From the FDA Drug Label
For symptomatic relief of anxiety and tension associated with psychoneurosis and as an adjunct in organic disease states in which anxiety is manifested. As a sedative when used as a premedication and following general anesthesia, hydroxyzine may potentiate meperidine and barbiturates, so their use in pre-anesthetic adjunctive therapy should be modified on an individual basis.
The use of hydroxyzine for sleep is not directly mentioned in the drug label. However, it does mention that hydroxyzine can be used as a sedative.
- Key points:
- Hydroxyzine has sedative properties.
- The label does not explicitly state its use for sleep. Given the information available, hydroxyzine may have a sedative effect, but its use specifically for sleep is not directly supported by the label 1.
From the Research
Hydroxyzine should not be used as a first-line treatment for insomnia, but rather considered a second-line option after addressing sleep hygiene practices and exploring non-pharmacologic approaches such as cognitive behavioral therapy for insomnia (CBT-i) 2, 3. When considering hydroxyzine for sleep, it's essential to weigh the potential benefits against the risks, particularly in older adults and individuals with certain medical conditions. Hydroxyzine works primarily as an antihistamine with sedating properties, which can help induce drowsiness and improve sleep quality. However, it is not FDA-approved specifically for insomnia and can have side effects such as morning drowsiness, dry mouth, and dizziness. Tolerance can also develop with regular use, potentially reducing its effectiveness over time.
Some key points to consider when evaluating the use of hydroxyzine for sleep include:
- The medication begins working within 15-30 minutes and its effects can last 4-6 hours, making it suitable for helping with sleep initiation
- Hydroxyzine should be used cautiously in older adults and avoided in people with certain conditions like narrow-angle glaucoma or severe urinary retention
- Non-pharmacologic approaches, such as CBT-i, have been shown to be effective in treating insomnia and should be considered as a first-line treatment 4, 5
- CBT-i encompasses sleep hygiene, stimulus control, sleep restriction, cognitive therapy, and relaxation training, and has been found to be an effective alternative to pharmacotherapy for insomnia 2, 3
In terms of specific recommendations, hydroxyzine can be used as a short-term sleep aid, typically at doses of 25-50mg taken 30 minutes before bedtime, but only after exploring non-pharmacologic approaches and addressing sleep hygiene practices 2, 3. It's best used occasionally rather than nightly, and any persistent sleep problems should prompt discussion with a healthcare provider about more appropriate long-term solutions.