Complete Patient Guide to Atarax (Hydroxyzine) in Australia

Complete Patient Guide to Atarax (Hydroxyzine) in Australia

If you've been prescribed Atarax, you're likely dealing with persistent itching from allergies, managing anxiety, or preparing for a medical procedure. This antihistamine medication has been used in Australia for decades, but it works differently from the newer non-sedating antihistamines you might be more familiar with. Understanding how to use Atarax safely and effectively is crucial, especially since it can cause significant drowsiness and has important interactions with other medications.

This guide covers everything Australian patients need to know about Atarax: what it treats, how to take it properly, what side effects to watch for, and critical safety information specific to the Australian healthcare context. I'll explain the medication using information from the Therapeutic Goods Administration (TGA) and current Australian prescribing guidelines, without medical jargon where possible.

Whether you're taking Atarax for the first time or want to better understand a medication you've been using, this guide provides the practical information you need to use it safely.

What Is Atarax and How Does It Work?

Active Ingredient and Drug Class

Atarax contains Hydroxyzine hydrochloride as its active ingredient. It belongs to a class of medications called first-generation antihistamines, sometimes referred to as sedating antihistamines. In Australia, Atarax is classified as a Schedule 4 medication under the TGA's Poisons Standard, meaning it requires a prescription from a doctor or other authorized prescriber.

The medication has been available in Australia since the 1970s and remains prescribed despite the availability of newer antihistamines. This is because hydroxyzine has unique properties that make it useful for conditions beyond typical allergies.

Mechanism of Action

Hydroxyzine works through multiple pathways in your body:

Antihistamine Effect: It blocks H1 histamine receptors throughout your body. Histamine is a chemical your immune system releases during allergic reactions, causing symptoms like itching, swelling, and redness. By blocking these receptors, hydroxyzine reduces these allergic symptoms.

Central Nervous System Effects: Unlike newer antihistamines (such as cetirizine or fexofenadine), hydroxyzine crosses the blood-brain barrier easily. This means it affects receptors in your brain, which explains both its sedative properties and its ability to reduce anxiety. It affects several brain receptors, including serotonin receptors, which contributes to its calming effects.

Anticholinergic Properties: Hydroxyzine also blocks acetylcholine receptors, which can cause side effects like dry mouth but also contributes to its anti-nausea effects.

The medication typically begins working within 15 to 30 minutes after taking it orally, with peak effects occurring at 2 hours. The effects last approximately 4 to 6 hours, though drowsiness may persist longer in some people.

Available Forms in Australia

In the Australian market, Atarax is primarily available as:

• Tablets: 25mg strength (most common)
• Syrup: 10mg per 5mL (particularly useful for children or those who have difficulty swallowing tablets)

Generic versions containing hydroxyzine hydrochloride are also available in Australia under different brand names or as generic hydroxyzine. Your pharmacist may dispense either the branded Atarax or a generic equivalent unless your doctor has specified "no substitution" on your prescription.

What Conditions Is Atarax Prescribed For?

Anxiety and Tension

Atarax is frequently prescribed for short-term relief of anxiety symptoms and tension. Australian doctors often use it for situational anxiety—such as dental anxiety, pre-flight nervousness, or stress related to specific events—rather than for ongoing generalized anxiety disorder.

The anxiolytic (anti-anxiety) effect comes from its action on brain receptors, not just its sedating properties. Research has shown hydroxyzine can be as effective as benzodiazepines for certain types of anxiety, but with a lower risk of dependence. However, it's typically reserved for short-term use (a few weeks to months) rather than as a long-term anxiety management strategy.

Allergic Conditions and Itching

This is one of the most common uses for Atarax in Australia. It's prescribed for:

• Chronic urticaria (hives): Particularly when the itching disrupts sleep
• Atopic dermatitis (eczema): To control itching, especially at night
• Contact dermatitis: Allergic skin reactions from plants, chemicals, or materials
• Pruritus (generalized itching): From various causes when other antihistamines haven't provided sufficient relief

The sedating property that's considered a "side effect" in other contexts becomes therapeutic here—helping patients sleep through nighttime itching that would otherwise cause scratching and worsen skin conditions.

