Hydroxyzine hydrochloride clinical uses
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Hydroxyzine Hydrochloride Clinical Uses: Anxiety, Pruritus, and More
Hydroxyzine Hydrochloride for Anxiety and Sedation
Hydroxyzine hydrochloride is widely used for the management of anxiety, particularly generalized anxiety disorder (GAD). Studies show that hydroxyzine is more effective than placebo in reducing acute symptoms of GAD and is comparable in efficacy, acceptability, and tolerability to other anxiolytic agents such as benzodiazepines and buspirone, though it is more likely to cause drowsiness or sleepiness as a side effect 7. Its sedative properties also make it useful for managing anxiety-induced insomnia 8.
Use in Dermatological Conditions: Pruritus and Dermatoses
Hydroxyzine is commonly prescribed for chronic pruritus (itching) due to dermatological causes. Clinical studies demonstrate significant improvement in pruritus symptoms and quality of life for patients treated with hydroxyzine, with most adverse effects being mild and transient, such as drowsiness, dry mouth, and dizziness 2. Additionally, hydroxyzine has shown effectiveness in treating dermatoses influenced by psychogenic factors, such as atopic dermatitis and neurodermatitis, providing both symptom relief and a calming effect 3.
Role in Pediatric Dentistry and Behavior Control
In pediatric dentistry, hydroxyzine hydrochloride is used as a pre-operative medication to reduce fear, apprehension, and uncooperative behavior in children undergoing dental procedures. It has been found to significantly improve cooperation and reduce anxiety without causing notable side effects, except for occasional drowsiness 4.
Antiemetic Use in Surgical and Obstetric Settings
Hydroxyzine hydrochloride is effective as an antiemetic, particularly in preventing nausea and vomiting after anesthesia. Studies in surgical and obstetric patients show that hydroxyzine reduces the incidence of post-anesthesia vomiting and the need for additional narcotics, making it a valuable adjunct in these settings 15. However, rare cases of hemolysis have been reported when used intravenously in surgical patients, indicating the need for caution in certain populations 6.
Other Clinical Applications: Sleep Bruxism and COVID-19
Hydroxyzine has also been studied for the treatment of sleep bruxism in children, where it was found to reduce symptoms more effectively than placebo, with no serious adverse effects reported 9. In a large observational study of patients hospitalized for COVID-19, hydroxyzine use was associated with reduced mortality, suggesting potential benefits beyond its traditional uses, though further research is needed to confirm these findings 10.
Safety and Adverse Effects
Hydroxyzine is generally well tolerated, with the most common side effects being drowsiness, dry mouth, and mild sedation 237. Rare but serious adverse events, such as hemolysis and priapism (especially when combined with other medications like risperidone), have been reported, highlighting the importance of monitoring and individualized risk assessment 68.
Conclusion
Hydroxyzine hydrochloride is a versatile medication with established clinical uses in the management of anxiety, pruritus, certain dermatological conditions, pediatric behavioral control, and as an antiemetic in surgical and obstetric settings. It is generally safe and well tolerated, though clinicians should be aware of its sedative effects and rare but serious adverse events. Emerging evidence suggests potential new applications, such as in COVID-19, warranting further investigation.
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