Hydroxyzine Dosing for Pediatric Patients
The recommended dosage of hydroxyzine for pediatric patients is 50 mg daily in divided doses for children under 6 years, and 50-100 mg daily in divided doses for children over 6 years. 1
Age-Based Dosing Recommendations
- For children under 6 years of age: 50 mg total daily dose, administered in divided doses throughout the day 1
- For children over 6 years of age: 50-100 mg total daily dose, administered in divided doses throughout the day 1
- For sedation as premedication: 0.6 mg/kg of body weight 1
Indication-Specific Dosing
Pruritus/Allergic Conditions
- For management of pruritus due to allergic conditions such as chronic urticaria, atopic dermatitis, and contact dermatoses 1:
Anxiety/Sedation
- For symptomatic relief of anxiety and tension 1:
- For procedural sedation (e.g., imaging studies): 0.6 mg/kg as premedication 2, 1
Special Considerations
Renal Impairment
- The dose of hydroxyzine should be reduced by half in patients with renal impairment 3, 2
- Hydroxyzine should be avoided in severe renal impairment (creatinine clearance <10 mL/min) 3
Hepatic Impairment
- Hydroxyzine should be avoided in patients with severe hepatic impairment due to its sedating effects 3, 2
Duration of Treatment
- For pruritus management, a dose of 0.7 mg/kg three times daily has been shown to be as effective as 1.4 mg/kg three times daily with significantly less sedation 4
- The shortest possible duration of treatment is recommended for preschool-age children due to potential concerns about long-term neurodevelopmental effects 5
Administration Considerations
- Hydroxyzine is available in syrup form, which facilitates administration to children 2
- When treatment is initiated by intramuscular route, subsequent doses may be administered orally 1
- Peak serum concentration occurs at approximately 2 hours after oral administration 4
- The elimination half-life increases with age (mean 7.1 ± 2.3 hours in children) 4
Adverse Effects
- The most common adverse effects are drowsiness and dry mouth 6
- Sedation is the primary side effect, which may be dose-dependent 4
- Caution should be exercised when combining hydroxyzine with other medications that may have synergistic sedative effects 6
Monitoring
- Adjust dosage according to the patient's response to therapy 1
- Monitor for excessive sedation, especially when using higher doses 4
- Be aware that hydroxyzine has a mean elimination half-life of approximately 7 hours in children 4
Remember that hydroxyzine dosing should be tailored based on the child's age, weight, and clinical response, with careful attention to the potential for sedation, especially at higher doses.