Sedation Before Medical Procedures

Doctors and dentists sometimes prescribe Atarax as pre-medication to help patients relax before procedures. This use is particularly common in:

• Dental procedures for anxious patients
• Minor surgical procedures
• Medical imaging (like MRI) for patients with claustrophobia
• Pediatric procedures where mild sedation helps cooperation

When used this way, you'll typically take it 1-2 hours before the appointment.

Off-Label Uses

While not officially approved for these purposes, Australian doctors sometimes prescribe Atarax for:

• Nausea and vomiting: Its anticholinergic properties help with motion sickness and post-operative nausea
• Insomnia: Short-term use when related to anxiety or itching
• Alcohol withdrawal symptoms: In hospital settings, occasionally used to manage mild withdrawal

Important caveat: Off-label prescribing is legal and common in medicine, but it means the TGA hasn't specifically evaluated the medication for that use. Your doctor should explain why they're prescribing it and what evidence supports that use.

How to Take Atarax: Dosage and Administration

Standard Dosing for Adults

Dosing varies significantly based on what condition is being treated:

For Anxiety and Tension:

• Typical dose: 25mg to 100mg, taken 3-4 times daily
• Maximum daily dose: 400mg (rarely needed)
• Starting dose is usually 25mg three times per day, adjusted based on response

For Allergic Conditions and Itching:

• Typical dose: 25mg taken 3-4 times daily
• Nighttime dose may be higher (50mg) to help with sleep disruption from itching
• Some patients get adequate relief with 25mg twice daily

For Pre-Procedure Sedation:

• Single dose: 50mg to 100mg, taken 1-2 hours before the procedure
• Pediatric dosing is calculated based on weight

Your doctor will determine the appropriate dose for your specific situation. Never adjust the dose yourself without consulting your prescriber.

Dosing for Children

Pediatric dosing is calculated based on body weight and the condition being treated. The Australian Medicines Handbook recommends:

For Itching or Allergies:

• Children 6 months to 6 years: 5-15mg (0.5-1.5mg/kg) per dose, up to 3-4 times daily
• Children over 6 years: 15-25mg per dose, up to 3-4 times daily

For Anxiety or Sedation:

• Doses are individually calculated by the prescriber based on weight and severity

The syrup formulation is generally preferred for children under 6 years. Always use the measuring device provided with the medication rather than household spoons to ensure accurate dosing.

How to Take It

With or Without Food: Atarax can be taken with or without food. Taking it with food may reduce stomach upset if you experience any.

With Water: Tablets should be swallowed whole with a full glass of water. Don't crush or chew them unless directed by your pharmacist or doctor.

Timing: If taking multiple doses per day, try to space them evenly. For example, if taking three times daily, aim for every 8 hours (like 8am, 4pm, and midnight). However, many doctors recommend taking the largest dose at bedtime when treating itching.

Duration: Follow your doctor's instructions about how long to continue treatment. For anxiety, it's typically prescribed for weeks to a few months. For allergic conditions, duration depends on symptom resolution.

What to Do If You Miss a Dose

If you miss a dose:

1. If it's within a few hours of the scheduled time: Take it as soon as you remember
2. If it's almost time for the next dose: Skip the missed dose and continue with your regular schedule
3. Never double up: Don't take two doses at once to make up for a missed dose

Missing occasional doses of Atarax doesn't typically cause withdrawal symptoms or rebound effects, but consistent use as prescribed provides the most reliable symptom control.

Side Effects: What to Expect

Common Side Effects

The most frequently reported side effects affect a significant portion of users:

Drowsiness and Sedation (very common, affecting more than 1 in 10 people):

• This is the most predictable effect and can be pronounced
• Usually most noticeable during the first few days but may persist throughout treatment
• Varies significantly between individuals—some people tolerate it well, others find it debilitating
• Tends to be worse with higher doses

Dry Mouth (common, affecting 1 in 10 to 1 in 100 people):

• Caused by the anticholinergic properties
• Can be managed by sipping water, sucking on ice chips, or using sugar-free gum
• May improve after a few days of use

Headache (common):

• Usually mild and temporary
• If persistent or severe, inform your doctor

Dizziness:

