Hydroxyzine Dosage and Usage for Anxiety and Itching
For anxiety, hydroxyzine is recommended at 50-100 mg four times daily for adults, while for itching/pruritus, the recommended dosage is 25 mg three to four times daily for adults. 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 Anxiety:
- Hydroxyzine is effective for generalized anxiety disorder (GAD), showing significant improvement compared to placebo 2, 3
- Benefits typically begin within the first week of treatment 4
- Can be used as a sedative premedication at 50-100 mg for adults or 0.6 mg/kg for children 1
- May be particularly useful for nighttime anxiety due to its sedative properties 5
For Pruritus:
- Effective for managing pruritus associated with allergic conditions including chronic urticaria and dermatoses 1
- Can be used for both localized and widespread pruritus 5
- Often combined with topical treatments for enhanced relief 5
Administration Guidelines
- Dosage should be adjusted according to patient response 1
- When initiating treatment via intramuscular route, subsequent doses may be administered orally 1
- For dermatologic conditions with pruritus:
Special Populations and Considerations
Renal Impairment:
- The dose of hydroxyzine should be halved in moderate renal impairment 5
- Avoid in severe renal impairment (creatinine clearance <10 mL/min) 5
Hepatic Impairment:
- Should be avoided in severe liver disease due to its sedating effects 5
Pregnancy:
- Hydroxyzine is specifically contraindicated during early stages of pregnancy 5
- Generally, all antihistamines should be avoided during pregnancy, especially in the first trimester 5
Elderly:
- Lower doses may be needed due to increased sensitivity to sedative effects 5
- Use with caution in patients with pre-existing conditions such as prostatic hypertrophy, elevated intraocular pressure, or cognitive impairment 5
Side Effects and Precautions
- Common side effects: Sedation/drowsiness (most common), dry mouth, weight gain, and loss of concentration 4
- Sedation typically appears during the first week and may diminish with continued use 4
- Can impair driving and psychomotor function; patients should be cautioned about operating machinery or driving 6
- No evidence of dependency or withdrawal symptoms after abrupt discontinuation 3, 4
Comparative Efficacy
- Hydroxyzine has shown equivalent efficacy to benzodiazepines and buspirone for anxiety 2
- Higher rates of sleepiness/drowsiness compared to other anxiolytics 2
- May provide better cognitive improvement than lorazepam in some studies 3
Practical Considerations
- Sedative effects can be beneficial for nighttime dosing but may limit daytime functionality 5
- When used for dermatologic conditions, hydroxyzine is often prescribed at 10-25 mg four times daily or at bedtime 5
- For anxiety management, the fixed dose of 50 mg has shown efficacy in clinical trials 3, 4
- Consider timing of medication to ensure highest drug levels when symptoms are anticipated 5
Common Pitfalls to Avoid
- Avoid combining with other CNS depressants as this may enhance sedation 6
- Do not use in patients with severe hepatic or renal impairment 5
- Be cautious when prescribing to elderly patients or those who need to maintain alertness 5
- Monitor for excessive sedation, especially during initial treatment 4
- Avoid abrupt discontinuation in patients who have been on long-term therapy, although withdrawal symptoms are not typically reported 3, 4