From the Guidelines
Hydroxyzine should be used with caution in 11-year-old children due to its potential for sedation, performance impairment, and anticholinergic effects, and alternative treatments such as second-generation antihistamines or other anxiolytics should be considered first. When used, the recommended dosage for children this age is typically 0.5-1 mg/kg/dose given every 6 hours as needed, with a maximum daily dose of 50-100 mg divided throughout the day, as reported in 1. For an average 11-year-old weighing about 35-40 kg, this would mean approximately 20-40 mg per dose. Hydroxyzine comes in tablet, capsule, and syrup forms, with the syrup (2 mg/ml) being easier to administer to children who have difficulty swallowing pills. Common side effects include drowsiness, dry mouth, and mild dizziness, as noted in 1. The medication works by blocking histamine receptors and has mild anticholinergic effects, which helps reduce anxiety and itching. It's essential to avoid combining hydroxyzine with other medications that cause drowsiness unless specifically directed by a healthcare provider, as warned in 1. Parents should monitor for excessive sedation and contact their doctor if the child experiences unusual side effects or if symptoms don't improve after starting the medication. Some key points to consider when using hydroxyzine in children include:
- The potential for sedation and performance impairment, which can be significant, as reported in 1
- The risk of anticholinergic effects, such as dry mouth and constipation, as noted in 1
- The importance of monitoring for excessive sedation and other side effects, as recommended in 1
- The need to consider alternative treatments, such as second-generation antihistamines or other anxiolytics, as suggested in 1 and 1.
From the FDA Drug Label
THE POTENTIATING ACTION OF HYDROXYZINE MUST BE CONSIDERED WHEN THE DRUG IS USED IN CONJUNCTION WITH CENTRAL NERVOUS SYSTEM DEPRESSANTS SUCH AS NARCOTICS, NON-NARCOTIC ANALGESICS AND BARBITURATES. Since drowsiness may occur with use of this drug, patients should be warned of this possibility and cautioned against driving a car or operating dangerous machinery while taking hydroxyzine.
The FDA drug label does not provide specific information about the use of hydroxyzine in an 11-year-old patient.
- Key considerations:
- The label does not mention a specific age range for pediatric use.
- It does provide general warnings about the use of hydroxyzine, including the potential for drowsiness and interactions with other central nervous system depressants.
- Caution is advised when using hydroxyzine in patients who may be more susceptible to its effects, but this does not specifically address pediatric use 2.
From the Research
Hydroxyzine Use in Children
- There is limited research on the use of hydroxyzine in children, particularly in 11-year-olds 3, 4.
- A study published in 2021 found that hydroxyzine use in preschool children was associated with an increased risk of mental and psychomotor disorders, such as tics, anxiety, and disturbance of conduct, up to the age of 10 years 4.
- However, there is no direct evidence on the use of hydroxyzine in 11-year-old children, and more research is needed to determine its safety and efficacy in this age group.
Hydroxyzine for Anxiety
- Hydroxyzine has been shown to be effective in reducing anxiety in adults with generalized anxiety disorder (GAD) 3, 5, 6.
- A study published in 2010 found that hydroxyzine was more effective than placebo in reducing symptoms of GAD, but the evidence was limited by a high risk of bias and small sample size 3.
- Another study published in 2021 found that hydroxyzine did not reduce pain or anxiety in patients with acute severe pain in the prehospital setting 7.
Safety and Efficacy
- Hydroxyzine has been shown to be generally safe and well-tolerated in adults, with common side effects including drowsiness and sleepiness 3, 6.
- However, the long-term use of hydroxyzine in children has been associated with an increased risk of mental and psychomotor disorders, and its use in this population should be approached with caution 4.
- More research is needed to determine the safety and efficacy of hydroxyzine in children and adolescents, particularly in the treatment of anxiety disorders.