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. The recommended dose of hydroxyzine for anxiety is:
- 50 to 100 mg every 4 hours (q.i.d.) for adults
- 50 mg daily in divided doses for children under 6 years
- 50 to 100 mg daily in divided doses for children over 6 years 1
From the Research
The recommended dose of hydroxyzine for anxiety in adults is typically 25-100 mg taken 3-4 times daily, with treatment usually beginning with a lower dose of 25 mg, which can be gradually increased as needed based on symptom response and tolerability. This dosing recommendation is based on the available evidence, including a study from 2010 2 that found hydroxyzine to be more effective than placebo for generalized anxiety disorder, although the study noted a high risk of bias in the included studies. Another study from 2020 3 discussed the pharmacotherapy of anxiety disorders, including the use of antihistamines like hydroxyzine, but did not provide specific dosing recommendations.
When considering the dosing of hydroxyzine, it's essential to take into account the patient's age and sensitivity to side effects. For elderly patients, starting doses should be lower, around 10-25 mg, due to increased sensitivity to side effects. Hydroxyzine works by blocking histamine H1 receptors in the central nervous system, which helps reduce anxiety symptoms, and it also has anticholinergic properties that contribute to its calming effects.
Some key points to consider when prescribing hydroxyzine for anxiety include:
- Starting with a lower dose and gradually increasing as needed
- Being aware of potential side effects, such as drowsiness, dry mouth, and dizziness
- Avoiding combination with other central nervous system depressants, like alcohol or benzodiazepines
- Monitoring patients for sedation risks and adjusting the dose accordingly
- Discussing any concerns about dosing with a healthcare provider
It's also important to note that while hydroxyzine can be effective for anxiety, other studies have compared its efficacy to other medications, such as selective serotonin reuptake inhibitors (SSRIs) and benzodiazepines, with mixed results 4, 5, 6. However, these studies do not provide specific guidance on the dosing of hydroxyzine for anxiety. Overall, the dosing of hydroxyzine for anxiety should be individualized and based on the patient's specific needs and response to treatment.