Hydroxyzine Dosing for Panic Attacks

For panic attacks, the recommended dose of hydroxyzine is 50-100 mg as needed, with a maximum of 400 mg daily in divided doses. 1

Dosing Guidelines

For adults with anxiety disorders including panic attacks, hydroxyzine is typically administered at 50-100 mg four times daily (q.i.d.) 1
The onset of action for oral hydroxyzine is approximately 15-30 minutes, with effects lasting 4-6 hours 2
Lower starting doses (25 mg) may be appropriate for elderly patients or those sensitive to sedative effects 2
The medication can be taken as needed for acute panic symptoms rather than on a scheduled basis 1

Hydroxyzine is a first-generation antihistamine with anxiolytic properties that works primarily through H1-receptor antagonism 2
Clinical trials have demonstrated hydroxyzine's efficacy for generalized anxiety disorder compared to placebo, with significant improvement beginning within the first week of treatment 3
Hydroxyzine (50 mg/day) has shown statistically significant anxiolytic effects compared to placebo in controlled studies 4
The medication has been found to be comparable in efficacy to benzodiazepines for anxiety symptoms 4

Hydroxyzine can be used as needed for acute anxiety/panic episodes rather than as a scheduled medication 1
When used for anxiety management, the dose should be adjusted according to the patient's response to therapy 1
For severe panic symptoms, the higher end of the dosing range (100 mg) may be more effective 1

The most common side effect is sedation/drowsiness, which occurs more frequently than with other anxiolytics (reported in approximately 28% of patients) 3
Other potential side effects include dry mouth (14%), weight gain (12%), and difficulty concentrating (9%) 3
Sedation typically appears during the first week of treatment and often diminishes with continued use 3
Hydroxyzine should be used with caution in patients with:
- Closed-angle glaucoma 2
- Prostatic hypertrophy 2
- Cognitive impairment 2
- Elderly patients (who are more susceptible to anticholinergic effects) 2

Unlike benzodiazepines, hydroxyzine does not cause physical dependence or withdrawal symptoms upon discontinuation 5
Hydroxyzine has an established safety profile with lack of organ toxicity 5
It may be particularly useful for patients with comorbid anxiety and insomnia due to its sedative properties 2
Hydroxyzine can be an appropriate alternative for patients with a history of substance abuse who should avoid benzodiazepines 6

The anticholinergic effects of hydroxyzine may provide better control of somatic symptoms (like trembling) compared to second-generation antihistamines 2
Hydroxyzine can be abruptly discontinued without rebound anxiety or withdrawal symptoms 3
For patients with panic disorder who also experience insomnia, administering a higher dose (50-100 mg) at bedtime may provide dual benefits 2, 1
Initial drowsiness tends to be transient, with tolerance to this side effect developing over time 3