First-generation antihistamine
Antagonizes H1 histamine receptors and exhibits anticholinergic effects, contributing to sedation and anxiolysis
Anxiety, pruritus, preoperative sedation
Short-term management of insomnia, acute agitation, adjunctive anxiety treatment in substance use disorders or when benzodiazepines are contraindicated
Oral tablets, capsules, syrup, and injectable forms
25–50 mg p.o. every 4–6 hours PRN for agitation or anxiety; lower doses (25–50 mg) at bedtime for insomnia
25–100 mg/day in single or divided doses
Metabolized in the liver, half-life approximately 20 hours; onset within 15–30 minutes after oral administration
Sedation, dry mouth, dizziness, blurred vision, cognitive dulling
Tolerance may develop with prolonged use
Monitor sedation and cognitive effects, especially with prolonged use or in vulnerable populations
None
Hydroxyzine is generally avoided in elderly individuals, patients with dementia, or those recovering from traumatic brain injury (TBI) due to increased risk of sedation, falls, and confusion. It may be helpful in managing anxiety or agitation in younger patients with developmental disorders or substance use concerns.