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/pruritus, the recommended dosage is 25 mg three to four times daily for adults. 1
Dosage Recommendations by Indication
For Anxiety:
- Adults: 50-100 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
For Pruritus/Itching:
- Adults: 25 mg three to 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
Mechanism and Efficacy
Hydroxyzine is a first-generation antihistamine that works by blocking H1 histamine receptors. It has demonstrated efficacy for:
- Anxiety: Studies show hydroxyzine is more effective than placebo for generalized anxiety disorder (GAD) 2, with early improvement in cognitive symptoms of anxiety 3
- Pruritus: Effective in managing itching associated with allergic conditions including chronic urticaria and atopic and contact dermatoses 1
Special Considerations
Sedation and CNS Effects
- Hydroxyzine has significant sedating properties with approximately 80% of patients experiencing sedation 4
- Can be beneficial when sleep disturbance accompanies anxiety or pruritus
- Consider timing doses to minimize daytime impairment
Renal Impairment
- Dose should be halved in moderate renal impairment 4
- Avoid in severe renal impairment (creatinine clearance <10 mL/min) 4
Hepatic Impairment
- Avoid in severe liver disease due to increased sedating effects 4
Pregnancy
- Specifically contraindicated during early stages of pregnancy 4
- Should be avoided throughout pregnancy if possible
Practical Administration Tips
- For anxiety with sleep disturbance: Higher doses (50-100 mg) may be more appropriate at bedtime
- For daytime anxiety: Lower doses may minimize sedation while maintaining efficacy
- For itching: Regular dosing provides better symptom control than as-needed use
Potential Side Effects and Monitoring
- Common: Drowsiness, dry mouth, headache
- Less common: Dizziness, constipation, blurred vision
- Monitoring: Assess for excessive sedation, especially in elderly patients or those with comorbid conditions
Contraindications
- Early pregnancy
- Severe renal impairment
- Severe hepatic impairment
- Known hypersensitivity to hydroxyzine
Comparison to Other Antihistamines
Hydroxyzine is more sedating than second-generation antihistamines but may provide better control of rhinorrhea due to its anticholinergic effects 4. The anticholinergic effects and sedation make hydroxyzine less suitable for older adults with conditions like prostatic hypertrophy, elevated intraocular pressure, or cognitive impairment 4.
When treating anxiety or pruritus, hydroxyzine offers a non-addictive alternative to benzodiazepines with demonstrated efficacy and an established safety profile when used appropriately according to dosing guidelines.