Escitalopram Vs. Hydroxyzine: Drug Comparison

Escitalopram is the active ingredient in the brand-name medication Lexapro^®. The information below is about brand name Lexapro. According to the FDA, “Generic medicines use the same active ingredients as brand-name medicines and work the same way, so they have the same risks and benefits as the brand-name medicines.”

Lexapro (escitalopram) is a selective serotonin reuptake inhibitor (SSRI) used to treat anxiety and depression by increasing available serotonin levels in the brain, which helps improve mood and reduce anxiety. Its FDA-approved indications include the treatment of major depressive disorder (MDD) and generalized anxiety disorder (GAD) in adults and adolescents. Off-label uses may include treating panic disorder, obsessive-compulsive disorder (OCD), and social anxiety disorder. Lexapro is available in tablet and oral solution forms, taken once daily. Common side effects include nausea, insomnia, and sexual dysfunction, and it carries a boxed warning for an increased risk of suicidal thoughts and behaviors in children, adolescents, and young adults, particularly during the initial stages of treatment.

Hydroxyzine is an antihistamine used to treat anxiety, allergies, and itching by blocking the action of histamine, a chemical in the body that causes allergic symptoms, and by exerting sedative effects on the brain. Its FDA-approved indications include the treatment of anxiety, allergic reactions, nausea, and insomnia. Off-label uses may include managing alcohol withdrawal, controlling agitation, and treating symptoms of nausea or vomiting. Hydroxyzine is available in oral tablets, capsules, liquid form, and as an injectable. Common side effects include drowsiness, dry mouth, and dizziness, and drug interactions may occur with central nervous system (CNS) depressants, increasing sedation. Caution is advised for use in elderly patients due to a risk of increased sedation and falls.

Selective serotonin reuptake inhibitor (SSRI)

Antihistamine

Lexapro (escitalopram) is indicated for the:

• Treatment of major depressive disorder (MDD) in adults and pediatric patients 12 years of age and older

• Treatment of generalized anxiety disorder (GAD) in adults and pediatric patients 7 years and older

Hydroxyzine is used:

• For symptomatic relief of anxiety and tension associated with psychoneurosis and as an adjunct in organic disease states in which anxiety is manifested

• In the management of pruritus due to allergic conditions such as chronic urticaria and atopic and contact dermatoses, and in histamine-mediated pruritus

• As a sedative when used as premedication and following general anesthesia

• Typically taken orally once daily

• Comes in 5 mg, 10 mg (scored), and 20 mg (scored) tablets

• Typically taken orally three or four times daily

• Comes in 10 mg, 25 mg, 50 mg, and 100 mg tablets

Most commonly observed adverse reactions (incidence ≥ 5% and at least twice the incidence of placebo patients) are:

• Insomnia

• Ejaculation disorder (primarily ejaculatory delay),

• Nausea

• Sweating increased

• Fatigue and sleepiness

• Decreased libido

• Inability to orgasm

Side effects reported with the administration of Atarax are usually mild and transitory in nature and include:

• Dry mouth

• Drowsiness

Concomitant use with SSRIs, SNRIs or Tryptophan is not recommended 
Use caution when concomitant use with drugs that affect Hemostasis (NSAIDs, Aspirin, Warfarin)

• Do not use MAOIs intended to treat psychiatric disorders with Lexapro or within 14 days of stopping treatment with Lexapro. Do not use Lexapro within 14 days of stopping an MAOI intended to treat psychiatric disorders. In addition, do not start Lexapro in a patient who is being treated with linezolid or intravenous methylene blue

• Concomitant use of pimozide

• Known hypersensitivity to escitalopram or citalopram or any of the inactive ingredients

• Drug interactions: SSRIs, SNRIs, tryptophan, drugs that affect hemostasis (NSAIDs, aspirin, warfarin)

• Hydroxyzine is contraindicated in early pregnancy.

• Hydroxyzine is contraindicated for patients who have shown a previous hypersensitivity to it

• Serotonin syndrome

• Discontinuation syndrome

• Seizures

• Activation of mania/hypomania

• Low blood sodium: Can occur in association with syndrome of inappropriate antidiuretic hormone secretion

• Increased risk of bleeding

• Interference with cognitive and motor performance

• Angle closure glaucoma

• Use in patients with concomitant illness

• Sexual dysfunction

• Pregnancy: SSRI use, particularly later in pregnancy, may increase the risk for persistent pulmonary hypertension and symptoms of poor adaptation (respiratory distress, temperature instability, feeding difficulties, hypotonia, tremor, irritability) in the neonate

• When central nervous system depressants are administered concomitantly with hydroxyzine their dosage should be reduced

• Breastfeeding: Hydroxyzine should not be given to nursing mothers

WARNING: SUICIDAL THOUGHTS AND BEHAVIORS

Increased risk of suicidal thoughts and behavior in pediatric and young adult patients taking antidepressants. Closely monitor all antidepressant-treated patients for clinical worsening and emergence of suicidal thoughts and behaviors. Lexapro is not approved for use in pediatric patients less than 7 years of age.

*This information is from the label for brand name Lexapro^®. See the Full Prescribing Information for more complete information. Escitalopram, the active ingredient in Lexapro, may also be the active ingredient in other medications, and this information may not be accurate for all medications that include the active ingredient escitalopram.

*This information is from the label for brand name Atarax^®. See the Full Prescribing Information for more complete information. Hydroxyzine, the active ingredient in Atarax, may also be the active ingredient in other medications, and this information may not be accurate for all medications that include the active ingredient hydroxyzine.