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Hydroxyzine and Heart Palpitations—What You Need To Know

Hydroxyzine and Heart Palpitations—What You Need To Know

If you’ve been experiencing sleepless nights that won’t go away, you should visit a sleep specialist. Depending on the factors contributing to your sleep problems, your doctor may recommend hydroxyzine, an antihistamine that can help you get a restful night’s sleep. 

But like most medications, this drug carries the risk of undesired reactions, including affecting the heart rhythm. Learn about the connection between hydroxyzine and heart palpitations and discover viable alternatives to address your sleep problems.

Can Hydroxyzine Cause Heart Palpitations?

Whether hydroxyzine can cause heart palpitation depends on several factors, including:

  • Your lifestyle
  • Your medical history
  • Adherence to your healthcare provider’s instructions

Patients with a history of heart disease or those who exceed the recommended dosage may experience unwanted reactions like heart palpitations. 

A recent study reported that out of 47,188 people who experienced unwanted reactions to hydroxyzine, about 393 (0.83%) had heart palpitations, implying that it’s a rare adverse reaction. This side effect was more common among female patients over 60 who had narcolepsy and were also taking Singulair, a medication used to treat asthma.

The signs of this undesirable reaction include:

  • Racing or pounding heartbeat
  • Fluttering sensation in the chest
  • Shortness of breath
  • Dizziness
  • Lightheadedness
  • Chest pain

If you experience these effects while on hydroxyzine, you should seek immediate medical attention.

Hydroxyzine’s Effects on Heart Rate

Hydroxyzine can cause both an increase and decrease in heart rate. The European Medicines Agency (EMA) found that this drug can prolong the QT interval and increase the torsades de pointes (TdP)—in other words, this medicine can lengthen the time between two crucial electrical signals that recharge the heart. This can result in irregular heartbeat, which can lead to concerning complications if not treated promptly.

Due to the high risks involved, doctors typically don’t prescribe hydroxyzine to individuals with the following heart conditions:

  • History of heart disease
  • Long QT syndrome
  • Arrhythmia
  • Recent heart attack

Before taking this medicine, you should inform your healthcare provider about your medical history and any heart medications you’ve been taking to help them determine whether it’s a safe treatment for you.

Is Hydroxyzine Safe if You Have PVCs?

You should avoid hydroxyzine if you have premature ventricular contractions (PVCs), a medical condition that causes extra heartbeats. Since hydroxyzine carries the risk of irregular heart rhythm, it can interact with PVCs and enhance the risk of cardiac problems.

Patients with frequent or chronic PVCs may experience more serious effects than those with occasional PVCs.

Your doctor may recommend this medicine in lower doses if your PVCs aren’t accompanied by heart disease or if the benefits of taking hydroxyzine outweigh the risks. You should stick to the prescribed dose to reduce the risk of tolerance and undesired reactions.

Source: Karolina Grabowska

How Hydroxyzine Works

Hydroxyzine is an antihistamine primarily indicated for treating the symptoms of allergic reactions, anxiety, and tension. The medication is FDA-approved, and it’s not a controlled substance since it carries no risk of physical addiction.

This drug works in two ways:

  1. It blocks histamine H1 receptors, limiting the effects of histamine in the body
  2. It slows down the central nervous system and increases serotonin levels in the brain, promoting the production of melatonin

The dual action alleviates the symptoms of allergic reactions, such as hives and contact dermatitis. It also induces drowsiness, promoting sleep. Due to its sedating properties, this medicine is used in the short-term treatment of insomnia, especially among adults with anxiety or tension.

Find the essential details about hydroxyzine in the table below:



FDA approval


Active component

Hydroxyzine dihydrochloride

Drug class


Controlled substance


Addiction risk

Low (psychological addiction can’t be ruled out)

Drug form

Tablets, capsules, liquid

Available doses

10 mg, 25 mg, 50 mg, 100 mg

Suitable for pregnant women


Prescription or OTC


Typical treatment duration

3–4 months maximum

Side Effects of Hydroxyzine

Hydroxyzine carries the risk of other unwanted reactions, which may be mild or severe, depending on the dosage and the patient’s health status. Most side effects rarely occur when patients follow their doctor’s instructions.

Common Side Effects of Hydroxyzine

Common undesirable reactions to hydroxyzine include:

  • Dizziness
  • Drowsiness
  • Nausea
  • Stomach upset
  • Dry mouth
  • Constipation, especially in the elderly

These side effects can be easily managed and typically subside as your body adapts to the medication. For instance, you can chew sugar-free candy to alleviate dry mouth or take this medication with food to prevent upsetting your stomach. Avoid caffeine and grapefruit since they affect this drug’s potency.

Rare Side Effects of Hydroxyzine

Rare but serious unwanted reactions to hydroxyzine may include:

  • Irregular heartbeat
  • Hallucinations
  • Itching, hives, or skin rash
  • Breathing problems
  • Chest pain or discomfort

The lists above aren’t exhaustive, so you should inform your doctor if you experience any unusual sensations when using hydroxyzine.

When Should You Consider Hydroxyzine Alternatives?

While hydroxyzine is generally safe for most patients, it’s contraindicated in certain cases. Your healthcare provider may recommend hydroxyzine alternatives if the risks of using this medicine are too high.

