Hydroxyzine Dosing for Flying Anxiety
For flying anxiety, hydroxyzine should be dosed at 25-50 mg taken 30-60 minutes before flight, with the option to repeat once during longer flights if needed. 1
Recommended Dosing Protocol
The FDA-approved dosing for hydroxyzine in anxiety conditions provides clear guidance:
- Adults: 50 mg per dose, up to 4 times daily (maximum 400 mg/day) 1
- For situational anxiety like flying, a single dose of 25-50 mg is typically sufficient
- Take 30-60 minutes before boarding to allow for onset of action
- For longer flights, a second dose may be taken if needed, maintaining at least 4-6 hours between doses
Considerations and Precautions
Patient-Specific Factors
- Age: Elderly patients require lower doses (25 mg) due to increased risk of cognitive effects and falls 2
- Liver/Kidney Function: Use with caution in patients with renal or hepatic impairment; consider dose reduction 2
- Pregnancy: Contraindicated in early pregnancy 2
Side Effect Management
- Sedation: Most common side effect (28% vs 14% with placebo) 3
- Warn patients about drowsiness that may persist after landing
- Avoid alcohol and other CNS depressants during flight
- Anticholinergic Effects: May cause dry mouth, blurred vision, urinary retention 2
- QT Prolongation: Use caution in patients with cardiac conditions or taking other QT-prolonging medications 2
Evidence for Efficacy
Hydroxyzine has demonstrated efficacy for anxiety conditions:
- Superior to placebo in generalized anxiety disorder (GAD) studies 4, 3
- Anxiolytic effects begin within the first week of treatment 5, 3
- Particularly effective for somatic symptoms of anxiety 3
Alternative Options
For patients concerned about sedation or with contraindications to hydroxyzine:
- Beta-blockers (particularly beta-1 selective like atenolol) may help with somatic symptoms of flight anxiety 6
- Non-pharmacological approaches like systematic desensitization are particularly suitable for specific flying phobia 7
- Benzodiazepines may be considered for severe cases, though they carry risks of dependence 7
Practical Recommendations
- Advise patients to test the medication before travel to assess individual response
- Combine with non-pharmacological strategies (deep breathing, distraction)
- For recurrent flying anxiety, consider referral for cognitive behavioral therapy
- Avoid driving or operating machinery after landing until effects wear off
- Ensure adequate hydration during flight to minimize potential for dry mouth