What is the recommended dosage and usage of Hydroxyzine for treating anxiety and itching?

Hydroxyzine Dosage and Usage for Anxiety and Itching

For treating anxiety and itching, hydroxyzine is recommended at a dose of 25 mg three to four times daily for adults with pruritus, and 50-100 mg four times daily for anxiety disorders. 1

Dosage Recommendations

For Anxiety:

• Adults: 50-100 mg four times daily 1
• Children over 6 years: 50-100 mg daily in divided doses 1
• Children under 6 years: 50 mg daily in divided doses 1

For Pruritus (Itching):

• Adults: 25 mg three to four times daily 1
• Children over 6 years: 50-100 mg daily in divided doses 1
• Children under 6 years: 50 mg daily in divided doses 1

Clinical Applications

For Dermatological Conditions:

• Effective for treating pruritus due to allergic conditions such as chronic urticaria and atopic and contact dermatoses 2
• Can be used for mild to moderate pruritus as a first-line treatment 2
• For Grade 1 pruritus (mild or localized), hydroxyzine 10-25 mg four times daily or at bedtime is recommended 2
• For Grade 2 pruritus (intense or widespread, intermittent), hydroxyzine 10-25 mg four times daily can be used alongside topical corticosteroids 2

For Anxiety Disorders:

• Effective for generalized anxiety disorder (GAD) compared to placebo 3, 4
• Onset of action is typically within the first week of treatment 5
• Efficacy is maintained throughout treatment period and after discontinuation without rebound anxiety 4, 5
• Can be used as an alternative to benzodiazepines, particularly when dependency is a concern 6, 4

Special Considerations

Renal Impairment:

• The dose of hydroxyzine should be halved in moderate renal impairment 2
• Should be avoided in severe renal impairment (creatinine clearance <10 mL/min) 2

Hepatic Impairment:

• Should be avoided in severe liver disease due to its sedating effects 2

Pregnancy:

• Hydroxyzine is contraindicated during early stages of pregnancy 2
• It's best to avoid all antihistamines in pregnancy, especially during the first trimester 2

Elderly Patients:

• Lower doses may be required due to increased sensitivity to anticholinergic and sedative effects 2
• Caution is advised in elderly patients with pre-existing conditions such as prostatic hypertrophy, elevated intraocular pressure, and cognitive impairment 2

Side Effects and Precautions

Common Side Effects:

• Sedation/drowsiness (most common side effect, typically transient) 5
• Dry mouth 5
• Weight gain 5
• Loss of concentration 5

Practical Considerations:

• Sedation typically appears during the first week of treatment and progressively diminishes 5
• May be beneficial when taken at night for patients with anxiety-related sleep disturbances 2
• Can be used in combination with non-sedating antihistamines (taken during the day) for 24-hour symptom control 2
• Does not cause dependency, unlike benzodiazepines 4

Combination Therapy

• Addition of hydroxyzine at night (10-50 mg) to a non-sedating antihistamine by day may help patients sleep better 2
• For dermatological conditions with significant pruritus, combining hydroxyzine with topical corticosteroids provides better symptom control 2
• In cases of severe pruritus not responding to antihistamines alone, systemic corticosteroids may be added 2

Monitoring and Follow-up

• Monitor for excessive sedation, especially during initial treatment 5
• Assess efficacy for anxiety symptoms within the first week of treatment 4, 5
• For pruritus, evaluate response within 1-2 weeks of initiating therapy 2
• Adjust dosing based on clinical response and tolerability 1