From the Guidelines
Hydroxyzine should be used with caution due to its potential for sedation, performance impairment, and anticholinergic effects, and its use is generally not preferred over second-generation antihistamines for the treatment of allergic rhinitis. Hydroxyzine is an antihistamine medication that can be used to treat anxiety, itching from allergic reactions, and as a sedative 1. It works by blocking histamine H1 receptors in the body, which helps reduce allergic symptoms, and also affects certain brain chemicals that may be unbalanced in people with anxiety. The typical adult dosage ranges from 25-100 mg taken 3-4 times daily, while children receive lower doses based on weight. However, according to a recent study, hydroxyzine is a sedative antihistamine approved for anxiolytic use both in Europe and in the United States (US) 1.
Key Considerations
- Hydroxyzine has significant potential to cause sedation, performance impairment, and anticholinergic effects, which can be undesirable and potentially dangerous 1.
- The use of hydroxyzine should be approached with caution in older adults, who are more sensitive to its psychomotor impairment and are at increased risk for complications such as fractures and subdural hematomas caused by falls 1.
- Hydroxyzine should not be combined with alcohol or other central nervous system depressants, as this can increase sedation 1.
- The medication typically begins working within 15-30 minutes and its effects can last 4-6 hours, making it useful for both acute anxiety episodes and allergic reactions.
Alternatives and Precautions
- Second-generation antihistamines are generally preferred over first-generation antihistamines like hydroxyzine for the treatment of allergic rhinitis due to their lower likelihood of adverse effects 1.
- Topical anticholinergic agents may be preferred over systemic agents like hydroxyzine for patients with persistent rhinorrhea despite a second-generation antihistamine and a intranasal corticosteroid 1.
- Hydroxyzine is not recommended for pregnant women, especially in the first trimester, or for people with certain heart conditions as it may prolong the QT interval.
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. Useful in the management of pruritus due to allergic conditions such as chronic urticaria and atopic and contact dermatoses and in histamine-mediated pruritus As a sedative when used as a premedication and following general anesthesia, hydroxyzine may potentiate meperidine and barbiturates, so their use in pre-anesthetic adjunctive therapy should be modified on an individual basis.
The use of Hydroxyzine (Atarax) is for:
- Anxiety and tension relief associated with psychoneurosis
- Pruritus management due to allergic conditions such as chronic urticaria and atopic and contact dermatoses
- Sedation as a premedication and following general anesthesia 2
From the Research
Uses of Hydroxyzine (Atarax)
- Hydroxyzine is used for the treatment of generalized anxiety disorder (GAD) 3, 4
- It is also used as an antihistamine medication for symptomatic relief of anxiety and tension 5
- In dentistry, hydroxyzine is prescribed to young patients as part of the first level of conscious sedation to manage anxiety during dental treatment procedures 6
- Hydroxyzine has been studied in combination with other anxiolytic agents, such as benzodiazepines, for its potential anxiolytic effects 3, 7
Efficacy of Hydroxyzine
- Studies have shown that hydroxyzine is more effective than placebo in alleviating the acute symptoms of GAD 3, 4
- Hydroxyzine has been found to be equivalent in terms of efficacy, acceptability, and tolerability compared to other anxiolytic agents, such as benzodiazepines and buspirone 3
- However, the use of hydroxyzine in combination with other anxiolytic agents, such as diazepam, may not have a synergistic effect on anxiolytic responses 7
Safety and Tolerability of Hydroxyzine
- Hydroxyzine has been found to be generally safe and well-tolerated, with a low risk of adverse effects 3, 4, 6
- However, hydroxyzine has been associated with a higher rate of sleepiness/drowsiness compared to other anxiolytic agents 3
- Careful analysis of the literature and results of studies have shown the safety of hydroxyzine within the maximum dose authorized without adverse effects 6