What is the use of Hydroxyzine (Atarax)?

From the Guidelines

Hydroxyzine is a sedative antihistamine that can be used for anxiolytic purposes in both children and adults, with a recommended dose of 0.5-1 mg/kg every 6 hours for children and 25-100 mg taken 3-4 times daily for adults 1.

Key Points

• Hydroxyzine is available in tablets and syrup, with few contraindications in children 1.
• The medication works by blocking histamine H1 receptors in the central nervous system, reducing anxiety and promoting sedation, and also blocks histamine receptors in peripheral tissues, reducing itching and allergic symptoms.
• Common side effects include drowsiness, dry mouth, and dizziness, and it should be used with caution in elderly patients and those with certain medical conditions like glaucoma, prostatic hypertrophy, or cardiac issues.
• Hydroxyzine should not be taken with alcohol or other central nervous system depressants as this can increase sedation.

Clinical Use

• For anxiety treatment, hydroxyzine is generally considered for short-term use rather than long-term management.
• In pediatric patients, hydroxyzine can be used as a sedative for diagnostic procedures, with a recommended dose of 0.5-1 mg/kg every 6 hours 1.
• In adults, hydroxyzine can be used to treat anxiety, itching from allergic reactions, and as a sedative, with a recommended dose of 25-100 mg taken 3-4 times daily.

Important Considerations

• Hydroxyzine has been shown to result in clinically significant improvement compared to placebo in patients with interstitial cystitis/bladder pain syndrome, particularly in those with systemic allergies 1.
• The medication typically begins working within 15-30 minutes and its effects can last 4-6 hours.
• Alternative treatments, such as ursodeoxycholic acid, may be considered for patients who cannot take hydroxyzine or who have continued symptoms on the maximum dosage 1.

From the FDA Drug Label

For symptomatic relief of anxiety and tension associated with psychoneurosis and as an adjunct in organic disease states in which anxiety is manifested. The primary use of Hydroxyzine is for the symptomatic relief of anxiety and tension.

• It is used to manage pruritus due to allergic conditions.
• It can be used as a sedative when used as a premedication and following general anesthesia. The effectiveness of hydroxyzine as an antianxiety agent for long term use (more than 4 months) has not been assessed by systematic clinical studies 2.

From the Research

Hydroxyzine Overview

• Hydroxyzine is an anti-histamine medication used in the treatment of anxiety 3, 4, 5.
• It has been studied in various clinical trials for its efficacy in generalized anxiety disorder (GAD) 3, 4, 5.

Efficacy of Hydroxyzine

• Hydroxyzine has been shown to be more effective than placebo in alleviating the acute symptoms of GAD (odds ratio (OR) 0.30,95% CI 0.15 to 0.58) 3.
• It has also been found to be equivalent in terms of efficacy, acceptability, and tolerability compared to other anxiolytic agents such as benzodiazepines and buspirone 3.
• A 3-month double-blind study confirmed the efficacy and safety of hydroxyzine in the treatment of GAD, with a significant reduction in Hamilton Rating Scale for Anxiety (HAM-A) scores compared to placebo 5.

Safety and Tolerability

• Hydroxyzine has been associated with a higher rate of sleepiness/drowsiness compared to active comparators (OR 1.74,95% CI 0.86 to 3.53) 3.
• However, it has been found to have a favorable safety profile, with no significant difference in safety results compared to bromazepam except for drowsiness 5.
• Cetirizine, a metabolite of hydroxyzine, has also been found to have a low risk of sedation and impairment of CNS function, making it a suitable alternative for patients who require long-term treatment 6.

Clinical Use

• Hydroxyzine may be considered as an alternative treatment to benzodiazepines for GAD, although its use should be carefully evaluated due to the high risk of bias in included studies and the small number of studies 3.
• Cetirizine, a second-generation antihistamine, has been found to be effective in the treatment of allergic disorders, including asthma and urticaria, and may be a useful alternative for patients who require concomitant treatment for anxiety and allergic disorders 6.