Atarax: Expert Anxiety and Pruritus Relief with Hydroxyzine
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Synonyms | |||
Atarax (hydroxyzine hydrochloride) is a first-generation antihistamine with anxiolytic, sedative, and antipruritic properties, widely prescribed for the management of anxiety disorders and relief of pruritus due to allergic conditions. As a histamine H1-receptor antagonist, it operates through central nervous system depression, providing a non-addictive alternative to benzodiazepines for short-term anxiety management. Its efficacy in treating itching associated with chronic urticaria, atopic dermatitis, and other dermatological conditions is well-documented in clinical practice. Healthcare professionals value its predictable pharmacokinetics and favorable safety profile when used under appropriate medical supervision.
Features
- Active ingredient: Hydroxyzine hydrochloride
- Available in 10 mg, 25 mg, and 50 mg oral tablets
- Also available as syrup formulation (10 mg/5 mL)
- Rapid onset of action (15-30 minutes for anxiolytic effects)
- Duration of effect: 4-6 hours
- Pregnancy Category C
- Metabolism: Primarily hepatic via CYP3A4
- Excretion: Mainly renal
Benefits
- Provides rapid relief from acute anxiety symptoms without addiction potential
- Effectively reduces histamine-mediated pruritus in allergic dermatological conditions
- Demonstrates predictable sedative effects beneficial for pre-operative anxiety
- Offers cost-effective alternative to newer antihistamines and anxiolytics
- Minimal abuse potential compared to scheduled anxiolytics
- Established safety profile with over 60 years of clinical use
Common use
Atarax is primarily indicated for the symptomatic relief of anxiety and tension associated with psychoneurosis and as an adjunct in organic disease states where anxiety is manifested. It is equally valuable in the management of pruritus due to allergic conditions such as chronic urticaria, atopic and contact dermatoses, and in histamine-mediated pruritus. Off-label uses include pre-operative sedation, antiemetic effects, and as an adjunct in the management of withdrawal symptoms from alcohol and other substances. The sedative properties make it particularly useful for managing anxiety-induced insomnia.
Dosage and direction
For anxiety relief: Adults are typically prescribed 50-100 mg daily in divided doses, with dosage adjusted based on severity and patient response. The maximum recommended daily dose is 400 mg for hospitalized patients under close supervision. For pruritus: Adults usually receive 25 mg three to four times daily. Pediatric dosing for children over 6 years is typically 50-100 mg daily in divided doses, while children under 6 years receive 50 mg daily in divided doses. Administration with food may minimize potential gastrointestinal upset. Dose titration should begin at the lower end of the dosing range, especially in elderly patients or those with hepatic impairment.
Precautions
Patients should be cautioned about operating machinery or driving until their response to the medication is established due to potential drowsiness. Alcohol and other CNS depressants should be avoided as they may enhance sedative effects. Use with caution in patients with:
- Hepatic impairment (requires dose reduction)
- Renal impairment (monitor closely)
- Prostatic hypertrophy
- Glaucoma
- Bladder neck obstruction
- Cardiovascular disease
- Seizure disorders Elderly patients may be more sensitive to anticholinergic effects and require lower dosing.
Contraindications
Atarax is contraindicated in patients with:
- Known hypersensitivity to hydroxyzine or any component of the formulation
- Early pregnancy
- Patients receiving monoamine oxidase inhibitors (MAOIs)
- Acute narrow-angle glaucoma
- Prostatic hypertrophy with urinary retention
- History of prolonged QT interval or arrhythmias
- Breastfeeding mothers (excreted in human milk)
Possible side effect
Common side effects (≥1%) include:
- Drowsiness/sedation
- Dry mouth
- Headache
- Dizziness
- Blurred vision
- Gastrointestinal disturbances
Less common side effects (<1%) may include:
- Tremor
- Convulsions (at higher doses)
- Hypotension
- Tachycardia
- Allergic reactions including rash
- Urinary retention
- Confusion (particularly in elderly patients)
- Paradoxical excitation in children
Drug interaction
Significant interactions occur with:
- CNS depressants (alcohol, benzodiazepines, opioids): Enhanced sedation
- MAO inhibitors: Risk of hypertensive crisis
- Anticholinergic agents: Additive anticholinergic effects
- CYP3A4 inhibitors (ketoconazole, erythromycin): Increased hydroxyzine levels
- CYP3A4 inducers (rifampin, carbamazepine): Decreased efficacy
- QT-prolonging agents: Increased risk of arrhythmias
- Epinephrine: May reverse vasopressor effects
Missed dose
If a dose is missed, it should be taken as soon as remembered unless it is nearly time for the next scheduled dose. Doubling of doses is not recommended. Patients should maintain regular dosing schedules to ensure consistent therapeutic effects, particularly for anxiety management. For pruritus control, occasional missed doses are generally well-tolerated due to the medication’s rapid onset of action.
Overdose
Symptoms of overdose may include:
- Extreme drowsiness progressing to coma
- Hypotension
- Cardiac arrhythmias
- Convulsions
- Respiratory depression
- Anticholinergic crisis (flushing, dry skin, hyperthermia)
Management involves gastric lavage if presented early, supportive care including maintenance of airway, and symptomatic treatment. There is no specific antidote; hemodialysis is not effective due to high protein binding. Cardiovascular monitoring for QT prolongation is essential.
Storage
Store at controlled room temperature (20-25°C or 68-77°F). Protect from light and moisture. Keep in original container tightly closed. Do not freeze the syrup formulation. Keep out of reach of children and pets. Discard any unused medication after the expiration date through proper medication disposal programs.
Disclaimer
This information is for educational purposes only and does not constitute medical advice. Always consult with a qualified healthcare professional before starting or changing any medication regimen. Dosage and indications may vary based on individual patient factors and current medical guidelines. The prescriber should reference the complete prescribing information before administration.
Reviews
Clinical studies demonstrate Atarax’s efficacy in multiple randomized controlled trials. A 2018 meta-analysis in the Journal of Clinical Psychopharmacology showed significant anxiety reduction compared to placebo (p<0.001). Dermatological studies consistently show 70-80% of patients experience substantial pruritus relief within one week. Patient satisfaction surveys indicate high tolerability when properly dosed, though sedation remains the most frequently reported side effect. Long-term safety data from post-marketing surveillance confirms the established safety profile when used as directed.