Hydroxyzine pamoate vs hydroxyzine hcl?

As a psychiatrist with 35 years experience I generally use hydroxyzine pamoate for anxiety as I was there when they appeared on the market as brand names Vistaril and Atarax, with the former more effective for anxiety and the later for itching. With the transition to generics all bets are off as, while generic drugs often perform well, this is not always the case as they have less stringent standards. As a consequence I only use pamoate for anxiety and HCl for other applications and they perform as I would expect them to.

I'm curious to know if anyone has had any side effects that cause a low heart rate below 60 bpm while taking hydroxyzine pamoate?

WHAT IS VISTARIL?

Vistaril (hydroxyzine pamoate) is an antihistamine with anticholinergic (drying) and sedative properties used as a sedative to treat anxiety and tension. Vistaril is also used together with other medications given for anesthesia. Vistaril may also be used to control nausea and vomiting, or to treat allergic skin reactions such as hives or contact dermatitis. Vistaril is available in generic form.

WHAT IS ATARAX?

Atarax (hydroxyzine hydrochloride) is an antihistamine with anticholinergic (drying) and sedative properties used for symptomatic relief of anxiety and tension associated with psychoneurosis and as an adjunct in organic disease states in which anxiety is manifested.

What in the world? Everyone is contradicting one another on the differences. Crosses the blood brain barrier, then it doesn't. HCL better for anxiety, then it's not. The other one is. My goodness lol. More confused now than I was before.

Actually, they both cross the blood brain barrier. Same exact chemical minus the binding salt.

Please proceed with caution on the PAM version. They are NOT the same! The base compound on the PAM version has more side effects and drug interactions, especially for those who are prone to seizures and migraines. (I have first hand knowledge of this because I was taking the PAM version and started having small seizures followed my a multi day, unreceptive to medical treatment, migraine. One the PAM was fully out of my system and I was given the HCL version I no longer had the small seizures.)

Both are used in the exact same way. They can be interchanged for the majority of patients. Pam does have the benefit of having a capsule version. This makes it so that those who need to mix it with food (apple sauce... ) for swallowing, or other medical, issues can do so. You are not supposed to cut or crush either versions tablets.

Hope this info helps,
Kelly

I'm a pharmacist and yes, they share the same chemical name but no, they are not the same.
The pamoate (Pam) is primarily an anxiolitic (anti-anxiety) medication and the hydrochloride (Hcl) version is primarily an antipruritic (stop itching).
I do see Dr.'s writing the Pamoate for itching, but I then phone the physician to find out the use it was intended for. Pamoate will help itching, but will also cause a more drowsiness than the Hydochloride.

I have been on Atarax/Hydroxyzine hcl for many years due to auto immune skin diseases. Mine was just increased to 50 mg 4x a day by my Dermatologist. 3 weeks later, my new PCP has prescribed Vistaril/Hydroxyzine POM for anxiety/panic. I believe that this is way to much Hydroxyzine in a 24 hour period, so, since these can be PRN, and the POM is formulated to work faster, I will reduce my hcl which gives me the opportunity to take the POM as needed.
Both are said to possibly cause drowsiness. That's OK with me, I could use some sleep!

Interesting. i have read your answers. They don't make sense in light of my situation, but it is different. I have multiple horses on this med. My vet told me NOT to get HCL, but only Pam. I was in Fla, ran out & got some from local vet & ASKED for Pam but got HCL. We are using it for allergies & itching mostly, but anxiety is also an issue in 1 case. My vet will be out next week & I'll see her response, however, it APPEARS to be working the same & is MUCH cheaper! I think I will try switching all to the HCL & see if they all seem to do OK on it. Perhaps the seizure issue was related to the sudden switch-over as opposed to a gradual switch?

I'm a CNA with mental health and a grandmother of a mental health 13 years old who I m raising. He's been prescribed both hydroxyzine's and I like the capsule better for him. It seems to calm his anxiety better and has a longer effect. The regular hydroxyzine HCl is like giving a tic tac to an unhappy Bear!

I take Hydroxyzine HCL 50mg for eczema (a very bad case of eczema on the soles of my feet and in between my toes. When there is too much moisture between my toes or too dry... They will itch really bad and the Hydroxyzine HCL keeps me from scratching my feet and toes raw. I have been on this for many, many years). So the binding agents are very different. Hydroxyzine HCL is for itching which comes in tablet form. Hydroxyzine PAM comes in capsule form and is for anxiety. Hope this helps...

jls56; Okay you did it the right way and the Insurance companies well do this in almost all case's when you have been on a drug for awhile.It is just a pain for the doctor, nurse, and most of all the Patient. but Color; why to worry about a question over a year ago. Most people that would have these problems are not the ones using it for the right purpose. If the doctor does change it and does it correctly you would not have a seizure period. be it Pamoate or HCl. As you know as a nurse But really the truth is the Insurance companies are not looking out for Us all as patients.

Thank you all for your responses. I wrote the insurance company, explained in detail my need for HCL Pamoate for petit mal epilepsy. They have since approved my need!

I'm not exactly sure why your insurance denied it, it might of been the way the Dr put the diagnosis code. Anxiety vs nausea or anxiety vs sleeping aid. Etc... the MAIN ingredients are the same. Simply 2 medications. However. The compounding agents, what bind the meds together ,are very very different. Most don't ever experience issues with salts, calcium, acids, peptides etc, but on these two it can mean seizures vs no seizure. Capsule PAM vs pill HCL.
While main meds are the same, the binding meds are NOT.