Maximum Recommended Dose of Atarax (Hydroxyzine)
The maximum recommended dose of hydroxyzine (Atarax) for adults is 100 mg four times daily (400 mg total daily dose). 1
Dosing Guidelines by Indication
For Anxiety and Tension:
- Adults: 50-100 mg four times daily (maximum 400 mg/day) 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) Management:
- Adults: 25 mg three or four times daily (maximum 100 mg/day) 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 Premedication/Sedation:
Special Considerations
Elderly Patients:
- Lower doses are generally recommended due to increased risk of anticholinergic effects and sedation 2
- Start with lower doses and titrate based on response and tolerability 1
Clinical Studies Support:
- Most clinical trials for anxiety disorders have used more moderate doses (50 mg/day) with good efficacy 3, 4, 5
- A 3-month study showed that 50 mg/day was effective for generalized anxiety disorder 5
Adverse Effects to Monitor at Higher Doses
- Sedation/drowsiness: Most common side effect (28% vs 14% with placebo) 3
- Anticholinergic effects: Dry mouth (14%), blurred vision 2
- Cognitive impairment: Particularly concerning in elderly patients 2
- Weight gain: Reported in 12% of patients in clinical trials 3
Important Precautions
- Hydroxyzine has a long half-life (20 ± 4.1 hours) which may lead to accumulation with repeated dosing 2
- Dosage should be adjusted according to individual patient response to therapy 1
- Higher doses increase risk of anticholinergic side effects, particularly problematic in elderly patients with conditions like prostatic hypertrophy, elevated intraocular pressure, or cognitive impairment 2
Clinical Pearl
While the maximum FDA-approved dose is 400 mg/day, most clinical trials demonstrating efficacy for anxiety disorders used more moderate doses of 50 mg/day with good tolerability and fewer side effects 3, 4, 5. Consider starting with lower doses and titrating up only as needed for symptom control.