Atarax

The scourge of the 21st century is stress. His faithful companions: anxiety, excitement, neuroses, panic attacks, somatic manifestations (urticaria, skin itching, allergic dermatitis, eczema), sleep disturbances. It would seem that there’s nothing wrong with it, just rest and everything will pass. But if it does not go away, gets worse and disrupts the usual rhythm of life, then you need to consult a doctor. During drug treatment, doctors often prescribe a prescription for the anxiolytic (tranquilizer) Atarax, which is allowed even for children over one year of age.

Stress is a very common problem

Composition of the medicine

The main active component - hydroxyzine - has a calming, anti-allergenic, analgesic, antispasmodic effect, and also increases concentration, improves attention and cognitive functions. If anxiety is pronounced, and chronic insomnia is also associated with it, then Atarax, or rather hydroxyzine, relieves anxiety, normalizes sleep, strengthening and increasing its duration, and reduces the frequency of awakenings at night. The drug is able to relax skeletal muscles, as well as smooth muscles. All this is due to the effect of the drug Atarax on certain areas of the subcortical zones of the brain.

The drug is absorbed into the gastrointestinal tract, after which it quickly enters the systemic circulation. That is why the effect of taking Atarax is noticeable within 15-30 minutes.

If you take Atarax for a long time, then addiction or dependence on the drug will not develop. This means that he does not have “withdrawal syndrome”.

Atarax for anxiety disorders (review)

Ryabokon I.V.

Anxiety is a state of fear and anxiety experienced by a person in anticipation of trouble. The causes of anxiety are varied: emotional instability, a sharp change in living conditions, the upcoming completion of a difficult task, etc. Anxiety may arise due to anticipation of a future threat (punishment or loss of loved ones). Typically, anxiety leads to defensive reactions. Anxiety is the result of frustration or its anticipation and is the primary psychological manifestation of stress. Z. Freud considered anxiety as a symptomatic manifestation of an internal emotional conflict caused by the fact that a person unconsciously suppresses sensations, feelings or impulses that are too threatening or irritating for him. With the emergence of anxiety, behavioral activity increases, the very nature of behavior changes, and additional physiological mechanisms of adaptation to changed conditions are activated.

Anxiety is a person’s tendency to experience a state of anxiety. Most often, a person’s anxiety is associated with the expectation of social consequences of his success or failure. Anxiety and anxiety are closely related to stress. On the one hand, anxious emotions are symptoms of stress. On the other hand, the initial level of anxiety determines individual sensitivity to stress. Like stress in general, the state of anxiety cannot be called unequivocally bad or good.

In other cases, anxiety is unnatural, pathological, inadequate, harmful. It becomes chronic, constant and begins to appear not only in stressful situations, but also for no apparent reason. Then anxiety not only does not help the person, but, on the contrary, begins to interfere with him in his daily activities.

The line between a “normal” stress response and a pathological anxiety disorder is often quite blurred, and it is difficult for a person to know when to seek professional help. These subsyndromal anxiety disorders are the most difficult to diagnose and often remain untreated, while having an extremely negative impact on the quality of life of the patient and those around him. It is believed that treatment options should be considered when anxiety about everyday events is beyond the patient's control. The following disorders may also be the reason for prescribing therapy: nervousness, fussiness, impaired concentration, irritability, sleep disturbance, symptoms of autonomic dysfunction.

In everyday medical practice, various herbal medicines, tranquilizers, barbiturates, antidepressants, and some antipsychotics are used to treat anxiety disorders.

One of the most powerful and quickly relieving sleep disorders and anxiety are benzodiazepine drugs. Among the disadvantages of treatment with benzodiazepines, the following should be mentioned: withdrawal syndrome (rapid resumption or transient increase in symptoms after discontinuation of the drug), the risk of addiction and the formation of drug dependence, impaired cognitive functions (attention, concentration, memory), and impaired coordination. Therefore, benzodiazepine drugs are not recommended to be taken for more than 2 weeks.

Hydroxyzine (Atarax) is neither a benzodiazepine nor a phenothiazine. The non-benzodiazepine anxiolytic Atarax (hydroxyzine) is a derivative of diphenylmetane, an antagonist of histamine H1 receptors.

Hydroxyzine is one of the oldest psychotropic drugs; it was introduced into clinical practice back in 1955. Atarax has a pronounced anti-anxiety, antihistamine, antipruritic and antiemetic effect. By reducing the concentration of histamine at the central level, it has the property of reducing anxiety, reducing aggressiveness and causing a persistent anxiolytic effect [2]. The drug acts within 15–30 minutes after oral administration (Cmax is noted 2 hours after taking the drug) and maintains this effect for 6–8 hours. Its main advantages are the absence of the “rebound” phenomenon, addiction (dependence), withdrawal symptoms and positive effect on cognitive function.

