What is the recommended dosage and usage of hydroxyzine for anxiety and itching?

Hydroxyzine Dosage and Usage for Anxiety and Itching

For anxiety, hydroxyzine is recommended at 50-100 mg four times daily for adults, while for itching conditions, the recommended dosage is 25 mg three to four times daily for adults. 1

Dosage Recommendations

For Anxiety:

• Adults: 50-100 mg four times daily
• Children over 6 years: 50-100 mg daily in divided doses
• Children under 6 years: 50 mg daily in divided doses

For Pruritus (Itching):

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

Clinical Efficacy

Hydroxyzine has demonstrated efficacy in treating both anxiety and itching:

• For generalized anxiety disorder (GAD), hydroxyzine has shown superiority over placebo in reducing anxiety symptoms, particularly targeting cognitive components of anxiety from the first week of treatment 2
• Studies have shown hydroxyzine to be effective in managing pruritus associated with allergic conditions such as chronic urticaria and atopic and contact dermatoses 1

Special Considerations

Sedation and Performance

• Hydroxyzine is a first-generation antihistamine with significant sedating properties (80% sedation rate) 3
• Sedation may be beneficial for nighttime dosing but can impair daytime functioning
• Consider timing administration to minimize impact on daily activities

Renal Impairment

• The dose of hydroxyzine should be halved in moderate renal impairment
• Avoid in severe renal impairment (creatinine clearance <10 mL/min) 3

Hepatic Impairment

• Hydroxyzine should be avoided in severe liver disease due to its sedating effects 3

Pregnancy and Lactation

• Hydroxyzine is specifically contraindicated during early stages of pregnancy 3
• Best to avoid during pregnancy, especially during the first trimester

Administration Tips

• For anxiety management, consider adding hydroxyzine at night (10-50 mg) to a non-sedating antihistamine taken during the day to help with sleep while minimizing daytime sedation 3
• For itching conditions, consistent dosing throughout the day may provide better symptom control
• Adjust dosage according to individual patient response 1

Potential Side Effects

• Drowsiness/sedation (most common)
• Anticholinergic effects (dry mouth, blurred vision, urinary retention)
• Cognitive impairment, especially in elderly patients 4
• May cause paradoxical agitation, especially in younger children 3

Monitoring

• Assess for improvement in anxiety symptoms or reduction in itching
• Monitor for excessive sedation, especially when initiating therapy
• Be cautious in elderly patients who may be more susceptible to side effects
• Avoid using in patients with severe respiratory depression, acute narrow-angle glaucoma, or known hypersensitivity to antihistamines 4

Hydroxyzine remains a useful option for both anxiety and itching conditions, but its sedating properties must be carefully considered when prescribing, especially for daytime use or in elderly patients.