Maximum Hydroxyzine Dose for a 5-Year-Old, 30 kg Child
For a 5-year-old child weighing 30 kg, the maximum daily dose of hydroxyzine is 50-100 mg per day in divided doses, which translates to approximately 1.7-3.3 mg/kg/day. 1
FDA-Approved Dosing Guidelines
The FDA label provides clear dosing parameters based on age rather than weight for hydroxyzine in children 1:
- Children under 6 years: 50 mg daily in divided doses (for all indications including anxiety, tension, and pruritus) 1
- Children over 6 years: 50-100 mg daily in divided doses 1
Since this child is 5 years old, they fall into the "under 6 years" category, making 50 mg per day the maximum recommended dose regardless of their 30 kg weight 1.
Weight-Based Considerations
For premedication/sedation purposes, the FDA label specifies a weight-based dose of 0.6 mg/kg 1. For a 30 kg child, this would equal 18 mg per dose. However, this is specifically for single-dose sedation use, not for chronic administration 1.
Clinical Context from Research
A pharmacokinetic study in children with atopic dermatitis demonstrated that 0.7 mg/kg three times daily (total daily dose of 2.1 mg/kg/day) was as effective as higher doses and caused significantly less sedation 2. For a 30 kg child, this would be approximately 21 mg three times daily (63 mg/day total) 2.
However, the FDA-approved maximum of 50 mg/day for children under 6 years should not be exceeded 1, even though the child's weight might theoretically support a higher dose based on mg/kg calculations.
Critical Safety Considerations
- Sedation is the primary dose-limiting adverse effect in children, with higher doses causing significantly more sedation without additional therapeutic benefit 2
- Renal impairment requires a 50% dose reduction, and severe renal impairment (creatinine clearance <10 mL/min) is a contraindication 3
- Hepatic disease is a contraindication due to inappropriate sedating effects and risk of precipitating hepatic complications 3
- Hydroxyzine is available in syrup form to facilitate pediatric administration 3
Common Pitfalls to Avoid
- Do not calculate pediatric doses by simply scaling adult doses by weight 4 - this results in doses that are too large for neonates and potentially inappropriate for young children 4
- Do not exceed the age-based maximum even if weight-based calculations suggest a higher dose would be appropriate 1
- Do not use during early pregnancy (contraindicated) 3
- Avoid in severe hepatic or renal disease 3
Practical Dosing Algorithm
For this specific 5-year-old, 30 kg child:
- Start with 12.5-16.7 mg three times daily (37.5-50 mg total daily dose) 1
- Maximum daily dose: 50 mg (divided into 2-4 doses throughout the day) 1
- Adjust based on response and sedation, but never exceed 50 mg/day for a child under 6 years 1
- Monitor for excessive sedation, which indicates the need for dose reduction 2