Hydroxyzine Dosage for Anxiety Management
For anxiety treatment, hydroxyzine is recommended at a dosage of 50-100 mg four times daily for adults, with a total daily dose ranging from 50-400 mg depending on symptom severity. 1
Adult Dosing Guidelines
- Standard adult dosage: 50-100 mg four times daily (200-400 mg/day total) 1
- Starting dose: Many clinicians begin with 25-50 mg three times daily and adjust based on response
- Geriatric patients: Lower starting doses (25 mg three times daily) are recommended due to increased sensitivity to sedative effects
Pediatric Dosing
- Children under 6 years: 50 mg total daily dose, divided into smaller doses throughout the day 1
- Children over 6 years: 50-100 mg total daily dose, divided into smaller doses 1
Administration Considerations
Hydroxyzine can be administered as:
- Oral tablets or capsules
- Oral suspension for patients who have difficulty swallowing pills
- The medication can be taken with or without food
Efficacy and Evidence
Clinical evidence supports hydroxyzine's efficacy for generalized anxiety disorder:
- Hydroxyzine at 50 mg/day has demonstrated superiority over placebo in reducing anxiety symptoms, with effects beginning within the first week of treatment 2, 3
- The medication shows equivalent efficacy to other anxiolytics such as benzodiazepines and buspirone 4
Side Effect Profile
Common side effects include:
- Sedation/drowsiness: Most common side effect (28% vs 14% with placebo) 2
- Dry mouth: Reported in 14% of patients (vs 5% with placebo) 2
- Weight gain: Reported in 12% of patients (vs 10% with placebo) 2
- Cognitive effects: Loss of concentration in 9% of patients (vs 8% with placebo) 2
Important Considerations
- Sedation management: Drowsiness typically appears during the first week of treatment and progressively diminishes with continued use 2
- Dosage adjustment: The dose should be adjusted according to individual patient response 1
- Elderly patients: Use with caution due to increased risk of anticholinergic effects and cognitive impairment 5
- Avoid in: Patients with severe respiratory depression, acute narrow-angle glaucoma, or known hypersensitivity to antihistamines 6
Monitoring
- Assess for improvement in anxiety symptoms
- Monitor for excessive sedation, especially during initial treatment
- Watch for anticholinergic side effects (dry mouth, urinary retention, constipation)
- Evaluate for any paradoxical reactions (increased agitation or insomnia)
Hydroxyzine offers an alternative to benzodiazepines for anxiety management with the advantage of no dependency or withdrawal issues, making it particularly useful for patients with a history of substance abuse or those requiring longer-term anxiety management.