Hydroxyzine and Fall Risk: Assessment and Mitigation Strategies

Risk Factors and Mechanisms

Hydroxyzine causes sedative effects, such as drowsiness and performance impairment, in many patients, which can lead to falls even when patients don't subjectively feel drowsy, according to the American Academy of Allergy, Asthma, and Immunology 1, 2
The anticholinergic effects of hydroxyzine, including dry mouth, dry eyes, constipation, and urinary retention, can contribute to fall risk, especially in older adults, as reported by the American Academy of Allergy, Asthma, and Immunology 1, 2
Older adults are particularly vulnerable to hydroxyzine's effects due to increased sensitivity to psychomotor impairment and greater susceptibility to anticholinergic effects, as noted by the American Academy of Allergy, Asthma, and Immunology 1, 2

Patients with pre-existing mobility issues face increased fall risk when taking hydroxyzine, according to Praxis Medical Insights 3
Those taking multiple medications have compounded risk, as reported by Praxis Medical Insights 3, 4

The American Academy of Allergy, Asthma, and Immunology recommends using second-generation antihistamines instead of hydroxyzine whenever possible for allergic conditions, with high strength of evidence 1, 2
Avoid the practice of using second-generation antihistamines in the morning and hydroxyzine at night, as the sedative effects of hydroxyzine can persist into the next day, according to the American Academy of Allergy, Asthma, and Immunology 1, 2

Regularly review all medications and consider alternatives to hydroxyzine when possible, as recommended by Praxis Medical Insights 3
Be particularly cautious with concomitant use of alcohol, as warned by the American Academy of Allergy, Asthma, and Immunology 1

Monitor for side effects and reassess the need for hydroxyzine regularly, as advised by Praxis Medical Insights 3

Consider home safety evaluation for high-risk patients, as suggested by Praxis Medical Insights 4
Implement fall prevention strategies, such as removing hazards, improving lighting, and appropriate footwear, as recommended by the American Medical Association 5
Consider exercise interventions to improve strength and balance in at-risk patients, with moderate strength of evidence, as reported by the American Medical Association 5

Regular monitoring of gait, balance, and orthostatic vital signs is recommended for older adults taking hydroxyzine, as advised by Praxis Medical Insights 4
Consider a multifactorial fall risk assessment for older adults taking hydroxyzine, with high strength of evidence, as recommended by the American Geriatrics Society and the American College of Physicians 5, 6