Hydroxyzine has been successfully used in a variety of areas of medicine: as a means of controlling tobacco smoking [3]; in pediatric dentistry [4]; for its intended purpose – for the treatment of anxiety neurosis (even in the era of the existence of such a nosological form) and for “mild” depression [5]; for behavioral and learning disorders in children [6]. Due to its antihistamine properties, hydroxyzine was used in allergology, to treat itching [7], and for urticaria pigmentosa (mastocytosis) in children [8]; in oncology [9]; in burn patients [10], in narcology [11] and in many other conditions.

Recently, there has been interest among researchers in the use of hydroxyzine in patients with generalized anxiety disorder (GAD). The prevalence of this pathology and the associated burden of social consequences in the current scientific literature appear to be quite significant. According to one review [E.G. Starostina. Generalized anxiety disorder and anxiety symptoms in general medical practice. Rus. honey. magazine 2004; 22 (222), 12: 1277] with reference to numerous foreign works, “GAD is among the top ten diseases with the greatest temporary disability and according to this indicator is on a par with coronary artery disease, diabetes, joint diseases, peptic ulcers, and mental disorders – with depression or even ahead of it.”

In a double-blind, placebo-controlled RCT for the treatment of GAD [17], the anxiolytic activity of Atarax at a dose of 50 mg (in 3 doses of 12.5 mg in the morning and afternoon plus 25 mg in the evening) was shown, which was manifested in a statistically significant, rapid and significant decrease symptoms of anxiety already at the end of the 1st week of treatment, which persisted for another 1 week after cessation of treatment (n=110; course duration 4 weeks; Hamilton-A score). In this case, there was no phenomenon of “rebound” or return of anxiety.

In another double-blind multicenter RCT [18], in which, along with placebo control, the benzodiazepine drug bromazepam was also used, it was shown that hydroxyzine used for 3 months was statistically significantly different from placebo and was as effective as the comparison drug. Moreover, with benzodiazepine, side effects of severe drowsiness were observed twice as often as with hydroxyzine (n = 334; dose of hydroxyzine 50 mg/day in 3 divided doses; bromazepam - 6 mg/day in 3 divided doses; improvement on the Hamilton-A scale >50 %; p<0.03 at the end of the 6th week and p<0.001 - after 12 weeks; the number of patients who responded to treatment: 40% at the 6th and 60% at the 12th week, respectively).

Another study [19] showed the effectiveness of Atarax (50 mg in 3 doses), comparable to that of the control buspirone (20 mg in 3 doses), with a statistically significant difference between Atarax and placebo on the 28th day of treatment (p<0.015) . There was no rebound phenomenon with abrupt withdrawal of both drugs (n=244; age 18–65 years).

In addition, one of the advantages of hydroxyzine is that, unlike benzodiazepines, it does not depress cognitive abilities [20] (triple crossover, double-blind RCT; comparing a single dose of 50 mg of hydroxyzine with a single dose of 2 mg of lorazepam and placebo; n = 9; healthy volunteers; 3-day interval before cross-over; assessment of cognitive functions 2–5 hours after taking comparator drugs).

Some studies have shown a positive effect of hydroxyzine on cognitive function [21] (comparison with lorazepam; double-blind multicenter RCT; n=30; GAD, Atarax 100 mg in 3 divided doses, lorazepam 4 mg in 3 divided doses; Beck score 28– th day of treatment). Unlike lorazepam, with the same anxiolytic activity, hydroxyzine restored cognitive function to normal limits.

Similar results were obtained in another, less conclusive study - an open RCT (A.E. Bobrov et al. Journal of Neurology and Psychiatry named after S.S. Korsakov. 1988; 2. GAD; n=50; outpatients; treatment course is 4 weeks, plus 2 weeks of follow-up).

Considering the characteristics of the drug (quick onset of action, good tolerability), lack of dependence and depression of the central nervous system make it an alternative drug to benzodiazepines in children and adolescents. In a study conducted at the Children's Psychiatry Center [23], Atarax was prescribed for various forms of mental illness in children and adolescents with manifestations of anxiety, irritability and insomnia-type sleep disorders, and its effectiveness was assessed. The study included 50 patients aged 5 to 18 years with various forms of mental illness, who were undergoing outpatient observation and treatment at the Children's Psychiatry Center. At the end of the 4th week of therapy, there was a decrease in the manifestations of anxiety and various fears noted earlier: falling asleep in the dark, staying at home in the absence of parents, fears of animals, noise of household appliances; in one case, a five-year-old boy could stay at home with a nanny without his parents (he had previously shown a pronounced affective reaction). In addition, all patients' sleep improved already in the second week of therapy, tearfulness, moodiness, and irritability were reduced. Simultaneously with the reduction of anxiety, the mood improved in 7 patients with a mixed anxious and depressive reaction caused by an adaptation disorder and with a mixed anxiety and depressive disorder, which was associated not with the direct antidepressant effect of Atarax, but with the comorbid dependence of anxiety and depression: anxiety was reduced - depression went away.

