Atarax: Expert Relief for Anxiety and Itching
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| Product dosage: 25mg | |||
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Synonyms | |||
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 to alleviate symptoms by modulating neurotransmitter activity, offering a non-addictive alternative to benzodiazepines for short-term anxiety management. Its well-established safety profile and rapid onset of action make it a versatile option in both psychiatric and dermatological contexts, particularly for patients requiring adjunctive therapy or those with contraindications to newer agents.
Features
- Contains hydroxyzine hydrochloride as the active pharmaceutical ingredient
- Available in 10mg, 25mg, and 50mg oral tablets, as well as syrup formulation (10mg/5mL)
- Exhibits potent antihistaminic, anxiolytic, and sedative effects
- Rapid absorption with onset of action within 15–30 minutes post-administration
- Metabolized primarily in the liver to active metabolite cetirizine
- Pregnancy Category C classification
Benefits
- Provides rapid relief from generalized anxiety symptoms without risk of pharmacological dependence
- Effectively reduces histamine-mediated pruritus in urticaria, eczema, and other dermatological conditions
- Serves as a preoperative sedative to reduce anxiety and diminish postoperative nausea and vomiting
- Offers an alternative for patients with contraindications to benzodiazepines or SSRIs
- Demonstrates a favorable side effect profile relative to other sedating antihistamines
- Cost-effective therapeutic option with widespread insurance formulary coverage
Common use
Atarax is primarily indicated for the symptomatic management of anxiety disorders and tension associated with stressful situations, where its sedative properties help alleviate psychic tension without producing euphoria or addiction. In dermatology, it is extensively used to control pruritus due to allergic conditions such as chronic urticaria, atopic dermatitis, and contact dermatitis. Off-label uses include management of nausea and vomiting, adjunct therapy in opioid withdrawal protocols, and as a sedative-hypnotic for insomnia, though these applications require careful risk-benefit assessment. It is particularly valuable in elderly patients where benzodiazepines are contraindicated due to fall risk.
Dosage and direction
Dosage must be individualized based on indication, patient response, and tolerance. For anxiety in adults: initial dose of 50-100mg daily in divided doses, titrated upward to maximum 400mg daily in divided doses. For pruritus: 25mg three to four times daily. Pediatric dosing for sedation: 0.6mg/kg/dose every 6 hours. Administer orally with or without food; tablets should be swallowed whole with water. For optimal anxiolytic effect, divide total daily dose into three or four administrations. Maximum daily dose should not exceed 100mg in patients under 6 years, 200mg in patients 6-12 years, and 400mg in adults. Duration of therapy typically limited to 4 months for anxiety due to tolerance development.
Precautions
Exercise caution in patients with hepatic impairment due to extensive hepatic metabolism; dose reduction of 50% recommended in moderate to severe liver disease. May impair mental and physical abilities required for hazardous tasks; warn patients against driving or operating machinery. Use with caution in patients with narrow-angle glaucoma, prostatic hypertrophy, or bladder neck obstruction due to anticholinergic effects. Monitor for paradoxical reactions including excitement and agitation, particularly in pediatric and geriatric populations. Regular assessment of renal function recommended during prolonged therapy. Pregnancy and lactation require careful risk-benefit consideration due to limited safety data.
Contraindications
Hypersensitivity to hydroxyzine, cetirizine, or any component of the formulation. Concomitant use with monoamine oxidase inhibitors (MAOIs) due to risk of serotonin syndrome. Early pregnancy (first trimester) unless potential benefit justifies potential risk. Patients with known QT prolongation or history of torsades de pointes. Severe respiratory depression or acute asthma attack. Pre-existing urinary retention or gastrointestinal obstruction. Hypersensitivity to other piperazine derivatives.
Possible side effect
Common (≥1%): Sedation (40-50%), dry mouth (20-30%), dizziness (10-15%), headache (5-10%). Less common (0.1-1%): Blurred vision, constipation, urinary retention, confusion, tremor. Rare (<0.1%): QT prolongation, seizures, blood dyscrasias, allergic reactions including rash and bronchospasm. Paradoxical reactions including agitation and insomnia reported particularly in children and elderly. Most side effects are dose-dependent and diminish with continued therapy or dose reduction.
Drug interaction
Potentiates CNS depression with alcohol, barbiturates, opioids, and other sedative-hypnotics (additive effects). MAOIs may increase anticholinergic side effects and risk of serotonin syndrome. Anticholinergic effects potentiated by tricyclic antidepressants, antipsychotics, and antispasmodics. May antagonize effects of cholinesterase inhibitors in dementia patients. CYP2D6 inhibitors (fluoxetine, paroxetine) may increase hydroxyzine concentrations. May enhance effects of norepinephrine and attenuate effects of epinephrine.
Missed dose
If a dose is missed, administer 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 administration. For patients on multiple daily dosing, if remembered within 2 hours of scheduled time, take immediately; otherwise skip and resume regular schedule. Maintain consistent dosing intervals to minimize breakthrough symptoms.
Overdose
Symptoms include severe CNS depression (coma, respiratory depression), hypotension, tachycardia, and anticholinergic crisis (hyperthermia, flushed skin, fixed dilated pupils). Management involves gastric lavage if presented within 1 hour, activated charcoal, and supportive care including IV fluids and vasopressors for hypotension. Physostigmine may be considered for severe central anticholinergic effects. Hemodialysis not effective due to high protein binding. Contact poison control center immediately for guidance.
Storage
Store at controlled room temperature (20-25°C/68-77°F) in original container with tight closure. Protect from light and moisture. Keep syrup formulation from freezing. Dispense in USP-compliant child-resistant containers. Discard any unused portion after 90 days of opening. Do not transfer to non-original containers without proper labeling. Keep out of reach of children and pets.
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. Dosage and indications may vary based on individual patient factors. Not all possible uses, interactions, or adverse effects are listed here. Healthcare providers should reference full prescribing information before administration.
Reviews
“Atarax remains a valuable tool in our dermatology practice for refractory pruritus. Its rapid onset provides relief when topical steroids alone are insufficient, though sedation requires careful patient selection.” - Dermatologist, 15 years experience
“As a psychiatrist, I find hydroxyzine particularly useful for patients with comorbid anxiety and allergic conditions. The lack of addiction potential makes it preferable to benzodiazepines for short-term management.” - Psychiatrist, MD
“Patients appreciate the dual benefit for anxiety and sleep, though some discontinue due to daytime drowsiness. Proper dosing timing is crucial for adherence.” - Clinical Pharmacist, PharmD