Hydroxyzine Dosage for Anxiety
For anxiety in adults, hydroxyzine is recommended at 50 to 100 mg four times daily (200-400 mg/day total). 1
Dosing Guidelines
The FDA-approved dosing for hydroxyzine in the treatment of anxiety is:
- Adults: 50-100 mg four times daily
- Children under 6 years: 50 mg daily in divided doses
- Children over 6 years: 50-100 mg daily in divided doses 1
Clinical Evidence and Efficacy
Hydroxyzine has demonstrated efficacy in generalized anxiety disorder (GAD) compared to placebo. Clinical trials have shown:
- Significant reduction in anxiety scores starting from the first week of treatment at a fixed dose of 50 mg/day 2, 3
- Maintained efficacy throughout 4 weeks of treatment 3
- No rebound anxiety or withdrawal symptoms after abrupt discontinuation 3
A Cochrane review found hydroxyzine to be more effective than placebo for GAD and comparable in efficacy to benzodiazepines and buspirone 4. However, the review noted limitations including high risk of bias in included studies and small sample sizes.
Side Effects and Considerations
Common side effects include:
- Sleepiness/drowsiness (most common, reported in 28% vs 14% with placebo) 3
- Dry mouth (14% vs 5% with placebo) 3
- Weight gain (12% vs 10% with placebo) 3
- Loss of concentration (9% vs 8% with placebo) 3
Important notes:
- Sleepiness typically appears during the first week and progressively diminishes with continued treatment 3
- Hydroxyzine may cause more drowsiness than other anxiolytic agents 4
- Elderly patients may be more sensitive to side effects and should be monitored closely
Practical Administration Tips
- Start at the lower end of the dosage range and adjust according to patient response
- Administer in divided doses throughout the day
- May be taken with or without food
- Consider lower doses in elderly patients or those with hepatic impairment
- Monitor for excessive sedation, especially when initiating therapy
Alternative Options
For patients who cannot tolerate hydroxyzine or have contraindications, consider:
- Benzodiazepines (e.g., lorazepam) for short-term use
- Buspirone for longer-term management
- SSRIs or SNRIs for chronic anxiety disorders
When using benzodiazepines, be aware of potential for dependence and withdrawal symptoms upon discontinuation 5.