Chapter Title: Management of Nausea and Vomiting with Dexamethasone and Hydroxyzine

Introduction to Medications

Dexamethasone is a widely used corticosteroid with anti-inflammatory and antiemetic properties, commonly administered in doses of 4-20 mg depending on the clinical context, as recommended by the American Society of Clinical Oncology (ASCO) 1, 2
Hydroxyzine is a first-generation antihistamine with sedative properties, used for managing pruritus, anxiety, and as an adjunct in antiemetic protocols, with more pronounced sedative and anticholinergic effects compared to second-generation antihistamines, as noted by the American Academy of Allergy, Asthma, and Immunology 3

The American Society of Clinical Oncology (ASCO) guidelines do not mention specific interactions between dexamethasone and hydroxyzine, suggesting their concurrent use is safe when clinically indicated 1, 2
The combination of dexamethasone and hydroxyzine may be useful for patients requiring both antiemetic and sedative effects, with hydroxyzine preferably administered at night, according to the American Society of Anesthesiologists 4, 2

Dexamethasone has a prolonged effect (24-72 hours) and is a fundamental component in antiemetic schemes for chemotherapy and surgery, as recommended by the American Society of Clinical Oncology (ASCO) 1, 2, 4
Hydroxyzine has a shorter effect and greater sedative potential, which should be considered, especially in elderly patients or those at risk of delirium, as cautioned by the American Geriatrics Society 3
For postoperative nausea, dexamethasone has been shown to be effective in doses of 4-8 mg, as supported by the American Society of Anesthesiologists 4

When using both medications for antiemetic purposes, it is essential to consider their individual effects, particularly hydroxyzine's sedative potential, as advised by the American Academy of Sleep Medicine 3
The sedative effects of hydroxyzine may be more pronounced when administered at night, and its anticholinergic effects should be carefully monitored, especially in vulnerable populations, as recommended by the American Geriatrics Society 3