What is the recommended dose of Atarax (hydroxyzine) for itching?

Hydroxyzine Dosage for Pruritus (Itching)

For adults with pruritus, the recommended dose of hydroxyzine (Atarax) is 25 mg three to four times daily. 1

Dosing Guidelines for Different Age Groups

• For adults with pruritus due to allergic conditions such as chronic urticaria and atopic and contact dermatoses, the standard dose is 25 mg three to four times daily (75-100 mg total daily dose) 1
• For children under 6 years of age, the recommended dose is 50 mg daily divided into multiple doses 1
• For children over 6 years of age, the recommended dose is 50 to 100 mg daily divided into multiple doses 1

Clinical Considerations

• Hydroxyzine is particularly effective for nighttime itching due to its sedative properties, making it useful when pruritus disrupts sleep 2
• For daytime itching, non-sedating second-generation antihistamines (like cetirizine, loratadine) are preferred to avoid sedation 3, 2
• The dose may need adjustment based on individual response to therapy 1
• For elderly patients, consider starting at a lower dose due to increased risk of anticholinergic effects 2

Special Populations

• In patients with moderate renal impairment, the dose should be reduced by half 2
• Hydroxyzine should be avoided in:
  • Elderly patients with cognitive impairment due to anticholinergic effects 2
  • Patients with severe liver disease due to inappropriate sedating effects 2
  • Early stages of pregnancy 2

Treatment Algorithm for Persistent Pruritus

• Start with standard dose of hydroxyzine (25 mg three to four times daily) 1
• If inadequate response after 1-2 weeks, consider:
  • Increasing the dose (within safe limits) 3
  • Adding an H2 antihistamine 3
  • For daytime symptoms, using non-sedating antihistamines during the day and hydroxyzine at night 2
• For severe or refractory pruritus, consider:
  • Topical treatments such as moderate/high-potency steroids 3
  • Other systemic options like gabapentin or pregabalin 3

Potential Side Effects

• Common: sedation, drowsiness, dry mouth 2
• Rare but serious: skin reactions have been reported with hydroxyzine use 4, 5
• Monitor for excessive sedation, especially when initiating therapy 2

Monitoring

• Assess response to treatment after 1-2 weeks 3
• If pruritus worsens after starting hydroxyzine, consider the rare possibility of drug hypersensitivity 4, 5
• Adjust dosing based on symptom control and side effect profile 1