Understanding Lexapro and Hydroxyzine
Lexapro and hydroxyzine are two distinct medications often prescribed in the context of mental health, but they serve different primary purposes and have different mechanisms of action. Understanding each drug individually is the first step in comprehending how they interact.
What is Lexapro (Escitalopram)?
Lexapro, with the generic name escitalopram, is a widely used antidepressant belonging to the selective serotonin reuptake inhibitor (SSRI) class [1.2.6]. It is approved for treating Major Depressive Disorder (MDD) and Generalized Anxiety Disorder (GAD) in adults and adolescents [1.2.6, 1.4.6]. SSRIs work by increasing the levels of serotonin, a neurotransmitter in the brain that helps regulate mood, sleep, and appetite [1.4.2]. By blocking the reabsorption (reuptake) of serotonin into neurons, Lexapro makes more serotonin available, which can help alleviate symptoms of depression and anxiety [1.4.2, 1.4.3]. Its effects are not immediate; it often takes several weeks to reach its full therapeutic potential [1.4.3].
Common side effects of Lexapro include nausea, insomnia, drowsiness, increased sweating, and sexual dysfunction [1.4.2, 1.4.7]. A more serious, though rare, concern is a black box warning for an increased risk of suicidal thoughts and behaviors, particularly in younger individuals [1.3.3].
What is Hydroxyzine (Vistaril, Atarax)?
Hydroxyzine is a first-generation antihistamine [1.5.1]. While it's used for treating itching (pruritus) from allergic reactions, it also has significant sedative and anxiolytic (anxiety-reducing) properties [1.5.1, 1.5.2]. Its calming effect is due to its action on the central nervous system, where it acts as a histamine H1 receptor antagonist [1.5.2]. It may also have weak antagonistic effects on serotonin and dopamine receptors, which could contribute to its anxiolytic effects [1.5.1]. Unlike Lexapro, hydroxyzine works quickly, often within 15 to 30 minutes, providing short-term relief from anxiety or insomnia [1.5.2, 1.5.4]. It is not considered habit-forming [1.3.3].
Common side effects include drowsiness, dry mouth, and headache [1.5.1]. Because of its potent sedative effects, users are advised to avoid driving or operating heavy machinery until they know how the drug affects them [1.3.3].
Can You Take Lexapro and Hydroxyzine Together?
Yes, doctors do prescribe Lexapro and hydroxyzine together, but this combination must be managed with extreme caution under professional guidance [1.2.5, 1.2.6]. The primary reason for this combination is to manage anxiety. Lexapro provides long-term control, while the fast-acting hydroxyzine can be used for immediate relief of acute anxiety or insomnia, especially when a patient is first starting the SSRI and waiting for it to take full effect [1.2.6].
However, combining these two drugs introduces several potential risks that both patients and prescribers must carefully consider. The main concerns are additive side effects and, more seriously, heart rhythm problems and serotonin syndrome [1.2.6, 1.3.1].
Major Risks and Interactions
1. Increased Sedation and Drowsiness: Both Lexapro and hydroxyzine can cause drowsiness and impair cognitive function on their own [1.2.3, 1.2.2]. When taken together, these central nervous system (CNS) depressant effects are additive, leading to heightened sleepiness, dizziness, confusion, and impaired motor skills [1.2.1, 1.2.6]. This can be particularly dangerous when performing tasks that require mental alertness, such as driving [1.2.4]. Alcohol must be strictly avoided as it significantly amplifies these sedative effects [1.2.1].
2. QT Prolongation: This is a significant and potentially life-threatening risk. QT prolongation refers to a disturbance in the heart's electrical rhythm, where the heart muscle takes longer than normal to recharge between beats [1.3.1, 1.3.5]. Both hydroxyzine and Lexapro (escitalopram) are known to carry a risk of causing this condition independently [1.3.1, 1.3.3]. Taking them together has an additive effect, increasing the overall risk of developing a dangerous arrhythmia like Torsades de Pointes, which can be fatal [1.3.2, 1.3.4]. The risk is higher in individuals with pre-existing heart conditions, electrolyte imbalances (low potassium or magnesium), or a congenital long QT syndrome [1.2.4, 1.3.7]. Symptoms to watch for include sudden dizziness, fainting, shortness of breath, or heart palpitations [1.2.4].
3. Serotonin Syndrome: This is another rare but serious risk. Serotonin syndrome occurs when there is an excess of serotonin in the brain [1.2.1]. Lexapro works by increasing serotonin levels. While hydroxyzine is primarily an antihistamine, it can also weakly interact with serotonin receptors [1.2.1, 1.5.1]. Combining them can increase the risk of this condition [1.2.1, 1.2.6]. Symptoms can range from mild (shivering, diarrhea, agitation) to severe (high fever, seizures, irregular heartbeat, unconsciousness) and require immediate medical attention [1.6.2].
Comparison: Lexapro vs. Hydroxyzine
| Feature | Lexapro (Escitalopram) | Hydroxyzine |
|---|---|---|
| Drug Class | Selective Serotonin Reuptake Inhibitor (SSRI) [1.2.6] | First-Generation Antihistamine [1.5.1] |
| Primary Use | Long-term treatment of depression and anxiety [1.2.6] | Short-term anxiety, allergies, itching, sedation [1.5.1] |
| Mechanism | Increases serotonin levels in the brain [1.4.2] | Blocks histamine receptors; CNS depressant [1.5.2] |
| Onset of Action | Slow (several weeks for full effect) [1.4.3] | Fast (15-30 minutes) [1.5.2] |
| Key Risks | Suicidal thoughts (black box warning), serotonin syndrome, QT prolongation [1.3.3] | QT prolongation, severe drowsiness, tissue injury (if injected) [1.3.3, 1.5.3] |
| Habit-Forming | Not considered addictive, but can cause withdrawal symptoms [1.4.6] | Not considered addictive [1.3.3] |
Who Should Avoid This Combination?
Certain individuals are at a higher risk of adverse effects and should generally avoid taking Lexapro and hydroxyzine together, or only do so under very close monitoring [1.2.6]:
- Individuals with Heart Conditions: Especially those with a known history of QT prolongation, arrhythmias, or other cardiac diseases [1.2.6, 1.3.3].
- Older Adults (65+): Elderly patients are more sensitive to the sedative and anticholinergic side effects, increasing the risk of falls, confusion, and other complications [1.2.6, 1.5.3].
- Patients with Kidney or Liver Problems: These conditions can affect how drugs are metabolized and cleared from the body, potentially increasing drug levels and side effects [1.2.6].
- Individuals Taking Other CNS Depressants or QT-Prolonging Drugs: The risk of severe side effects is magnified when combined with other medications that have similar effects [1.2.1].
Conclusion: A Decision for Your Doctor
While you can take Lexapro and hydroxyzine together under a doctor's supervision, it is not a risk-free combination. The decision to use these medications concurrently is a clinical judgment made by a healthcare professional after weighing the potential benefits against the significant risks, including additive sedation, serotonin syndrome, and life-threatening heart rhythm changes (QT prolongation) [1.2.5, 1.2.6].
Never combine these medications on your own or adjust doses without consulting your doctor. Always disclose all medications you are taking, including over-the-counter drugs and supplements, to your provider [1.2.1]. If you are prescribed this combination and experience dizziness, heart palpitations, extreme drowsiness, or confusion, seek medical attention immediately [1.2.4].
For more information from an authoritative source on drug interactions, you can visit Drugs.com.
