Hydroxyzine Hydrochloride is used for:

1. Relief of anxiety and tension related to psychoneurosis or as a supportive treatment in organic diseases where anxiety occurs.
2. Management of pruritus (itching) caused by allergic conditions such as chronic urticaria, atopic dermatitis, contact dermatitis, and histamine-mediated itching.
3. Sedation as a premedication before procedures and after general anesthesia.

The effectiveness of hydroxyzine for long-term use (more than 4 months) as an anti-anxiety agent has not been fully evaluated. Physicians should periodically reassess whether the drug remains useful for each patient.

Hydroxyzine Hydrochloride is an anxiolytic antihistamine of the piperazine class and acts as an H1 receptor antagonist.

• It is not a cortical depressant, but its calming effects may result from reducing activity in certain subcortical areas of the central nervous system.
• It causes skeletal muscle relaxation experimentally.
• Bronchodilator, antihistaminic, and analgesic effects have been demonstrated in both experiments and clinical practice.
• Anti-emetic effects have been shown through apomorphine and veriloid tests.
• Hydroxyzine is rapidly absorbed from the gastrointestinal tract, with clinical effects usually appearing within 15–30 minutes after oral administration.

For symptomatic relief of anxiety and tension

• Adults: 50-100 mg 4 times daily.
• Children (>6 years): 50-100 mg (5-10 teaspoonfuls) daily in divided doses.
• Children (<6 years): 50 mg (5 teaspoonfuls) daily in divided doses.

Pruritus due to allergic conditions

• Adults: 25 mg 3 to 4 times daily.
• Children ( 6 years): 50-100 mg (5-10 teaspoonfuls) daily in divided doses.
• Children (<6 years): 50 mg (5 teaspoonfuls) daily in divided doses.

As a sedative (premedication and following general anesthesia)-

• Adults: 50-100 mg.
• Children: 0.6 mg/kg of body weight.

Hydroxyzine may enhance the effects of Meperidine and barbiturates, so their use as pre-anesthetic adjuncts should be adjusted individually. The drug does not affect atropine or other belladonna alkaloids. Hydroxyzine is not known to interfere with digitalis and can be used safely alongside it.

Note: Concurrent use of Hydroxyzine with monoamine oxidase inhibitors (MAOIs) should be avoided.

Hydroxyzine should not be used in patients who are allergic to Hydroxyzine or any of its components.

Side effects associated with Hydroxyzine Hydrochloride are generally mild and temporary. The most common include drowsiness, headache, impaired psychomotor function, and antimuscarinic effects such as urinary retention, dry mouth, blurred vision, and gastrointestinal disturbances. Less commonly, antihistamines may cause hypotension, palpitations, arrhythmias, extrapyramidal symptoms, dizziness, confusion, depression, sleep disturbances, tremors, and convulsions. Rarely, hypersensitivity reactions (including bronchospasm, angioedema, anaphylaxis, skin rashes, and photosensitivity), blood disorders, liver dysfunction, and angle-closure glaucoma may occur.

There is insufficient clinical data to confirm the safety of Hydroxyzine during early pregnancy. Until more information is available, Hydroxyzine should not be used in early pregnancy. It is unknown whether Hydroxyzine passes into human breast milk. Because many drugs can be excreted in milk, Hydroxyzine should not be administered to breastfeeding mothers.

Hydroxyzine can enhance the effects of central nervous system (CNS) depressants, including narcotics, non-narcotic analgesics, and barbiturates. When used together, the dosage of these medications should be reduced accordingly.

Because Hydroxyzine may cause drowsiness, patients should be warned not to drive or operate machinery while taking the drug. Patients should also be advised against using other CNS depressants simultaneously and cautioned that alcohol may increase the sedative effects.

Patients with renal impairment: The dose should be reduced to half of the normal dose.

Elderly patients: It is recommended to start with half the usual dose because the drug’s effects may last longer in this population.

The most common sign of Hydroxyzine overdose is excessive sedation. As with any drug overdose, it is important to consider that multiple substances may have been taken.

If vomiting has not occurred naturally, it should be induced, and immediate gastric lavage is recommended. General supportive care is essential, including frequent monitoring of vital signs and close observation of the patient.

Although rare, hypotension can occur and may be managed with intravenous fluids and medications such as Levarterenol or Metaraminol. Epinephrine should not be used, as Hydroxyzine can block its pressor effect.

There is no specific antidote for Hydroxyzine overdose. Hemodialysis is generally not effective, unless other drugs like barbiturates have been taken concurrently. Currently, there is no practical method to measure Hydroxyzine levels in body fluids or tissues after ingestion.

Sedating Anti-histamine

Store in a cool, dry place and protect from light. Keep out of reach of children.