Hydroxyzine is an antihistamine with sedative and atropine-like effects. Taken orally, it is authorized in adults and children, especially for minor manifestations of anxiety, and in the symptomatic treatment of urticaria. In children over the age of 3 it is authorized as a second-line treatment for some insomnias, when behavioural measures alone are insufficient.

When an oral treatment is deemed preferable for patients experiencing discomfort from the symptoms of urticaria, antihistamines have only a limited efficacy. Non-sedative and non atropine-like antihistamines such as cetirizine or loratadine are first-line options.

In anxious patients, when a drug is considered appropriate, a benzodiazepine for a short period has an acceptable harm-benefit balance. There is little evidence to support the efficacy of antihistamines such as hydroxyzine in treating anxiety. There is no evidence that hydroxyzine used as a hypnotic in children experiencing sleeping difficulties is any more effective than a placebo, and the use of hypnotics in children should be avoided.

Hydroxyzine's adverse effects profile comprises chiefly atropine like and neuropsychological disorders, particularly in children. Hydroxyzine also exposes patients to the risk of allergic reactions and to cardiac arrhythmia. If hydroxyzine is taken during pregnancy, the fetus is exposed to its adverse effects and the newborn may suffer withdrawal syndrome. It is better to opt for other alternatives.

©Prescrire 1 July 2015

"Hydroxyzine: choose other treatments" Prescrire Int 2015; 24 (162): 191. (Pdf, subscribers only).