From the Guidelines
Alternatives to Atarax (Hydroxyzine) for Inpatient Anxiety
Alternatives to Atarax (hydroxyzine) for inpatient anxiety include benzodiazepines such as lorazepam (1-2 mg orally or intravenously every 4-6 hours) or midazolam (2.5-5 mg orally or intravenously every 4-6 hours) 1. Non-benzodiazepine options like buspirone (5-10 mg orally three times a day) or antidepressants such as sertraline (25-50 mg orally daily) may also be considered, although their onset of action may be delayed 1.
Pharmacological Interventions
- Haloperidol (0.5-1 mg orally or subcutaneously) may be used for acute anxiety management in the inpatient setting, with caution due to the risk of extrapyramidal side effects (EPSEs) 1.
- Olanzapine (2.5-5 mg orally or intravenously) may also be used, with caution due to the risk of oversedation and respiratory depression when combined with benzodiazepines 1.
- Quetiapine (25 mg orally) may be considered, with caution due to the risk of orthostatic hypotension and dizziness 1.
Non-Pharmacological Interventions
- Cognitive behavioral therapy may be effective in treating anxiety in patients with cancer 1.
- Support and education should be provided to all patients and their families about anxiety and its treatment 1.
Important Considerations
- The choice of anxiolytic should be informed by the adverse effect profiles of the medications, tolerability of treatment, and patient preference 1.
- Caution is warranted with respect to the use of benzodiazepines in the treatment of anxiety, specifically over the longer term, due to the risk of abuse and dependence 1.
From the Research
Alternatives to Atarax (Hydroxyzine) for Inpatient Anxiety
- Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are considered first-line drugs for anxiety disorders 2
- Other treatment options include:
- Calcium modulator pregabalin
- Tricyclic antidepressants
- Buspirone
- Moclobemide
- Novel treatment strategies that act on GABA, glutamate, and other neurotransmitter systems 2
- Benzodiazepines are not recommended for routine use due to their possible addiction potential, but may be considered in certain cases 2, 3, 4
- Nonpharmacological alternatives, such as:
- Mindfulness
- Meditation
- Yoga may be safely recommended to patients with anxiety 5
- Antidepressants, such as SSRIs, may be more effective and better tolerated than benzodiazepines for panic disorder 3
- The choice of treatment should be guided by the patient's preference and should balance benefits and harms from treatment in a long-term perspective 4