Hydroxyzine Dosing in Children
The recommended dosage of hydroxyzine for children is 50 mg daily in divided doses for children under 6 years, and 50-100 mg daily in divided doses for children over 6 years, according to FDA guidelines. 1
Age-Based Dosing Recommendations
Children Under 6 Years
- Total daily dose: 50 mg divided throughout the day 1
- For anxiety and tension: 50 mg daily in divided doses
- For pruritus/allergic conditions: 50 mg daily in divided doses
- For sedation as premedication: 0.6 mg/kg body weight 1
Children Over 6 Years
- Total daily dose: 50-100 mg divided throughout the day 1
- For anxiety and tension: 50-100 mg daily in divided doses
- For pruritus/allergic conditions: 50-100 mg daily in divided doses
- For sedation as premedication: 0.6 mg/kg body weight 1
Specific Dosing Considerations
For Pruritus/Allergic Conditions
- Lower doses (0.7 mg/kg three times daily) have been shown to be as effective as higher doses (1.4 mg/kg three times daily) for treating pruritus in children with atopic dermatitis, with significantly less sedation 2
- Peak serum concentration typically occurs at approximately 2 hours after oral administration 2
- Antipruritic effects can last from 1 to 24 hours, with maximum effect (>85% suppression) between 2-12 hours 2
For Anxiolysis
- Hydroxyzine is approved for anxiolytic use in both Europe and the United States 3
- Available in tablet and syrup formulations, making administration easier in children 3
- Has fewer contraindications in children compared to some other anxiolytics 3
Administration Guidelines
- Adjust dosage according to the patient's response to therapy 1
- When treatment is initiated by intramuscular route, subsequent doses may be administered orally 1
- For sedation purposes, a single dose of 3.7 mg/kg has been used effectively 4
Safety Considerations
- Primary adverse effect is sedation, which should be monitored 2
- The elimination half-life increases with age (mean 7.1 ± 2.3 hours in children) 2
- Long-term use in preschool children has been associated with potential neurodevelopmental concerns; consider shortest possible duration of use 5
- Studies have shown an association between repeat hydroxyzine prescriptions in young children and increased rates of tic disorders, anxiety, and conduct disturbances compared to single prescriptions 5
Clinical Pearls
- Hydroxyzine can be combined with other agents like nitrous oxide for procedural sedation when needed 4
- Second-generation antihistamines may be preferred for long-term use due to lower sedative effects 6
- When transitioning from parenteral to oral administration, dosing can be maintained as appropriate for age 1
By following these dosing guidelines and considering the patient's specific needs and response, hydroxyzine can be effectively and safely used in pediatric patients for various indications including anxiety, pruritus, and sedation.