Hydroxyzine: Patient Information for Australia
Basic Product Information
| International Nonproprietary Name (INN) | Hydroxyzine |
|---|---|
| Brand Names in Australia | Atarax®, Ucerax®, others (consult your pharmacist for current brands) |
| ATC Code | N05BB01 |
| Forms & Strengths | Tablets: 10 mg, 25 mg Oral solution: 10 mg/5 mL (Note: Some strengths and forms may not be available in all pharmacies) |
| Manufacturers | Pfizer Australia Pty Ltd, Sandoz Pty Ltd and other reputable international manufacturers |
| Prescription Status | S4 (Prescription Only Medicine in Australia) |
Mechanism of Action
For Patients: Hydroxyzine is a type of medicine called an antihistamine. It works by blocking the action of histamine — a chemical in the body that is involved in allergic reactions and can also affect mood and alertness. By doing this, hydroxyzine can help relieve itching, calm anxiety, or help you relax before surgery or at bedtime.
For Professionals: Hydroxyzine acts as a first-generation H1 receptor antagonist, with additional anticholinergic and sedative properties. It moderately suppresses activity in subcortical brain regions, accounting for its anxiolytic and sedative effects; it does not inhibit cortical activity or produce euphoria. It is not structurally related to benzodiazepines or barbiturates and has minimal risk of dependence or abuse.
Pharmacokinetics
- Absorption: Rapidly absorbed from the gastrointestinal tract, with peak effects in 2 hours.
- Metabolism: Primarily in the liver; main metabolite is cetirizine (an inactive antihistamine).
- Elimination: Via urine (renal); elimination half-life around 20 hours in adults, longer in older adults and those with kidney or liver impairment.
- Duration of Action: 4–6 hours for sedative effects; antihistamine and anxiolytic effects may last up to 24 hours.
Everyday Use and Best Practices
Hydroxyzine is commonly used in Australia to:
- Relieve itching and discomfort from allergies, hives, dermatitis, and some chronic skin conditions
- Help manage short-term anxiety, especially before medical or dental procedures
- Support sleep for people struggling with insomnia related to anxiety or itching
Typical Tablets: Swallow whole with a glass of water, at the dose prescribed by your doctor.
Oral Solution: Use a measuring device or syringe to ensure accurate dosing.
Best Practices in Australia:
- Always follow your doctor’s or pharmacist’s instructions.
- Do not drive or operate machinery if you feel drowsy after taking hydroxyzine.
- Avoid alcohol while taking this medication.
- If allergic to cetirizine, consult your doctor before use (hydroxyzine metabolises to cetirizine).
- Keep all medicines out of reach of children, as per TGA guidelines.
Dosing in the Morning vs Evening
- Evening dosing: Often preferred when the aim is to reduce itchiness overnight or promote sleep. Sedative effects may last into the morning for some.
- Morning dosing: Suitable for daytime anxiety or itch, but may cause excessive drowsiness especially in sensitive individuals. Caution is advised if you need to stay alert.
Tip: Take at the same time each day for best results. Discuss timing with your healthcare provider to minimise sedation while maximising benefit.
Taking with Food or on an Empty Stomach
- Hydroxyzine can be taken with or without food.
- Taking with food may reduce stomach upset, though this is uncommon.
- Australian dietary habits allow flexibility. If you have a sensitive stomach, take with a meal such as breakfast or dinner.
- Avoid grapefruit juice, as with many medicines, to prevent altering levels in the body (although clinically significant interactions are rare).
Interactions: Food, Alcohol, Medicines
| Substance/Drug | Interaction | Advice |
|---|---|---|
| Alcohol | May increase drowsiness, impair coordination | Avoid alcohol during treatment |
| Other Sedating Medicines (e.g. benzodiazepines, sleep aids) | Increased risk of sedation/respiratory depression | Discuss with doctor or pharmacist |
| Anticholinergic Drugs | Increased anticholinergic side effects (dry mouth, confusion) | Caution in older adults |
| CYP450 Inhibitors | Potentially increased hydroxyzine levels | Rare, but inform your prescriber of all medicines taken |
| Grapefruit or Citrus Juice | Unlikely to cause major issue, but best avoided | Prefer water for swallowing tablets |
| Monoamine Oxidase Inhibitors (MAOIs) | Combined sedative effects possible | Discuss with prescriber |
Indications
| Indication | Regulatory Status in Australia | Details/Notes |
|---|---|---|
| Symptomatic relief of itching from allergic skin conditions | Approved (PBS lipid eligible) | Includes urticaria, eczema, dermatitis |
| Short-term management of anxiety | Approved | May be used as an adjunct for insomnia related to anxiety |
| Pre-operative sedation | Approved | Prior to surgery or dental procedures |
| Off-label: Support for general insomnia | Off-label | Prescriber discretion; preferred where risk of addiction is a concern |
| Off-label: Management of nausea/vomiting | Off-label | Rarely used; alternatives preferred |
Dosing According to Clinical Indication
| Patient Group | Itching/Allergies (Urticaria, Eczema) | Anxiety/Insomnia | Pre-operative Sedation |
|---|---|---|---|
| Adults | 10–25 mg two to three times daily (max 100 mg per day) | 25–50 mg once daily (evening), or divided doses | 50–100 mg, 1 hour before procedure |
| Children (6–12 years) | 5–10 mg two to three times daily (max 50 mg per day) | 10–25 mg once daily | 0.6 mg/kg up to 50 mg once, 1 hour before procedure |
| Older Adults (over 65 years) | Start with 10 mg once or twice daily; use lowest possible effective dose | 10–25 mg once daily; higher doses increase risk of side effects | Use low end of adult dose range; monitor for confusion or drowsiness |
Doses may need to be adjusted in patients with liver or kidney impairment. Children under 6 years: consult paediatrician.
