Hydroxyzine Dosing in ESRD Patients
For patients with end-stage renal disease (ESRD), hydroxyzine should be dosed at 25 mg once daily, as demonstrated safe and effective in a clinical trial of dialysis patients. 1
Evidence-Based Dosing Recommendation
The recommended dose is hydroxyzine 25 mg orally once daily for ESRD patients on dialysis, based on a randomized controlled trial that specifically evaluated this dose in 32 dialysis patients over 6 weeks. 1
This dosing regimen was well-tolerated and effective in the dialysis population without reported significant adverse effects. 1
Key Pharmacokinetic Considerations
Hydroxyzine is primarily metabolized hepatically, but patients with ESRD have altered drug handling due to decreased renal clearance of metabolites and uremic toxicity risk. 2
Administer the medication after hemodialysis sessions on dialysis days to prevent premature drug removal and ensure adequate therapeutic levels. 3
ESRD patients are at increased risk for adverse drug reactions, particularly CNS-related effects (sedation, confusion) and anticholinergic burden. 4
Monitoring and Safety
Monitor closely for excessive sedation, confusion, and anticholinergic effects (dry mouth, urinary retention, constipation), as ESRD patients have heightened sensitivity to CNS-active medications. 4
Be aware that hydroxyzine can cause orthostatic hypotension and falls, particularly problematic in ESRD patients who may be on concurrent antihypertensives and diuretics. 5
Reassess clinical response within 48-72 hours and adjust if excessive sedation or inadequate symptom control occurs. 6
Critical Pitfalls to Avoid
Do not use standard adult doses (50 mg or higher) without dose reduction, as this increases risk of drug accumulation and toxicity in ESRD. 3
Avoid administering before dialysis sessions, which would result in subtherapeutic levels. 3
Do not combine with other anticholinergic or sedating medications without careful consideration of additive CNS depression and fall risk. 5