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Atarax (hydroxyzine) is an interesting and versatile medication. Originally marketed as an antihistamine to treat allergic reactions, it was soon discovered that the medication is also an effective sedative and anti-anxiety agent. Today it sees use in treating:

• Allergies
• Skin rash
• Itching
• Nausea
• Vomiting
• Anxiety
• Tension
• Ease anxiety and induce sleep prior to surgery

Use in the above conditions is about the same; it is effective, and thus widely used, in all of them. Somewhat less commonly Atarax may be used to aid in opioid withdrawal.

This medication is available in several formulas, including tablets, capsules, oral solution, and solution for injections.

Atarax should not be taken by pregnant women, particularly in the first and second trimester. The medication is also generally avoided in the elderly, as the risk for serious side effects is significantly increased.

Atarax as an Antihistamine

Atarax inhibits the body's production of histamine, produced in response to an allergen, thus preventing or alleviating allergic reactions. The medication is effective against common allergies, such as rhinitis, as well as less common ailments, such as chronic urticaria. It may be taken in advance of anticipated allergen exposure or used to relieve already-existing symptoms.

Treatment typically consists of:

• Take 25 mg three or four times per day.

Treatment should not extend past 4 consecutive months; in most cases as an antihistamine use is for a much shorter period of time.

Treating Anxiety and Tension

Atarax is used to treat anxiety and tension from a range of causes, though it is not always the preferred treatment, and a poor choice for long-term treatment as use beyond 4 months is unstudied. A doctor can help determine which medication is best.

Most commonly Atarax is used to treat relatively brief episodes of anxiety or tension, rather than a chronic condition. In these cases:

• Take 50 to 100 mg four times per day.

While it can induce calmness, deep sleep, vivid dreams, and similar reactions that some individuals enjoy recreationally, Atarax is not considered addictive and vast majority of patients do not develop dependency.

Treating Nausea and Vomiting

Atarax is good at easing nausea and vomiting from many causes, including motion sickness and alcohol or opioid withdrawal. In this application:

• Take 25 to 100 mg every 6 to 8 hours as needed.

Note that Atarax is a very poor choice for nausea or vomiting while pregnant; while no human studies exist, the medication did produce birth defects in animal studies.

Pre- and Post-Operative Use

Atarax is used prior to surgery to induce sleepiness, enhance other medications, and prevent nausea. Post-surgery it is predominantly used to prevent nausea, with the added benefit of keeping the patient sedated. The medication may be administered by injection or IV in this case, though some patients take tablets.

Standard dosing is:

• Take 50 to 100 mg.

Dosage may vary to some extent depending on patient response, as well as other factors like age and weight.

Precautions & Side Effects

Atarax is a potent medication, and it does have serious risks associated with use. Long-term use beyond 4 months may (or may not) increase risk of severe side effects, the subject is not well studied.

Patients who should not take Atarax include those who:

• Are in the first or second trimester of pregnancy
• Are elderly (65+)
• Have prolonged QT intervals
• Have a history of allergy to hydroxyzine, cetirizine, or levocetirizine

Atarax is known to interact with the following medications:

• Antibiotics, such as erythromycin
• Antidepressants, such as citalopram
• Antipsychotics, such as clozapine
• Medications that influence heart rhythm, such as quinidine or amiodarone
• methadone
• pentamidine
• ondansetron
• droperidol

The above don't necessarily mean Atarax can't be taken, but dosage modifications of one or more medications may be needed.

Common side effects include:

• Dry mouth
• Drowsiness
• Fatigue

Sleepiness is dose-dependent to some extent, but all patients are at risk. Use caution when performing potentially dangerous tasks even if taking very low doses until effects are known.