You should consider a hydroxyzine substitute if:

  • You’re pregnant, breastfeeding, or planning to get pregnant
  • You have glaucoma
  • You have electrolyte imbalance
  • You have urinary tract obstruction
  • You have digestive tract obstruction
  • You used MAO inhibitors within the past 14 days

This list isn’t exhaustive, and your doctor will analyze your medical history before determining whether you can take hydroxyzine. If the risk of unwanted reactions is high, they may recommend the following alternatives:

None of these sleep aids is a one-size-fits-all solution. Sleeplessness can stem from numerous factors, and the best treatment combines gentle and effective sleep medications like hydroxyzine with non-pharmaceutical methods.

To get satisfying results, you should see a sleep specialist. However, with only 1% of physicians in the U.S. trained in sleep medicine and 30% of adults grappling with sleeplessness, sleep experts are hard to book. Kick, an online performance medicine clinic, lets you skip long waiting lines and connect with sleep specialists almost instantly.

Source: Ron Lach

Kick—Celebrate Your Mornings

Designed by Dr. Alex Dimitriu, a Stanford sleep specialist with years of experience, Kick’s sleep program offers a comprehensive approach to tackling sleep issues. Once you sign up for the program, our team will evaluate your medical history and specific sleep issues and prescribe two trial medications. Your designated doctor will guide you and monitor your progress via ongoing consultations.

If the initial prescription doesn’t yield the desired results, our expert will adjust the dosage to optimize the treatment. Your doctor will also give tips on cognitive behavioral therapy for insomnia (CBT-i) best practices to help you cultivate healthy sleep habits and address the underlying factors contributing to your sleepless nights.

If our team decides Kick isn’t the best solution for your sleep issues, you won’t be billed for the initial consultation as per our Doctor Guarantee.

How Kick Works

To begin your journey to restful nights with Kick, follow these three easy steps:

  1. Navigate to our Sleep Visit page to start your 15-minute consultation
  2. Enter your sleep history and medical details in the intake form
  3. Provide your delivery address and billing details

Our experts will review your information and design a treatment plan tailored to your medical history and sleep issues. Kick’s fast-acting medications include:

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

Your medication will be delivered to your home or local pharmacy in discreet and convenient packaging, ensuring privacy throughout the treatment. 

Our program has received glowing reviews on Trustpilot, affirming its effectiveness in helping patients overcome sleepless nights.


Hydroxyzine and Common Heart Medications

Hydroxyzine can interact with the drugs commonly used in cardiovascular medicine, raising the risk of unwanted reactions or reducing the potency of some heart medications. Get the details in the following sections.

Can You Take Hydroxyzine With Atenolol?

You shouldn’t take hydroxyzine with atenolol. These drugs have moderate interaction, and combining them can contribute to the risk of low blood pressure, leading to the following symptoms:

  • Lightheadedness
  • Fainting
  • Changes in the heart rate
  • Headache 

Patients are most likely to experience these side effects on three occasions:

  1. At the beginning of treatment
  2. Following an adjustment in the dose
  3. When treatment is interrupted and then restarted 

If the benefits outweigh the risks, your doctor may prescribe lower doses or instruct you to take these drugs at different times of day to prevent side effects. Monitor potential physical and cognitive-behavioral changes when mixing hydroxyzine and atenolol.

Contact your doctor immediately if you experience the following symptoms:

  • Weight loss or poor appetite
  • Swollen hands, feet, or ankles
  • Fatigue
  • Blood in the urine
  • Unusual thoughts

If you experience dizziness or drowsiness, avoid driving or operating heavy machinery until the effect subsides.

Hydroxyzine and Beta-Blockers—Potential Interactions

Beta-blockers like propranolol are typically used to treat conditions like high blood pressure, angina pectoris, and irregular heart rhythm. They block the effects of specific hormones on the heart, slowing down the heart rate and reducing blood pressure. 

When combined with hydroxyzine, the effects of beta-blockers can be enhanced, contributing to the decrease in heart rate and blood pressure. The combination can raise the risk of other side effects, such as:

  • Dizziness
  • Drowsiness
  • Fainting
  • Fatigue

Unless instructed by your healthcare provider, you should avoid mixing hydroxyzine with beta-blockers. 

Can You Take Hydroxyzine and Amlodipine Together?

You should avoid taking hydroxyzine and amlodipine at the same time. When taken together, these drugs can raise the risk of low blood pressure and enhance drowsiness. A study of FDA data shows that combining these drugs can contribute to accidental falls and chronic kidney problems among male patients.

Like with other medications, these reactions may vary among patients, so you should report any unexplained changes if your doctor advises you to use these drugs at the same time.

Source: Thirdman

Is It OK To Take Hydroxyzine With Aspirin?

It’s generally safe to take hydroxyzine with aspirin. Still, individual reactions vary, so you should consult your doctor before combining these drugs.

A study of 4,935 patients taking both medications showed that some experienced unwanted reactions. For example, female patients reported problems with back pain, while males with kidney diseases experienced worsened symptoms after mixing these drugs. These findings were based on long-term use, so you should take hydroxyzine for a maximum of 3–4 months to reduce the risk of these adverse reactions.

Featured image source: Ron Lach