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 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 Guidelines by Indication and Age

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

For Pre-procedural Sedation:

• Adults: 50-100 mg 1
• Children: 0.6 mg/kg of body weight 1

Administration Considerations

• Hydroxyzine can be administered orally after initial intramuscular treatment if needed 1
• Evening dosing is preferred for patients with itching to minimize daytime drowsiness while maintaining skin H1-receptor antagonism the following morning 2
• Avoid AM/PM dosing regimens due to prolonged half-lives and potential for significant daytime drowsiness 3

Clinical Efficacy

• Hydroxyzine is effective for nighttime pruritus due to its sedative effects, particularly in dermatological conditions 3
• For anxiety disorders, hydroxyzine (50 mg/day) has shown efficacy over placebo, with effects beginning during the first week of treatment 4, 5
• In a 3-month study, hydroxyzine (50 mg/day) demonstrated maintained efficacy comparable to bromazepam (6 mg/day) for generalized anxiety disorder 5

Special Populations and Dose Adjustments

• Elderly patients: Reduce dosage due to increased sensitivity to psychomotor impairment and anticholinergic effects 3
• Hepatic impairment: Start with half the standard dose 3
• Renal impairment: Dose reduction required 3

Side Effects and Precautions

Common Side Effects:

• Sedation/drowsiness (most common) 6, 3
• Dry mouth 3
• Weight gain 4
• Loss of concentration 4

Important Precautions:

1. Sedation: Hydroxyzine causes significant drowsiness, which can impair driving and cognitive performance 3
2. Anticholinergic effects: Can cause dry mouth, constipation, urinary retention, and increased risk for narrow-angle glaucoma 3
3. Pregnancy: Contraindicated during early pregnancy 3
4. Allergy testing: Should be discontinued 7-10 days before allergy testing procedures 3

Practical Usage Tips

• For itching conditions, hydroxyzine can be combined with topical corticosteroids for enhanced relief 6

  • For mild itching (covering <10% body surface area): Hydroxyzine 10-25 mg four times daily or at bedtime 6
  • For moderate itching (10-30% body surface area): Same dosage plus topical corticosteroids 6

• When used for anxiety, efficacy is maintained throughout treatment and after discontinuation without rebound anxiety or withdrawal symptoms 4

• Sleepiness with hydroxyzine typically appears during the first week of treatment and progressively diminishes with continued use 4

Alternative Options

• For daytime itching control with less sedation, consider second-generation antihistamines like cetirizine or loratadine 6, 3
• For anxiety, SSRIs, SNRIs, or buspirone may be safer alternatives for long-term management 3

Remember that hydroxyzine's sedative properties can be beneficial for nighttime itching but may be problematic during daytime use, especially for those who need to drive or operate machinery.