Safety Profile and Possible Side Effects
| Common Side Effects | Rare Side Effects | Warnings/Precautions |
|---|---|---|
| - Drowsiness - Dry mouth - Headache - Mild dizziness - Stomach upset | - Involuntary movements, tremor - Palpitations/heart rhythm changes - Allergic reaction - Seizure (mainly in overdose) | - Avoid in individuals with known QT prolongation or arrhythmias - Older adults more likely to experience confusion, sedation, falls - Use with caution if history of epilepsy, asthma, glaucoma, urinary retention, or prostate troubles |
If you experience palpitations, severe dizziness, breathing difficulties, or swelling of the lips/face, seek immediate medical help.
Guidelines for Proper Use (Advice for Australian Patients)
- Read the Consumer Medicine Information (CMI) leaflet supplied with your medication and keep it for reference.
- Only use the dose and frequency prescribed for you. Do not share with others.
- If you miss a dose, take it as soon as you remember. If it is nearly time for your next dose, skip the missed dose – do not double up.
- If you think you or someone else has taken too much (overdose), call the Poisons Information Centre (13 11 26) immediately.
- Discuss any concerns about drowsiness, memory, or side effects with your GP or pharmacist, especially if you are older or take multiple medications.
- Store below 25°C in a dry place, away from direct sunlight—standard for Australian households.
- Dispose of unused or expired medicines at your local pharmacy (return unwanted medicines scheme—RUM Project).
Alternative Treatment Options
| Alternative | Reimbursed by National Health | Advantages | Disadvantages |
|---|---|---|---|
| Cetirizine (Zyrtec®) | PBS | Non-sedating, once-daily, effective for allergies | Less effective for anxiety/sedation |
| Loratadine (Claratyne®) | PBS | Non-sedating, long duration | Not helpful for sleep/anxiety |
| Diazepam (Valium®) and Other Benzodiazepines | PBS with authority | Strong anxiolytic/sedative effect | Risk of dependency, withdrawal |
| Promethazine (Phenergan®) | PBS | Good for itching/sedation | Similar drowsiness effects, anticholinergic burden |
| Melatonin (for sleep) | PBS for children with sleep disorders | Safe in many cases, non-habit forming | Not effective for allergies or anxiety |
Your doctor or pharmacist can advise on which alternative may be best for you, depending on your specific symptoms and risk factors.
Legal Status, Registration, and Reimbursement in Australia
Hydroxyzine is classified as a Schedule 4 (S4) medicine under the Therapeutic Goods Administration (TGA), available only by prescription from a registered Australian healthcare provider. It is not a controlled drug but requires a prescription due to its sedating and potential cardiac side effects.
- Registered for use in Australia by the TGA.
- Listed on the Pharmaceutical Benefits Scheme (PBS) for certain allergies and pruritus.
- Usual prescription is for 25–100 tablets/suspension for up to 1–3 months.
- No government age restrictions, but special caution in older adults and children under 6 years.
Latest Research and Clinical Guidance (2022–2025)
- Itching/Pruritus: Recent Australian and international guidelines (e.g., Australasian Society of Clinical Immunology and Allergy, ASCIA) place hydroxyzine as a useful adjunct for patients with severe nocturnal itching not controlled by non-sedating antihistamines. (ASCIA guidelines 2023)
- Anxiety: Hydroxyzine remains a first-line non-benzodiazepine option for short-term management of anxiety, especially in those unable to take SSRIs or benzodiazepines (RACGP, 2022).
- Safety: 2023 TGA reports highlight rare risk of QT prolongation and arrhythmia, particularly at higher doses or in those with predisposing cardiac factors.
- Older adults: Recommendations continue to emphasise low-dose use and caution in the elderly due to increased confusion and risk of falls (Beers Criteria 2023).
Availability, Pack Sizes, and Delivery in Australia
- Pack sizes: Commonly available as 25 mg film-coated tablets in packs of 25, 50, or 100; oral solution typically in 100 mL or 150 mL bottles.
- Indicative price: From AU$7–20 per pack (PBS-subsidised price is lower, standard dispensing fees apply).
| City | Expected Delivery (In-Store Pickup) | Online Pharmacy Delivery |
|---|---|---|
| Sydney | Same day to 1 business day | 1-2 business days |
| Melbourne | Same day to 1 business day | 1-2 business days |
| Brisbane | 1 business day | 1-3 business days |
| Perth, Adelaide | 1-2 business days | 2-4 business days |
| Regional/rural Australia | 1-3 business days | Up to 5 business days |
Always check with your pharmacy for real-time availability and delivery options.
FAQ – Common Patient Questions
- Can I take hydroxyzine every day?
Answer: Yes, but only as directed by your doctor and usually for a limited period. Long-term daily use is rarely recommended, except on advice of a specialist. - Does hydroxyzine make you sleepy?
Answer: Drowsiness is a common effect, especially when you first start the medication or increase the dose. Avoid driving until you know how it affects you. - Can I drink alcohol while taking hydroxyzine?
Answer: No. Alcohol increases the sedative effects and can be dangerous. - Is it safe for children or older adults?
Answer: Hydroxyzine can be prescribed for children and older adults, but dosing is lower, and side effects are more likely. Always follow your doctor's instructions. - What should I do if I miss a dose?
Answer: Take it as soon as you remember unless it’s nearly time for your next dose. Skip the missed dose if close to the next scheduled dose; never double-dose.
For further information, speak with your GP or pharmacist, or visit the NPS MedicineWise website.
