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hydroxyzine HCl vs hydroxyzine pamoate

Psychiatric   (36,425 Views | 8 Replies)

Findingmynitch has 10 years experience .

2,480 Profile Views; 22 Posts

I know these two medications are very similar with one being in tablet form vs the other being a capsule. Would it be a medication error if you gave one when the other is ordered?

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loveofrn has 3 years experience as a BSN, RN and specializes in MICU.

347 Posts; 7,099 Profile Views

Yes it is a med error because part of the 8 rights of medication administration is right drug.

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Davey Do has 41 years experience and specializes in Psych, CD, HH, Admin, LTC, OR, ER, Med Surge.

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Different Bases. A Med Variance (Error) that should have No Adverse Effects.

According to what a Pharmacist told me, "supposedly", the HCl has more of an Antihistamine affect whereas the Pamoate has more of an Antianxiety effect.

Edited by Davey Do
additional info

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Meriwhen is a ASN, BSN, RN and specializes in Psych ICU, addictions.

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Technically, yes, it's a medication error. Both are hydroxyzine but different formulations and therefore different drugs. It's like the three Wellbutrins.

A provider would probably not spazz if you ended up giving a patient Vistaril instead of Atarax (or the reverse). But it's still an error nonetheless.

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TerpGal02 has 6 years experience as a ASN and specializes in Psych.

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They're given interchangeably everywhere I've ever worked. At my last hospital, the docs could order Atarax (hcl) or Vistaril (pamoate) and they were getting hcl, no matter what. Hcl was the only formulation we carried. Where I work now, if a doc goes to order hydroxyzine, the order reads like This: hydroxyzine (Atarax/Vistaril) and the pt would get the pamoate because that's what we stock.

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Jules A is a MSN and specializes in Family Nurse Practitioner.

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They're given interchangeably everywhere I've ever worked. At my last hospital, the docs could order Atarax (hcl) or Vistaril (pamoate) and they were getting hcl, no matter what. Hcl was the only formulation we carried. Where I work now, if a doc goes to order hydroxyzine, the order reads like This: hydroxyzine (Atarax/Vistaril) and the pt would get the pamoate because that's what we stock.

I don't think we have both at my hospital but if we did and a RN called me to report a med error for the administration of one vs the other I'd just cover the order. To me they are virtually the same and although I might be mistaken I do not think the reported antihistamine vs anxiolytic effects differences are substantiated.

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TCASII has 8 years experience as a ADN.

197 Posts; 3,897 Profile Views

Both salts dissociate in the gut to a completely equal form at the same strength, therefore no therapeutic difference exists really. Only the dissociated drug crosses the BBB, so it's a moot point. Only real difference is that the pamoate salt is insoluble in water, thus not available as an IM. The HCL version, as an IM, was given the reputation over the years as being the effective drug for anxiety. No difference clinically, yet I suppose someone could nitpick on a med variance.

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1 Post; 19 Profile Views

Does someone want to do the chemistry here and remember the largest reason for different bindings for this are the drug interactions? Every biological reaction breaks down to chemistry and breathing is one of the more important ones I prefer to keep doing. Normally it should not make a difference but the pamoate binding is used because it does not have breakdown when used alongside anesthesic medication or when benzos need to be mixed for muscle relaxers and anxiety after a surgery and these are pretty much the two use cases for pamoate. It's also more expensive to make and less frequently needed so HCL is used a lot. If you have a major surg center that nerve blocks are out and you can end up with bone, muscle, tissue, epidermal, and nerve pain; pamoate will be necessary and should be at higher dose than HCL would normally be at. 

Sorry for rant but just scary to see this. 

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