{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T19:51:35Z","timestamp":1787169095233,"version":"build-2736575974"},"reference-count":17,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2025,4,23]],"date-time":"2025-04-23T00:00:00Z","timestamp":1745366400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,9,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Hydroxyzine (Vistaril\u00a9) is an unscheduled, first-generation antihistamine prescribed for nausea\/vomiting, atopic dermatitis or eczema, and anxiety. It can produce adverse central nervous system (CNS) depressant effects such as fatigue, sedation, and impaired memory and concentration. Several clinical studies have shown hydroxyzine is able to impair driving and psychomotor function; however, no case series have been published highlighting driving performance and roadside observations in driving under the influence of drugs investigations (DUID). Between January 2017 and October 2024, 319 blood specimens submitted for DUID testing confirmed positive for hydroxyzine. Mean and median blood concentrations were 70 \u00b1 79 and 48\u2009ng\/mL, respectively, with a range of 8.0\u2013600\u2009ng\/mL. More than half of hydroxyzine positive drivers were female (57%) with a mean age of 42\u2009years. Common drug combinations in this study involved antidepressants (74%), opioids (44%), and anticonvulsants (38%). Only seven cases have been reported involving a single substance, and four of these investigations have been presented. Behavioral observations included incoordination, slow and slurred speech, and difficulty following instructions on standardized field sobriety tests. Driving observations included erratic driving, crashes, driving in opposite lanes of travel, and running stop signs. This is concerning since hydroxyzine became the most identified antihistamine in this population in 2023 outpacing diphenhydramine.<\/jats:p>","DOI":"10.1093\/jat\/bkaf030","type":"journal-article","created":{"date-parts":[[2025,4,18]],"date-time":"2025-04-18T07:54:21Z","timestamp":1744962861000},"page":"505-508","source":"Crossref","is-referenced-by-count":2,"title":["Hydroxyzine in impaired driving investigations"],"prefix":"10.1093","volume":"49","author":[{"given":"Jolene J","family":"Bierly","sequence":"first","affiliation":[{"name":"Toxicological Services, NMS Labs , Horsham, PA 19044,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda L","family":"D\u2019Orazio","sequence":"additional","affiliation":[{"name":"Toxicological Services, NMS Labs , Horsham, PA 19044,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,4,23]]},"reference":[{"key":"2025122016070196000_R1","doi-asserted-by":"publisher","DOI":"10.1186\/1939-4551-4-S3-S22","article-title":"Pharmacology of antihistamines","author":"Church","year":"2011","journal-title":"World Allergy Organ J"},{"key":"2025122016070196000_R2","article-title":"CUT: A Guide to Adulterants, Bulking Agents and Other Contaminants Found in Illicit Drugs","author":"Cole","year":"2010"},{"key":"2025122016070196000_R3","doi-asserted-by":"publisher","DOI":"10.3390\/ijms232314619","article-title":"Molecular insights and clinical outcomes of drugs of abuse adulteration: new trends and new psychoactive substances","volume":"23","author":"Di Trana","year":"2022","journal-title":"Int J Mol Sci"},{"key":"2025122016070196000_R4","article-title":"Vistaril Drug Summary","author":"Physicians Drug Reference"},{"key":"2025122016070196000_R5","doi-asserted-by":"publisher","first-page":"685","DOI":"10.1016\/S0091-6749(95)70173-7","article-title":"Effect of the H2-antagonist cimetidine on the pharmacokinetics and pharmacodynamics of the H1-antagonists hydroxyzine and cetirizine in patients with chronic urticaria","volume":"95","author":"Simons","year":"1995","journal-title":"J Allergy Clin Immunol"},{"key":"2025122016070196000_R6","doi-asserted-by":"publisher","first-page":"1456","DOI":"10.1002\/jps.2600681134","article-title":"Sensitive assay for determination of hydroxyzine in plasma and its human pharmacokinetics","volume":"68","author":"Fouda","year":"1979","journal-title":"J Pharm Sci"},{"key":"2025122016070196000_R7","first-page":"1030","volume-title":"Hydroxyzine. 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