Hydroxyzine Opioids

The incidence of opioid-induced nausea and vomiting is markedly increased in ambulatory patients. If narcotic analgesic therapy must be continued, nausea and vomiting can be treated with hydroxyzine or a phenothiazine antiemetic. 

Stool softeners and cathartics can be used in children, as in adults, to relieve symptoms of constipation. Nausea and vomiting generally diminish as opioid therapy is continued, but antihistamines with antiemetic effects, such as hydroxyzine or promethazine, may be helpful as adjuvants to diminish impleasant G1 symptoms. Reducing the opioid dose to minimal analgesic levels may help to limit sedation or drowsiness. Mild respiratory depression, an uncommon side effect in children, may require only that the opioid dose be reduced. 

Nerve blocks can be given in cases of very painful outbreaks. A mixture of lidocaine with adrenaline (epinephrine) and ropivacaine or bupivacaine" can be used. In some cases, the doctor will have to prescribe opioids to relieve severe pain. However, treatment with opioids might well get rid of the pain but will not affect the itching. It could even aggravate the pruritus. The itching sometimes resists hydroxyzine and diphenhydramine. Asken reported that he once had to inject propanolol intravenously to relieve unbearable pruritus. 

Sedation and sleep promotion can be achieved with drugs that are not classed as sedatives or hypnotics, including antihistamines (e.g., hydroxyzine) and opioid analgesics. Tricyclic antidepressants (TCAs) have been used in anxiety characterized by panic and/or phobias, and more recently the selective serotonin reuptake inhibitors (SSRIs) have been used. Propranolol has efficacy in performance anxiety and social phobias. 

Increased respiratory depression has been seen with hydroxyzine and opioids in one study, but not in two others. The US manufacturers warn that hydroxyzine may enhance the effects of opio-... 

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