CARDIAC ARRHYTHMIAS CAUSED BY HYDROXYZINE USE

Hydroxyzine, an H1 receptor antagonist, is a drug commonly used to treat anxiety, pruritus, urticaria or used during premedication before surgery. It was introduced to the market as early as the 1950s, but it was not until 2015 that a warning was issued regarding its potential to cause arrhythmias. This action is due to its effect on the transport of potassium ions through ion channels in myocardial cells, leading to a prolongation of the QT segment, which can contribute to torsade de pointes-type arrhythmias. Numerous clinical cases of cardiac arrhythmias and QT prolongation following hydroxyzine use have been reported in the literature. This is most likely to occur in patients with comorbidities, genetic factors that prolong the QT segment, or those taking other drugs that can cause arrhythmias. Meta-analyses of safety reports published by manufacturers of drugs containing hydroxyzine and non-clinical studies also provide information on the potential for cardiac torsade de pointes arrhythmias while taking hydroxyzine. Therefore, it is extremely important to take a thorough patient history before initiating hydroxyzine treatment, to rule out risk factors for cardiac arrhythmias, and to assess the benefits and risks of the drug. This is particularly important in elderly patients and those suffering from multiple chronic diseases. Extreme caution should also be exercised when administering hydroxyzine to patients in emergency conditions in a hospital emergency department setting or by emergency medical teams, when it may not be possible to establish an accurate history. Despite the high efficacy of hydroxyzine in both reducing symptoms of anxiety, pruritus and premedication preoperatively, the potential risk of cardiac arrhythmias in certain groups of patients should always be considered and the benefit/risk ratio assessed when including treatment.