What is the recommended dose frequency of Vistaril (hydroxyzine) 50 mg for psychiatric patients?

Hydroxyzine 50mg Dosing Frequency for Psychiatric Patients

The recommended dosing frequency for Vistaril (hydroxyzine) 50mg in psychiatric patients is four times daily (q.i.d.), with a total daily dose of 50-100mg q.i.d. for anxiety and tension associated with psychoneurosis. 1

Dosing Guidelines

According to the FDA label for hydroxyzine, the following dosing regimen is recommended for psychiatric indications:

• For anxiety and tension associated with psychoneurosis: 50 to 100 mg four times daily (q.i.d.) for adults 1
• As a sedative: 50 to 100 mg as a single dose 1

Dosing Considerations

Patient-Specific Factors

• Age: Dosing should be adjusted according to the patient's response to therapy 1
• Elderly patients: May require lower doses due to increased risk of side effects
• Hepatic/renal impairment: May require dose adjustment

Clinical Efficacy

• Clinical trials have shown hydroxyzine to be effective for generalized anxiety disorder at doses of 50 mg/day, with significant anxiolytic effects starting during the first week of treatment 2
• A 3-month double-blind study demonstrated efficacy of hydroxyzine 50 mg/day in treating generalized anxiety disorder, with results comparable to bromazepam 6 mg/day 3

Side Effect Profile

• The most common side effects include:

  • Sleepiness/drowsiness (28% vs 14% with placebo) 2
  • Dry mouth (14% vs 5%) 2
  • Weight gain (12% vs 10%) 2
  • Loss of concentration (9% vs 8%) 2

• Sleepiness typically appears during the first week of treatment and progressively diminishes with continued use 2

Alternative Medications for Anxiety

If hydroxyzine is not suitable or effective, other medication options include:

• Benzodiazepines:

  • Lorazepam (Ativan): Dosage varies by agent 4
  • Oxazepam (Serax): Dosage varies by agent 4

• Non-benzodiazepines:

  • Buspirone (BuSpar): Initial dosage 5 mg twice daily; maximum 20 mg three times daily 4
  • Note: Buspirone may take 2-4 weeks to become effective and is useful only in patients with mild to moderate agitation 4

Important Clinical Considerations

• Hydroxyzine has been shown to maintain efficacy throughout treatment periods without development of tolerance 3
• No rebound anxiety or withdrawal symptoms have been observed after abrupt discontinuation 2
• When comparing hydroxyzine to haloperidol for delirium, hydroxyzine showed a higher rate of delirium improvement (23.9% vs 8.5%) 5
• Hydroxyzine may be a viable alternative to antipsychotics in certain situations due to its relatively favorable side effect profile 5

Monitoring Recommendations

• Assess response to treatment regularly
• Monitor for side effects, particularly sedation
• Evaluate need for continued treatment periodically
• Consider dose adjustments based on clinical response and tolerability

By following these dosing guidelines, clinicians can effectively use hydroxyzine for managing anxiety and tension in psychiatric patients while minimizing adverse effects.