Hydroxyzine is an antihistamine with antiemetic properties that is often used as a sedative for pediatric patients before dental procedures. It has been demonstrated to be safe for most patients in combination with many other drugs when used in the appropriate dosages. Hydroxyzine is ideal for mild sedation of pediatric patients because it has a good safety profile with limited adverse effects. It does not impair cardiovascular or respiratory functioning like stronger sedatives. The 25mg/5mL suspension we compound is the same dose as Vistaril – a brand name version of hydroxyzine that is no longer commercially available.

Hydroxyzine is effective for patients who have mild to moderate anxiety or who are hyperactive. It has an onset of action that is about 15 to 30 minutes after administration and the effects will be strongest after 2 hours. For our 25mg/5mL alternative to Vistaril, one teaspoon contains 25mg of hydroxyzine. For a pediatric patient it is recommended that hydroxyzine be administered in a 25mg to 100mg dose (or about 1-2mg/kg), which will provide mild sedation (anxiolysis). Anxiolysis is the lightest level of sedation compared to deep sedation and general anesthesia. After taking hydroxyzine, the patient will be calmer but still be able to respond to verbal commands.

Sometimes a dosing schedule is prescribed for how hydroxyzine should be taken preoperatively. It may be prescribed to be taken 2 hours before and again 1 hour before the procedure. For patients with more severe anxiety or other issues it may be prescribed to be taken 3 times the day of the procedure, followed with another dose 2 hours before and again 1 hour before. The exact dosages prescribed should be based on patient’s body weight and how much sedation they need.

Hydroxyzine can also be used as a preoperative sedative for adults in a dose between 25mg-100mg. For many adult patients, the use of a light sedative can help take the edge off what may be an anxiety-inducing experience. Patients who have a gag reflex that may interfere with a procedure can also be given given this medication.

Research

• Oral Sedation: A Primer on Anxiolysis for the Adult Patient – PubMed
• Anxiolysis in General Dental Practice – Dentistry Today
• Oral Sedation in Pediatric Dentistry: The Growing Wave of Chemical Restraint – Oral Health Group