Which hydroxyzine formulation, tablet or capsule, is used to treat hives and anxiety?

Hydroxyzine Formulations for Treating Hives and Anxiety

Both hydroxyzine tablet and capsule formulations are effective for treating hives and anxiety, as they contain the same active ingredient (hydroxyzine hydrochloride) and differ only in their inactive ingredients and delivery form. 1

Formulation Information

• Hydroxyzine hydrochloride is available in tablet form in 10 mg, 25 mg, and 50 mg strengths 2
• The active ingredient is the same in both tablet and capsule formulations, with the primary difference being the inactive ingredients and delivery mechanism
• Tablets contain: anhydrous lactose, colloidal silicon dioxide, crospovidone, hypromellose, magnesium stearate, microcrystalline cellulose, polyethylene glycol, polysorbate, and titanium dioxide 2

Dosing for Hives (Urticaria)

• For adults with urticaria, the recommended dosage is 25 mg three to four times daily 1
• For severe cases of hives, consider adding a non-sedating antihistamine during daytime hours 1
• Hydroxyzine can be used as a nighttime sedating antihistamine (10-50 mg) to complement daytime non-sedating antihistamines for 24-hour symptom control 1
• For pruritus management associated with allergic conditions, including chronic urticaria, the recommended dose is 25-50 mg daily for adults 1

Dosing for Anxiety

• Hydroxyzine has demonstrated efficacy in generalized anxiety disorder compared to placebo 1, 3
• Studies have shown efficacy at 50 mg/day for anxiety disorders 4, 5
• The medication begins working during the first week of treatment and maintains effectiveness throughout continued use 5

Special Considerations

Elderly Patients

• Start at the lowest possible dose (10 mg) due to increased sensitivity to psychomotor impairment and higher risk of complications such as falls 1

Patients with Impaired Renal or Hepatic Function

• In moderate renal impairment, reduce dose by 50% 1
• In severe renal impairment, avoid use 1
• Use with caution or avoid altogether in patients with severe liver disease 1

Side Effects to Monitor

• The most common side effect is transient sleepiness/drowsiness, which typically appears during the first week of treatment and progressively diminishes 5
• Other potential side effects include dry mouth, weight gain, and loss of concentration 5
• First-generation antihistamines like hydroxyzine can impair learning and school performance in children, driving ability in adults, and increase risk of occupational accidents 1

Important Clinical Pearls

• Hydroxyzine works better as a prophylactic than as an acute treatment for hives because once symptoms appear, it's too late to block histamine binding to receptors 6
• For severe or prolonged urticaria, combining hydroxyzine with other treatments may be necessary 7
• Avoid concomitant use with alcohol, sedatives, hypnotics, or antidepressant medications as this may enhance performance impairment 1
• Hydroxyzine is contraindicated during early pregnancy 1

In summary, both tablet and capsule formulations of hydroxyzine are effective for treating hives and anxiety. The choice between them should be based on patient preference, availability, and specific dosing requirements rather than differences in efficacy.