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

Hydroxyzine Dosage and Use for Anxiety and Itching

Hydroxyzine is recommended at a dose of 25 mg three times daily for itching conditions and 50-100 mg daily in divided doses for anxiety, with dosage adjustments based on patient age and clinical response. 1

Dosage Recommendations

For Anxiety:

• Adults: 50-100 mg daily divided into 4 doses (12.5-25 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
• Elderly patients: Lower doses recommended due to increased risk of anticholinergic effects 2

For Pruritus (Itching):

• Adults: 25 mg three times daily or 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 atopic dermatitis in children: 0.7 mg/kg three times daily has shown effective pruritus control with minimal sedation 3

For Pre-procedural Sedation:

• Adults: 50-100 mg as a single dose 1
• Children: 0.6 mg/kg of body weight 1

Clinical Efficacy

For Anxiety:

• Hydroxyzine has demonstrated efficacy for generalized anxiety disorder (GAD) compared to placebo, with significant improvement in anxiety scores starting from the first week of treatment 4, 5
• A 3-month study showed hydroxyzine (50 mg/day) was effective for GAD with comparable efficacy to bromazepam (6 mg/day) 6

For Itching:

• Provides significant antipruritic effects in children with atopic dermatitis, with >85% suppression of itching from 2-12 hours after administration 3
• Particularly effective for histamine-mediated pruritus and allergic conditions 1

Special Considerations

Adverse Effects:

• Most common side effect is transient sleepiness/drowsiness (28% vs 14% with placebo), which typically appears during the first week and progressively diminishes 4
• Other reported side effects include dry mouth (14%), weight gain (12%), and loss of concentration (9%) 4

Precautions:

• Use with caution in elderly patients due to increased risk of cognitive decline, falls, and anticholinergic effects 2
• Reduce dosage in patients with hepatic or renal impairment 2
• For children with atopic dermatitis, lower doses (0.7 mg/kg three times daily) provide effective pruritus control with less sedation than higher doses 3

Contraindications:

• Contraindicated during early pregnancy 2
• Use caution in patients with seizure disorders as hydroxyzine may lower seizure threshold

Treatment Algorithm

1. Initial Assessment:

   • For anxiety: Confirm diagnosis of anxiety disorder
   • For itching: Identify underlying cause (allergic, atopic dermatitis, etc.)

2. Dosing Strategy:

   • Start with lower doses and titrate based on response
   • For anxiety: Begin with 25 mg four times daily in adults
   • For itching: Begin with 25 mg three times daily in adults

3. Monitoring:

   • Assess response within 1 week (significant effects should be seen by this time) 4
   • Monitor for sedation, especially during the first week of treatment
   • Adjust dose as needed based on clinical response

4. Duration of Treatment:

   • For anxiety: Effective for up to 3 months with continued efficacy 6
   • For itching: Can be used as needed for symptom control
   • No evidence of withdrawal symptoms upon abrupt discontinuation 4

Hydroxyzine provides an effective alternative to benzodiazepines for anxiety and is particularly valuable for patients with comorbid anxiety and pruritus conditions.