Hydroxyzine

How to order Hydroxyzine

1. Find the drug you need on our site.
2. Pick a clinic. See the price.
3. Fill in a short health form.
4. A doctor reads your form.
5. If it is safe for you, they say yes.
6. Your order ships fast to your door.
7. It comes in a plain, sealed box.

Why use us? We compare UK clinics. We show you the price and how fast they ship. We do not sell drugs. We just help you find the best one for you.

Is it safe? Yes. All our clinics are UK-based. A real doctor reads each form. They will not sell to you if it is not safe for you.

Hydroxyzine on Prescriptsy

Hydroxyzine is described on Prescriptsy as independent product information.

Here you can understand how online consultation works, what medical checks partner clinics carry out, and which factors matter when comparing providers.

We do not sell medicines directly, but help users compare licensed healthcare partners on price, delivery speed, service quality, and overall trustworthiness.

Hydroxyzine is a first-generation antihistamine with sedating and anxiolytic (anti-anxiety) properties, used in the United Kingdom for the short-term management of anxiety, the relief of pruritus (itching) associated with allergic conditions, and as a pre-medication before surgery.

It is available as hydroxyzine hydrochloride tablets in strengths of 10 mg and 25 mg (brand name Atarax). Hydroxyzine is a prescription-only medicine.

This page provides a comprehensive clinical overview of hydroxyzine, including how it works, dosing guidance, side effects, important safety warnings (including the MHRA alert on cardiac risk), and how to obtain it in the UK.

Anxiety disorders are among the most common mental health conditions in the UK, affecting approximately 8 million people at any given time.

While first-line treatments for generalised anxiety disorder include psychological therapies (such as cognitive behavioural therapy) and selective serotonin reuptake inhibitors (SSRIs), hydroxyzine may be considered as a short-term option in certain clinical situations, particularly when rapid symptom relief is needed or when other treatments are not suitable.

Pruritus is a troublesome symptom associated with a wide range of dermatological and systemic conditions, including urticaria (hives), eczema, allergic reactions, and liver or kidney disease.

Hydroxyzine is one of several antihistamines used to relieve itching, with the added advantage of promoting sleep in patients whose pruritus disrupts rest.

Important safety information about hydroxyzine

Before reading further, note the following essential safety points about hydroxyzine.

• Hydroxyzine is a prescription-only medicine and must be used at the lowest effective dose for the shortest possible duration.
• The MHRA has warned that hydroxyzine can prolong the QT interval, increasing the risk of serious heart rhythm disturbances.
• The maximum daily dose is 100 mg for adults and 50 mg for elderly patients.
• Do not drive or operate machinery until you know how hydroxyzine affects you.
• Avoid alcohol while taking hydroxyzine.
• Hydroxyzine is contraindicated during pregnancy.

Understanding anxiety and pruritus

Anxiety is a normal emotional response to stress, but it becomes a disorder when it is persistent, disproportionate to the situation, and interferes with daily functioning.

Generalised anxiety disorder (GAD) is characterised by excessive worry about everyday matters, accompanied by physical symptoms such as muscle tension, restlessness, difficulty concentrating, irritability, and sleep disturbance.

Other anxiety disorders include social anxiety, panic disorder, and specific phobias.

NICE guideline CG113 recommends a stepped-care approach, starting with psychoeducation and self-help, progressing to psychological therapies and pharmacotherapy as needed.

Pruritus (itching) is one of the most common symptoms in dermatology and can significantly impair quality of life.

It may be caused by primary skin diseases (eczema, psoriasis, urticaria, scabies, dermatitis herpetiformis), systemic conditions (liver disease, chronic kidney disease, thyroid disorders, iron deficiency, lymphoma), drug reactions, or psychogenic factors.

Treatment depends on the underlying cause, but antihistamines are frequently used for symptomatic relief, particularly in histamine-mediated conditions such as urticaria.

Non-sedating (second-generation) antihistamines (cetirizine, loratadine, fexofenadine) are preferred as first-line therapy during the day, as they do not impair alertness.

Sedating antihistamines such as hydroxyzine may be preferred at bedtime when pruritus disrupts sleep.

How hydroxyzine works: mechanism of action

Hydroxyzine is a piperazine-derivative first-generation H1 antihistamine. It competitively and reversibly blocks H1 histamine receptors on target cells throughout the body.

In the skin, this prevents histamine from causing vasodilatation, increased capillary permeability, and stimulation of sensory itch nerves, thereby reducing redness, swelling, and pruritus.

