What is the recommended dosage and usage of hydroxyzine pamoate for treating anxiety and itching?

Hydroxyzine Pamoate Dosage for Anxiety and Itching

For adults with anxiety, hydroxyzine pamoate should be administered at 50-100 mg four times daily, while for treating pruritus (itching), the recommended dosage is 25 mg three to four times daily. 1

Dosage Recommendations

For Anxiety:

• Adults: 50-100 mg four times daily 1
• Children over 6 years: 50-100 mg daily in divided doses 1
• Children under 6 years: 50 mg daily in divided doses 1

For Pruritus/Itching:

• Adults: 25 mg three to four times daily 1
• Children over 6 years: 50-100 mg daily in divided doses 1
• Children under 6 years: 50 mg daily in divided doses 1

Clinical Efficacy

Hydroxyzine has demonstrated efficacy for both anxiety and pruritus:

• For anxiety: Hydroxyzine has shown statistically significant anxiolytic effects compared to placebo, with benefits appearing during the first week of treatment and maintained throughout treatment periods 2
• For pruritus: Hydroxyzine is recommended as a first-line antihistamine for treating itching, particularly for nighttime use due to its sedative properties 3

Administration Considerations

• Timing: For pruritus that worsens at night, consider administering a larger portion of the daily dose at bedtime to take advantage of the sedative properties
• Duration: Efficacy has been demonstrated for up to 12 weeks of continuous treatment for anxiety 2
• Onset: Effects typically begin within the first week of treatment 4

Special Populations

Renal Impairment:

• Hydroxyzine should be avoided in severe renal impairment (creatinine clearance <10 mL/min) 3
• In moderate renal impairment, dose should be reduced

Hepatic Impairment:

• Avoid in severe liver disease as the sedating effect may be inappropriate 3

Pregnancy:

• Hydroxyzine is specifically contraindicated during early stages of pregnancy 3
• If antihistamine therapy is necessary during pregnancy, other options with longer safety records should be considered

Common Side Effects

• Sedation/drowsiness: Most common side effect (28% vs 14% with placebo) 4
• Dry mouth (14% vs 5% with placebo) 4
• Weight gain (12% vs 10% with placebo) 4

Clinical Pearls

• Sedation typically appears during the first week and progressively diminishes with continued treatment 4
• Unlike benzodiazepines, hydroxyzine does not cause withdrawal symptoms upon discontinuation 4
• For severe or widespread pruritus that doesn't respond to hydroxyzine alone, consider adding topical corticosteroids 3
• When treating anxiety, hydroxyzine has shown comparable efficacy to benzodiazepines but with a different side effect profile 2

Treatment Algorithm for Pruritus

1. Mild or localized pruritus: Start with hydroxyzine 25 mg at bedtime; add daytime doses as needed
2. Moderate pruritus: Hydroxyzine 25 mg 3-4 times daily, with higher dose at bedtime
3. Severe or widespread pruritus: Hydroxyzine 25 mg 3-4 times daily plus topical corticosteroids; if inadequate response after 2 weeks, consider adding GABA agonists (pregabalin/gabapentin) 3