Atarax (hydroxyzine) is a first-generation antihistamine and anxiolytic medication widely prescribed for the management of anxiety disorders and pruritus associated with allergic conditions. Its dual-action mechanism provides both central nervous system calming effects and potent antihistaminic properties, making it a versatile therapeutic option in clinical practice. Available in oral tablet and syrup formulations, it offers a well-established safety profile when used as directed under medical supervision.

Features

• Active ingredient: Hydroxyzine hydrochloride
• Available strengths: 10 mg, 25 mg, 50 mg tablets; 10 mg/5 mL oral syrup
• Mechanism: Histamine H1-receptor antagonist with additional anticholinergic and anxiolytic properties
• Onset of action: 15–30 minutes for anxiolytic effects; 30–60 minutes for antipruritic effects
• Duration: 4–6 hours per dose
• Pregnancy category: C (risk cannot be ruled out)

Benefits

• Provides rapid relief from symptoms of generalized anxiety and tension
• Effectively reduces itching associated with urticaria, dermatitis, and other allergic skin conditions
• Demonstrates sedative properties beneficial for pre-operative anxiety and as adjunctive therapy in anesthesia
• Offers an alternative for patients who cannot tolerate newer generation antihistamines or benzodiazepines
• Cost-effective compared to many newer anxiolytic medications
• May reduce nausea through central antiemetic effects

Common use

Atarax is primarily indicated for the symptomatic relief of anxiety and tension associated with psychoneurosis and as adjunctive therapy in organic disease states where anxiety is manifested. It is equally effective for 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- and post-operative adjunctive sedation, antiemetic therapy, and as an adjunct in the management of alcohol withdrawal symptoms.

Dosage and direction

Dosage must be individualized according to patient needs and response. For adults with anxiety: 50-100 mg daily in divided doses. For pruritus: 25 mg three to four times daily. For elderly patients: initiate with lower doses due to increased sensitivity. Pediatric dosing for children over 6 years: 50-100 mg daily in divided doses; under 6 years: 50 mg daily in divided doses. Administration with food may minimize potential gastrointestinal upset. The medication should be taken exactly as prescribed; do not crush or chew extended-release formulations.

Precautions

Patients should be cautioned about engaging in activities requiring mental alertness such as operating machinery or driving until their response to the medication is established. Avoid alcohol consumption and other CNS depressants during therapy. Use with caution in patients with: narrow-angle glaucoma, prostatic hypertrophy, bladder neck obstruction, cardiovascular disease, hepatic impairment, or seizure disorders. Periodic evaluation of hepatic function is recommended during prolonged therapy. Abrupt discontinuation after prolonged use may produce withdrawal symptoms.

Contraindications

Atarax is contraindicated in patients with known hypersensitivity to hydroxyzine, cetirizine, or any component of the formulation. Additional contraindications include: early pregnancy, nursing mothers, patients with porphyria, and those taking monoamine oxidase inhibitors (concurrent or within 14 days). Should not be administered intra-arterially due to risk of gangrene. Not recommended for patients with urinary retention or gastrointestinal obstruction.

Possible side effect

Common side effects (≥1%): drowsiness, dry mouth, headache, dizziness. Less common side effects: blurred vision, constipation, nausea, agitation, tremor. Rare but serious side effects requiring immediate medical attention: seizures, severe hypotension, tachycardia, allergic reactions including anaphylaxis, jaundice, blood dyscrasias. Paradoxical reactions including excitement and hyperactivity may occur, particularly in children and elderly patients.

Drug interaction

Significant interactions occur with: CNS depressants (alcohol, benzodiazepines, opioids—additive sedation), anticholinergic agents (increased anticholinergic effects), epinephrine (hydroxyzine may reverse vasopressor effects), cholinesterase inhibitors (reduced effectiveness). May potentiate effects of narcotic analgesics permitting reduced narcotic dosage. Concurrent use with medications that prolong QT interval should be avoided. Monitor for increased serum levels when used with CYP2D6 inhibitors.

Missed dose

If a dose is missed, take it as soon as remembered unless it is nearly time for the next scheduled dose. Do not double the dose to make up for a missed one. Maintain regular dosing schedule to ensure consistent therapeutic effect. If multiple doses are missed, contact healthcare provider for guidance on resumption of therapy.

Overdose

Symptoms of overdose may include: extreme drowsiness, nausea/vomiting, hypotension, respiratory depression, seizures, cardiac arrhythmias. In case of suspected overdose, seek immediate medical attention. Treatment is supportive and symptomatic; gastric lavage may be beneficial if performed soon after ingestion. There is no specific antidote; hemodialysis is not effective due to high protein binding. Monitor cardiac function and respiratory status closely.

Storage

Store at room temperature (15-30°C/59-86°F) in tightly closed container. Protect from light and moisture. Keep out of reach of children and pets. Do not use after expiration date printed on packaging. Properly discard any unused medication through medication take-back programs or according to FDA guidelines.

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. Individual response to medication may vary. The prescribing physician should be informed of all medical conditions and concurrent medications. Not all possible uses, precautions, side effects, or interactions are listed here.

Reviews

Clinical studies demonstrate Atarax’s efficacy with 70-80% of patients showing significant improvement in anxiety symptoms within the first week of therapy. Dermatological studies report 85% reduction in pruritus scores in chronic urticaria patients. Patient satisfaction surveys indicate high tolerability when properly dosed, though sedation remains the most frequently reported side effect. Long-term studies confirm maintained efficacy without significant tolerance development when used as directed.