What is the recommended dosing for Atarax (hydroxyzine)?

Hydroxyzine (Atarax) Dosing Recommendations

The recommended dosing for Atarax (hydroxyzine) varies by indication and age, with adults typically receiving 25-100 mg 3-4 times daily depending on the condition being treated.1

Adult Dosing

• Anxiety and tension:

  • 50-100 mg 4 times daily 1
  • For generalized anxiety disorder, clinical studies have shown efficacy at 50 mg/day 2, 3

• Pruritus/allergic conditions:

  • 25 mg 3-4 times daily 1

• Premedication/sedation:

  • 50-100 mg as a single dose 1

Pediatric Dosing

• Children under 6 years:

  • 50 mg total daily dose, divided throughout the day 1

• Children over 6 years:

  • 50-100 mg total daily dose, divided throughout the day 1

• Premedication/sedation in children:

  • 0.6 mg/kg body weight 1

Administration Guidelines

• Hydroxyzine is available in tablet form 4
• Dosage should be adjusted according to the patient's response to therapy 1
• When treatment is initiated by intramuscular route, subsequent doses may be administered orally 1

Clinical Efficacy

• For anxiety disorders, hydroxyzine shows significant anxiolytic effects starting in the first week of treatment 2
• In a 3-month study, hydroxyzine (50 mg/day) demonstrated maintained efficacy throughout the treatment period without development of tolerance 3
• Unlike benzodiazepines, hydroxyzine does not appear to induce amnesia at therapeutic doses 5

Side Effects and Monitoring

• Common side effects:

  • Drowsiness/sedation (28% vs 14% with placebo) - typically transient and decreases after the first week 2
  • Dry mouth (14% vs 5% with placebo) 2
  • Weight gain (12% vs 10% with placebo) 2

• Precautions:

  • Anticholinergic effects may be more pronounced in elderly patients 4
  • Use with caution in patients with prostatic hypertrophy, elevated intraocular pressure, or cognitive impairment 4

Clinical Pearls

• Hydroxyzine may be better at controlling rhinorrhea compared to second-generation antihistamines due to its anticholinergic effects 4
• Hydroxyzine has been shown to be effective in treating cardiovascular manifestations of anxiety (cardioneurosis) 6
• Unlike benzodiazepines, abrupt discontinuation of hydroxyzine does not appear to cause rebound anxiety or withdrawal symptoms 2

Common Pitfalls to Avoid

• Do not confuse hydroxyzine with other antihistamines that have different dosing schedules
• Avoid using high doses in elderly patients due to increased risk of anticholinergic side effects 4
• Be aware that drowsiness is common initially but often improves with continued treatment 2

Hydroxyzine's favorable safety profile and lack of dependence potential make it a useful option for treating anxiety and pruritus, particularly when benzodiazepines are contraindicated or concerns about dependence exist.