Atarax

Atarax (hydroxyzine hydrochloride) is a first-generation antihistamine with anxiolytic, sedative, and anti-pruritic properties, widely prescribed in clinical practice for its dual therapeutic action. It functions primarily as a histamine H1-receptor antagonist, providing robust symptomatic control for conditions ranging from generalized anxiety to allergic dermatoses. Its well-established efficacy and favorable safety profile make it a versatile agent in both psychiatric and dermatological contexts, offering rapid onset of action and predictable pharmacokinetics.

Features

• Active ingredient: Hydroxyzine hydrochloride
• Available forms: Oral tablets (10 mg, 25 mg, 50 mg), oral syrup, intramuscular injection
• Mechanism: Potent histamine H1-receptor antagonism
• Onset of action: 15–30 minutes for sedation; 30–60 minutes for antipruritic effects
• Half-life: Approximately 20 hours
• Metabolism: Hepatic, via cytochrome P450 enzymes
• Excretion: Primarily renal

Benefits

• Provides rapid relief from symptoms of anxiety and tension
• Effectively reduces pruritus associated with allergic conditions
• Induces sedation useful for pre-operative anxiolysis and insomnia
• Demonstrates antiemetic properties, reducing nausea and vomiting
• Lacks addictive potential or dependence liability typical of benzodiazepines
• Cost-effective compared to many newer anxiolytic or antipruritic agents

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 pruritus due to allergic conditions such as chronic urticaria, atopic dermatitis, and contact dermatitis. Off-label uses include pre-operative sedation, antiemetic adjunct therapy, and insomnia management. Its versatility across indications stems from its central and peripheral antihistaminic effects.

Dosage and direction

Dosage must be individualized based on indication, patient response, and tolerability. For anxiety in adults: 50–100 mg orally, divided into 3–4 doses daily. For pruritus: 25 mg orally at bedtime or 25 mg three to four times daily. For elderly or debilitated patients: initiate with lower doses (e.g., 10–25 mg daily). Intramuscular administration is reserved for acute settings; typical dose is 50–100 mg. Administer with or without food; taking with food may reduce gastrointestinal upset.

Precautions

Use with caution in patients with hepatic or renal impairment; dosage adjustment may be necessary. Avoid activities requiring mental alertness, such as driving or operating machinery, until response is known. May cause drowsiness; alcohol and other CNS depressants may potentiate this effect. Not recommended during pregnancy unless potential benefit justifies potential risk. Use in pediatric populations should be guided by weight and clinical indication.

Contraindications

Hypersensitivity to hydroxyzine or any component of the formulation. Early pregnancy; hydroxyzine is contraindicated in the first trimester. Patients with known QT prolongation or risk factors for torsades de pointes. Acute narrow-angle glaucoma. Severe respiratory depression or untreated sleep apnea. Concurrent use with monoamine oxidase inhibitors (MAOIs).

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 or insomnia have been reported, particularly in pediatric or elderly patients. Serious but rare adverse effects include QT prolongation, seizures, and severe hypersensitivity reactions. Most side effects are dose-dependent and diminish with continued use.

Drug interaction

Potentiates effects of CNS depressants including alcohol, benzodiazepines, and opioids. Concurrent use with anticholinergic agents may increase risk of dry mouth, constipation, or urinary retention. May enhance effects of drugs that prolong QT interval, such as certain antipsychotics or antiarrhythmics. Inhibitors of CYP enzymes (e.g., fluoxetine, ketoconazole) may increase hydroxyzine levels. Avoid use with MAOIs due to risk of serotonin syndrome.

Missed dose

If a dose is missed, take it as soon as remembered unless it is nearly time for the next dose. Do not double the dose to make up for a missed one. Resume regular dosing schedule. Consistent dosing is important for maintaining therapeutic effect, particularly in anxiety management.

Overdose

Symptoms of overdose may include severe drowsiness, nausea, vomiting, hypotension, QT prolongation, or seizures. In case of suspected overdose, seek immediate medical attention. Treatment is supportive and symptomatic; there is no specific antidote. Activated charcoal may be administered if ingestion was recent. ECG monitoring is advised due to risk of arrhythmias.

Storage

Store at room temperature (20–25°C); excursions permitted between 15–30°C. Protect from light and moisture. Keep in original container with lid tightly closed. Do not freeze oral liquid formulation. Keep out of reach of children and pets. Discard any unused medication after expiration date or as directed by a healthcare provider.

Disclaimer

This information is 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, discontinue, or change dosage of Atarax without medical supervision.

Reviews

Clinical studies and post-marketing surveillance consistently report high patient satisfaction with Atarax, particularly for its rapid anxiolytic and antipruritic effects. Many users note significant improvement in sleep quality and reduction in allergic symptoms. Some report drowsiness as a limiting factor, though this often diminishes with continued use. Physicians appreciate its non-habit-forming profile and cost-effectiveness in long-term management.