Hydroxyzine HCl
ATARAX
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.
FDA-approved for
- anxiety (~1956)
- pruritus (~1956)
Off-label
- insomnia
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Anxiety/tension (psychoneurosis) | Adults | 50–100 mg QID | 50–100 mg QID | |
| Anxiety/tension | Children <6 yr | 50 mg/day divided | 50 mg/day divided | |
| Anxiety/tension | Children >6 yr | 50–100 mg/day divided | 50–100 mg/day divided | |
| Pruritus (allergic conditions) | Adults | 25 mg TID–QID | 25 mg TID–QID | |
| Pruritus | Children <6 yr | 50 mg/day divided | 50 mg/day divided | |
| Pruritus | Children >6 yr | 50–100 mg/day divided | 50–100 mg/day divided | |
| Sedative (premedication/post-anesthesia) | Adults | 50–100 mg | 50–100 mg | |
| Sedative (premedication/post-anesthesia) | Children | 0.6 mg/kg | 0.6 mg/kg |
Renal Undefined
Hepatic Undefined
Instructions
- May initiate by IM route, then switch to oral
- Adjust dose to patient response
Contraindications
- Prolonged QT interval
- Early pregnancy (animal fetal abnormalities; human safety not established)
- Known hypersensitivity to cetirizine or levocetirizine
Cautions
- Drowsiness/sedation (usually transitory)
- Anticholinergic effects (dry mouth)
- QT prolongation, Torsade de Pointes
- Involuntary motor activity, rare tremor/convulsions at high doses
- AGEP and fixed drug eruptions (postmarketing)
Adverse reactions
- Drowsiness
- Dry mouth
- Headache
- QT prolongation/Torsades
- Hallucination
- Pruritus, rash, urticaria
Pregnancy Contraindicated in early pregnancy; caused fetal abnormalities in animals, human safety not established
Lactation Undefined
NO BOXED WARNINGS
Principal riskSedation and fall risk; QT at high dose
Cost, est. cash$5–$150/month
Generic entry1982
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilitySedation, falls, dependence and additive respiratory depression with opioids or other CNS depressants.
Active metabolites
Mechanism of action: Hydroxyzine HCl ballicule
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