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 effectiveness of hydroxyzine as an antianxiety agent for long term use, that is more than 4 months, has not been assessed by systematic clinical studies. The physician should reassess periodically the usefulness of the drug for the individual patient. The recommended duration of hydroxyzine use for anxiety treatment is not explicitly stated, but it is noted that the effectiveness for long term use, more than 4 months, has not been assessed 1.
- The physician should reassess periodically the usefulness of the drug for the individual patient.
From the Research
Hydroxyzine should be used for anxiety on a short-term basis, typically for a few weeks to a few months, due to potential side effects like sedation and anticholinergic effects, as well as the risk of QT prolongation and torsade de pointes 2. The typical adult dosage ranges from 25-100mg taken 3-4 times daily as needed for anxiety symptoms. While hydroxyzine works quickly (within 30 minutes) by blocking histamine receptors in the brain, which helps reduce anxiety symptoms, it's best used as a temporary solution while establishing longer-term anxiety management strategies. Some key points to consider when using hydroxyzine for anxiety include:
- The medication can be effective in reducing anxiety symptoms, with studies showing significant improvements in anxiety scores compared to placebo 3, 4, 5.
- However, the risk of side effects like sedation, anticholinergic effects, and QT prolongation must be carefully considered, particularly in patients with underlying heart conditions or those taking other medications that may interact with hydroxyzine 2.
- Hydroxyzine may be equivalent in terms of efficacy to other anxiolytic agents like buspirone, but it may have a more rapid onset of action 6, 5.
- The medication should be used with caution in patients with a history of substance abuse or dependence, as it may have the potential for abuse or dependence 2. If you find yourself needing hydroxyzine for more than a few months, consult with your healthcare provider about alternative treatments such as SSRIs, SNRIs, or buspirone, which are better suited for long-term anxiety management. Some people may develop tolerance to hydroxyzine's effects over time, making it less effective with prolonged use. Always follow your doctor's instructions regarding duration of use and never stop taking the medication abruptly without medical guidance.