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Massive tissue necrosis after hydroxyzine injection

G Tokodi¹, F C Huber

¹Selby General Hospital, Marietta, Ohio, USA.

The Journal of the American Osteopathic Association

|October 1, 1995

Summary

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Intramuscular hydroxyzine hydrochloride injections can cause severe gluteal muscle necrosis due to arterial thrombosis. This adverse event, leading to significant tissue loss and long-term disability, suggests the drug is contraindicated for intramuscular use.

Area of Science:

Pharmacology
Clinical Medicine
Surgical Complications

Background:

Hydroxyzine hydrochloride is commonly administered intramuscularly for various indications.
Intramuscular injections carry inherent risks, including localized tissue damage and vascular injury.

Observation:

A patient developed severe gluteal tissue necrosis following a preoperative intramuscular injection of hydroxyzine hydrochloride.
The necrosis resulted from the needle inadvertently penetrating the gluteal artery, causing thrombosis and subsequent muscle infarction.

Findings:

The case demonstrates a direct causal link between intramuscular hydroxyzine administration and significant gluteus maximus muscle necrosis.
Surgical excision of 100g of necrotic tissue was required, resulting in permanent muscle loss and impaired mobility.

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Implications:

Intramuscular administration of hydroxyzine hydrochloride is associated with a high risk of severe local complications.
Based on this and similar cases, intramuscular hydroxyzine is considered contraindicated due to the potential for devastating tissue injury.