What is the recommended dosing for hydroxyzine (antihistamine) for treating anxiety or itching?

From the Guidelines

Hydroxyzine is typically prescribed at 25-100 mg 3-4 times daily for adults, with a usual starting dose of 25 mg 3-4 times daily, but due to its sedative effects, it should be used with caution, especially in elderly patients and those with certain cardiac conditions 1. When considering the dosing for hydroxyzine, it's essential to weigh the benefits against the potential risks, particularly sedation and anticholinergic effects, which can impact morbidity, mortality, and quality of life.

Key Considerations

• For anxiety, the recommended dose is 25-100 mg 3-4 times daily for adults, with a starting dose of 25 mg 3-4 times daily.
• For itching (pruritus), the recommended adult dose is 25 mg 3-4 times daily.
• Children's dosing varies by weight and age, with those 6 years and older typically receiving 12.5-25 mg 3-4 times daily, and younger children (under 6) receiving approximately 2 mg/kg/day divided into 3-4 doses.
• Elderly patients should start at the lower end of the dosing range due to increased sensitivity to side effects, as noted in studies such as 1.

Important Safety Information

• Hydroxyzine can cause drowsiness, so it's best taken when sedation won't interfere with daily activities.
• Patients should avoid alcohol and other CNS depressants while taking hydroxyzine, as these combinations can increase sedation.
• Hydroxyzine should be used with caution in patients with certain cardiac conditions due to potential QT interval prolongation, highlighting the need for careful patient selection and monitoring, as suggested by 1.

Clinical Context

• The choice of hydroxyzine should consider the potential for sedative effects, which can be beneficial for sleep induction but may impair daytime functioning, especially in tasks requiring alertness and coordination, as discussed in 1.
• Given the availability of second-generation antihistamines with less sedative potential, hydroxyzine's use should be carefully justified, particularly in populations vulnerable to its side effects, such as the elderly, as cautioned in 1 and 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: adults, 50 to 100 mg q.i.d. ; children under 6 years, 50 mg daily in divided doses; children over 6 years, 50 to 100 mg daily in divided doses. For use in the management of pruritus due to allergic conditions such as chronic urticaria and atopic and contact dermatoses and in histamine-mediated pruritus: adults, 25 mg t.i.d. or q.i.d. ; children under 6 years, 50 mg daily in divided doses; children over 6 years, 50 to 100 mg daily in divided doses. The recommended dosing for hydroxyzine is:

• For anxiety: 50 to 100 mg four times a day for adults, and 50 to 100 mg daily in divided doses for children over 6 years.
• For itching: 25 mg three or four times a day for adults, and 50 to 100 mg daily in divided doses for children over 6 years. 2

From the Research

Recommended Dosing for Hydroxyzine

The recommended dosing for hydroxyzine varies depending on the condition being treated.

• For anxiety, the typical dose is 50-100 mg per day, divided into 3-4 doses 3.
• For itching, the dose can range from 25-100 mg per day, depending on the severity of the symptoms.

Efficacy of Hydroxyzine

Hydroxyzine has been shown to be effective in treating generalized anxiety disorder (GAD) and itching.

• Studies have demonstrated that hydroxyzine is more effective than placebo in alleviating symptoms of GAD 4, 3.
• Hydroxyzine has also been shown to be equivalent to other anxiolytic agents, such as benzodiazepines and buspirone, in terms of efficacy and tolerability 4.

Side Effects and Interactions

Hydroxyzine can cause side effects, including drowsiness, dry mouth, and dizziness.

• It can also interact with other medications, such as sedatives and antidepressants, which can increase the risk of adverse effects 5.
• The pharmacokinetics of hydroxyzine, including its metabolism and plasma level variations, can affect its clinical efficacy and safety 5.

Clinical Considerations

When prescribing hydroxyzine, clinicians should consider the patient's medical history, current medications, and potential risks and benefits.

• Hydroxyzine may not be suitable for patients with certain medical conditions, such as glaucoma or urinary retention 4.
• Clinicians should also be aware of the potential for dependence and withdrawal symptoms when using hydroxyzine, particularly in patients with a history of substance abuse 6.