In the gastrointestinal tract, H1 blockade produces antiemetic effects. In the respiratory tract, it has mild bronchodilator properties.

Unlike second-generation antihistamines (such as cetirizine, which is actually the primary active metabolite of hydroxyzine), hydroxyzine readily crosses the blood-brain barrier.

In the central nervous system, blockade of H1 receptors in the tuberomammillary nucleus of the hypothalamus produces sedation.

Modulation of subcortical neuronal activity produces anxiolytic effects, reducing feelings of anxiety, tension, and agitation without the euphoria, tolerance, dependence, or withdrawal associated with benzodiazepines.

This makes hydroxyzine a useful option for short-term anxiety management in patients for whom benzodiazepines are inappropriate or when dependence is a concern.

Hydroxyzine also possesses anticholinergic (antimuscarinic) properties, blocking muscarinic acetylcholine receptors. This produces drying of secretions (dry mouth, reduced salivation), urinary retention, constipation, and pupil dilatation.

These effects contribute to its side-effect profile and are particularly problematic in elderly patients, in whom the anticholinergic burden should be carefully considered.

Clinical evidence and UK prescribing guidance

Hydroxyzine has been available since the 1950s and has a long clinical track record.

Several randomised controlled trials have demonstrated its efficacy in reducing anxiety symptoms in the short term, with effects comparable to low-dose benzodiazepines but without the risk of dependence.

A Cochrane review of hydroxyzine for generalised anxiety disorder concluded that it is more effective than placebo, though the quality of evidence is moderate and its use is limited by sedation.

NICE guideline CG113 recommends SSRIs (sertraline) as first-line pharmacological treatment for GAD, with SNRIs (duloxetine, venlafaxine) and pregabalin as alternatives.

Hydroxyzine is mentioned as an option but is not first-line.

It may be considered for short-term use when rapid anxiolytic effect is needed, when SSRIs are not tolerated, or when there is a specific concern about dependence with benzodiazepines.

For pruritus, hydroxyzine is widely used in dermatology practice, particularly for nocturnal itching.

The sedating effect helps patients sleep through the night without scratching, which can itself perpetuate the itch-scratch cycle and worsen skin conditions.

For daytime symptom control, non-sedating antihistamines are preferred.

The MHRA Drug Safety Update (April 2015) restricted the use of hydroxyzine due to the risk of QT prolongation and torsade de pointes.

Prescribers must now use the lowest effective dose for the shortest duration, observe the new maximum dose limits, and avoid use in patients at risk of cardiac arrhythmias.

Hydroxyzine compared with other anxiolytics and antihistamines

For anxiety, the main alternatives to hydroxyzine include SSRIs (sertraline, escitalopram, paroxetine), SNRIs (duloxetine, venlafaxine), pregabalin, buspirone, and benzodiazepines (diazepam, lorazepam).

SSRIs and SNRIs are first-line for long-term anxiety management. Pregabalin is effective but carries its own dependency risk.

Benzodiazepines are effective for acute anxiety but are restricted to short-term use (2 to 4 weeks) due to tolerance, dependence, and withdrawal.

Hydroxyzine occupies a niche for patients who need short-term anxiolysis without the dependency risk of benzodiazepines.

For pruritus, cetirizine (the active metabolite of hydroxyzine) provides comparable antihistaminic activity without sedation and is preferred for daytime use. Loratadine and fexofenadine are other non-sedating options.

Chlorphenamine (Piriton) is another sedating antihistamine alternative, available over the counter.

For patients whose itching is not histamine-mediated, other treatments (topical emollients, topical corticosteroids, or specific therapy for the underlying cause) may be more appropriate.

Dosage and administration

For anxiety in adults, start with 25 mg at bedtime.

Increase if needed to 25 mg two to four times daily, up to a maximum of 100 mg daily (50 mg in elderly patients).

For pruritus, the same dosing schedule applies. For pre-operative sedation, 25 to 100 mg may be given 1 to 2 hours before the procedure.

Reduce the dose in elderly patients and in those with hepatic or renal impairment. Use for the shortest duration clinically necessary.

Side effects of hydroxyzine

Common side effects

Drowsiness is the most frequently reported side effect, occurring in the majority of patients. It is dose-dependent and usually most pronounced during the first few days of treatment.

Dry mouth, headache, fatigue, dizziness, and blurred vision are also common. These effects result from the combined antihistaminic and anticholinergic actions of the drug.

Anticholinergic effects

Constipation, urinary retention, difficulty with visual accommodation, and dry eyes are anticholinergic side effects that may be particularly troublesome in elderly patients.

