Hydroxyzine

Table of Contents

• Definition
• How Hydroxyzine Works
• Uses and Conditions
• What to Expect When Starting
• Benefits
• Side Effects and Risks
• Safety Considerations
• Drug Interactions
• Dosing and Administration
• Hydroxyzine vs. Other Anxiety Medications
• Stopping Hydroxyzine
• Cost and Insurance
• Alternatives
• When Hydroxyzine is Ideal
• Monitoring and Follow-up
• Remember
• References

Definition

How Hydroxyzine Works

• H1 histamine receptor blocking - blocks histamine in the brain and body
• Anticholinergic effects - blocks acetylcholine receptors
• Sedating properties - causes drowsiness and relaxation
• Anti-anxiety effects - calms the nervous system
• No GABA interaction - doesn't work like benzodiazepines

In the Brain: Hydroxyzine crosses the blood-brain barrier and blocks histamine receptors in areas of the brain involved in wakefulness and anxiety. This creates a calming, sedating effect that can help with both anxiety and sleep problems without the dependence risks of other anxiety medications.

Uses and Conditions

• Generalised anxiety disorder - for short-term relief
• Situational anxiety - before medical procedures or stressful events
• Panic attacks - as adjunct treatment
• Performance anxiety - for specific situations
• Anxiety in elderly - safer alternative to benzodiazepines

Sleep Problems:

• Insomnia - particularly when related to anxiety
• Sleep onset difficulties - trouble falling asleep
• Situational sleep problems - temporary sleep disturbances
• Sleep maintenance - staying asleep through the night

Other Mental Health Uses:

• Alcohol withdrawal - reduces anxiety and agitation
• Agitation in dementia - calming effect in elderly
• Autism spectrum disorders - for anxiety and sleep issues
• ADHD - as adjunct for sleep problems
• Bipolar disorder - for anxiety and sleep during mood episodes

Medical Uses:

• Allergic reactions - hives, itching, allergic rhinitis
• Nausea and vomiting - anti-nausea effects
• Preoperative sedation - before surgery or procedures
• Dermatitis - itching from skin conditions

What to Expect When Starting

• Effects typically felt within 30-60 minutes
• Drowsiness is common and expected
• Anxiety relief may be noticeable quickly
• Take as needed or as prescribed
• Effects last 4-6 hours

Short-term Use:

• Effective for immediate anxiety relief
• Helps with sleep when taken at bedtime
• Side effects usually mild and temporary
• Can be used as needed for specific situations
• No tolerance or dependence develops

Considerations:

• Not intended for long-term daily use
• Best for short-term or situational anxiety
• May be used intermittently as needed
• Regular evaluation of continued need
• Consider other treatments for chronic anxiety

Benefits

• Rapid onset - works within 30-60 minutes
• Non-addictive - no dependence or withdrawal
• Safe profile - fewer serious side effects than alternatives
• Flexible use - can be taken as needed
• No tolerance - doesn't lose effectiveness over time

For Sleep:

• Sleep induction - helps fall asleep faster
• Sleep maintenance - may help stay asleep
• No morning hangover - less grogginess than some sleep aids
• Safe for elderly - appropriate for older adults
• Non-habit forming - can be used intermittently

General Benefits:

• Dual purpose - helps both anxiety and allergies
• Well-studied - long history of safe use
• Affordable - generic versions widely available
• Multiple formulations - tablets, capsules, liquid, injection
• Pediatric use - safe for children when appropriate

Side Effects and Risks

• Drowsiness - most common, especially initially
• Dry mouth - reduced saliva production
• Dizziness - particularly when standing up
• Blurred vision - temporary vision changes
• Constipation - reduced bowel movement frequency
• Difficulty urinating - especially in elderly men

Less Common Side Effects:

• Headache
• Nausea or stomach upset
• Fatigue and weakness
• Confusion (especially in elderly)
• Tremor or shaking
• Skin rash or itching

Serious Risks:

• QT prolongation - heart rhythm changes (rare but serious)
• Severe allergic reactions - rash, difficulty breathing
• Anticholinergic toxicity - confusion, delirium, especially in elderly
• Falls - due to sedation and dizziness
• Respiratory depression - when combined with other sedatives

Safety Considerations

• Tell your doctor about all medications and supplements
• Discuss history of heart rhythm problems
• Mention glaucoma or prostate enlargement
• Review alcohol and substance use
• Discuss pregnancy or breastfeeding plans

While Taking:

• Avoid alcohol - increases sedation and side effects
• Be careful driving - especially when starting
• Rise slowly from sitting or lying positions
• Stay hydrated - helps with dry mouth
• Use caution in hot weather - may affect body temperature regulation

Special Populations:

• Elderly - more sensitive to side effects, lower doses needed
• Children - safe when used appropriately, weight-based dosing
• Pregnancy - generally considered safe but discuss with doctor
• Heart conditions - monitor for rhythm changes
• Glaucoma - may worsen narrow-angle glaucoma

Drug Interactions

• CNS depressants - alcohol, benzodiazepines, opioids (increased sedation)
• Anticholinergic medications - increased dry mouth, constipation, confusion
• QT-prolonging drugs - medications that affect heart rhythm
• MAO inhibitors - can increase hydroxyzine effects

