From the Guidelines
Hydroxyzine is a recommended medication for treating anxiety, particularly in cases where an antihistamine is preferred, as it has been approved for anxiolytic use in both Europe and the United States 1.
Key Points to Consider
- Hydroxyzine is available in tablets and syrup, making it a versatile option for patients, and it has few contraindications in children 1.
- The medication works by blocking histamine receptors in the brain, which helps reduce anxiety symptoms.
- Unlike benzodiazepines, hydroxyzine is not habit-forming, making it suitable for longer-term use.
- Common side effects include drowsiness, dry mouth, and dizziness.
- Hydroxyzine should be used cautiously in older adults and those with certain medical conditions.
Dosage and Administration
- The typical dosage for adults with anxiety is 25-100 mg taken 3-4 times daily as needed.
- Treatment can begin with a lower dose (25 mg) and be adjusted based on the patient's response.
- Hydroxyzine starts working within 15-30 minutes, and its effects last about 4-6 hours.
Special Considerations
- Always take hydroxyzine as prescribed and discuss with your doctor if you're pregnant, breastfeeding, or taking other medications, as interactions can occur.
- It's particularly helpful for anxiety with physical symptoms like tension or sleep disturbances.
- For patients with cancer, addressing anxiety and depressive symptoms is crucial, as these conditions can significantly impact quality of life and even survival rates 1.
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. Hydroxyzine is used for symptomatic relief of anxiety and tension.
- The drug is indicated for anxiety associated with psychoneurosis.
- It can be used as an adjunct in organic disease states where anxiety is present. The effectiveness of hydroxyzine for long term use (more than 4 months) has not been assessed by systematic clinical studies 2.
From the Research
Efficacy of Hydroxyzine for Anxiety
- Hydroxyzine has been shown to be effective in treating generalized anxiety disorder (GAD) compared to placebo 3, 4, 5.
- Studies have demonstrated that hydroxyzine is equivalent in terms of efficacy to other anxiolytic agents such as benzodiazepines and buspirone 3.
- Hydroxyzine has been found to be effective in reducing anxiety symptoms, improving sleep, and reducing stress and anxiety associated with coronary disease 4.
Safety and Tolerability of Hydroxyzine
- Hydroxyzine has been shown to be generally safe and well-tolerated, with a side effect profile similar to that of other anxiolytic agents 3, 5.
- However, hydroxyzine has been associated with a higher rate of sleepiness/drowsiness compared to other active comparators 3.
- Studies have found that hydroxyzine does not have a high risk of dependency or organ toxicity 4, 5.
Comparison with Other Treatments
- Hydroxyzine has been compared to other treatments for anxiety, including benzodiazepines, buspirone, and selective serotonin reuptake inhibitors (SSRIs) 3, 4, 6, 5.
- While hydroxyzine may not be considered a first-line treatment for GAD due to the high risk of bias in included studies and small sample size, it may be an effective alternative treatment to benzodiazepines 3, 5.
- Co-administration of hydroxyzine with SSRIs may be a viable option, as it does not appear to antagonize the effects of SSRIs on reversing helpless behavior in animal models 7.