In a comparative study [22] of etifoxine and Atarax (hydroxyzine), the compared anxiolytics demonstrated high effectiveness in a wide range of psychopathological manifestations of adjustment disorders and generalized anxiety disorder. The results of therapy with etifoxine and Atarax showed the comparability of the clinical effect of the compared drugs, confirmed by a number of formalized indicators. The proportions of responders were comparable: 73.3 and 53.3% in the HARS assessment; 66.7 and 53.3% - as assessed by CGI-S for the groups receiving etifoxine and Atarax. The main clinical effect of the drugs in both groups was a decrease in the severity of manifestations of mental anxiety: the symptoms of internal tension (ethifoxine - in the 2nd week, Atarax - in the 3rd week), reactive (emotional) lability (one of the sub-items of “depressive mood”) were most quickly reduced "). In general, similar dynamics of cognitive anxiety were observed in both groups.

To summarize, we can reiterate that hydroxyzine (Atarax) has shown clear advantages over benzodiazepine anxiolytics in the treatment of anxiety disorders. Being as therapeutically effective as benzodiazepine anxiolytics, it does not produce rebound effects, does not depress cognitive function, and does not cause pathological dependence.

Literature:

1. Psychotropics 2000/2001 Lundbeck.

2. Krebs MO. Le trouble anxieux: cliniqu et implicacion neurobiologiques. La Revfue des Entretiens de Bichat 2001; 2 (5).

3. Turle G. An investigation into the therapeutic action of hydroxyzine/Atarax in the treatment of nervous disorders and the control of tobacco-habit. Brit J Psychiat 1958; 104: 82 rub. 33.

4. Lang L. An evaluation of the efficacy of hydroxyzine (atarax–vistaril) in controlling the behavior of child patients. J-Dent-Child 1965; 32, 4: 253–8)

5. R.Middlefell, K.Edwards Hydroxyzine/Atarax in the relief of tension associated with anxiety neurosis and mild depressive states. Brit J Psychiat 1959; 105:792–4.

6. Segal L, Tansley A. A clinical trial with Hydroxyzine (Atarax) on a group of maladjusted educationally subnormal children. J Mental–Science; Br J Psychiat from 1963; 1957; 103:677–81.

7. Rhoades R, Leifer K, Cohan R, Wittig H. Suppression of histamine-induced pruritus by three antihistaminic drugs. J Allergy Clin Immunol, 1975 Mar.; 55, 3: 180–5.

8. Kettelhut B, Berkebile C, Bradley D, Metcalfe D. A double-blind, placebo-controlled, crossover trial of ketotifen versus hydroxyzine in the treatment of pediatric mastocytosis. J Allergy Clin Immunol 1989 May; 83, 5: 866–70)

9. Broder L, Lean N, Hilsenbeck S. A randomized blinded clinical trial comparing delta–9–tetrahydrocannabinol (THC) and hydroxizine (HZ) as antiemetics (AE) for cancer chemotherapy (CT). PROC–AM–ASSOC–CANCER–RES; 1982; 23:514.

10. Vitale M, Fields–Blache C, Luterman. A Severe itching in the patient with burns. J burn care & rehabilitation 1991; 12, 4: 330–3.

11. Kaim S, Klett C, B. Rothfeld. Treatment of the acute alcohol withdrawal state: a comparison of four drugs. Agressologie: revue internationale de physio-biologie et de pharmacologie appliquees aux effets de l'agression, 1968; 9, 2: 305–8.

12. Chignon G. Le trouble Anxiete Generalise: du probleme diagnostique au defi therapeutique. Nervure J psychiat 1988; 11 (suppl.): 1–16.

13. Wittchen H–U, Jakobi F. Size and burden of mental disorders in Europe – a critical review and appraisal of 27 studies. Eur Neuropsychopharmacol 2005; 15: 357–76; For details, see the February issue of our magazine).

14. Goodwin R, Gorman J. Psychopharmakologic Treatment of generalized anxiety disorder and risk of major Depression. Am J Psychiat 2002; 159:1935–7.

