Is Atarax (hydroxyzine) used to relieve itching?

Hydroxyzine (Atarax) for Itching

Yes, hydroxyzine (Atarax) is specifically indicated for the management of pruritus (itching) due to allergic conditions such as chronic urticaria and atopic and contact dermatoses. 1

FDA-Approved Indications and Dosing

Hydroxyzine is FDA-approved for:

• Management of pruritus due to allergic conditions including:
  • Chronic urticaria
  • Atopic dermatitis
  • Contact dermatoses
  • Histamine-mediated pruritus

Recommended dosing for pruritus:

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

Role in Treatment Guidelines

Hydroxyzine is recognized in clinical guidelines as a treatment option for pruritus, but with important limitations:

• For generalized pruritus of unknown origin (GPUO), hydroxyzine is recommended only for short-term use or in palliative settings due to its sedative properties 2
• Non-sedating antihistamines (fexofenadine, loratadine) or mildly sedative agents (cetirizine) are generally preferred as first-line options for GPUO 2
• Hydroxyzine should not be prescribed for elderly patients with pruritus due to increased risk of adverse effects 2

Clinical Considerations and Cautions

Benefits:

• Effective for acute pruritus relief due to dual antihistamine and sedative effects
• Particularly useful for nighttime itching when sedation may be beneficial
• Can be helpful in short-term management of severe pruritic conditions

Important cautions:

1. Sedation: Hydroxyzine causes significant sedation, which may limit daytime use
2. Anticholinergic effects: Can cause dry mouth, urinary retention, and confusion
3. Elderly patients: Should be avoided in elderly due to increased risk of falls, confusion, and anticholinergic effects 2
4. Rare allergic reactions: In rare cases, hydroxyzine itself can cause allergic reactions, particularly in patients with sensitivities to ethylenediamine compounds 3, 4, 5

Alternative Treatment Options

For patients who cannot tolerate hydroxyzine or when it's contraindicated:

• First-line alternatives:

  • Non-sedating antihistamines: fexofenadine 180 mg or loratadine 10 mg
  • Mildly sedating antihistamines: cetirizine 10 mg 2, 6

• For persistent pruritus:

  • Consider combination H1 and H2 antagonists (e.g., fexofenadine and cimetidine)
  • Neuromodulators: gabapentin (300mg 1-3 times daily) or pregabalin (75mg twice daily) 2, 6
  • Other options: paroxetine, mirtazapine, naltrexone, ondansetron 2

Summary

Hydroxyzine (Atarax) is an effective medication for treating itching, particularly for allergic conditions. However, its use should be limited to short-term therapy or palliative settings due to sedative effects. Non-sedating antihistamines are generally preferred for daytime use and in elderly patients. Always consider the patient's age, comorbidities, and other medications when prescribing hydroxyzine for pruritus.