Hydroxyzine HCl
ATARAX
Pronunciation: hye-DROX-i-zeen
“Hydrozoan’s Atari”
What it isFirst-generation H1 antagonist with 5-HT2A and alpha-1 blockade; pruritus and anxiety.
Why this oneUnlike buspirone, it can relieve anxiety as needed; unlike benzodiazepines, it has no dependence liability.
What limits itSedation and falls make it poor for older adults; QT prolongation matters when risks are stacked.
Pearls
- FDA-labeled for anxiety, but GAD benefit shown only short-term.
Hydroxyzine HCl prescription history
Animated chart of estimated U.S. prescriptions per year, H1 antihistamines (1944–2026). Hydroxyzine HCl enters in 1956 (estimated).
FDA-approved for
- anxiety (~1956)
- pruritus (~1956)
Off-label
- insomnia
Principal riskSedation and fall risk; QT at high dose
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilitySedation, falls, dependence and additive respiratory depression with opioids or other CNS depressants.
FDA label
Read the full label on DailyMed ↗
NO BOXED WARNINGS
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Anxiety and tension | Adults | 50–100 mg QID | 50–100 mg QID | |
| Anxiety and tension | Children (<6 yr: 50 mg/day; >6 yr: 50–100 mg/day; divided) | <6 yr: 50 mg/day divided; >6 yr: 50–100 mg/day divided | ||
| Pruritus (allergic conditions) | Adults | 25 mg TID–QID | 25 mg TID–QID | |
| Pruritus (allergic conditions) | Children (<6 yr: 50 mg/day; >6 yr: 50–100 mg/day; divided) | <6 yr: 50 mg/day divided; >6 yr: 50–100 mg/day divided | ||
| Sedative (premedication and post-anesthesia) | Adults & pediatric | 50–100 mg (adults); 0.6 mg/kg (children) |
Renal Undefined (extent of renal excretion not determined; care in impaired renal function).
Hepatic Undefined.
Instructions
- Reduce dose of concomitant CNS depressants
- May initiate by IM route then switch to oral
Available strengths
- tab 10, 25, 50 mg
- sol 10 mg/5 mL
- inj 25, 50 mg/mL
Contraindications
- Prolonged QT interval
- Early pregnancy
- Hypersensitivity to cetirizine or levocetirizine
Cautions
- QT prolongation/torsades de pointes
- Additive effect with CNS depressants
- Acute generalized exanthematous pustulosis (AGEP)
- Sedation/drowsiness
Adverse reactions
- Drowsiness
- Dry mouth
- Headache
- Tremor/convulsions (at high doses)
- QT prolongation (postmarketing)
Pregnancy Contraindicated in early pregnancy (animal fetal abnormalities; human safety not established).
Lactation Avoid; unknown whether excreted in human milk — should not be given to nursing mothers.
Cost
| Strength | #/mo | generic $/mo | CostPlus | |
|---|---|---|---|---|
| 10 mg | tab | 120 QID | $3.44 | offered |
| 25 mg | tab | 120 QID | $3.91 | offered |
| 50 mg | tab | 120 QID | $6.69 | offered |
Other forms: Hydroxyzine IM (VISTARIL IM)
Generic entry1982
Active metabolites
Open Hydroxyzine HCl in the interactive console ↗
Memory aids: interaction avatars
Open Hydroxyzine HCl in the interactive console ↗
Self-check
- Can hydroxyzine relieve anxiety as needed?
Yes. - Which age group is especially vulnerable to hydroxyzine sedation and falls?
Older adults.