15. Goodwin RD, Jack M. Gorman. Treatment of generalized anxiety disorder with psychotropic drugs and the risk of major depressive disorder

16. Martin P. Coprescription, Antidepresseurs et anxiolytiques: consequences pratiques de la meilleure connaissance desmecanismes d'action putatifs des anxiolytiques. Actuel Psychiat 2001; 19 (1/2): 2–7.

17. Ferreri M, Hantouche T, M. Billardon. Interet de l'hydroxizyne dans des troubles d'anxiete generalisee: etude controlee en double aveugle versus placebo. L'encephale 1994; 20: 785–91.

18. Llorka P. et al. Efficiency and safety of hydroxysyne in the treatment of generalized anxiety disorder: a 3-month double-blind study. J Clin Psychiatry 2002; 63:1020–7.

19. Lader Scotto J. A multicenter double–blind comparison of hydroxizine, buspirone and placebo in patient with generalized anxiety disorder. Psychopharmacology 1998; 139:402–6.

20. De Brabander A, Deberdt W. Effect of hydroxizyne on attention and memory. Human Psychopharmacology 1990; 357–62.

21. Samuelian J, Billardon M, Guillou N. Retentissment sur les functions cognitives de deux traits anxiolitiques chez des patients souffrant d'anxiete generalisee. L'encephale 1995; 21:147

22. Andryushchenko A.V., Beskova D.A., Romanov D.V. Psychopharmacotherapy of generalized anxiety (experience with the use of Strezam and Atarax) Mental disorders in general medicine No. 1; pp. 33–36

23. Rezakov A.A. Experience of using hydroxyzine (atarax) in children and adolescents. "PHARMIndex-Practik" issue 10; 2006, pp.37–39

Indications

Indications for use of the drug are:

relief of psychomotor agitation, tension, irritability in mental, neurological, somatic diseases;
symptomatic treatment of withdrawal syndrome that occurs against the background of chronic alcoholism;
anxiety;
providing a sedative effect during premedication;
therapy for itchy skin.

Why and why Atarax needs to be taken is determined by the attending physician. As a rule, taking Atarax is provoked by diagnosed skin diseases, which are accompanied by severe skin itching.

Contraindications

Contraindications to the use of the drug:

pregnancy;
lactation period;
porphyria;
intolerance or hypersensitivity to the components of the drug;
high sensitivity to cetirizine, piperazine derivatives, as well as ethylenediamine or aminophylline;
angle-closure glaucoma;
impaired absorption of glucose and galactose;
hereditary galactose intolerance.

Pregnant women should not use Atarax.

Atarax is used with caution in the following cases:

myasthenia gravis;
prostatic hyperplasia;
difficulty defecating and urinating;
dementia;
increased intraocular pressure;
predisposition to arrhythmia and seizures.

Side effects

Since Atarax is a drug that acts on the central nervous system, it can sometimes cause suppression of certain functions or paradoxical stimulation. Also, when taking it, negative reactions from the body may occur:

From the cardiovascular system: blood pressure rarely decreases, heart rate increases.
From the point of view: decreased clarity of vision, impaired accommodation.
From the gastrointestinal tract: a feeling of dry mouth, rarely - vomiting, nausea, problems with intestinal motility and, as a result, constipation.
From the immune system: hypersensitivity, rarely anaphylactic shock may develop.
From the urinary system: urine retention is rarely possible.
From the respiratory system: rarely - bronchospasm and suffocation.
Neurological disorders: drowsiness, headache, insomnia, dizziness, rarely – convulsions.
Mental disturbances are rare: agitation, disorientation, and hallucinations are possible.
Skin: itching, rash, rarely - swelling.
General disorders: weakness, fever, fatigue.

How to take Atarax

At the pharmacy, Atarax can be purchased in two forms - a solution for intramuscular injection and tablets for oral administration. The dosage is selected by the attending physician and depends on the clinical picture of the disease, symptoms, nature of the course and the patient himself, or rather his individual reaction of the body to therapy with Atarax.

How to take Atarax correctly

Atarax in ampoules

Premedication

children: 1 mg/kg body weight 1 hour before surgery, if necessary, the dose can be administered at night before anesthesia;
adults: 50–200 mg 1 hour before surgery, if necessary, the same dose can be administered the night before anesthesia.

Symptomatic treatment of itching

children 1–6 years old: 1–2.5 mg/kg per day in several doses;
children over 6 years old: 1–2 mg/kg per day in several doses;
adults: at the beginning of treatment - 25 mg 1 time / day, if necessary, increase the dose to 25 mg 4 times / day. In this case, the maximum dose should not exceed 300 mg per day and 200 mg at a time.

