Hydroxyzine Starting Dose for an 11-Year-Old with Anxiety
The recommended starting dose of hydroxyzine for an 11-year-old child with anxiety is 12.5-25 mg given 3-4 times daily, with a total daily dose of 50-100 mg divided throughout the day. 1
Dosing Guidelines
- For children over 6 years old (which includes an 11-year-old), the FDA-approved dosage for anxiety is 50-100 mg daily in divided doses 1
- The typical administration schedule is 3-4 times daily, which would translate to approximately 12.5-25 mg per dose 1
- Hydroxyzine is available in syrup form, which can facilitate administration to children 2
Dosing Considerations
- Start at the lower end of the dosage range (12.5 mg per dose) and titrate up based on clinical response and tolerability 1
- The dose should be adjusted according to the patient's response to therapy 1
- Sedation is the most common side effect to monitor for when initiating therapy 3
- Temporary drowsiness may occur initially but often resolves with continued therapy at the same dosage level 4
Special Considerations
- Reduce the dose by half in patients with renal impairment 2
- Avoid use in patients with severe renal impairment (creatinine clearance <10 mL/min) 2
- Avoid use in patients with severe hepatic impairment due to its sedating effects 2
- Monitor for daytime sedation that might affect school performance 3
Monitoring
- Assess for effectiveness in reducing anxiety symptoms within the first week of treatment 5
- Monitor for common side effects including drowsiness/sedation, which occurs more frequently than with other anxiolytics 3
- Evaluate cognitive functioning, as hydroxyzine has been shown to improve cognitive symptoms of anxiety in clinical trials 5
Important Caveats
- Hydroxyzine is not recommended as a first-line long-term treatment for generalized anxiety disorder due to limited evidence in children 3
- There is a high risk of sedation which may interfere with school activities and learning 3
- Unlike benzodiazepines, hydroxyzine does not cause dependency or withdrawal symptoms, making it potentially advantageous for pediatric use 5