From the Guidelines
Hydroxyzine can be used for urticaria, particularly for nighttime itching, at a dose of 10-50 mg, but its use should be considered with caution due to potential sedating effects. According to the guidelines for evaluation and management of urticaria in adults and children 1, sedating antihistamines like hydroxyzine can be effective and well tolerated by some individuals, but their use as monotherapy is now less common due to concerns about reduced concentration and performance. The study suggests that the addition of a sedating antihistamine at night, such as hydroxyzine 10-50 mg, to a non-sedating antihistamine by day may help patients sleep better, although it probably has little additional clinical effect on urticaria if the H1 receptor is already saturated.
Some key points to consider when using hydroxyzine for urticaria include:
- The potential for sedating effects, which may be beneficial for nighttime itching but could cause drowsiness during the day
- The need to avoid alcohol and activities requiring mental alertness until you know how the medication affects you
- The possibility of side effects such as dry mouth and constipation
- The importance of consulting your healthcare provider if your urticaria persists beyond a few weeks or is severe, as additional treatments may be needed
It's also worth noting that cetirizine, the active metabolite of hydroxyzine, is a nonsedating H1 antihistamine that may be a better option for some patients, especially those who need to maintain alertness during the day 1. However, the choice of antihistamine should be individualized based on the patient's specific needs and circumstances.
From the Research
Urticaria Treatment Options
- Urticaria is a cutaneous syndrome characterized by dermal edema and erythema that blanches with pressure, typically lasting less than 24 hours and usually pruritic 2.
- The mainstay of treatment for urticaria is avoidance of triggers, if identified, and first-line pharmacotherapy is second-generation H1 antihistamines, which can be titrated to greater than standard doses 3.
Hydroxyzine for Urticaria
- Hydroxyzine is a first-generation H1 antihistamine that can be used as an adjunctive treatment for urticaria 3.
- Studies have shown that hydroxyzine is effective in the treatment of urticarias, but it also has marked sedative and anticholinergic effects 2, 4, 5.
- In a study comparing cetirizine with hydroxyzine and placebo in chronic idiopathic urticaria, cetirizine was found to be equivalent to hydroxyzine in controlling symptoms, but with fewer sedative effects 5.
- Another study found that loratadine was as effective as hydroxyzine in the treatment of urticaria, but with significant antipruritic effects and without the central nervous system effects of hydroxyzine 4.
Alternative Treatment Options
- Second-generation H1 antihistamines, such as loratadine and cetirizine, are preferred over first-generation antihistamines like hydroxyzine due to their reduced sedative and anticholinergic effects 2, 4, 5.
- In cases of acute urticaria, a 4-day "burst" course of prednisone added to standard treatment with H1 antihistamines, such as hydroxyzine, may improve symptomatic and clinical response 6.