Hydroxyzine (Vistaril) Cream Does Not Exist for Pediatric Itching
Hydroxyzine is only available as an oral medication (tablets, syrup) or intramuscular injection—there is no FDA-approved topical cream formulation of hydroxyzine for clinical use in children or adults. 1
Critical Clarification
- Topical antihistamines are not recommended for treating pruritus in children, as current evidence shows insufficient efficacy and increased risk of contact dermatitis 1
- If you are seeking treatment for pediatric itching, oral hydroxyzine is the appropriate formulation, not a cream 2
- One experimental study explored hydroxyzine microsponges for topical delivery in research settings, but this is not commercially available and remains investigational 3
Oral Hydroxyzine Dosing for Pediatric Itching (If Appropriate)
For children with atopic dermatitis or urticaria, oral hydroxyzine 0.7 mg/kg three times daily is the evidence-based dose that provides effective pruritus relief with minimal sedation 2:
- Peak serum concentration occurs at 2 hours after administration 2
- Pruritus suppression exceeds 85% from 2-12 hours post-dose 2
- Higher doses (1.4 mg/kg TID) provide no additional benefit but cause significantly more sedation 2
- The elimination half-life increases with age (mean 7.1 hours in children) 2
Important Caveats and Warnings
Hydroxyzine should be avoided in specific pediatric populations 1:
- Contraindicated in severe hepatic disease due to sedating effects 1
- Dose must be halved in moderate renal impairment (creatinine clearance 10-20 mL/min) 1
- Special caution required in children with epilepsy, as convulsions have been reported 1
- Risk of contact dermatitis exists in ethylenediamine-sensitive patients (hydroxyzine can cross-react) 4
Preferred Alternatives for Pediatric Itching
Second-generation non-sedating oral antihistamines are first-line therapy for most pediatric pruritic conditions 1, 5, 6:
- Cetirizine, loratadine, or fexofenadine are preferred over hydroxyzine due to better safety profiles 6
- These agents have minimal cognitive and antimuscarinic side effects compared to first-generation antihistamines like hydroxyzine 6
- Hydroxyzine may be added at bedtime (10-50 mg) only as adjunctive therapy to improve sleep in children already on non-sedating antihistamines during the day 1
For topical itch relief, use cooling lotions (calamine or 1% menthol in aqueous cream) rather than seeking topical antihistamines 1