Atarax (hydroxyzine hydrochloride) is a first-generation antihistamine with anxiolytic, sedative, and antipruritic properties, widely prescribed in clinical practice for its dual efficacy in managing anxiety disorders and allergic pruritus. As a histamine H1-receptor antagonist, it operates centrally and peripherally to alleviate symptoms by blocking histamine pathways, thereby reducing hypersensitivity reactions and moderating neurotransmitter activity associated with anxiety. Its well-established pharmacokinetic profile ensures predictable absorption and metabolism, making it a reliable option for both acute and short-term therapeutic use. Available in oral tablet and syrup formulations, Atarax is valued for its rapid onset of action and favorable safety record when administered under appropriate medical supervision.

Features

• Active ingredient: Hydroxyzine hydrochloride
• Available formulations: Oral tablets (10 mg, 25 mg, 50 mg) and syrup (10 mg/5 mL)
• Pharmacologic class: First-generation antihistamine, piperazine derivative
• Mechanism of action: Histamine H1-receptor antagonism, central nervous system depression
• Half-life: Approximately 20 hours for hydroxyzine; active metabolite cetirizine has a half-life of 8–10 hours
• Bioavailability: Well-absorbed orally with peak plasma concentrations reached within 2 hours
• Excretion: Primarily hepatic metabolism via glucuronidation; renal excretion of metabolites

Benefits

• Provides rapid relief from generalized anxiety and tension without risk of dependence associated with benzodiazepines
• Effectively reduces pruritus associated with allergic conditions such as urticaria, dermatitis, and histamine-mediated reactions
• Induces sedation which can aid in managing insomnia secondary to anxiety or pruritus
• Demonstrates antiemetic properties, useful in controlling nausea and vomiting in perioperative settings
• Offers a cost-effective therapeutic alternative with extensive clinical history and documented efficacy
• Suitable for both adult and pediatric populations (with age-appropriate dosing adjustments)

Common use

Atarax is commonly prescribed for the management of anxiety disorders, including generalized anxiety and anxiety associated with somatic conditions. It is also indicated for the symptomatic relief of pruritus due to allergic conditions such as chronic urticaria, atopic dermatitis, and contact dermatitis. Off-label uses include preanesthetic sedation, antiemesis adjunct therapy, and management of agitation in palliative care settings. Its sedative effects are utilized in short-term treatment of insomnia where anxiety is a contributing factor.

Dosage and direction

Dosage must be individualized based on patient condition, age, and clinical response. For anxiety in adults: initial dose of 50–100 mg orally divided into three or four doses daily, not to exceed 400 mg/day. For pruritus in adults: 25 mg orally three or four times daily. For pediatric patients (6 years and older): 50–100 mg/day orally in divided doses; for children under 6 years: 50 mg/day in divided doses. Administration with food may minimize gastrointestinal upset. Dose reduction is recommended in elderly patients or those with hepatic impairment due to decreased metabolism. Therapy is generally limited to short-term use (less than 4 months) for anxiety due to tolerance development.

Precautions

Patients should be cautioned regarding potential drowsiness and impaired cognitive or motor performance; activities requiring alertness (e.g., driving, operating machinery) should be avoided until individual response is ascertained. Use with caution in patients with hepatic impairment, urinary retention, angle-closure glaucoma, or prostatic hypertrophy due to anticholinergic effects. May exacerbate narrow-angle glaucoma or seizure disorders. Electrolyte imbalances should be corrected prior to initiation due to risk of QT prolongation. Pregnancy Category C: use only if potential benefit justifies potential risk to fetus. Not recommended during lactation due to secretion into breast milk.

Contraindications

Atarax is contraindicated in patients with known hypersensitivity to hydroxyzine, cetirizine, or any component of the formulation. Contraindicated in early pregnancy and during lactation. Should not be used in patients with prolonged QT interval or history of tachyarrhythmias. Avoid in patients with severe hepatic impairment or acute intermittent porphyria. Concomitant use with monoamine oxidase inhibitors (MAOIs) is contraindicated due to risk of serotonin syndrome and enhanced CNS depression.

Possible side effect

Common side effects (≥1%) include drowsiness, dry mouth, headache, and dizziness. Less frequently (0.1–1%), patients may experience agitation, confusion, blurred vision, urinary retention, constipation, or tachycardia. Rare adverse effects (<0.1%) include QT prolongation, seizures, allergic reactions including rash or bronchospasm, and blood dyscrasias. Sedation and anticholinergic effects are dose-dependent and often diminish with continued therapy. Patients should report persistent or severe side effects promptly.

Drug interaction

Concomitant use with CNS depressants (alcohol, benzodiazepines, opioids) may result in additive sedation and respiratory depression. MAOIs may potentiate anticholinergic effects and increase risk of serotonin syndrome. Anticholinergic drugs (e.g., tricyclic antidepressants) may enhance side effects like dry mouth and urinary retention. Hydroxyzine may inhibit CYP2D6, potentially increasing levels of substrates such as metoprolol or codeine. Use with QT-prolonging agents (e.g., antipsychotics, antiarrhythmics) may increase risk of arrhythmias.

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. In that case, the missed dose should be skipped and the regular dosing schedule resumed. Doubling the dose to compensate for a missed dose is not recommended due to increased risk of side effects such as excessive sedation or anticholinergic effects.

Overdose

Symptoms of overdose may include severe drowsiness, nausea, vomiting, hypotension, QT prolongation, seizures, or cardiorespiratory collapse. Management is supportive and symptomatic: gastric lavage or activated charcoal if ingestion was recent, maintenance of airway and hemodynamic stability, and ECG monitoring for QT interval. There is no specific antidote; forced diuresis is not effective. Contact a poison control center immediately for guidance.

Storage

Store at controlled 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 after the expiration date printed on the packaging. Dispose of unused medication via take-back programs or according to local regulations to prevent accidental ingestion or environmental contamination.

Disclaimer

This information is for educational purposes only and does not constitute medical advice. Always consult a qualified healthcare provider for diagnosis and individualized treatment recommendations. Do not initiate, adjust, or discontinue medication without professional supervision. The prescribing physician should be aware of the patient’s full medical history and concurrent medications.

Reviews

Clinical studies and meta-analyses consistently support the efficacy of hydroxyzine in reducing anxiety symptoms and pruritus. A 2018 systematic review in Journal of Clinical Psychopharmacology demonstrated significant anxiety reduction compared to placebo (p<0.01). Dermatological studies confirm antipruritic efficacy in 70–80% of patients with chronic urticaria. Patient reports frequently note effective sedation and itch relief, though some cite drowsiness as a limiting factor. Long-term data are limited; most experts recommend periodic reevaluation of continued use.