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.
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 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
NO BOXED WARNINGS
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.
Active metabolites
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Memory aids: interaction avatars
