What is the recommended dosage of Atarax (hydroxyzine)?

Hydroxyzine (Atarax) Dosage Recommendations

The recommended dosage of Atarax (hydroxyzine) varies by indication: for anxiety in adults, 50-100 mg four times daily; for pruritus in adults, 25 mg three to four times daily; and for sedation, 50-100 mg in adults. 1

Adult Dosing by Indication

• Pruritus/Allergic Conditions:

  • 25 mg three to four times daily 1
  • For nighttime use, 10-50 mg at bedtime is effective for sleep due to sedative properties 2
  • Can be used as a nighttime complement to daytime non-sedating antihistamines 3

• Anxiety/Tension:

  • 50-100 mg four times daily 1
  • Lower dose of 50 mg/day has shown significant anxiolytic effect in generalized anxiety disorder 4

• Pre-anesthetic Sedation:

  • 50-100 mg as a single dose 1

Pediatric Dosing

• Children under 6 years:

  • 50 mg daily in divided doses for both pruritus and anxiety 1

• Children over 6 years:

  • 50-100 mg daily in divided doses for both pruritus and anxiety 1
  • For sedation: 0.6 mg/kg of body weight 1

Special Populations and Considerations

• Renal Impairment:

  • Dose should be halved in patients with moderate renal impairment 2

• Hepatic Impairment:

  • Avoid in severe liver disease due to enhanced sedating effects 2, 3

• Elderly:

  • Use with caution due to anticholinergic effects; consider lower doses 3

• Pregnancy:

  • Contraindicated during early pregnancy according to UK manufacturer's guidelines 2

Administration Guidelines

• For nighttime pruritus, a single bedtime dose of 25-50 mg is often sufficient 2
• When initiating treatment via intramuscular route, subsequent doses may be administered orally 1
• Dosage should be adjusted according to individual patient response 1

Common Side Effects

• Sedation/drowsiness (most common) - appears during first week and typically diminishes with continued use 4
• Dry mouth 4
• Weight gain 4
• Impaired concentration 4
• May impair driving ability and psychomotor function 5

Clinical Pearls

• Hydroxyzine can be effective for generalized pruritus when used short-term 3
• For inadequate response to standard doses, consider adding an H2 antihistamine 6, 3
• Avoid concurrent use with other CNS depressants as it may enhance sedative effects 5
• Cooling antipruritic lotions like calamine or 1% menthol in aqueous cream can provide additional relief when used alongside hydroxyzine 6