Maximum Single Dose of Vistaril (Hydroxyzine) for Anxiety
The maximum single dose of Vistaril (hydroxyzine) for anxiety in adults is 100 mg. 1
Dosing Guidelines for Hydroxyzine in Anxiety
- According to the FDA label, for symptomatic relief of anxiety and tension associated with psychoneurosis, the recommended adult dose is 50 to 100 mg four times daily 1
- The maximum single dose should not exceed 100 mg in adults 1
- For elderly or debilitated patients, lower doses are typically recommended due to increased risk of sedation and other side effects 2
Administration Considerations
- Hydroxyzine can be administered orally for anxiety management 1
- When used as a premedication for sedation, doses of 50-100 mg may be given 1
- Dosage should be adjusted according to the patient's response to therapy 1
Special Populations
- For children under 6 years: 50 mg daily in divided doses 1
- For children over 6 years: 50 to 100 mg daily in divided doses 1
- For elderly patients: Consider reduced dosing similar to recommendations for benzodiazepines in this population (25-50% reduction) 2
Clinical Efficacy and Safety
- Clinical studies have demonstrated hydroxyzine's efficacy at doses of 50 mg/day for generalized anxiety disorder 3
- Hydroxyzine has shown comparable efficacy to benzodiazepines in treating anxiety symptoms 4, 3
- Hydroxyzine has been studied at fixed doses of 50 mg with superiority over placebo on anxiety measures from the first week of treatment 5
Side Effects and Precautions
- The most common side effect is drowsiness/sedation, which is more pronounced than with some other anxiolytics 4
- Hydroxyzine may impair driving ability and psychomotor function 6
- Caution should be exercised when combining hydroxyzine with other CNS depressants, particularly benzodiazepines, as this may increase sedation 2
Important Clinical Considerations
- While hydroxyzine is effective for anxiety, it is not typically considered a first-line treatment for generalized anxiety disorder due to its sedating properties 4
- Unlike benzodiazepines, hydroxyzine does not carry a risk of dependency or addiction 5
- When prescribing for anxiety, be aware that the onset of action is relatively quick compared to some other anxiolytics like buspirone 2
- For patients who cannot tolerate or have contraindications to other anxiolytics, hydroxyzine represents a reasonable alternative 3