Atarax (hydroxyzine hydrochloride) is a first-generation antihistamine with anxiolytic, antiemetic, and antipruritic properties. It is widely prescribed for the management of anxiety disorders, tension, and pruritus due to allergic conditions. By acting as a central nervous system depressant, it provides symptomatic relief while offering a favorable safety profile when used as directed under medical supervision. This medication is available in oral tablet and syrup formulations, allowing for flexible dosing based on individual patient needs and clinical indications.

Features

• Active ingredient: Hydroxyzine hydrochloride
• Available forms: Oral tablets (10 mg, 25 mg, 50 mg) and syrup (10 mg/5 mL)
• Pharmacologic class: Piperazine-derivative antihistamine (H1-receptor antagonist)
• Onset of action: Typically 15–30 minutes after administration
• Duration of effect: 4–6 hours per dose
• Prescription status: Rx-only in most jurisdictions
• Compatibility: Can be used adjunctively with other therapies under medical guidance

Benefits

• Rapid relief from symptoms of generalized anxiety and tension
• Effective reduction of itching associated with allergic skin conditions
• Sedative properties aid in managing insomnia related to anxiety or pruritus
• Lower abuse potential compared to benzodiazepines for short-term anxiety management
• Cost-effective therapeutic option with widespread availability
• Useful as premedication to reduce anxiety before surgical or dental procedures

Common use

Atarax is commonly prescribed for the short-term management of anxiety disorders and tension-associated symptoms in adults. It is also indicated for pruritus due to allergic conditions such as chronic urticaria, atopic dermatitis, and contact dermatitis. In clinical practice, it may be used as an adjunctive therapy for nausea and vomiting, as well as preoperatively for sedative purposes. Off-label uses may include management of agitation in elderly patients (with caution due to anticholinergic effects) and as an alternative for patients who cannot tolerate benzodiazepines.

Dosage and direction

Dosage must be individualized based on patient response, indication, and clinical status. For anxiety: Adults typically receive 50-100 mg daily in divided doses. For pruritus: Adults may take 25 mg three to four times daily. Pediatric dosing for sedation or pruritus is based on weight (0.5-1 mg/kg/dose every 6 hours as needed). The medication should be taken with or without food, but consistent administration with food may reduce potential gastrointestinal upset. Tablets should be swallowed whole with water; the syrup should be measured using an appropriate dosing device.

Precautions

Patients should be cautioned about performing activities requiring mental alertness (e.g., driving, operating machinery) due to sedative effects. Alcohol and other CNS depressants should be avoided during treatment. Use with caution in patients with:

• Hepatic impairment (consider dose reduction)
• Renal impairment (may require adjusted dosing)
• Bladder outflow obstruction
• Angle-closure glaucoma
• Prostatic hypertrophy
• Cardiovascular disease
• Seizure disorders Elderly patients may be more sensitive to anticholinergic and sedative effects.

Contraindications

Atarax is contraindicated in patients with:

• Known hypersensitivity to hydroxyzine, cetirizine, or any component of the formulation
• Early pregnancy
• Prolonged QT interval or known risk factors for QT prolongation
• Acute asthma episodes
• Concurrent use with monoamine oxidase inhibitors (MAOIs)

Possible side effect

Common side effects (≥1%) may include:

• Drowsiness/sedation
• Dry mouth
• Headache
• Dizziness
• Gastrointestinal discomfort

Less common side effects (<1%) may include:

• Tremor
• Blurred vision
• Confusion (particularly in elderly patients)
• Urinary retention
• Hypotension
• Tachycardia
• Allergic reactions (rash, urticaria)
• Paradoxical excitation (especially in children)

Drug interaction

Significant interactions may occur with:

• CNS depressants (alcohol, benzodiazepines, opioids): Enhanced sedation
• Anticholinergic agents: Additive anticholinergic effects
• QT-prolonging agents: Increased risk of arrhythmias
• Monoamine oxidase inhibitors: Risk of hypertensive crisis
• Epinephrine: May reverse vasopressor effects
• Cholinesterase inhibitors: Reduced effectiveness

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, skip the missed dose and resume the regular dosing schedule. Do not double the dose to make up for a missed one.

Overdose

Symptoms of overdose may include extreme drowsiness, nausea, vomiting, hypotension, QT prolongation, seizures, and cardiorespiratory arrest. Management includes gastric lavage if presented early, supportive care, and symptomatic treatment. There is no specific antidote; hemodialysis is not effective due to high protein binding. Cardiovascular monitoring is essential in cases of significant overdose.

Storage

Store at room temperature (15-30°C/59-86°F) in a tight, light-resistant container. Keep out of reach of children and pets. Do not use after the expiration date printed on the packaging. The syrup formulation should not be frozen.

Disclaimer

This information is for educational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional before starting, changing, or stopping any medication. The prescribing physician should be aware of the patient’s complete medical history and current medications. Proper diagnosis and individualized treatment planning are essential for safe and effective use.

Reviews

“Prescribed Atarax for preoperative anxiety - effective sedation with minimal hangover effect next day.” - Medical professional, 34

“Used for chronic urticaria after multiple antihistamines failed. Significant itch reduction within 30 minutes, though sedation was notable during initial days.” - Patient, 41

“Helpful for breakthrough anxiety episodes when benzodiazepines are contraindicated. Appreciate the rapid onset though duration is shorter than preferred.” - Psychiatrist, 52

“Pediatric patient with severe atopic dermatitis showed marked improvement in sleep quality due to reduced nighttime itching. Dose adjustment was necessary to balance efficacy and morning drowsiness.” - Pediatric allergist, 38