What are the guidelines for using hydroxyzine in elderly patients?

From the Guidelines

Hydroxyzine should be used with extreme caution in elderly patients due to its high risk of adverse effects, including sedation, anticholinergic effects, and increased risk of falls and cognitive impairment. The use of hydroxyzine in elderly patients is associated with significant potential risks, including sedative effects, performance impairment, and anticholinergic effects, as noted in the study by 1. Elderly patients are more sensitive to the psychomotor impairment promoted by first-generation antihistamines, such as hydroxyzine, and are at increased risk for complications such as fractures and subdural hematomas caused by falls.

Some key considerations when using hydroxyzine in elderly patients include:

• Lower starting doses, typically 10-25 mg per dose, with a maximum daily dose not exceeding 50-75 mg divided throughout the day
• Careful monitoring for adverse effects, including sedation, dizziness, urinary retention, and constipation
• Use for the shortest duration necessary due to increased risk of side effects in this population
• Regular reassessment of the need for continued therapy, with consideration of non-pharmacological approaches or alternative medications with better safety profiles

The study by 1 highlights the importance of caution when prescribing first-generation antihistamines, such as hydroxyzine, to elderly patients, due to their increased susceptibility to adverse anticholinergic effects and increased risk of falls and cognitive impairment. Alternative medications with better safety profiles should be considered when possible, and hydroxyzine should only be used when the benefits outweigh the risks.

From the FDA Drug Label

In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal or cardiac function, and of concomitant disease or other drug therapy Sedating drugs may cause confusion and over sedation in the elderly; elderly patients generally should be started on low doses of hydroxyzine and observed closely.

The guidelines for using hydroxyzine in elderly patients are to:

• Start with a low dose
• Be cautious in dose selection due to potential decreased hepatic, renal, or cardiac function
• Monitor closely for signs of confusion and over-sedation 2

From the Research

Guidelines for Using Hydroxyzine in Elderly Patients

There are no specific guidelines provided in the given studies for using hydroxyzine in elderly patients. However, the following points can be considered:

• Hydroxyzine is an anti-histamine medication that has been used in the treatment of anxiety disorders, including generalized anxiety disorder (GAD) 3, 4, 5.
• The efficacy and safety of hydroxyzine in the treatment of GAD have been demonstrated in several studies, including a 3-month double-blind study 5.
• Hydroxyzine has been compared to other anxiolytic agents, such as benzodiazepines and buspirone, and has been found to be equivalent in terms of efficacy, acceptability, and tolerability 3.
• The side effects of hydroxyzine, including drowsiness, have been reported in several studies 3, 5, 6.
• The sedative effects of hydroxyzine can vary depending on the time of administration, with morning doses potentially causing more impairment than evening doses 6.

Considerations for Elderly Patients

When considering the use of hydroxyzine in elderly patients, the following points should be taken into account:

• Elderly patients may be more susceptible to the sedative effects of hydroxyzine due to age-related changes in pharmacokinetics and pharmacodynamics.
• The risk of adverse effects, such as drowsiness and cognitive impairment, may be higher in elderly patients.
• Hydroxyzine should be used with caution in elderly patients, and the dosage should be carefully titrated to minimize the risk of adverse effects.
• Alternative treatment options, such as cognitive behavioral therapy (CBT) and other psychological strategies, may be considered for elderly patients with anxiety disorders 7.

Key Findings

• Hydroxyzine is effective in the treatment of GAD, with a significant reduction in anxiety symptoms compared to placebo 3, 5.
• Hydroxyzine is generally well-tolerated, with a side effect profile similar to that of other anxiolytic agents 3, 5.
• The sedative effects of hydroxyzine can be significant, particularly when administered in the morning 6.