• Related to both the sedation and effects on Blood Pressure
• Be careful when standing up quickly, especially when first starting the medication

Less Common but Important Side Effects

Cognitive Effects:

• Difficulty concentrating or confusion
• Memory problems, particularly in older adults
• Slowed reaction time

Gastrointestinal Effects:

• Constipation (due to anticholinergic action)
• Nausea
• Stomach discomfort

Vision Changes:

• Blurred vision
• Difficulty focusing on close objects

Urinary Changes:

• Difficulty urinating (urinary retention)
• More common in older men with prostate enlargement

Serious Side Effects Requiring Immediate Attention

Seek immediate medical attention if you experience:

Cardiac Effects:

• Irregular heartbeat or palpitations
• Chest pain
• Fainting or severe dizziness

Hydroxyzine has been associated with QT prolongation (a change in heart rhythm) in some patients. While rare, this can lead to a serious irregular heartbeat called torsades de pointes.

Severe Allergic Reaction:

• Difficulty breathing or swallowing
• Swelling of face, lips, tongue, or throat
• Severe skin rash or hives

Yes, ironically, you can be allergic to an anti-allergy medication. This is rare but serious.

Seizures:

• Particularly in patients with a history of seizure disorders
• Has been reported rarely with hydroxyzine

Severe Involuntary Movements:

• Tremors, muscle stiffness, or uncontrollable movements
• May indicate a rare but serious reaction

Long-Term Use Considerations

Tolerance: Some patients develop tolerance to the sedating effects over time, meaning the drowsiness may decrease. However, you should not increase your dose without medical consultation.

Anticholinergic Burden: Long-term use of anticholinergic medications like hydroxyzine, particularly in older adults, has been associated with increased risk of cognitive decline and dementia in some studies. This is still being researched, but it's one reason doctors prefer short-term use when possible.

Dependence: Unlike benzodiazepines, hydroxyzine doesn't cause physical dependence in the traditional sense. However, your body does adjust to it, and stopping suddenly after prolonged use may temporarily worsen the symptoms it was treating (rebound effect).

Important Safety Information

Who Should Not Take Atarax

Absolute Contraindications (never use):

• Known Allergy to hydroxyzine or cetirizine (Zyrtec)—these medications are chemically related
• Early pregnancy (first trimester) due to potential birth defect risks
• Hereditary QT prolongation syndromes
• Porphyria (a rare blood disorder)

Relative Contraindications (use with extreme caution and medical supervision):

• Myasthenia gravis (muscle weakness disorder)
• Glaucoma, particularly angle-closure glaucoma
• Severe liver disease
• Severe kidney disease
• Enlarged prostate or urinary retention problems
• Epilepsy or history of seizures
• Older adults (over 65) due to increased sensitivity to anticholinergic effects

Drug Interactions

Hydroxyzine interacts with numerous medications. Always tell your doctor and pharmacist about everything you're taking, including over-the-counter medications and supplements.

Significant Interactions:

Central Nervous System Depressants (additive sedation):

• Benzodiazepines (diazepam, temazepam)
• Opioid pain medications (codeine, oxycodone, tramadol)
• Sleep medications (zolpidem, zopiclone)
• Other sedating antihistamines
• Pregabalin and gabapentin

Taking these with hydroxyzine significantly increases drowsiness and can be dangerous, particularly affecting breathing during sleep.

Medications Affecting Heart Rhythm:

• Antiarrhythmics (amiodarone, sotalol)
• Certain Antibiotics (erythromycin, clarithromycin)
• Antipsychotics (Quetiapine, risperidone)
• Antidepressants (Citalopram, Escitalopram)
• Domperidone (used for nausea)

These medications can increase the risk of QT prolongation and dangerous heart rhythms when combined with hydroxyzine.

Anticholinergic Medications (additive effects):

• Tricyclic Antidepressants (Amitriptyline)
• Certain medications for overactive bladder (oxybutynin)
• Some anti-Parkinson's medications
• Scopolamine patches

Combining these increases risks of dry mouth, constipation, urinary retention, confusion, and falls—especially in older adults.

