What is the recommended dosage of Atarax (hydroxyzine) for adults?

Atarax (Hydroxyzine) Dosage for Adults

For adults with anxiety and tension, the recommended dose is 50-100 mg four times daily (q.i.d.), while for pruritus from allergic conditions like chronic urticaria, the dose is 25 mg three to four times daily. 1

Standard Adult Dosing by Indication

Anxiety and Tension Relief

• 50-100 mg four times daily (q.i.d.) for symptomatic relief of anxiety and tension associated with psychoneurosis or as adjunct therapy in organic disease states where anxiety manifests 1
• Clinical studies demonstrate efficacy at 50 mg/day for generalized anxiety disorder, with significant reduction in Hamilton Anxiety Scale scores compared to placebo 2, 3
• Anxiolytic effects typically begin within the first week of treatment and are maintained throughout the treatment period 3

Pruritus Management

• 25 mg three to four times daily (t.i.d. or q.i.d.) for management of pruritus due to allergic conditions including chronic urticaria, atopic dermatitis, and contact dermatoses 1
• This lower dose is specifically recommended for histamine-mediated pruritus 1
• May be used as adjunctive therapy for opioid-induced pruritus in cancer patients, particularly when rotating from opiates to synthetic opioids is not feasible 4

Sedation/Premedication

• 50-100 mg as premedication before procedures or following general anesthesia 1
• When initiated via intramuscular route, subsequent doses may be administered orally 1

Critical Dosing Considerations

Elderly Patients

• Lower doses are strongly recommended due to increased risk of anticholinergic effects, sedation, and cognitive impairment 5
• The long half-life of 20 ± 4.1 hours increases risk of drug accumulation with repeated dosing in elderly patients 5
• Higher doses significantly increase anticholinergic side effects, particularly problematic in patients with prostatic hypertrophy, elevated intraocular pressure, or baseline cognitive impairment 5

Renal Impairment

• Dose should be halved in patients with moderate to severe renal impairment 4
• Hydroxyzine should be avoided in severe renal impairment (creatinine clearance < 10 mL/min) 4

Hepatic Impairment

• Avoid in severe liver disease as sedating effects are inappropriate and may precipitate complications 4

Safety and Tolerability Profile

Common Side Effects

• Transient drowsiness/sleepiness occurs in 28-36% of patients, typically appearing during the first week and progressively diminishing with continued treatment 6, 3
• Anticholinergic effects including dry mouth (14%) and blurred vision, particularly concerning in elderly patients 5, 6
• Weight gain (12%), weakness (18%), and headache (6%) reported in clinical trials 6

Contraindications and Precautions

• Contraindicated in early pregnancy, particularly first trimester, as it is the only antihistamine specifically contraindicated during early pregnancy stages 4
• Should be avoided during lactation when possible 4
• Discontinue at least 6 days before skin prick testing due to antihistaminic effects 4

Dose Adjustment Strategy

Dosage should be adjusted according to individual patient response to therapy 1. The evidence supports starting at standard doses and titrating based on:

• Clinical efficacy in symptom control
• Tolerability of side effects, particularly sedation
• Patient-specific factors including age, renal function, and hepatic function
• Concomitant medications that may interact or potentiate sedation

Duration of Treatment

• For anxiety disorders, studies demonstrate maintained efficacy over 12 weeks without rebound anxiety or withdrawal symptoms upon abrupt discontinuation 2
• Treatment duration should be determined by clinical response and underlying condition being treated 1