In this population, anticholinergic medicines are associated with increased risk of cognitive impairment, confusion, delirium, and falls.

The cumulative anticholinergic burden of all a patient's medicines should be reviewed regularly.

Cardiac effects

QT prolongation and torsade de pointes are rare but potentially fatal adverse effects.

The risk is increased in patients with pre-existing heart disease, electrolyte abnormalities (hypokalaemia, hypomagnesaemia), bradycardia, or concomitant use of other QT-prolonging drugs.

The MHRA advises using the lowest effective dose and avoiding hydroxyzine in patients at significant cardiac risk.

Other effects

Weight gain, paradoxical excitation (particularly in children), seizures (rare, at high doses), hypersensitivity reactions, and hepatic dysfunction have been reported.

When to seek urgent medical advice

Contact your GP or call NHS 111 if you experience persistent palpitations, dizziness, fainting, or any symptom that concerns you.

Call 999 if you experience a seizure, severe difficulty breathing, chest pain, collapse, or signs of a severe allergic reaction.

Report suspected adverse reactions to the MHRA via the Yellow Card scheme at yellowcard.mhra.gov.uk .

Warnings and precautions

MHRA cardiac safety alert

The MHRA Drug Safety Update (April 2015) warns that hydroxyzine can cause dose-dependent QT prolongation, increasing the risk of cardiac arrhythmia (torsade de pointes).

Prescribers must use the lowest effective dose, observe maximum daily limits (100 mg in adults, 50 mg in elderly), and avoid prescribing to patients at risk of QT prolongation.

An ECG should be considered in patients with cardiovascular risk factors.

Contraindications

Hydroxyzine is contraindicated in patients with known QT prolongation or significant risk factors for QT prolongation, porphyria, pregnancy, and hypersensitivity to hydroxyzine, cetirizine, or piperazine derivatives.

Elderly patients

Use with extreme caution. Reduce the maximum dose to 50 mg daily. Monitor for sedation, falls, confusion, and anticholinergic adverse effects. Consider non-pharmacological alternatives first.

Hepatic and renal impairment

Reduce the dose by 50% in patients with hepatic impairment, as hydroxyzine is extensively metabolised in the liver. Reduce the dose in moderate to severe renal impairment, as metabolites are renally excreted.

Driving and machinery

Hydroxyzine significantly impairs psychomotor performance. Patients must not drive or operate dangerous machinery until they are certain the drug does not affect their alertness. The effects may persist the morning after a bedtime dose.

Pregnancy and breastfeeding

Hydroxyzine is contraindicated in pregnancy. Animal studies have shown teratogenic effects, and neonatal withdrawal symptoms have been reported after maternal use near term.

Non-sedating antihistamines (cetirizine, loratadine) are safer alternatives for pruritus during pregnancy. Hydroxyzine and its metabolite cetirizine are excreted in breast milk; avoid use during breastfeeding.

Interactions

Avoid concomitant use with alcohol and other CNS depressants (opioids, benzodiazepines, barbiturates, other sedating antihistamines). Avoid combination with other QT-prolonging medicines unless the benefit clearly outweighs the risk. MAO inhibitors may potentiate anticholinergic effects.

How to get hydroxyzine in the UK

Hydroxyzine is a prescription-only medicine. Your GP can prescribe it following a clinical assessment.

It is generally reserved for short-term use when other treatments are not suitable or have not been effective. Your prescriber will explain the risks and monitoring requirements.

The NHS prescription charge in England is currently 9.90 pounds per item; prescriptions are free in Scotland, Wales, and Northern Ireland.

Managing anxiety without medication

Medication is only one approach to managing anxiety. Evidence-based psychological therapies, including cognitive behavioural therapy (CBT), are recommended as first-line treatment for most anxiety disorders.

Self-help strategies such as regular physical exercise, mindfulness meditation, structured problem-solving, reducing caffeine intake, maintaining a regular sleep routine, and limiting alcohol consumption can all help reduce anxiety symptoms.

NHS Talking Therapies (formerly IAPT) services provide free access to psychological therapies across England. You can self-refer without a GP appointment.

Discuss your options with your GP to develop a comprehensive anxiety management plan.

Sources

• Atarax 25 mg Film-Coated Tablets, Summary of Product Characteristics (EMC)
• Hydroxyzine hydrochloride, British National Formulary (BNF)
• NICE CG113: Generalised anxiety disorder and panic disorder in adults
• MHRA Drug Safety Update: Hydroxyzine, risk of QT prolongation
• Generalised anxiety disorder, NHS
• MHRA Yellow Card Scheme