
  • Using a mouthwash

Can Hydroxyzine Cause GI Bleeds?

Gastrointestinal (GI) bleeding isn’t a commonly reported adverse reaction to hydroxyzine. Still, you should watch out for any GI changes and report them to your doctor. Some of the symptoms may include:

  • Dark or bloody stools
  • Vomiting blood
  • Severe abdominal pain

In some cases, these unwanted reactions may arise from other conditions or medications you’re taking alongside hydroxyzine.

Does Hydroxyzine Cause Blurred Vision?

Although rare, hydroxyzine carries the risk of blurred vision. The medication blocks the action of acetylcholine—a neurotransmitter involved in several functions, including the dilation and constriction of the pupils. By blocking the neurotransmitter, hydroxyzine affects the muscles that control the lens and pupils of your eyes, potentially causing blurred vision.

If you experience this unwanted reaction, follow these guidelines:

  • Stop taking the medication 
  • Avoid activities that require sharp vision, including driving and operating heavy machinery
  • Inform your doctor if the issue persists

Does Hydroxyzine Cause Edema?

Edema, or swelling caused by fluid retention, isn’t a commonly reported side effect of hydroxyzine. However, some patients may experience swelling as a sign of an allergic reaction to the drug.

If you experience this unwanted reaction when using the medication, follow these guidelines:

  • Elevate the swollen area above the level of your heart 
  • Stay active to reduce fluid buildup in your tissues
  • Avoid tight clothing since it may exacerbate the problem
  • Limit salt intake to reduce the swelling

Hydroxyzine may also cause urinary retention, which can lead to swollen legs. You should inform your doctor if you experience unexplained physical or cognitive changes when using this medication.

Does Hydroxyzine Make You Constipated?

Hydroxyzine can slow down the digestive system, causing constipation. This side effect can be especially pronounced in the elderly due to their slow metabolism. The medication may also interact with other substances, exacerbating the risk of constipation. 

This side effect is easily manageable. Some helpful tips for preventing it are:

  • Stay hydrated—Drinking 0.7–1 gallon of fluids daily can help alleviate this discomfort
  • Eat fiber-rich foods—Food like oats, beans, carrots, and brown rice can promote regular bowel movements
  • Exercise regularly—Staying active can stimulate your intestines, reducing the risk of constipation
  • Take the prescribed dose—You should avoid going above the prescribed dose as it raises the risk of unwanted reactions

If constipation persists, you should consult your healthcare provider. They may recommend a laxative, adjust the dose, or suggest an alternative to hydroxyzine.

Featured image source: cottonbro studio