Hydroxyzine (Atarax) Dosage Recommendations
The recommended dosage of hydroxyzine (Atarax) varies by indication: for anxiety, adults should take 50-100 mg four times daily; for pruritus/allergic conditions, adults should take 25 mg three to four times daily; and for sedation/premedication, adults should take 50-100 mg as a single dose. 1
Adult Dosing by Indication
Anxiety Treatment
- Anxiety disorders/psychoneurosis: 50-100 mg four times daily 1
- Standard dose for generalized anxiety disorder: 50 mg/day 2
- Clinical trials have shown efficacy at 50 mg/day for generalized anxiety disorder 3, 4
Pruritus/Allergic Conditions
- Pruritus due to allergic conditions: 25 mg three to four times daily 1
- Effective for histamine-induced pruritus with significantly greater suppression compared to other antihistamines 5
- Can be used for chronic urticaria and atopic/contact dermatoses 1
Sedation/Sleep
Pediatric Dosing
Children under 6 years:
- 50 mg total daily dose, divided throughout the day 1
Children over 6 years:
Special Populations
Elderly Patients
- Reduced dosing required due to increased risk of:
- Cognitive decline
- Falls
- Anticholinergic effects 2
- Start with approximately half the standard adult dose
Hepatic Impairment
- Start with half the standard dose
- Monitor closely for side effects 2
Renal Impairment
- Reduced dosing required 2
- Adjust based on severity of impairment
Administration Considerations
- When initiated by intramuscular route, subsequent doses may be administered orally 1
- Adjust dosage according to individual patient response 1
- For anxiety, effects begin within the first week of treatment 3
- For pruritus, hydroxyzine shows superior efficacy compared to other antihistamines 5
Common Side Effects
- Sleepiness/drowsiness (most common, typically transient) 3
- Dry mouth 3
- Weight gain 3
- Loss of concentration 3
Cautions and Contraindications
- Contraindicated during early pregnancy 2
- Use with caution in patients with:
- Prostatic hypertrophy
- Elevated intraocular pressure
- Cognitive impairment 6
- Discontinue 7-10 days before allergy testing 2
Hydroxyzine is a versatile medication with multiple indications. When prescribing, consider the specific indication and patient characteristics to determine the appropriate dosage regimen. The medication has demonstrated efficacy for anxiety disorders comparable to benzodiazepines with a different side effect profile 4.