Hydroxyzine Dosages for Adults and Children: Your GoodRx Guide

Hydroxyzine (Vistaril) is a first-generation antihistamine that was first approved in 1957. Today, it’s used to treat anxiety, itching due to allergies, and to help you relax before and after receiving general anesthesia.

In this guide, we’ll go over the typical hydroxyzine dosages for adults and children. But it's important to follow the instructions from your healthcare team if they’ve instructed you to take it differently.

What dosage forms does hydroxyzine come in?

Hydroxyzine is available in two different salt forms: hydroxyzine pamoate (Vistaril) and hydroxyzine hydrochloride. And each type of hydroxyzine is available in different dosage forms. Hydroxyzine pamoate is only available in 25 mg and 50 mg capsules. Hydroxyzine hydrochloride is available in 10 mg, 25 mg, and 50 mg tablets. It also comes in an oral syrup (liquid) that contains 10 mg of hydroxyzine per 5 mL.

All forms of hydroxyzine are approved for the same uses. And for all health conditions, the dosage is the same no matter which type of hydroxyzine or what dosage form you’re taking. In most cases, you’ll take hydroxyzine 3 to 4 times a day. You can take it with or without food. And hydroxyzine usually starts working within 15 to 30 minutes after you take it.

What’s the typical hydroxyzine dosage for adults?

The recommended hydroxyzine dosage for adults depends on why you’re taking it.

Anxiety

For anxiety in adults, the typical hydroxyzine dosage starts at 50 mg 4 times a day. The maximum recommended hydroxyzine dosage for anxiety is 100 mg 4 times a day. Keep in mind that hydroxyzine works quickly, which is why it’s sometimes prescribed for panic attacks. But it can make you feel sleepy — especially at higher doses. And it’s only meant for short-term anxiety relief, it isn’t considered a long-term treatment option.

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Itching and chronic hives (Pruritus and chronic urticaria)

Itchy skin is often caused by things like an allergic reaction, chronic urticaria (hives), or atopic dermatitis (eczema). For itching and hives, the typical hydroxyzine dosage for adults is 25 mg by mouth 3 to 4 times a day. Similar to anxiety symptoms, it should start to relieve itching within 15 to 30 minutes.

Sedation

To help you relax before surgery, the typical hydroxyzine dosage for adults is 50 mg to 100 mg by mouth before and after general anesthesia.

Sleep issues (insomnia)

Hydroxyzine isn’t FDA approved for sleep, so there isn’t a recommended dosage for this use. Studies suggest that 25 mg to 100 mg of hydroxyzine at bedtime may help improve sleep, and it’s likely safe for short-term use. But the evidence is mixed as to whether hydroxyzine is effective, and it may leave you feeling drowsy the next day. So it’s best to check with your prescriber before taking hydroxyzine for reasons other than what it’s approved for. 

What’s the typical hydroxyzine dosage for children?

In children, hydroxyzine is approved to treat all of the same conditions as adults. However, the dosage in children is usually much lower. Your child’s hydroxyzine dosage will depend on their age and the reason they’re taking hydroxyzine.

Similar to adults, the recommended dose for each condition is the same across all dosage forms (e.g., capsule, tablet, or syrup). Your child can take their hydroxyzine dose with or without food.

Anxiety

For anxiety in children younger than 6 years old, the typical hydroxyzine dosage is 50 mg by mouth daily. For children 6 years and older, the typical hydroxyzine dosage is 50 mg to 100 mg by mouth daily.

Your child’s total daily hydroxyzine dose should be divided into smaller doses given throughout the day when treating anxiety.

Itching and chronic hives

For itching and chronic hives in children younger than 6 years old, the typical hydroxyzine dosage is 50 mg by mouth daily. For children 6 years and older, the typical hydroxyzine dosage is 50 mg to 100 mg by mouth daily.

Your child’s total daily hydroxyzine dose should be divided into smaller doses given throughout the day when treating itching and hives.

Sedation

When used for sedation with general anesthesia, your child’s medical care team will calculate the dosage based on your child’s body weight. The typical hydroxyzine dosage is 0.6 mg per kg of body weight by mouth before and after general anesthesia.

Are there any dosage adjustments for medical conditions?

Hydroxyzine is broken down by the liver and removed from your body through the kidneys. If your liver or kidneys aren’t working as well, you may have an increased risk of side effects.

There aren’t any recommended dosage adjustments for people with liver or kidney problems. But your prescriber may have you take a lower dosage to be safe.

In general, experts recommend avoiding hydroxyzine in adults ages 65 and older. That’s because first-generation antihistamines like hydroxyzine can cause worse side effects in this age group. But if you’re over 65 and your prescriber recommends it, they may have you take a lower dosage.

Discuss your full medical history with your healthcare provider before starting hydroxyzine. And make sure they have your current list of medications and supplements. That’s because several hydroxyzine interactions can also increase the risk of side effects.

What happens if you miss a dose of hydroxyzine?

Since hydroxyzine is usually taken multiple times a day, it can be easy to forget your dose. If this happens, take the missed dose as soon as possible. You can then continue with your regular dosing schedule. But if it’s getting close to your next dose, just skip the missed dose.

Never double up to make up for missed doses, since this can make side effects more likely. If you have trouble remembering to take your medications, using a pill organizer or a medication reminder app might help. If you aren’t sure how to handle a missed dose of hydroxyzine, contact your healthcare provider or pharmacist.

What should you do if you take too much hydroxyzine?

If you take an extra dose of hydroxyzine by mistake, it’s unlikely to be an issue. The most common symptom you’ll experience is excessive drowsiness.

But large amounts of hydroxyzine can be more serious. You may have nausea, vomiting, and uncontrolled shaking. Hallucinations, abnormal heart rhythms, and coma are also possible. To avoid this, don’t take more hydroxyzine than recommended by your prescriber. And keep your medication out of reach and away from children to prevent an accidental overdose.

If you or your child might have taken too much hydroxyzine, contact Poison Control online or by phone at 1-800-222-1222. If you notice any symptoms described above, seek emergency care right away.

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Written by:

Kristianne Hannemann, PharmD

Kristianne Hannemann, PharmD, is a licensed pharmacist in California. She has been a retail pharmacy manager and staff pharmacist for over 7 years and has contributed drug information content to different health companies.

Edited by:

Stacia Woodcock, PharmD

Stacia Woodcock, PharmD, is a pharmacy editor for GoodRx. She earned her Doctor of Pharmacy degree from the University of Kentucky and is licensed in New York and Massachusetts.

Reviewed by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

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