What is the use of Hydroxyzine (Atarax)?

From the Guidelines

Hydroxyzine should be used with caution, particularly in elderly patients and those with certain medical conditions, due to its potential for sedation and anticholinergic effects, as noted in studies such as 1 and 1. When considering the use of hydroxyzine, it's essential to weigh the benefits against the potential risks, especially in vulnerable populations.

• The medication is commonly used to treat anxiety, itching from allergic reactions, and as a sedative, with typical dosing ranging from 25-100 mg 3-4 times daily for anxiety and 25 mg 3-4 times daily for itching or allergic reactions.
• Hydroxyzine begins working within 15-30 minutes, and its effects last 4-6 hours, as mentioned in general medical knowledge.
• Side effects may include drowsiness, dry mouth, headache, and constipation, with drowsiness being the most notable, as reported in studies such as 1 and 1.
• The medication should be used cautiously in elderly patients and those with certain medical conditions like glaucoma or urinary retention, and it's not recommended during pregnancy, especially the first trimester, as noted in 1.
• Hydroxyzine should not be combined with other central nervous system depressants like alcohol or certain medications that can affect heart rhythm, as warned in 1 and 1.
• The medication is available in tablet, capsule, and syrup forms, allowing for flexible administration based on patient needs, as mentioned in 1. It's crucial to consider the most recent and highest-quality evidence when making decisions about hydroxyzine use, such as the study from 1, which highlights its potential as a sedative antihistamine approved for anxiolytic use in both Europe and the United States.

From the FDA Drug Label

For symptomatic relief of anxiety and tension associated with psychoneurosis and as an adjunct in organic disease states in which anxiety is manifested. 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.

Hydroxyzine is used for the symptomatic relief of anxiety and tension associated with psychoneurosis. It can also be used as an adjunct in organic disease states where anxiety is manifested.

• The drug may potentiate the effects of central nervous system depressants such as narcotics, non-narcotic analgesics, and barbiturates, so their dosage should be reduced when used concomitantly with hydroxyzine 2 2.
• Caution is recommended when using hydroxyzine in patients with risk factors for QT prolongation or torsade de pointes.
• Elderly patients should be started on low doses and observed closely due to the potential for confusion and over sedation.

From the Research

Hydroxyzine Overview

• Hydroxyzine is an anxiolytic drug that has been shown to be effective in treating generalized anxiety disorder 3
• It has a beneficial effect on sleep and reduces stress and anxiety associated with coronary disease 3
• Hydroxyzine has been found to have a lack of organ toxicity and an absence of dependency 3

Comparison with Other Anxiolytic Drugs

• Hydroxyzine has been compared to lorazepam in a controlled trial, with hydroxyzine demonstrating greater and more rapid cognitive improvement 3
• In another study, hydroxyzine was found to be a better anxiolytic drug to coadminister with antidepressants, particularly with specific serotonin reuptake inhibitors, compared to benzodiazepines 4

Effects on Cognition

• A study found that hydroxyzine impaired performance on cognitive tasks, with the impairment being more prominent after morning doses compared to evening doses 5
• The sedative effects of hydroxyzine were found to be apparent in the evening after an evening dose, but smaller in the morning after a morning dose 5

Other Relevant Information

• A review of anxiolytic drugs discussed the metabolism and method of action of benzodiazepines, as well as newer groups of anxiolytic drugs such as triazolobenzodiazepines and azaspirodecanediones 6
• A systematic review of lorazepam found it to be a clinically effective means of treating acute agitation, although it was not directly compared to hydroxyzine 7