Is Atarax (hydroxyzine) used to relieve itching?

Hydroxyzine (Atarax) for Itching

Yes, hydroxyzine (Atarax) is effective for treating itching (pruritus) of various causes and is FDA-approved for this indication. 1

Mechanism and Indications

• Hydroxyzine is a first-generation antihistamine that relieves pruritus by blocking H1 receptors and has sedative properties that can be beneficial for nighttime itching 2
• The FDA-approved dosage for management of pruritus due to allergic conditions is 25 mg three to four times daily for adults 1
• It is particularly useful for treating pruritus associated with chronic urticaria, atopic dermatitis, and contact dermatoses 1

Clinical Applications

• Hydroxyzine is recommended for nighttime use in patients with pruritus due to its sedative properties, while non-sedating second-generation antihistamines are preferred for daytime use 2
• It can be used for various types of pruritus including:
  • Allergic conditions (chronic urticaria, atopic dermatitis) 1
  • Cancer therapy-related pruritus 2
  • Generalized pruritus of unknown origin (GPUO) - recommended for short-term or palliative settings 2

Efficacy

• Real-world observational studies have shown that hydroxyzine significantly improves symptoms of pruritus and quality of life in patients with chronic pruritus over a 12-week period 3
• In clinical practice, it is often added as a nighttime medication to complement daytime non-sedating antihistamines for better sleep and 24-hour itch control 2

Dosing Considerations

• For adults: 25 mg three to four times daily for pruritus management 1
• For children under 6 years: 50 mg daily in divided doses 1
• For children over 6 years: 50-100 mg daily in divided doses 1
• Dose adjustments are necessary in patients with renal impairment - the dose should be halved in moderate renal impairment 2

Precautions and Contraindications

• Hydroxyzine should be avoided in:
  • Severe liver disease due to inappropriate sedating effects 2
  • Early stages of pregnancy (specifically contraindicated) 2
  • Elderly patients with cognitive impairment due to anticholinergic effects 2
• Use with caution in patients with known sensitivities to phenothiazines or ethylenediamines due to rare cases of cross-reactivity 4, 5, 6, 7

Side Effects

• Common side effects include sedation, drowsiness, dizziness, dry mouth, and constipation 3
• Cognitive impairment and performance issues may occur, especially in elderly patients 2
• Rare cases of skin reactions have been reported in patients with specific sensitivities 5, 6

Treatment Algorithm for Pruritus

1. First-line for daytime itching: Non-sedating second-generation antihistamines (loratadine, cetirizine) 2
2. First-line for nighttime itching: First-generation antihistamines like hydroxyzine (25-50 mg) 2
3. For inadequate response: Consider increasing dose, adding H2 antihistamines, or switching to alternative treatments 2
4. For severe or refractory pruritus: Consider adding GABA agonists (pregabalin/gabapentin) as second-line treatment 2

Remember that treatment should address any underlying cause of pruritus when possible, and hydroxyzine is most appropriate for managing the symptom of itching rather than treating the underlying condition 2.