Hydroxyzine — NZ Medication Guide

What is Hydroxyzine?

Hydroxyzine (generic name: hydroxyzine hydrochloride) is used for short-term anxiety, pruritus (itching), and urticaria (hives). Hydroxyzine (Atarax) is prescription-only in New Zealand, funded by Pharmac for anxiety and pruritus.

What is Hydroxyzine Used For?

• Short-term anxiety and tension
• Preoperative sedation
• Chronic urticaria and pruritus
• Pruritus from allergic dermatitis
• Alcohol withdrawal symptoms (adjunct)

How Does Hydroxyzine Work?

Hydroxyzine is a first-generation H1 antihistamine with significant CNS activity producing anxiolytic, sedative, antihistaminergic, and antiemetic effects. Unlike benzodiazepines, it does not cause physical dependence, making it useful for short-term anxiety without addiction risk.

How to Take Hydroxyzine

For anxiety: 25-50mg 3-4 times daily. For pruritus: 25mg 3-4 times daily. Take with or without food. Causes significant sedation — avoid driving, operating machinery, and alcohol. Tolerance to sedation develops with regular use.

Common Side Effects

• Sedation and drowsiness (very common — significant)
• Dry mouth
• Constipation
• Urinary retention
• Blurred vision
• Headache

Serious Side Effects — Seek Medical Attention

• QTc prolongation — cardiac arrhythmia risk
• Excessive sedation in elderly — falls and confusion risk
• Severe allergic reaction
• Seizures in overdose

Drug Interactions

• Alcohol and CNS depressants — significantly enhanced sedation — AVOID alcohol
• QTc-prolonging medications — additive cardiac risk
• MAO inhibitors — increased anticholinergic effects
• Opioids — additive CNS and respiratory depression

New Zealand Prescribing Information

BPAC NZ recommends hydroxyzine as a short-term option for anxiety where benzodiazepines are inappropriate. It is classified as potentially inappropriate in older patients (Beers Criteria) due to anticholinergic effects and fall risk. Medsafe NZ has issued guidance on QTc prolongation — baseline ECG should be considered in patients with cardiac risk factors.

Frequently Asked Questions

Is hydroxyzine addictive?

No — it does not cause physical dependence like benzodiazepines. However, tolerance to its sedative effects can develop with regular use. Use at the lowest effective dose for the shortest necessary time.

Is hydroxyzine suitable for long-term anxiety?

It is intended for short-term use. For long-term anxiety, CBT and SSRIs/SNRIs are the recommended evidence-based treatments. Speak to your GP about a comprehensive treatment plan.

References & Further Information

The following New Zealand and international resources were used to inform this page:

• New Zealand Formulary — Hydroxyzine
• Pharmac — Funded Medicines Schedule
• BPAC NZ — Anxiety Management
• Medsafe — Atarax Data Sheet

Reviewed by a Registered Pharmacist — KiwiMeds New Zealand