What are the uses of Hydroxyzine (antihistamine) 25mg?

Uses of Hydroxyzine 25mg

Hydroxyzine 25mg is FDA-approved for anxiety treatment, management of pruritus due to allergic conditions, and as a sedative for premedication, with dosing typically three to four times daily for adults. 1

Primary Indications

Anxiety Management

• Indicated for symptomatic relief of anxiety and tension associated with psychoneurosis
• Can be used as an adjunct in organic disease states where anxiety is manifested
• Adult dosing: 25mg three to four times daily (total 75-100mg/day) 1
• Shows efficacy in generalized anxiety disorder (GAD), though not recommended as first-line treatment due to limited high-quality evidence 2

Pruritus Treatment

• Effective for managing itching due to:
  • Chronic urticaria
  • Atopic dermatitis
  • Contact dermatoses
  • Histamine-mediated pruritus
• Adult dosing: 25mg three to four times daily 1
• Used as a treatment option for dermatologic conditions with pruritus 3

Sedation

• Used as a premedication before procedures
• Administered before and following general anesthesia
• Adult dosing: 50-100mg 1

Clinical Considerations

Advantages

• Non-habit forming (unlike benzodiazepines)
• No risk of dependency 4
• Can be beneficial for patients with both anxiety and pruritus

Important Precautions

Sedation and Performance Impairment

• Significant potential for sedation and performance impairment
• Can impair driving ability - drivers taking first-generation antihistamines are 1.5 times more likely to be responsible for fatal accidents 3
• May impair work performance and increase risk of occupational accidents 3
• Sedative effects can persist into the following day even when dosed only at bedtime 3

Special Populations

• Elderly patients: Use with extreme caution due to:
  • Increased sensitivity to psychomotor impairment
  • Higher risk of falls and complications (fractures, subdural hematomas)
  • Susceptibility to anticholinergic effects 3, 5
• Children: May impair learning and school performance 3, 5
• Pregnancy: Contraindicated during early pregnancy 5
• Liver/kidney impairment: Use with caution 5

Drug Interactions

• Enhanced CNS depression with alcohol, sedatives, hypnotics, or antidepressants 3
• Listed as a QT-prolonging medication 5

Practical Application Guidelines

For Dermatologic Conditions

• For mild pruritus/skin conditions (covering <10% BSA): 10-25mg QID or at bedtime 3
• For moderate conditions (10-30% BSA): Same dosing, but consider dermatology referral 3
• Can be combined with topical corticosteroids for enhanced effect 3

For Anxiety Treatment

• While effective for anxiety, second-generation antihistamines or SSRIs/SNRIs may be preferred for long-term management 5
• Buspirone may be a safer alternative for anxiety treatment 5

Common Pitfalls to Avoid

1. AM/PM dosing regimens: Combining second-generation antihistamines in the morning with hydroxyzine at night is not recommended due to the prolonged half-life causing daytime impairment 3
2. Underestimating sedation: Patients may deny feeling sedated while still experiencing significant performance impairment 3
3. Overlooking anticholinergic effects: Can cause dry mouth, constipation, urinary retention, and risk of narrow-angle glaucoma 3
4. Cross-reactivity: Rare cases of worsening dermatitis in patients with sensitivities to ethylenediamines 6

When prescribing hydroxyzine, physicians should ensure patients understand both the potential adverse effects and the availability of alternative medications with fewer side effects, especially when considering first-generation antihistamines like hydroxyzine 3.