Hydroxyzine (Atarax) Indications and Dosage
Hydroxyzine (Atarax) Indications and Dosage
- allergic rhinitis †
- anxiety
- atopic dermatitis
- ethanol withdrawal
- insomnia †
- nausea/vomiting
- pruritus
- sedation induction
- urticaria
† non-FDA-approved indication
Hydroxyzine (Atarax) Indications and Dosage
For the adjunct treatment of anxiety and tension associated with psychoneurosis or organic disease; or for generalized anxiety disorder (GAD):
NOTE: The efficacy of hydroxyzine as an anti-anxiety agent in long term use (i.e., > 4 months) has not been established in clinical trials. Periodically reassess the clinical response of the individual patient.
Oral dosage:
Adults: Per the manufacturer, 50 - 100 mg PO four times daily, adjusted to patient response. Lower dosages have been reported effective in controlled clinical trials for generalized anxiety, such as 12.5 mg PO in the morning and at mid-day followed with 25 mg PO at bedtime. Other trials have effectively used 50 mg/day PO, given in divided doses.
Elderly: Per OBRA guidelines, the maximum recommended dose in the skilled nursing facility resident is 50 mg/day PO. Hydroxyzine is not considered by HCFA as a drug of choice for treatment of anxiety disorders in the elderly.
Children >= 6 years: Per the manufacturer, 50 - 100 mg/day PO, given in divided doses. Alternatively, some pediatric texts recommend 2 mg/kg/day PO given in divided doses every 6 - 8 hours as needed. Other alternatives include 15 mg/m2/day given in divided doses.
Children < 6 years: Per the manufacturer, 50 mg/day PO, given in divided doses. Alternatively, some pediatric texts recommend 2 mg/kg/day PO given in divided doses every 6 - 8 hours as needed. Other alternatives include 15 mg/m2/day given in divided doses.
Intramuscular dosage:
Adults: 50 - 100 mg IM initially, and repeated every 4 - 6 hours as needed. Switch to oral therapy when practicable.
for the adjunct treatment of emotional disturbances (e.g., anxiety or agitation) associated with acute ethanol withdrawal:
Intramuscular dosage:
Adults: 50 - 100 mg IM initially, repeat every 4 - 6 hours as needed.
For the short term treatment of insomnia † :
Oral dosage:
Adults: The recommended dose is 50 - 100 mg PO given 30 - 60 minutes before bedtime.
Elderly: Per OBRA guidelines, the maximum recommended dose in the skilled nursing facility resident is 50 mg/day PO. Hydroxyzine is not considered by HCFA as a drug of choice for treatment of insomnia in the elderly.
Intramuscular dosage:
Adults: The recommended dose is 50 mg IM given 30 - 60 minutes before bedtime.
For the treatment of pruritus due to histamine-mediated conditions or due to allergic conditions like chronic urticaria, atopic dermatitis or contact dermatitis:
Oral dosage:
Adults: Per the manufacturer, 25 mg PO 3 - 4 times per day.
Children >= 6 years: Per the manufacturer, 50 - 100 mg/day PO, in divided doses. Alternatively, some pediatric texts recommend 2 mg/kg/day PO given in divided doses every 6 - 8 hours as needed. Other alternatives include 15 mg/m2/day given in divided doses.
Children < 6 years: Per the manufacturer, 50 mg/day PO, in divided doses. Alternatively, some pediatric texts recommend 2 mg/kg/day PO given in divided doses every 6 - 8 hours as needed. Other alternatives include 15 mg/m2/day given in divided doses.
Intramuscular dosage:
Adults: 50 - 100 mg IM initially, and repeated every 4 - 6 hours as needed. Switch to oral therapy when practicable.
Children: Use oral therapy whenever possible. Some pediatric texts recommend 0.5 - 1 mg/kg/dose IM every 4 - 6 hours as needed.
For pre- and postoperative adjunctive medication to control nausea/vomiting:
NOTE: Do not use hydroxyzine for nausea and vomiting of the first trimester of pregnancy (see Contraindications).
Intramuscular dosage:
Adults: The recommended dose is 25 - 100 mg IM as a single dose.
Children: The recommended dose is 1.1 mg/kg IM as a single dose.
For perioperative sedation induction or adjunctively for pre- and postoperative or pre-and post-partum therapy to permit dosage reduction of narcotic analgesia:
Oral dosage:
Adults: The recommended dose is 50 - 100 mg PO.
Children: The recommended dose is 0.6 mg/kg PO.
Intramuscular dosage:
Adults: The recommended dose is 25 - 100 mg IM.
Children: The recommended dose is 1.1 mg/kg IM.
For the treatment or prophylaxis of allergic rhinitis † :
Oral dosage:
Adults: Hydroxyzine is not commonly used for this purpose. However, doses of up to 150 mg/day PO total have been reported effective for seasonal allergies. Drowsiness and dry mouth are frequently reported.
Maximum Dosage Limits:
- Adults: 400 mg/day PO.
- Elderly: 400 mg/day PO; OBRA guidelines for skilled care residents recommend a maximum dose of 50 mg/day PO for anxiety/insomnia.
- Adolescents: 100 mg/day PO or 2 mg/kg/day PO.
- Children >= 6 years: 100 mg/day PO or 2 mg/kg/day PO.
- Children < 6 years: 50 mg/day PO or 2 mg/kg/day PO.
- Infants: Safety and efficacy not established.
Patients with hepatic impairment:
Dosage reduction may be necessary based on clinical response and degree of hepatic impairment; hydroxyzine is primarily metabolized by the liver.
Patients with renal impairment:
CrCl > 50 ml/min: No dosage adjustment needed.
CrCl <= 50 ml/min: Dosage reduction may be necessary; a 50% dosage reduction is recommended.
Intermittent hemodialysis:
See dosage for CrCl < 10 ml/min. Hydroxyzine is not effectively removed by hemodialysis; may accumulate in ESRD.
† non-FDA-approved indication
[ Last revised: 5/20/2004 2:59:00 PM ]
References
. Gurvich T, Cunningham JA. Appropriate Use of Psychotropic Drugs in Nursing Homes. Am Fam Physician 2000;61:1437 - 46.
. Schaaf L, Hendeles L, Weinberger M. Suppression of seasonal allergic rhinitis symptoms with daily hydroxyzine. J Allergy Clin Immunol 1979;63:129 - 33.
. Wong L, Hendeles L, Weinberger M. Pharmacologic prophylaxis of allergic rhinitis: relative efficacy of hydroxyzine and chlorpheniramine. J Allergy Clin Immunol 1981;67:223 - 8.
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