From the Guidelines
Hydroxyzine can cause anticholinergic side effects such as impairment of cognition, blurry vision, trouble urinating, and constipation, making option A the correct answer. The provided evidence does not directly discuss hydroxyzine's use in generalized anxiety disorder (GAD) but highlights various aspects of anxiety management and treatment options. However, based on general medical knowledge, hydroxyzine is known for its antihistamine properties and is sometimes used for its anxiolytic effects.
- Key points about hydroxyzine in the context of GAD include:
- It is not typically recommended as a first-line treatment for GAD due to its side effect profile, which includes sedation and anticholinergic effects.
- Hydroxyzine can be useful for short-term relief of anxiety symptoms, especially in patients who cannot tolerate first-line treatments.
- Its use should be cautious, particularly in elderly patients and those with certain medical conditions.
- The medication works by antagonizing H1 histamine receptors in the central nervous system, providing relief from anxiety symptoms without the dependence and tolerance issues associated with benzodiazepines, as noted in general medical practice 1. Given the information and focusing on the question about hydroxyzine in GAD, the most relevant point is its potential to cause anticholinergic side effects, aligning with option A.
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. The correct answer is B: Its not approved as monotherapy for GAD, only as adjunct.
- Hydroxyzine can be used for symptomatic relief of anxiety and tension associated with psychoneurosis, which includes generalized anxiety disorder (GAD).
- It is used as an adjunct in organic disease states in which anxiety is manifested, indicating it may not be used as a monotherapy for GAD. 2
From the Research
Hydroxyzine in Generalized Anxiety Disorder (GAD)
- Hydroxyzine is an anti-histamine medication that has been used in the treatment of anxiety, including GAD 3, 4, 5, 6.
- Studies have shown that hydroxyzine is more effective than placebo in alleviating the acute symptoms of GAD, with a significant decrease in anxiety scores compared to placebo 4, 6.
- 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, 6.
- Common side effects of hydroxyzine include sleepiness, weight gain, dry mouth, loss of concentration, and insomnia, with sleepiness being the most common side effect 4, 6.
- Hydroxyzine has been shown to produce a statistically and clinically significant anxiolytic effect, commencing during the first week of treatment and maintained throughout the 4-week period, with no rebound of anxiety or withdrawal symptoms after abrupt discontinuation 4, 5.
Comparison with Other Treatments
- Hydroxyzine has been compared to lorazepam, a benzodiazepine, and found to demonstrate greater and more rapid cognitive improvement 5, 7.
- A multicentre double-blind comparison of hydroxyzine, buspirone, and placebo found that hydroxyzine was significantly more effective than placebo in improving anxiety symptoms, with buspirone also showing efficacy 6.
Side Effects and Tolerability
- Hydroxyzine has been associated with a higher rate of sleepiness/drowsiness compared to other anxiolytic agents, but this side effect is often transient 3, 4.
- The most common side effects of hydroxyzine are sleepiness, weight gain, dry mouth, loss of concentration, and insomnia, with the majority of side effects being mild and transient 4, 6.
Efficacy and Acceptability
- Hydroxyzine has been found to be effective and acceptable in the treatment of GAD, with a significant decrease in anxiety symptoms and improvement in cognitive function 3, 4, 5, 6.
- The efficacy and acceptability of hydroxyzine are comparable to other anxiolytic agents, such as benzodiazepines and buspirone, making it a useful treatment option for GAD 3, 6.