What is the recommended dosage and usage of Hydroxyzine for anxiety and itching?

Hydroxyzine Dosage and Usage for Anxiety and Itching

For anxiety, hydroxyzine is recommended at 50-100 mg four times daily for adults, while for itching/pruritus, the recommended dosage is 25 mg three to four times daily for adults. 1

Dosage Recommendations by Indication and Age Group

For Anxiety:

• Adults: 50-100 mg four times daily 1
• Children over 6 years: 50-100 mg daily in divided doses 1
• Children under 6 years: 50 mg daily in divided doses 1

For Pruritus/Itching:

• Adults: 25 mg three to four times daily 1
• Children over 6 years: 50-100 mg daily in divided doses 1
• Children under 6 years: 50 mg daily in divided doses 1

Clinical Efficacy

• Hydroxyzine has demonstrated significant efficacy for generalized anxiety disorder at 50 mg/day compared to placebo, with anxiety reduction beginning within the first week of treatment 2
• For pruritus management, hydroxyzine is effective as an oral antihistamine for various grades of skin conditions 3
• In a 3-month study, hydroxyzine (50 mg/day) showed maintained efficacy and safety comparable to bromazepam (6 mg/day) for generalized anxiety disorder 4

Administration Guidelines

• When initiating treatment, dosage should be adjusted according to patient response 1
• For sedation before procedures or following general anesthesia: 50-100 mg for adults and 0.6 mg/kg for children 1
• For dermatologic conditions, hydroxyzine can be combined with topical corticosteroids for enhanced symptom relief 3

Side Effects and Precautions

• Common side effects include:

  • Sleepiness/drowsiness (most common, typically transient and resolving after the first week) 2
  • Dry mouth 2
  • Weight gain 2
  • Loss of concentration 2

• Hydroxyzine should be used with caution in:

  • Patients with liver disease (may require dose reduction) 5
  • Elderly patients (increased risk of anticholinergic effects)
  • Early pregnancy (contraindicated) 5

Special Considerations

• First-generation antihistamines like hydroxyzine have more sedative effects than second-generation alternatives 3
• For patients with liver disease, second-generation antihistamines are generally preferred over hydroxyzine, with dose adjustments 5
• In cases where anxiety is severe, hydroxyzine has shown efficacy at 50 mg/day without significant withdrawal symptoms upon discontinuation 2

Practical Application

• For itching conditions:

  • Grade 1 (mild/localized): Hydroxyzine 10-25 mg QID or at bedtime, combined with topical corticosteroids 3
  • Grade 2 (intense/widespread): Hydroxyzine 10-25 mg QID or at bedtime, combined with topical steroids and possibly oral corticosteroids 3
  • Grade 3 (severe): Hydroxyzine 10-25 mg QID or at bedtime, with dermatology referral and systemic therapy 3

• For anxiety management:

  • Start with 50 mg/day for generalized anxiety disorder 2
  • May increase to 50-100 mg QID if needed for symptom control 1
  • Monitor for sedation, especially during initial treatment period

Hydroxyzine provides effective relief for both anxiety and itching conditions when dosed appropriately, with manageable side effects primarily related to its sedative properties.