Atarax tablet

Description
Hydroxyzine HCl is 1-(p-chlorobenzhydryl)4-[2-(2-hydroxyethoxy)-ethyl] piperazine dihydrochloride.

Actions
Pharmacology: Atarax is unrelated chemically to the phenothiazines, reserpine, meprobamate or the benzodiazepines.
Atarax is not a cortical depressant, but its action may be due to a suppression of activity in certain key regions of the subcortical area of the central nervous system. Primary skeletal muscle relaxation has been demonstrated experimentally.
Bronchodilator activity and antihistaminic and analgesic effects have been demonstrated experimentally and confirmed clinically.
An antiemetic effect, both by the apomorphine test and the veriloid test, has been demonstrated. Pharmacological and clinical studies indicate that hydroxyzine in therapeutic dosage does not increase gastric secretion or acidity and in most cases has mild antisecretory activity.
Hydroxyzine is rapidly absorbed from the gastrointestinal tract and Atarax's clinical effects are usually noted within 15-30 min after oral administration.

Indications
For symptomatic relief of anxiety and tension associated with psychoneurosis and as an adjunct in organic disease states in which anxiety is manifested.
Useful in the management of pruritus due to allergic conditions eg, chronic urticaria and atopic and contact dermatoses and in histamine-mediated pruritus.
As a sedative when used as premedication and following general anesthesia. Hydroxyzine may potentiate meperidine (Demerol) and barbiturates, so their use in preanesthetic adjunctive therapy should be modified on an individual basis. Atropine and other belladonna alkaloids are not affected by the drug. Hydroxyzine is not known to interfere with the action of digitalis in any way and it may be used concurrently with this agent.
The effectiveness of hydroxyzine as an antianxiety agent for long-term use, that is >4 months, has not been assessed by systematic clinical studies. The physician should reassess periodically the usefulness of the drug for the individual patient.

Dosage
Symptomatic Relief of Anxiety and Tension Associated with Psychoneurosis and as an Adjunct in Organic Disease States in which Anxiety is Manifested: Adults: 50-100 mg 4 times a day. Children >6 years: 50-100 mg daily in divided doses; <6 years: 50 mg daily in divided doses.
Management of Pruritus due to Allergic Conditions eg, Chronic Urticaria, Atopic and Contact Dermatoses and in Histamine-Mediated Pruritus: Adults: 25 mg 3 or 4 times a day. Children >6 years: 50-100 mg daily in divided doses; <6 years: 50 mg daily in divided doses.
As a Sedative When Used as a Premedication and Following General Anesthesia: 50-100 mg in adults and 0.6 mg/kg in children.
When treatment is initiated by the IM route of administration, subsequent doses may be administered orally.
As with all medications, the dosage should be adjusted according to the patient's response to therapy.

Overdosage
The most common manifestation of Atarax overdosage is hypersedation. As in the management of overdosage with any drug, it should be borne in mind that multiple agents may have been taken.
If vomiting has not occurred spontaneously, it should be induced. Immediate gastric lavage is also recommended. General supportive care, including frequent monitoring of the vital signs and close observation of the patient, is indicated. Hypotension, though unlikely, may be controlled with IV fluids and Levophed (levarterenol) or Aramine (metaraminol). Do not use epinephrine as Atarax counteracts its pressor action.
There is no specific antidote. It is doubtful that hemodialysis would be of any value in the treatment of overdosage with hydroxyzine. However, if other agents eg, barbiturates have been ingested concomitantly, hemodialysis may be indicated. There is no practical method to quantitate hydroxyzine in body fluids or tissue after its ingestion or administration.

Contraindication
Hydroxyzine, when administered to the pregnant mouse, rat and rabbit, induced fetal abnormalities in the rat and mouse at doses substantially above the human therapeutic range. Clinical data in human beings are inadequate to establish safety in early pregnancy. Until such data are available, hydroxyzine is contraindicated in early pregnancy.
Hydroxyzine is contraindicated for patients who have shown a previous hypersensitivity to it.

Warning
Use in lactation: It is not known whether this drug is excreted in human milk. Since many drugs are so excreted, hydroxyzine should not be given to nursing mothers.

Precautions
Effects on the Ability to Drive or Operate Machinery: The potentiating action of hydroxyzine must be considered when the drug is used in conjunction with CNS depressants eg, narcotics, non-narcotic analgesics and barbiturates. Therefore, when CNS depressants are administered concomitantly with hydroxyzine their dosage should be reduced. Since drowsiness may occur with use of Atarax, patients should be warned of this possibility and cautioned against driving a car or operating dangerous machinery while taking Atarax. Patients should be advised against the simultaneous use of other CNS depressant drugs and cautioned that the effect of alcohol may be increased.

Adverse Reactions
Side effects reported with the administration of Atarax (hydroxyzine HCl) are usually mild and transitory in nature.
Anticholinergic: Dry mouth.
CNS: Drowsiness is usually transitory and may disappear in a few days of continued therapy or upon reduction of the dose. Involuntary motor activity including rare instances of tremor and convulsions have been reported, usually with doses considerably higher than those recommended. Clinically significant respiratory depression has not been reported at recommended doses.

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