What is the recommended dose of hydroxyzine (Hydroxyzine) for treating panic disorders?

Hydroxyzine Dosing for Panic Disorder

For panic disorder, hydroxyzine should be administered at a dose of 50 to 100 mg four times daily in adults. 1

Dosing Recommendations

• The FDA-approved dosage of hydroxyzine for anxiety and tension associated with psychoneurosis is 50 to 100 mg four times daily for adults 1
• This dosing can be applied to panic disorder as it falls under the anxiety spectrum disorders 2
• Dosing should be adjusted according to the patient's response to therapy 1

Pharmacological Considerations

• Hydroxyzine is an antihistamine with anxiolytic properties that can help manage acute anxiety symptoms 3
• It may be particularly useful for patients with panic disorder who experience somnolence as a beneficial side effect 4
• The medication works quickly and can be used for both acute episodes and ongoing management 4

Treatment Context

• While hydroxyzine can be effective for symptom management in panic disorder, it is not considered a first-line treatment 5
• First-line pharmacological treatments for panic disorder include:
  • Selective serotonin reuptake inhibitors (SSRIs) 2, 6
  • Serotonin-norepinephrine reuptake inhibitors (SNRIs) 5
• Cognitive behavioral therapy (CBT) has strong evidence supporting its effectiveness and should be considered alongside pharmacological treatment 6

Precautions and Side Effects

• The most common side effect of hydroxyzine is drowsiness/sedation 3
• Hydroxyzine may cause more drowsiness than other anxiolytic agents 3
• The sedative effects may be beneficial for patients with insomnia or sleep disturbances related to their panic disorder 4
• Temporary drowsiness often resolves with continued therapy at the same dosage level 4

Clinical Pearls

• Hydroxyzine can be used as an adjunct treatment when first-line treatments are insufficient or not tolerated 5
• For acute panic symptoms, hydroxyzine's relatively rapid onset of action may be advantageous 4
• Benzodiazepines (like lorazepam) are sometimes used for acute anxiety management but carry risks of dependence and are not recommended for routine use 2, 5
• After symptom remission with any medication treatment, continuation for 6-12 months is typically recommended to prevent relapse 5

Alternative Anxiolytics for Panic Disorder

• If hydroxyzine is ineffective or not tolerated, consider:
  • Buspirone: Initial dosage 5 mg twice daily; maximum 20 mg three times daily 2
  • Lorazepam: For acute anxiety management (not for long-term use) 2
  • SSRIs: Recommended as first-line pharmacological treatment 2, 6