Hydroxyzine (Atarax) Dosage for a 17-Year-Old with Anxiety
For a 17-year-old with anxiety, the recommended dosage of hydroxyzine (Atarax) is 50-100 mg daily in divided doses. 1
Dosing Guidelines
The FDA-approved dosing for hydroxyzine in anxiety is age-specific:
- Adults: 50-100 mg four times daily
- Children over 6 years (including adolescents): 50-100 mg daily in divided doses 1
For a 17-year-old patient, who falls into the adolescent category but is approaching adulthood, the following dosing approach is recommended:
- Initial dosing: Start with 25 mg three times daily or 50 mg twice daily
- Titration: Adjust based on response and tolerability
- Maximum daily dose: 100 mg daily in divided doses
Administration Considerations
- Hydroxyzine can be taken with or without food
- Divided doses (2-4 times daily) are preferred to maintain consistent anxiolytic effects
- Evening/bedtime dosing may be emphasized if sedation is a desired effect to help with sleep
Efficacy for Anxiety
Hydroxyzine has demonstrated efficacy for generalized anxiety disorder:
- Superior to placebo in reducing anxiety symptoms 2, 3
- Effects typically begin within the first week of treatment 3
- Maintains efficacy throughout treatment periods without developing tolerance 4
Side Effects and Monitoring
Common side effects to monitor in adolescents:
- Sedation/drowsiness (most common, reported in 28% vs. 14% with placebo) 3
- Dry mouth (14% vs. 5% with placebo)
- Weight changes
- Concentration difficulties
Important note: Sedation tends to be most prominent during the first week of treatment and often diminishes with continued use 3.
Advantages and Limitations
Advantages:
- Non-habit forming (unlike benzodiazepines)
- No withdrawal syndrome upon discontinuation
- No evidence of dependency development 4
- Can be used as needed or regularly
Limitations:
- Sedation may interfere with school performance or driving
- Limited long-term efficacy data specifically in adolescents
- May not be sufficient for severe anxiety disorders
Alternative Options
If hydroxyzine is ineffective or poorly tolerated, consider:
- SSRIs: First-line pharmacological treatment for persistent anxiety disorders in adolescents 5
- Psychotherapy: Cognitive behavioral therapy (CBT) has strong evidence for anxiety in adolescents 5
- Combination therapy: CBT plus medication may be more effective than either treatment alone for persistent anxiety 5
Clinical Pearls
- Avoid combining with other CNS depressants which may increase sedation
- Counsel the patient about potential drowsiness, especially when initiating treatment
- Reassess efficacy after 2-4 weeks of consistent use
- Consider as a short-term solution while implementing longer-term strategies like CBT
- Monitor for paradoxical reactions (rare but possible in adolescents)
Remember that medication management should be part of a comprehensive treatment approach for adolescent anxiety that includes appropriate psychological interventions.