Atarax (hydroxyzine hydrochloride) is a first-generation antihistamine with anxiolytic, sedative, and antipruritic properties, widely prescribed in clinical practice for its dual-action efficacy. As a histamine H1-receptor antagonist, it modulates neurotransmitter activity in the central nervous system, providing symptomatic relief for conditions ranging from generalized anxiety to allergic dermatoses. Its well-established safety profile and rapid onset of action make it a versatile option in both psychiatric and dermatological contexts, offering patients and providers a reliable therapeutic tool backed by decades of clinical use.

Features

• Active ingredient: Hydroxyzine hydrochloride
• Available in 10 mg, 25 mg, and 50 mg oral tablets
• Also supplied as an oral syrup (10 mg/5 mL) and injectable solution for intramuscular use
• Rapid absorption with onset of action within 15–30 minutes for anxiety; 30–60 minutes for pruritus
• Metabolism primarily hepatic via glucuronidation; elimination half-life of approximately 20 hours
• Excretion mainly renal

Benefits

• Provides rapid relief from symptoms of anxiety and tension without risk of dependence
• Effectively reduces itching associated with allergic conditions such as urticaria and atopic dermatitis
• Induces sedation which can aid in managing insomnia related to anxiety or pruritus
• Low abuse potential compared to benzodiazepines and other controlled anxiolytics
• Cost-effective generic availability improves accessibility for long-term treatment
• Useful as adjunct therapy in perioperative settings to reduce nausea and provide mild sedation

Common use

Atarax is commonly prescribed for the management of anxiety disorders, including generalized anxiety disorder (GAD) and adjustment disorder with anxious features. It is also indicated for the symptomatic relief of pruritus due to allergic conditions such as chronic urticaria, atopic and contact dermatitis, and histamine-mediated reactions. Off-label uses include preanesthetic sedation, antiemetic adjunct therapy, and management of agitation in elderly patients where sedation is desirable. Its versatility across psychiatric and dermatological domains underscores its clinical utility.

Dosage and direction

Dosage must be individualized based on indication, patient response, and tolerability. For anxiety in adults: initial dose of 50–100 mg daily in divided doses, titrated up to a maximum of 400 mg/day if needed. For pruritus: 25 mg at bedtime or 25 mg three to four times daily. Elderly or debilitated patients should begin with lower doses (e.g., 10 mg three times daily). Administer orally with or without food; tablets may be crushed if swallowing difficulty exists. Injectable form is for IM use only and should not be administered intravenously.

Precautions

Use with caution in patients with hepatic or renal impairment; dosage adjustment may be necessary. May impair mental or physical abilities required for hazardous tasks such as driving or operating machinery. Avoid alcohol and other CNS depressants during treatment. Elderly patients are more susceptible to anticholinergic effects (e.g., dry mouth, constipation, urinary retention). Not recommended during pregnancy unless potential benefit justifies potential risk; hydroxyzine is excreted in breast milk. Pediatric use should be carefully monitored for paradoxical reactions.

Contraindications

Hypersensitivity to hydroxyzine or any component of the formulation. Early pregnancy; hydroxyzine is contraindicated in the first trimester due to potential fetal risk. Patients with known QT prolongation or risk factors for torsades de pointes. Acute narrow-angle glaucoma. Urinary retention, pyloroduodenal obstruction, or prostatic hypertrophy. Concurrent use with monoamine oxidase inhibitors (MAOIs) due to risk of serotonin syndrome.

Possible side effect

Common side effects include drowsiness, dry mouth, headache, and dizziness. Less frequently, patients may experience blurred vision, constipation, or urinary retention. Paradoxical reactions such as agitation, insomnia, or excitation may occur, particularly in children and elderly patients. Rare but serious adverse effects include QT prolongation, seizures, and severe hypersensitivity reactions. Injectable form may cause pain or sterile abscess at injection site.

Drug interaction

Potentiates effects of CNS depressants including alcohol, benzodiazepines, opioids, and sedative-hypnotics. Concurrent use with anticholinergic agents may increase risk of adverse effects. May enhance effects of epinephrine and other vasopressors. QT-prolonging agents (e.g., antipsychotics, antiarrhythmics) may increase risk of cardiac arrhythmias. Avoid use with MAOIs due to theoretical risk of serotonin syndrome.

Missed dose

If a dose is missed, it should be taken as soon as remembered unless it is nearly time for the next dose. In that case, skip the missed dose and resume the regular dosing schedule. Do not double the dose to make up for a missed one. Consistent dosing is recommended to maintain therapeutic effect, particularly for anxiety management.

Overdose

Symptoms of overdose may include severe drowsiness, nausea, vomiting, hypotension, and QT prolongation. In severe cases, seizures, respiratory depression, or cardiac arrest may occur. Management is supportive and symptomatic; there is no specific antidote. Gastric lavage may be considered if presented early. ECG monitoring is advised due to risk of arrhythmias. Hemodialysis is not effective due to high protein binding.

Storage

Store at room temperature (20–25°C or 68–77°F) in a tightly closed container, protected from light and moisture. Keep out of reach of children and pets. Do not use beyond the expiration date printed on the packaging. Oral syrup should not be frozen. Discard any unused medication via take-back programs or following local disposal guidelines.

Disclaimer

This information is intended for educational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional for diagnosis and individualized treatment recommendations. Do not initiate, adjust, or discontinue medication without professional supervision. Efficacy and safety may vary based on individual health status and concomitant conditions.

Reviews

Clinical studies and decades of use support the efficacy of hydroxyzine for anxiety and pruritus. In randomized trials, it demonstrates significant improvement in Hamilton Anxiety Scale scores compared to placebo. Dermatological studies confirm reduction in pruritus intensity and improved sleep quality. Patient reports frequently note rapid relief of symptoms, though sedation is a common drawback. Overall, it remains a valued option for its dual indications and favorable safety profile.