hydroxyzine

Adjunctive therapy • Brands: VISTARIL, ATARAX

Last reviewed: 2025-12-28

General information

Class: Adjunctive therapy
Common US brands: VISTARIL, ATARAX
Typical dose range: Anxiety/acute distress (off label patterns vary): 25–50 mg every 6–8 hours as needed; consider 10–25 mg starting doses in older adults or high fall risk.
Therapeutic drug monitoring not routinely recommended.
Last reviewed: 2025-12-28

Dosing & forms

Forms/strengths: Oral tablets (hydroxyzine HCl) and oral capsules (hydroxyzine pamoate) are commonly used; strengths vary by manufacturer.
Frequency: Insomnia symptoms (off label): 25–50 mg at bedtime as needed; nightly indefinite use is generally avoided.
Typical range: Anxiety/acute distress (off label patterns vary): 25–50 mg every 6–8 hours as needed; consider 10–25 mg starting doses in older adults or high fall risk.

Mechanism (brief)

First-generation antihistamine (H1 antagonist) with sedating and anxiolytic effects; anticholinergic/antiemetic properties.

Metabolism & Half‑life

Metabolism: Hepatic
Half‑life: —

Therapeutic Drug Monitoring (TDM)

Recommended: No

View labelExact

Monitoring highlights

Sedation, falls, and driving impairment are often reassessed after initiation and during dose changes—especially in older adults.
Anticholinergic effects (constipation, urinary retention, confusion) are commonly monitored; total anticholinergic burden is minimized when possible.
QT risk: QT-prolonging co-medications and electrolytes are typically reviewed, and baseline ECGs are often considered when risk factors stack.
If use becomes frequent, the diagnosis is often revisited and plans may shift toward long-term anxiety treatment rather than continued PRN escalation.

Sources

Hydroxyzine hydrochloride prescribing information — DailyMed (2025)
Hydroxyzine pamoate prescribing information — DailyMed (2025)
Evidence-based pharmacological treatment of anxiety disorders — Depression and Anxiety (2014)
New restrictions to minimise the risks of effects on heart rhythm with hydroxyzine-containing medicines — European Medicines Agency (2015)
Guidelines for the pharmacological treatment of anxiety disorders, obsessive-compulsive disorder and posttraumatic stress disorder in primary care — International Journal of Psychiatry in Clinical Practice (2012)

General information

Class: Adjunctive therapy

Common US brands: VISTARIL, ATARAX

Typical dose range: Anxiety/acute distress (off label patterns vary): 25–50 mg every 6–8 hours as needed; consider 10–25 mg starting doses in older adults or high fall risk.

Therapeutic drug monitoring not routinely recommended.

Last reviewed: 2025-12-28

Dosing & forms

Forms/strengths: Oral tablets (hydroxyzine HCl) and oral capsules (hydroxyzine pamoate) are commonly used; strengths vary by manufacturer.

Frequency: Insomnia symptoms (off label): 25–50 mg at bedtime as needed; nightly indefinite use is generally avoided.

Typical range: Anxiety/acute distress (off label patterns vary): 25–50 mg every 6–8 hours as needed; consider 10–25 mg starting doses in older adults or high fall risk.

Monitoring highlights

Sedation, falls, and driving impairment are often reassessed after initiation and during dose changes—especially in older adults.

Anticholinergic effects (constipation, urinary retention, confusion) are commonly monitored; total anticholinergic burden is minimized when possible.

QT risk: QT-prolonging co-medications and electrolytes are typically reviewed, and baseline ECGs are often considered when risk factors stack.

If use becomes frequent, the diagnosis is often revisited and plans may shift toward long-term anxiety treatment rather than continued PRN escalation.