What is the typical dose and frequency of hydroxyzine (hydroxyzine hydrochloride) for treating panic disorders?

Hydroxyzine Hydrochloride Dosage for Panic Disorder

For panic disorder, hydroxyzine hydrochloride should be administered at 50-100 mg 3-4 times daily in adults, with a total daily dose of 200-400 mg divided throughout the day. 1

Dosage Recommendations

• For adults with anxiety disorders including panic:

  • 50-100 mg 3-4 times daily (q.i.d.) 1
  • Maximum daily dose should not exceed 400 mg 1

• Timing of administration:

  • Doses should be evenly spaced throughout the day to maintain therapeutic effect 1
  • Can be taken with or without food 1

• Duration of treatment:

  • Short-term use is preferred due to potential for sedation and tolerance 2
  • Reassess efficacy and side effects after 2-4 weeks of treatment 3

Clinical Considerations

• Hydroxyzine works rapidly for anxiety symptoms, with effects often noticeable within the first week of treatment 3
• Sedation is a common side effect that may be beneficial for patients with anxiety-related insomnia 4
• Initial sedation tends to be most pronounced during the first week of treatment and often diminishes over time 3

Precautions and Monitoring

• Start at the lower end of the dosage range (50 mg 3 times daily) and titrate up based on response and tolerability 1
• Monitor for excessive sedation, especially during the initial treatment period 3
• Use with caution in elderly patients or those with hepatic impairment; consider lower doses 1
• Be aware of potential drug interactions, particularly with other CNS depressants 4

Side Effects to Monitor

• Common side effects include:

  • Drowsiness/sedation (28% vs 14% with placebo) 3
  • Dry mouth (14% vs 5% with placebo) 3
  • Weight gain (12% vs 10% with placebo) 3
  • Concentration difficulties (9% vs 8% with placebo) 3

• Rare but serious concerns:

  • Risk of priapism may be increased when combined with medications that have alpha-adrenergic antagonism (such as risperidone) 4

Treatment Alternatives

• For panic disorder, first-line treatments typically include:

  • SSRIs and SNRIs are standard treatments with better long-term safety profiles 5
  • Benzodiazepines like alprazolam may be used for short-term treatment in non-responsive cases when there's no history of dependency 5
  • Cognitive behavioral therapy combined with medication offers the most successful treatment approach 5

• Hydroxyzine is generally considered an adjunctive or alternative treatment when first-line options are not suitable or effective 5