Is Atarax (hydroxyzine) used for itching?

Hydroxyzine (Atarax) is Effective for Treating Pruritus

Yes, hydroxyzine (Atarax) is specifically indicated for the management of pruritus due to allergic conditions such as chronic urticaria and atopic and contact dermatoses. 1

Mechanism of Action and Efficacy

• Hydroxyzine is a first-generation antihistamine that relieves itching by blocking H1 receptors and has sedative properties particularly beneficial for nighttime itching 2
• In clinical studies, hydroxyzine has demonstrated remarkable efficacy, showing a 750-fold increase in the histamine dose required to produce pruritus compared to baseline, significantly outperforming other antihistamines 3

Clinical Applications

• The FDA-approved indication for hydroxyzine includes "management of pruritus due to allergic conditions such as chronic urticaria and atopic and contact dermatoses and in histamine-mediated pruritus" 1
• Hydroxyzine is particularly 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, 4
• It can be effectively used for cancer therapy-related pruritus as part of a comprehensive management approach 4

Dosing Recommendations

• For adults: 25 mg three or 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 to 100 mg daily in divided doses 1
• Dose adjustments are necessary in patients with renal impairment, with the dose halved in moderate renal impairment 4

Treatment Algorithm for Pruritus

• For mild-to-moderate pruritus, consider topical treatments first (menthol 0.5%, topical corticosteroids, or lotions containing urea or polidocanol) 4
• For systemic therapy:
  • Daytime: Non-sedating second-generation antihistamines (e.g., loratadine 10 mg daily) 4
  • Nighttime: First-generation antihistamines like hydroxyzine (25-50 mg daily) due to their beneficial sedative properties 4
• For inadequate response, consider:
  • Increasing the dose (common practice though off-label) 4
  • Adding H2 antihistamines for better control 4
  • Second-line treatments such as antiepileptic agents (pregabalin, gabapentin) for refractory cases 4

Precautions and Contraindications

• Avoid hydroxyzine in severe liver disease due to inappropriate sedating effects 4
• Contraindicated in early stages of pregnancy 4
• Use with caution in elderly patients due to anticholinergic effects 2
• Rare cases of skin reactions and sensitization to hydroxyzine have been reported, particularly in patients with sensitivities to phenothiazines and/or ethylenediamines 5, 6, 7, 8

Clinical Pearls

• Hydroxyzine's sedative properties make it particularly useful for nighttime itching, helping patients sleep while controlling pruritus 4, 2
• Consider combination therapy with a non-sedating antihistamine during the day and hydroxyzine at night for 24-hour symptom control 4
• Monitor for drowsiness, which is the most common side effect 3
• In patients with known sensitivity to ethylenediamine, be cautious as rare cross-reactivity with hydroxyzine has been reported 6, 8