Alcohol and Atarax

Do not drink alcohol while taking Atarax. Alcohol significantly enhances the sedative effects of hydroxyzine, leading to:

• Extreme drowsiness
• Impaired judgment and coordination
• Increased risk of accidents
• Dangerous central nervous system depression
• Potential respiratory depression

This combination is particularly dangerous if you're also taking other sedating medications or opioids.

Pregnancy and Breastfeeding

Pregnancy: Hydroxyzine is classified as Category B3 under the Australian categorization system (which was used until 2021). Current evidence indicates:

• First Trimester: Should be avoided due to potential increased risk of birth defects. Some studies have suggested a possible link to cardiac defects and other abnormalities, though evidence is not conclusive.
• Later Pregnancy: Generally avoided unless potential benefits outweigh risks
• Near Term: Can cause effects in newborns including sedation and withdrawal symptoms

If you become pregnant while taking Atarax, contact your doctor immediately. Don't stop suddenly without medical advice, but generally, safer alternatives should be considered.

Breastfeeding: Hydroxyzine is excreted in breast milk. It can cause drowsiness and other effects in nursing infants. The Australian Breastfeeding Association generally recommends avoiding hydroxyzine while breastfeeding, or using it only with close medical supervision and monitoring of the infant for sedation, poor feeding, or other effects.

Driving and Operating Machinery

Critical Warning: Atarax significantly impairs your ability to drive and operate machinery safely.

The TGA requires warnings on hydroxyzine packaging about driving and machinery operation. Specifically:

• Do not drive or operate machinery when starting treatment
• Do not drive if you feel drowsy, dizzy, or impaired in any way
• The impairment may be present even if you don't subjectively feel drowsy
• Impairment is worse when combined with alcohol or other sedating medications
• Individual variation is significant—some people are more affected than others

In Australia, driving while impaired by prescription medication is illegal, even if you have a valid prescription. You can be charged with drug driving if an accident occurs or police determine you're impaired.

Practical Advice: Many patients find they can't drive safely while taking Atarax, at least initially. Plan alternative transportation, particularly for the first few days. Even if drowsiness decreases over time, remain cautious—reaction times may still be affected.

Atarax vs. Other Antihistamines

Understanding how Atarax compares to other antihistamines available in Australia helps explain why your doctor may have chosen it specifically.

Comparison Table

Feature	Atarax (Hydroxyzine)	Newer Antihistamines (e.g., Zyrtec, Telfast)	Phenergan (Promethazine)
Sedation	Significant (therapeutic in some cases)	Minimal to none	Significant
Anti-anxiety Effect	Yes	No	Minimal
Duration of Action	4-6 hours	12-24 hours	4-6 hours
Driving Impairment	Yes, significant	Minimal	Yes, significant
Anti-itch Efficacy	Excellent, especially for sleep disruption	Good for daytime use	Good
Prescription Required	Yes (Schedule 4)	No (most are Pharmacist Only or Pharmacy Medicine)	Yes (Schedule 4)
Anticholinergic Effects	Moderate	Minimal	Strong
Suitable for Long-term Use	Less preferred (weeks to months)	Yes (months to years)	Less preferred

When Atarax Is Preferred

Your doctor might choose Atarax over newer antihistamines when:

Sedation is Desirable: If itching from eczema or hives disrupts sleep, the sedating property becomes therapeutic rather than problematic. Taking hydroxyzine at bedtime helps you sleep through the itch.

Anti-anxiety Properties Needed: For patients with both allergic symptoms and anxiety, or situational anxiety where mild sedation is acceptable, hydroxyzine addresses both issues.

Other Antihistamines Haven't Worked: Some patients don't respond adequately to non-sedating antihistamines. Hydroxyzine's different mechanism and brain penetration may provide relief when others haven't.

Cost Considerations: While generic non-sedating antihistamines are inexpensive in Australia (many under $10 for a month's supply over the counter), hydroxyzine may be more affordable when prescribed if you have a Healthcare Card or meet PBS criteria for certain indications.

