Hydroxyzine Dosage and Usage for Anxiety and Pruritus
For anxiety in adults, hydroxyzine should be administered at 50-100 mg four times daily, while for pruritus management, the recommended dosage is 25 mg three to four times daily. 1
Dosage Recommendations
For Anxiety:
- Adults: 50-100 mg four times daily 1
- Efficacy has been demonstrated at a fixed dose of 50 mg in generalized anxiety disorder, with superiority over placebo from the first week of treatment 2
- Hydroxyzine shows beneficial effects on sleep and reduces stress and anxiety without causing dependency 2
For Pruritus:
- Adults: 25 mg three to four times daily 1
- For nocturnal pruritus: 10-50 mg at bedtime as a sedating antihistamine, which can complement non-sedating antihistamines used during daytime 3
- In urticaria cases, adding hydroxyzine to a non-sedating antihistamine regimen can improve sleep quality 3
Special Populations
Elderly:
- Lower dosages should be considered due to increased risk of sedative effects 3
- Start at the lower end of the dosage range and titrate based on response 1
Renal Impairment:
- For moderate renal insufficiency (creatinine clearance 10-20 mL/min): Reduce dosage by 50% 3
- Adjust according to patient's response to therapy 1
Hepatic Impairment:
- Avoid use in severe hepatic disease due to enhanced sedative effects 3
- When used in patients with milder hepatic impairment, careful dose adjustment is necessary 1
Administration Considerations
- When treatment is initiated via intramuscular route, subsequent doses may be administered orally 1
- For sedation as premedication: 50-100 mg for adults 1
- Dosage should be adjusted according to individual patient response to therapy 1
Precautions and Contraindications
- Contraindicated during early stages of pregnancy 3
- Use caution when combining with other sedative or central nervous system depressant medications 3
- Prolonged use as monotherapy is not recommended due to concerns about reduced concentration and performance 3
- Rare but serious side effects may include supraventricular tachycardia, as reported in a pediatric case 4
- Most common side effect is temporary drowsiness, which typically resolves with continued therapy at the same dosage 5
Clinical Pearls
- Hydroxyzine can be used as supportive therapy during benzodiazepine withdrawal, with 25-50 mg daily showing improvement in anxiety levels and reduction of withdrawal symptoms 6
- For pruritus management in dermatological conditions, hydroxyzine can be particularly effective when administered at bedtime to address nighttime itching while minimizing daytime sedation 3
- When using hydroxyzine for anxiety, progressive rather than abrupt initiation may be better tolerated 6