Hydroxyzine Dosing in Children
For children under 6 years, administer 50 mg daily in divided doses; for children over 6 years, administer 50-100 mg daily in divided doses, with the specific dose depending on the indication (anxiety/pruritus vs sedation). 1
Standard Dosing by Age and Indication
For Anxiety, Tension, and Pruritus
- Children under 6 years: 50 mg daily in divided doses 1
- Children over 6 years: 50-100 mg daily in divided doses 1
- The FDA label specifies these doses apply to both anxiety/tension management and pruritus from allergic conditions including chronic urticaria, atopic dermatitis, and contact dermatoses 1
For Procedural Sedation/Premedication
- All pediatric patients: 0.6 mg/kg of body weight 1
- This weight-based dosing is specifically for sedation as premedication and following general anesthesia 1
- Hydroxyzine can be used for anxiolytic purposes during procedures such as imaging studies 2
Practical Administration Considerations
- Hydroxyzine is available in syrup form, which facilitates administration to children 3, 2, 4
- When treatment is initiated intramuscularly, subsequent doses may be administered orally 1
- Dosage should be adjusted according to the patient's response to therapy 1
Evidence-Based Dosing Refinement
A pharmacokinetic study in children with atopic dermatitis demonstrated that 0.7 mg/kg three times daily was as effective as 1.4 mg/kg three times daily for relieving pruritus and promoting skin lesion resolution, while causing significantly less sedation 5. This study found:
- Peak serum concentrations occurred at approximately 2 hours 5
- Pruritus was suppressed for 1-24 hours after dosing, with greater than 85% suppression from 2-12 hours 5
- The elimination half-life increased with age (mean 7.1 hours) 5
Critical Dose Adjustments
Renal Impairment
- Reduce the dose by 50% in patients with moderate to severe renal impairment 3, 4
- Avoid hydroxyzine entirely in severe renal impairment (creatinine clearance <10 mL/min) 3, 4
- Failure to halve the dose in renal impairment increases toxicity risk 3
Hepatic Impairment
- Avoid hydroxyzine in patients with severe hepatic impairment due to inappropriate sedating effects and risk of precipitating hepatic complications 3, 4
Contraindications and Precautions
- Hydroxyzine is contraindicated during early pregnancy 3, 2, 4
- Avoidance or caution is recommended during lactation 3
- None of the currently licensed antihistamines is contraindicated in children 12 years and older 3
Common Pitfall to Avoid
The most critical error is failing to reduce the dose by half in patients with renal impairment, which significantly increases the risk of toxicity 3. Always assess renal function before initiating therapy in children with known kidney disease.