From the Guidelines
For a patient whose anxiety is not adequately controlled with hydroxyzine 10mg, I recommend starting sertraline as a non-controlled medication alternative, given its relatively favorable side effect profile and lower propensity for drug interactions compared to other SSRIs 1. When initiating sertraline, it is essential to start with a low dose, such as 25mg daily, and gradually increase to 50-200mg daily as tolerated, to minimize the risk of adverse effects, particularly in the first 24 to 48 hours after dosage changes 1. Some key considerations when prescribing sertraline include:
- Monitoring for symptoms of discontinuation syndrome, such as dizziness, fatigue, and nausea, especially when stopping or reducing the dose 1
- Avoiding concomitant administration with monoamine oxidase inhibitors (MAOIs) due to the increased risk of serotonin syndrome 1
- Being cautious when co-administering sertraline with drugs that prolong the QT interval, as this may increase the risk of Torsade de Pointes and ventricular tachycardia 1 It is also crucial to continue hydroxyzine for 1-2 weeks while the new medication takes effect to ensure a smooth transition and minimize the risk of withdrawal symptoms. Other non-controlled options, such as buspirone or escitalopram, may also be considered, but sertraline is a reasonable first-line choice due to its established efficacy and safety profile 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Non-Control Medication Options for Anxiety
If hydroxyzine 10mg is not effective for a patient's anxiety, there are other non-control medication options that can be considered.
- Buspirone is an anxiolytic agent that can be used as a third-line agent for anxiety treatment, as stated in the study 2.
- Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are commonly used to treat anxiety disorders, as mentioned in the study 2.
- Anticonvulsants and antipsychotics may also be helpful in treating anxiety, although the evidence base is limited, as noted in the study 2.
- Hydroxyzine can be co-administered with antidepressants, particularly with specific serotonin reuptake inhibitors, as suggested in the study 3.
Considerations for Medication Switching
When switching medications, it is essential to consider the potential interactions and side effects.
- The study 3 suggests that combined benzodiazepine-specific serotonin reuptake inhibitors should be avoided.
- The study 4 notes that hydroxyzine is associated with a higher rate of sleepiness/drowsiness than active comparators.
- The study 5 found that adding hydroxyzine to morphine in the prehospital setting did not reduce pain or anxiety in patients with acute severe pain.
Alternative Treatment Options
In addition to medication, other treatment options can be considered for anxiety.