Can hydroxyzine be given for insomnia?

From the Guidelines

Hydroxyzine should not be used as a first-line treatment for insomnia due to its potential for serious side effects and limited evidence for its efficacy and safety, as noted in the 2008 clinical guideline for the evaluation and management of chronic insomnia in adults 1. When considering the use of hydroxyzine for insomnia, it's essential to weigh the potential benefits against the risks. Hydroxyzine is an antihistamine with sedative properties that can promote drowsiness, but its use is not FDA-approved specifically for insomnia.

• Typical dosing for sleep ranges from 25-100 mg taken 30 minutes before bedtime.
• The medication has a relatively long half-life of 20-25 hours, which may cause morning grogginess in some patients.
• Side effects can include dry mouth, constipation, blurred vision, and daytime sedation.
• Hydroxyzine should be used cautiously in elderly patients and those with certain medical conditions like narrow-angle glaucoma, prostatic hypertrophy, or significant cardiac issues. According to the 2016 American College of Physicians guideline for the management of chronic insomnia disorder in adults, cognitive behavioral therapy for insomnia (CBT-I) and practicing good sleep hygiene are recommended as better options for chronic insomnia 1.
• CBT-I is a multimodal cognitive behavioral therapy targeted specifically to insomnia, consisting of cognitive therapy, behavioral interventions, and educational interventions.
• Various delivery methods are available, including in-person individual or group therapy, telephone- or Web-based modules, and self-help books.
• Trained clinicians or mental health professionals can administer CBT-I. It's generally not recommended to use hydroxyzine for long-term insomnia treatment as tolerance to its sedative effects can develop, and it doesn't address underlying causes of sleep difficulties.

From the FDA Drug Label

Since drowsiness may occur with use of this drug, patients should be warned of this possibility and cautioned against driving a car or operating dangerous machinery while taking hydroxyzine. The answer to whether hydroxyzine can be given for insomnia is: Yes, hydroxyzine can cause drowsiness, which may be beneficial for insomnia. However, it should be used with caution, especially in the elderly, and the dosage should be selected carefully, usually starting at the low end of the dosing range 2.

From the Research

Hydroxyzine for Insomnia

• Hydroxyzine can be considered as a short-term treatment option for adults with insomnia, particularly for those who have not responded to previous therapy or have contraindications to other treatments 3.
• The efficacy of hydroxyzine for insomnia has been demonstrated in some studies, with mixed results in terms of sleep onset, sleep maintenance, and sleep quality 3.
• Hydroxyzine has been shown to be effective in reducing anxiety and stress, which can contribute to insomnia, and has been used in the treatment of generalized anxiety disorder (GAD) 4, 5, 6.

Safety and Tolerability

• The most common adverse effect of hydroxyzine is dry mouth, although other side effects such as drowsiness and sleepiness have also been reported 3, 4, 6.
• Hydroxyzine has been shown to be generally well-tolerated and safe, with no significant organ toxicity or dependency reported 5, 6.

Comparison to Other Treatments

• Hydroxyzine has been compared to other anxiolytic agents, such as benzodiazepines and buspirone, and has been shown to be equivalent in terms of efficacy and tolerability 4, 6.
• Hydroxyzine may be a useful alternative treatment to benzodiazepines, which can have significant side effects and risks of dependency 6.