Hydroxyzine Dosing for Insomnia

Hydroxyzine should be taken at 25-50 mg at bedtime as needed for insomnia, not exceeding 100 mg per day. 1

Recommended Dosing

Hydroxyzine is typically prescribed at 25 mg three or four times daily for anxiety conditions, but for insomnia specifically, a single bedtime dose of 25-50 mg is appropriate 1
For adults using hydroxyzine as a sedative, the FDA-approved dosage range is 50-100 mg, though the lower end of this range (50 mg) is generally sufficient for insomnia 1
Administration should be on an empty stomach to maximize effectiveness 2

Hydroxyzine is an antihistamine that is used off-label for insomnia due to its sedating properties 3
Hydroxyzine is not FDA-approved specifically for insomnia treatment, though its sedating effects make it an option for some patients 3
Current clinical guidelines do not recommend antihistamines as first-line therapy for chronic insomnia due to limited evidence of efficacy 2
The American Academy of Sleep Medicine specifically advises against using diphenhydramine (another antihistamine) for treating either sleep onset or sleep maintenance insomnia, which suggests caution with similar antihistamines like hydroxyzine 2

Tolerance to the sedative effects of antihistamines can develop quickly, often after 3-4 days of continuous use 2
Hydroxyzine has alpha-adrenergic antagonist properties that may cause adverse effects, particularly when combined with other medications with similar properties 3
A comparative safety study found that sedating antihistamines had a higher hazard ratio for suicide attempts compared to zolpidem, though the difference was not statistically significant (HR = 1.37,95% CI 0.90-2.07) 4
Caution is advised if signs/symptoms of depression, compromised respiratory function, or hepatic heart failure are present 2
Hydroxyzine is not recommended during pregnancy or nursing 2

Cognitive behavioral therapy for insomnia (CBT-I) is recommended as first-line treatment for chronic insomnia 2, 5
If medication is necessary, non-benzodiazepine receptor agonists (e.g., zolpidem, eszopiclone) or short-acting benzodiazepines may be more appropriate first-line pharmacological options 2
For short-term use, zolpidem 10 mg, eszopiclone 2-3 mg, or temazepam 15-30 mg have stronger evidence supporting their efficacy 2

Patients should be followed regularly, every few weeks initially, to assess effectiveness and possible side effects 2
The lowest effective maintenance dosage should be employed, with attempts to taper medication when conditions allow 2
Patients should be cautioned about potential additive effects when combined with other CNS depressants or alcohol 2