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: adults, 50 to 100 mg q.i.d. ; children under 6 years, 50 mg daily in divided doses; children over 6 years, 50 to 100 mg daily in divided doses. The dosage of hydroxyzine for anxiety disorder is:
- Adults: 50 to 100 mg four times a day (q.i.d.)
- Children over 6 years: 50 to 100 mg daily in divided doses
- Children under 6 years: 50 mg daily in divided doses 1
From the Research
Hydroxyzine is typically prescribed for anxiety at doses of 25-100 mg taken 3-4 times daily as needed, with a maximum daily dose not exceeding 400 mg, as supported by the most recent and highest quality study available 2. For most adults with anxiety, starting with 25 mg three times daily is common, with the possibility of increasing to 50-100 mg per dose if needed and tolerated. Some key points to consider when prescribing hydroxyzine for anxiety include:
- Elderly patients or those with liver impairment usually start at lower doses, around 10-25 mg per dose.
- Hydroxyzine works as an antihistamine with sedative properties that helps reduce anxiety symptoms by affecting histamine and serotonin in the brain.
- It begins working within 15-30 minutes and effects typically last 4-6 hours.
- Common side effects include drowsiness, dry mouth, and dizziness, which is why it's often taken at bedtime if sedation is problematic during the day.
- Hydroxyzine should not be combined with other central nervous system depressants like alcohol, and patients should avoid driving or operating machinery until they know how the medication affects them. The efficacy of hydroxyzine in treating generalized anxiety disorder has been demonstrated in several studies, including a multicentre double-blind comparison of hydroxyzine, buspirone, and placebo, which showed that hydroxyzine was significantly more effective than placebo in improving symptoms of anxiety 2. Other studies have also supported the use of hydroxyzine for anxiety, including a study that found hydroxyzine to be more effective than placebo in reducing anxiety symptoms, with a significant difference in improvement on the Hamilton Anxiety Scale 3. However, it's essential to consider the potential side effects and interactions of hydroxyzine, as well as individual patient factors, when determining the optimal dosage and treatment plan. In terms of specific dosing recommendations, a study found that hydroxyzine at a dose of 50 mg per day was effective in reducing anxiety symptoms, with a significant improvement in anxiety scores compared to placebo 3. Another study found that hydroxyzine at a dose of 25-100 mg per day was effective in treating generalized anxiety disorder, with a significant reduction in anxiety symptoms compared to placebo 4. Overall, the available evidence supports the use of hydroxyzine at doses of 25-100 mg per day for the treatment of anxiety, with individualized dosing based on patient response and tolerability.