When Newer Antihistamines Are Better:

• When you need to maintain normal alertness for work, study, or driving
• For long-term management of allergic conditions (safer profile for extended use)
• For once-daily convenience
• When anticholinergic effects are problematic (elderly patients, those with glaucoma or prostate issues)

Getting Atarax in Australia

Prescription Requirements

As a Schedule 4 medication, you need a prescription from:

• A medical doctor (GP or specialist)
• A nurse practitioner with prescribing rights
• In some states, authorized dentists for pre-procedural sedation
• Buy Atarax via overseas online pharmacy under different (no presription required ) scheme

Prescriptions for Atarax in Australia:

• Can be written for up to 12 months of repeats
• Each repeat is typically for a one-month supply
• Must be dispensed within 12 months of the prescription date
• Some states have limits on total quantity per prescription

Your doctor will determine appropriate repeat numbers based on whether this is for short-term (acute itching, situational anxiety) or longer-term management (chronic urticaria).

Cost and PBS Coverage

PBS Status: Atarax and generic hydroxyzine are listed on the Pharmaceutical Benefits Scheme for specific indications, but not all uses are covered.

Approximate Costs (as of 2025):

• With PBS concession card: $7.70 per prescription (or free if you've reached Safety Net threshold)
• General PBS: Around $31.60 per prescription for covered indications
• Private prescription (not PBS): $15-35 depending on pharmacy and brand vs. generic

If your use isn't PBS-covered (such as for anxiety), the prescription will be written as a private prescription and not receive PBS subsidy.

Generic vs. Brand: Generic hydroxyzine is usually less expensive than branded Atarax. Pharmacists can legally substitute generic for brand unless your doctor writes "no substitution" on the prescription. The active ingredient and effectiveness are the same.

Brand vs. Generic Options

In Australia, hydroxyzine is available as:

• Atarax: Original brand, UCB Pharma
• Generic hydroxyzine hydrochloride: Various manufacturers

Both contain the same active ingredient at the same strength and are therapeutically equivalent—they work the same way with the same effectiveness. The TGA requires generic medications to meet strict bioequivalence standards.

Some patients report feeling differences between brands, but this is likely due to:

• Different inactive ingredients (fillers, coatings) affecting absorption rate slightly
• Placebo/nocebo effect
• Natural variation in symptoms

If you feel strongly about staying with one particular brand, ask your doctor to specify "no substitution" on the prescription.

Frequently Asked Questions

How long does it take to work?

Atarax typically begins working within 15 to 30 minutes of taking it orally. You'll notice:

• Drowsiness starting within 20-30 minutes
• Anti-itch effects within 30-60 minutes
• Peak effects at approximately 2 hours
• Effects lasting 4-6 hours on average

For pre-procedure sedation, take it 1-2 hours before the appointment for optimal timing. For itching that disrupts sleep, taking it 30-60 minutes before bed works well for most people.

Can I take it long-term?

This depends on what you're treating and your individual circumstances:

Short-term is preferred (weeks to a few months) for:

• Situational anxiety
• Acute allergic reactions
• Temporary itch relief

Longer-term use (several months) may be appropriate for:

• Chronic urticaria not controlled by other antihistamines
• Chronic pruritus from specific conditions
• When used intermittently rather than daily

However, long-term daily use (many months to years) is generally not recommended due to:

• Anticholinergic burden, especially in older adults
• Tolerance development
• Availability of alternatives with better long-term safety profiles

Your doctor should regularly review whether continued use is appropriate, typically every 3-6 months.

Will it show up on a drug test?

This is a common concern for employment or legal reasons:

Standard workplace drug screenings: Hydroxyzine typically does not trigger positive results on standard urine drug screens for drugs of abuse.

However: Hydroxyzine can potentially cause false-positive results for:

• Benzodiazepines (rare, but reported)
• Methadone (very rare)

These are false positives—meaning the screening test detects something incorrectly, but confirmatory testing would clarify that you don't have those drugs in your system.

What to do:

• Always inform the testing facility about all your medications, including Atarax
• Bring your prescription or a letter from your doctor
• If a false positive occurs, confirmatory testing (like gas chromatography-mass spectrometry) will distinguish hydroxyzine from the drug the test initially detected

Can I stop taking it suddenly?

