What is hydroxyzine used for?

Hydroxyzine Uses in Clinical Practice

Hydroxyzine is primarily used for the management of pruritus due to allergic conditions (such as chronic urticaria and atopic/contact dermatoses), anxiety disorders, and as a sedative for premedication before procedures. 1

Primary Clinical Indications

1. Dermatological Uses

• Pruritus management:
  • Effective for pruritus associated with allergic conditions including:
    • Chronic urticaria
    • Atopic dermatitis
    • Contact dermatitis
    • Histamine-mediated pruritus 1
  • Dosing: 25-50 mg daily (often divided) for adults 2, 3
  • Can be used as a nighttime sedating antihistamine (10-50 mg) to complement daytime non-sedating antihistamines 2, 3

2. Psychiatric Uses

• Anxiety disorders:
  • Symptomatic relief of anxiety and tension associated with psychoneurosis 1
  • Adjunctive therapy in organic disease states with anxiety manifestations
  • Typically dosed at 50 mg/day for generalized anxiety disorder 4
  • Note: Long-term efficacy (beyond 4 months) has not been established by systematic clinical studies 1

3. Procedural Uses

• Pre-anesthetic medication:
  • Used as a sedative before and after general anesthesia 1
  • May potentiate effects of meperidine and barbiturates

Special Considerations

Dosing Adjustments

• Renal impairment:

  • Moderate impairment: Reduce dose by 50%
  • Severe impairment: Avoid use 2, 3

• Hepatic impairment:

  • Severe liver disease: Avoid use due to inappropriate sedating effects 2

Contraindications and Cautions

• Pregnancy: Contraindicated during early pregnancy 2, 3
• QT prolongation risk: Use with caution in patients with risk factors for QT prolongation or TdP 1
• CNS depression: Potentiates effects of other CNS depressants; dosage adjustments needed 1
• Elderly patients: Start at lowest possible dose (10 mg) due to increased sensitivity 3

Efficacy Evidence

• Significantly improves quality of life and reduces pruritus scores in patients with chronic pruritus 5
• More effective than placebo for generalized anxiety disorder (GAD) 6
• Effective in suppressing symptoms of seasonal allergic rhinitis 7

Side Effects and Monitoring

• Common side effects:

  • Sedation/drowsiness (most common, typically transient) 4
  • Dry mouth
  • Dizziness
  • Weight gain 4

• Rare but serious reactions:

  • Acute Generalized Exanthematous Pustulosis (AGEP) 1
  • Potential worsening of contact dermatitis in ethylenediamine-sensitive patients 8

Clinical Pearls

• Hydroxyzine's sedating properties make it particularly useful for nighttime dosing in pruritic conditions 2
• Consider combination therapy with non-sedating antihistamines for 24-hour coverage 3
• Monitor for drowsiness, especially when initiating therapy or increasing dose
• Avoid concomitant use with alcohol and other CNS depressants 1
• Discontinue if signs of hypersensitivity reactions appear 1

Remember that hydroxyzine's sedating effects can be both therapeutic (for sleep disturbance from pruritus) and problematic (for daytime functioning), so timing of administration should be considered carefully based on the patient's needs and schedule.