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: adults, 50 to 100 mg q.i.d. ; children under 6 years, 50 mg daily in divided doses; children over 6 years, 50 to 100 mg daily in divided doses. For use in the management of pruritus due to allergic conditions such as chronic urticaria and atopic and contact dermatoses and in histamine-mediated pruritus: adults, 25 mg t.i.d. or q.i.d. ; children under 6 years, 50 mg daily in divided doses; children over 6 years, 50 to 100 mg daily in divided doses. As a sedative when used as a premedication and following general anesthesia: 50 to 100 mg for adults and 0. 6 mg/kg of body weight in children.
The recommended dose of hydroxyzine is:
- 50 to 100 mg every 4 hours (q.i.d.) for adults for symptomatic relief of anxiety and tension
- 25 mg three or four times a day (t.i.d. or q.i.d.) for adults for management of pruritus due to allergic conditions
- 50 mg daily in divided doses for children under 6 years
- 50 to 100 mg daily in divided doses for children over 6 years
- 50 to 100 mg for adults as a sedative when used as a premedication and following general anesthesia
- 0.6 mg/kg of body weight in children as a sedative when used as a premedication and following general anesthesia 1
From the Research
Hydroxyzine is typically dosed at 25-50 mg three to four times daily for adults when used for anxiety or as an antihistamine. For elderly patients or those with hepatic impairment, starting at a lower dose of 10-25 mg is recommended 2. Children aged 6 and older may receive 12.5-25 mg three to four times daily, while younger children (2-6 years) should receive 12.5 mg three to four times daily. For sedation before procedures, adults may take 50-100 mg, and children 0.6 mg/kg. When used for itching or allergic reactions, the total daily dose should not exceed 100 mg for adults.
Key Considerations
- Hydroxyzine works by blocking histamine H1 receptors and has additional anticholinergic and sedative effects 3.
- The medication begins working within 15-30 minutes and lasts 4-6 hours, which is why multiple daily doses are often needed.
- Side effects include drowsiness, dry mouth, and blurred vision, so patients should avoid driving or operating machinery until they know how the medication affects them.
- Hydroxyzine should not be combined with other central nervous system depressants like alcohol or opioids due to increased sedation risk 4.
Recent Evidence
A recent study from 2024 found that hydroxyzine prescriptions increased following a new insomnia diagnosis, while z-drug and benzodiazepine prescriptions declined 4. Another study from 2002 confirmed the efficacy and safety of hydroxyzine in the treatment of generalized anxiety disorder over a 3-month period 5.
Important Interactions
It's essential to note that benzodiazepines, which are sometimes used for similar indications, have a high potential for dependence and withdrawal symptoms, and their use should be carefully considered and monitored 6. In contrast, hydroxyzine has been shown to be effective and safe for the treatment of anxiety and insomnia, making it a viable alternative to benzodiazepines in some cases.
Dosage and Administration
The dosage of hydroxyzine may vary depending on the specific indication and patient population. The recommended dose for adults is 25-50 mg three to four times daily, while children and elderly patients may require lower doses. It's crucial to follow the recommended dosage and administration guidelines to minimize the risk of side effects and ensure optimal efficacy.