Recommended Dosage of Hydroxyzine (Atarax) in Children
The recommended dosage of hydroxyzine (Atarax) for children under 6 years is 50 mg daily in divided doses, and for children over 6 years, 50 to 100 mg daily in divided doses. 1
Dosage Guidelines by Age
Children Under 6 Years:
- Total daily dose: 50 mg
- Administration: Divide into 2-4 doses per day
- This typically translates to approximately 12.5 mg 4 times daily or 16.7 mg 3 times daily
Children Over 6 Years:
- Total daily dose: 50-100 mg
- Administration: Divide into 2-4 doses per day
- This typically translates to 25 mg 2-4 times daily
Dosage by Indication
For Anxiety and Tension:
- Children under 6 years: 50 mg daily in divided doses
- Children over 6 years: 50-100 mg daily in divided doses 1
For Pruritus (Itching) Due to Allergic Conditions:
- Children under 6 years: 50 mg daily in divided doses
- Children over 6 years: 50-100 mg daily in divided doses 1
For Premedication Sedation:
- 0.6 mg/kg of body weight 1
Alternative Weight-Based Dosing
Research suggests that for specific indications like pruritus in atopic dermatitis, a dose of 0.7 mg/kg three times daily is as effective as higher doses while causing significantly less sedation 2. This translates to:
- For a 10 kg child: 7 mg three times daily
- For a 20 kg child: 14 mg three times daily
- For a 30 kg child: 21 mg three times daily
Important Considerations
Efficacy and Side Effects
- 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 while causing significantly less sedation 2
- The most common adverse effect is sedation, which is dose-dependent 2
Safety Precautions
- Hydroxyzine should be adjusted according to the patient's response to therapy 1
- Overdose can cause serious adverse effects including seizures and tachycardia, as documented in case reports of toxicity 3
- Monitor for excessive sedation, especially when initiating therapy
Pharmacokinetics in Children
- Peak serum concentration occurs at approximately 2 hours after oral administration 2
- The elimination half-life in children averages around 7 hours and increases with age 2
- Significant antipruritic effects can last from 1 to 24 hours after administration 2
Practical Administration Tips
- Hydroxyzine is available in tablet, capsule, and syrup formulations
- The syrup formulation may be preferred for younger children for ease of administration and dosage adjustment
- Consider timing doses to minimize daytime sedation if that's a concern (e.g., larger portion of daily dose at bedtime)
Always adjust dosing based on clinical response and monitor for side effects, particularly excessive sedation. The FDA-approved dosing provides a framework, but the optimal dose may vary based on the specific indication and individual patient factors.