Hydroxyzine Formulations for Pediatric Anxiety

Comparison of Formulations

The European Journal of Nuclear Medicine and Molecular Imaging recommends hydroxyzine hydrochloride over hydroxyzine pamoate for treating anxiety in children due to its more established use in pediatric anxiety management and better pharmacokinetic profile for this indication 1
Hydroxyzine is an effective sedative antihistamine approved for anxiolytic use in both Europe and the United States for children, with differences in absorption rates and onset of action between the pamoate and HCl formulations 1, 2

Hydroxyzine has demonstrated efficacy as an anxiolytic in children with few contraindications, serving as an alternative to benzodiazepines, which are generally not recommended in children under 16 years of age 1

Common side effects of hydroxyzine include drowsiness/sedation, dry mouth, and dizziness, with hydroxyzine having fewer safety concerns in children compared to benzodiazepines 1, 2, 3

The Journal of the American Academy of Child and Adolescent Psychiatry recommends cognitive-behavioral therapy (CBT) as first-line treatment for mild to moderate anxiety in children, with selective serotonin reuptake inhibitors (SSRIs) having the strongest evidence base for long-term treatment of anxiety disorders in children 2, 4, 5
Hydroxyzine is appropriate for short-term or situational anxiety management, and can be used as an adjunct to SSRIs or as monotherapy for milder cases 1

The American Academy of Child and Adolescent Psychiatry suggests using hydroxyzine at the lowest effective dose to minimize sedation, and avoiding combination with other medications having anticholinergic properties 3
Non-pharmacological approaches, such as distraction and relaxation techniques, should be incorporated alongside medication when possible 1

Avoid using hydroxyzine as the sole treatment for severe, chronic anxiety disorders where SSRIs would be more appropriate, and be cautious about long-term use due to potential tolerance development 2, 3, 5