From the Guidelines
Atarax (hydroxyzine) should not be the first-line treatment for urticaria due to its sedating effects and potential for performance impairment, as evidenced by studies such as 1. Instead, nonsedating H1 antihistamines like cetirizine, desloratadine, or fexofenadine are preferred for their efficacy and safety in treating urticaria, as recommended in guidelines such as 1. Key points to consider when treating urticaria include:
- The choice of antihistamine may vary based on individual patient response and tolerance, with the option to increase the dose above the licensed recommendation if benefits outweigh risks, as noted in 1.
- Sedating antihistamines like hydroxyzine can be effective but are generally less preferred due to their side effects, which can include sedation, dry mouth, and constipation, as discussed in 1.
- The addition of an H2 antihistamine may sometimes provide better control of urticaria than an H1 antihistamine alone, although this is more commonly beneficial for accompanying dyspepsia, as mentioned in 1.
- Patients should be aware of the potential for sedation and performance impairment with first-generation antihistamines and should avoid activities requiring alertness and alcohol consumption while taking these medications, as warned in 1. Considerations for specific patient populations, such as older adults or those with renal impairment, are crucial, with caution advised due to increased sensitivity to psychomotor impairment and anticholinergic effects, as highlighted in 1 and 1, respectively. In summary, while Atarax can be used for urticaria, its use should be carefully considered against the backdrop of newer, nonsedating antihistamines that offer comparable efficacy with fewer side effects, as supported by the most recent and highest quality evidence available 1.
From the FDA Drug Label
Hydroxyzine hydrochloride... antihistaminic... effects have been demonstrated experimentally and confirmed clinically. The antihistaminic effects of Atarax (hydroxyzine) make it a suitable treatment for urticaria.
- Atarax can be used to treat urticaria due to its antihistaminic properties 2
From the Research
Atarax for Urticaria
- Atarax, also known as hydroxyzine, is a first-generation antihistamine that has been used in the past to treat urticaria 3, 4, 5.
- According to the studies, first-generation antihistamines like Atarax were employed similarly to second-generation antihistamines, but they are no longer the first line of treatment due to their sedative effects 3, 4.
- The treatment of chronic spontaneous urticaria typically begins with antihistamines, and the dose required often exceeds that recommended for allergic rhinitis 3.
- In some cases, Atarax may still be used, especially if symptoms are severe and associated with angioedema, and if the patient is anxious and disturbed at night 5.
- However, it is essential to note that Atarax is not the primary treatment option for urticaria, and other medications like omalizumab and cyclosporine may be more effective in treating chronic spontaneous urticaria 3, 4, 6.
- The choice of treatment for urticaria depends on the severity of symptoms, the presence of autoimmunity, and the patient's response to previous treatments 3, 4, 5, 6, 7.