Unlike benzodiazepines or antidepressants, Atarax doesn't typically cause physical withdrawal symptoms when stopped suddenly. However:

You may experience:

• Return of the symptoms it was treating (rebound itching, anxiety)
• Temporary worsening of symptoms beyond baseline for a day or two
• Potential sleep disruption if you were relying on its sedating effects

Best practice:

• For short-term use (a few days to weeks): Usually fine to stop abruptly when symptoms resolve
• For longer-term use (months): Consider tapering gradually over a week or two to minimize rebound symptoms
• Always follow your doctor's instructions about discontinuation

If you're taking it for anxiety and want to stop, discuss this with your doctor first—they may want to ensure you have alternative coping strategies in place.

What should I do if I take too much?

Hydroxyzine overdose can be serious. Symptoms include:

• Extreme drowsiness or inability to stay awake
• Confusion or disorientation
• Seizures
• Severe dizziness or fainting
• Rapid or irregular heartbeat
• Difficulty breathing
• Hallucinations

If overdose is suspected:

1. Call the Poisons Information Centre: 13 11 26 (available 24/7 across Australia)
2. If symptoms are severe, call 000 for an ambulance
3. Do not try to make the person vomit
4. Take the medication packaging with you to the hospital

Treatment for hydroxyzine overdose is mainly supportive—there's no specific antidote. Hospital staff will monitor heart rhythm, breathing, and manage symptoms as needed.

Can I take it with paracetamol or Ibuprofen?

Yes, hydroxyzine can generally be taken safely with:

• Paracetamol (Panadol)
• Ibuprofen (Nurofen) or other NSAIDs
• Most common over-the-counter pain relievers

These medications don't interact significantly with hydroxyzine. However:

Avoid combining with:

• Over-the-counter sleep aids (they add to sedation)
• Codeine-containing pain relievers (increases sedation and may be dangerous)
• Other antihistamines unless specifically directed by your doctor

Always check with your pharmacist when buying over-the-counter medications to ensure they're safe to combine with your Atarax prescription.

Key Takeaways

1. Atarax (hydroxyzine) is a first-generation antihistamine prescribed in Australia for itching, allergies, anxiety, and pre-procedure sedation. It works differently from newer antihistamines by significantly crossing into the brain, causing both sedation and anti-anxiety effects.

2. Drowsiness is the most common side effect and can be severe—do not drive or operate machinery while taking this medication, especially when first starting. The sedation is sometimes the therapeutic goal (for sleep-disrupting itch) but a problematic side effect in other situations.

3. Dosing varies widely from 25mg to 100mg taken multiple times daily depending on the condition being treated. Always follow your doctor's specific instructions and never adjust the dose yourself.

4. Serious interactions exist with many medications, particularly other sedatives, opioid pain relievers, and medications that affect heart rhythm. Always inform healthcare providers about all medications you're taking.

5. Avoid alcohol completely while taking Atarax—the combination significantly increases sedation and can be dangerous.

6. Pregnancy and breastfeeding require caution—avoid use in early pregnancy due to potential birth defect risks, and discuss alternatives with your doctor if pregnant or nursing.

7. Short-term use is generally preferred (weeks to a few months) rather than long-term daily use, particularly in older adults due to anticholinergic effects and cognitive concerns with prolonged use.

References and Further Information

Australian Regulatory Information:

• Therapeutic Goods Administration (TGA): www.tga.gov.au - for approved uses, safety alerts, and product information
• Australian Medicines Handbook: Available through subscription or some libraries—provides evidence-based prescribing information

For Patients:

• NPS MedicineWise: www.nps.org.au - independent information about medicines for Australian consumers
• Poisons Information Centre: Call 13 11 26 (24/7) for questions about overdose, interactions, or medication concerns
• Healthdirect Australia: www.healthdirect.gov.au - government-funded health advice service

Product Information Document: Your pharmacist can provide the approved Product Information (PI) document for Atarax, which contains comprehensive prescribing and safety information approved by the TGA.

If You Have Concerns: Always discuss questions or concerns about Atarax with your prescribing doctor or pharmacist. They can provide advice tailored to your specific health situation and other medications you're taking.

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Medical Disclaimer: This guide provides general information about Atarax for Australian patients and should not replace professional medical advice. Individual circumstances vary significantly—what's appropriate for one person may not be for another. Always follow your doctor's specific instructions and discuss any concerns with your healthcare provider before making changes to your medication regimen.