Generally Safe Combinations:

• Most antidepressants
• Blood pressure medications
• Diabetes medications
• Most antibiotics
• Over-the-counter pain relievers

Alcohol:

• Significantly increases sedation and impairment
• Can be dangerous combination
• Avoid alcohol completely while taking hydroxyzine
• Increases risk of falls and accidents

Dosing and Administration

• Adults - 25-100mg, 3-4 times daily as needed
• Children - weight-based dosing, typically 0.6mg/kg
• Can be taken with or without food
• Take 30-60 minutes before anticipated anxiety

For Sleep:

• Adults - 25-50mg at bedtime
• Take 30-60 minutes before desired sleep time
• Can be combined with good sleep hygiene
• Use lowest effective dose

Administration Tips:

• Can be taken with food to reduce stomach upset
• Liquid formulation available for those who can't swallow pills
• Effects peak in 2 hours, last 4-6 hours
• Can be cut in half if scored tablets
• Store at room temperature, away from moisture

Hydroxyzine vs. Other Anxiety Medications

• Onset - Hydroxyzine: 30-60 minutes, Benzodiazepines: 15-30 minutes
• Dependence - Hydroxyzine: none, Benzodiazepines: high risk
• Duration - Hydroxyzine: 4-6 hours, Benzodiazepines: varies
• Cognitive effects - Hydroxyzine: minimal, Benzodiazepines: significant

Hydroxyzine vs. Buspirone:

• Onset - Hydroxyzine: immediate, Buspirone: weeks
• Use pattern - Hydroxyzine: as needed, Buspirone: daily
• Sedation - Hydroxyzine: significant, Buspirone: minimal
• Duration of treatment - Hydroxyzine: short-term, Buspirone: long-term

Stopping Hydroxyzine

• Generally can be stopped without tapering
• No withdrawal syndrome
• Original symptoms may return
• Can be restarted if needed
• No rebound anxiety

What to Expect:

• Return of original anxiety or sleep problems
• No physical withdrawal symptoms
• May need alternative treatment for ongoing issues
• Can be used intermittently as needed

Cost and Insurance

• Generic hydroxyzine widely available and very inexpensive
• Insurance typically covers generic versions
• Over-the-counter alternatives available for allergies
• Patient assistance programs rarely needed due to low cost

Typical Costs:

• Generic hydroxyzine: $5-15 per month
• One of the most affordable anxiety medications
• Costs vary by dose and pharmacy
• Excellent value for short-term anxiety relief

Alternatives

• Benzodiazepines - faster onset but dependence risk
• Buspirone - for long-term anxiety management
• Antidepressants - SSRIs, SNRIs for chronic anxiety
• Beta-blockers - for physical symptoms of anxiety
• Therapy - CBT, relaxation techniques

For Sleep:

• Melatonin - natural sleep hormone
• Trazodone - antidepressant with sleep benefits
• Zolpidem - prescription sleep medication
• Sleep hygiene - behavioural approaches
• Cognitive behavioural therapy for insomnia (CBT-I)

When Hydroxyzine is Ideal

• People needing short-term anxiety relief
• Those with substance use history (non-addictive)
• Elderly patients (safer than benzodiazepines)
• People with both anxiety and allergies
• Those who need occasional sleep help
• Individuals wanting to avoid habit-forming medications

Situations Where It's Helpful:

• Medical or dental procedures
• Temporary stressful situations
• Occasional sleep problems
• Anxiety while waiting for antidepressants to work
• Situational anxiety (flying, public speaking)

Monitoring and Follow-up

• Effectiveness for target symptoms
• Side effects and tolerability
• Need for continued use
• Consideration of long-term alternatives
• Overall mental health status

What to Report:

• Excessive sedation or impairment
• Heart palpitations or rhythm changes
• Severe confusion or memory problems
• Allergic reactions
• Lack of effectiveness

Remember

References

U.S. Food and Drug Administration. (2024). Hydroxyzine Drug Information. Retrieved from https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/hydroxyzine-information

Guaiana, G., et al. (2010). Hydroxyzine for generalised anxiety disorder. Cochrane Database of Systematic Reviews, (12), CD006815. https://pubmed.ncbi.nlm.nih.gov/21154374/

Llorca, P. M., et al. (2002). Efficacy and safety of hydroxyzine in the treatment of generalized anxiety disorder: A 3-month double-blind study. Journal of Clinical Psychiatry, 63(11), 1020-1027. https://pubmed.ncbi.nlm.nih.gov/12444816/

Simons, F. E. R., & Simons, K. J. (2011). Histamine and H1-antihistamines: Celebrating a century of progress. Journal of Allergy and Clinical Immunology, 128(6), 1139-1150. https://pubmed.ncbi.nlm.nih.gov/22035879/

Lader, M., & Scotto, J. C. (1998). A multicentre double-blind comparison of hydroxyzine, buspirone and placebo in patients with generalised anxiety disorder. Psychopharmacology, 139(4), 402-406. https://pubmed.ncbi.nlm.nih.gov/9809858/

National Institute for Health and Care Excellence (NICE). (2019). Generalised anxiety disorder and panic disorder in adults: Management. Retrieved from https://www.nice.org.uk/guidance/cg113