What is the recommended dose of hydroxyzine (antihistamine) for a 16-year-old with anxiety and itching?

Hydroxyzine Dosing for a 16-Year-Old with Anxiety and Itching

For a 16-year-old with anxiety and itching, the recommended dose of hydroxyzine is 50-100 mg daily in divided doses, typically administered as 10-25 mg four times daily or at bedtime. 1

Dosing Considerations

Age-Specific Dosing

• For patients over 6 years old (including adolescents): 50-100 mg daily in divided doses 1
• This applies to both anxiety management and treatment of pruritus (itching)

Dosing Schedule Options

1. For anxiety management:

   • 10-25 mg four times daily (QID) 2
   • Can be administered at bedtime to minimize daytime sedation 2

2. For pruritus/itching:

   • 10-25 mg four times daily (QID) 2
   • Can be given at bedtime for nighttime symptom relief 2

Clinical Considerations

Sedation Management

• Hydroxyzine is a first-generation antihistamine with significant sedative properties 2
• Consider timing administration to minimize impact on daily activities:
  • Evening/bedtime dosing can help minimize daytime sedation while maintaining efficacy 3
  • Morning doses may impair school performance due to drowsiness

Efficacy Considerations

• Hydroxyzine is effective for both anxiety and pruritus:
  • For anxiety: Demonstrates significant anxiolytic effects starting within the first week of treatment 4
  • For pruritus: Effective for allergic conditions including chronic urticaria 2

Potential Side Effects

• Common side effects include:
  • Drowsiness/sedation (most common) 5
  • Dry mouth 4
  • Potential cognitive impairment 5
  • Prolonged reaction time 5

Important Precautions

Performance Considerations

• Hydroxyzine significantly prolongs both simple and choice reaction times 5
• Warn the 16-year-old about potential impairment for:
  • Driving (if applicable)
  • Operating machinery
  • School performance requiring alertness

Monitoring

• Assess response to initial dosing and adjust as needed
• Monitor for excessive sedation, especially during the first week of treatment 4
• Sedation often improves with continued use as tolerance develops 4

Alternative Approaches

• If daytime sedation is problematic:
  • Consider once-daily dosing at bedtime 3
  • Non-sedating antihistamines may be preferable for daytime itching control 2
  • For anxiety, consider combining with non-pharmacological approaches

Special Considerations for Adolescents

• Start at the lower end of the dosing range (50 mg daily divided) and titrate as needed
• Avoid combining with other CNS depressants
• Assess impact on school performance and adjust dosing schedule accordingly

Remember that hydroxyzine's sedative effects may be beneficial for nighttime symptoms but could interfere with daytime functioning in a school-aged adolescent.