Symptomatic treatment of anxiety: morning and afternoon - 12.5 mg, at night - 25 mg (total daily dose - 50 mg).

If the need arises, the doctor can increase the daily dose to 300 mg (maximum value). But if the patient has a history of renal or liver failure, or if the patient is elderly, then the dose is reduced.

Atarax tablets

Reception during premedication and for symptomatic treatment of itching coincides with the recommendations when using Atarax injection solution.

Anxiety

The daily dose for adults is 50 mg and, if necessary, can be increased to 300 mg. A quarter of the daily dose is taken in the morning during the day, and all that remains is taken before bed.

If the medicine is used by patients with a history of renal or liver failure, as well as people in older age groups, dosage adjustment (reduction) may be required.

Atarax (INN hydroxyzine) is a tranquilizer from the Belgian pharmaceutical company UCB Pharma, SA. It was developed in the mid-50s of the last century and became the world's first non-benzodiazepine tranquilizer. He laid the foundation for a new class of drugs called ataractics. Largely thanks to Atarax (and only later - Viagra), a small pharmaceutical company at that time, which received a license to distribute the drug in the United States, grew to become a global giant and industry leader.

As a tranquilizer, Ataracas exhibits anxiolytic (suppresses anxiety) and sedative effects. In addition to this, the drug has an antihistamine (blocks histamine H1 receptors), m-cholinergic blocking (inactivates central m-cholinergic receptors) and antiemetic effects. It is important that pathological dependence does not develop to the drug. The pharmacological effect develops 20-30 minutes after the active substance enters the gastrointestinal tract. The drug normalizes cognitive functions (memory, mental performance, attention). Relaxes striated and smooth muscles. Dilates the bronchi. Has an analgesic effect. Suppresses the release of digestive enzymes into the lumen of the stomach. Reduces itching in allergic manifestations and dermatological diseases (dermatitis, eczema). With a long course of medication, after the end of taking the drug, withdrawal syndrome does not develop and there is no deterioration in cognitive activity.

A polysomnographic study in patients suffering from insomnia and anxiety disorders demonstrates a significant increase in sleep duration and a decrease in the number of episodes of awakenings at night after taking a single dose of Atarax. A decrease in muscle hypertonicity with increased anxiety has been demonstrated when taking Atarax at a dose of 50 mg three times a day. The drug is well absorbed from the gastrointestinal tract: its maximum plasma concentration is recorded two hours after oral administration. The bioavailability of hydroxyzine is 80%. Penetrates through the BBB, metabolic products enter breast milk. The half-life is 14 hours. The side effects inherent in the drug are mainly associated with the anticholinergic effect: hyposalivation, difficulty urinating, constipation, spasm of accommodation. Atarax is incompatible with ethanol, so during the medication course you should refrain from consuming ethanol-containing products. When taking the drug, it is necessary to take into account that hydroxyzine can slow down the reaction rate and impair concentration. Atarax enhances the effect of drugs that suppress the activity of the central nervous system: opioid painkillers, tranquilizers, barbiturates, sedatives. If it is necessary to combine them, you should be especially careful when choosing drugs.

Compatibility with other drugs

A separate issue when taking Atarax is its interaction with other medications. Thus, barbiturates, tranquilizers, opioid analgesics, ethanol-containing drugs, sleeping pills and any other drugs that depress the central nervous system, when taken simultaneously with the drug Atarax, enhance the effects. That is, lethargy, indifference, drowsiness and other effects will appear several times brighter and stronger. But if it is still necessary to take everything together, then the doctor monitoring the patient will draw up a dosage regimen and select an individual dosage for each drug.

Compatibility of other drugs with Atarax

The combination of Atarax + MAO inhibitors, anticholinergics is not recommended. Atarax is able to inhibit the action of epinephrine (adrenaline) and suspend the anticonvulsant effect of phenytoin.

Atarax has a destructive effect on the metabolism of substrate drugs for uridine diphosphate and glucuronyl transferase.

If you drink Cimetidine and Atarax at the same time, the concentration of hydroxyzine in the blood plasma will increase, but on the contrary, the concentration of metabolites will decrease.

As for cardiac glycosides, atropines, antihypertensive drugs, antiallergic drugs, Atarax does not in any way affect their functionality; the pharmacological effect provided.

However, it is worth remembering that it is better not to take drugs whose side effects indicate possible arrhythmia with Atarax. When they are mixed, there is a risk of prolongation of the QT interval and the development of ventricular tachycardia of the “pirouette” type.

Anti-anxiety effectiveness of Atarax

Sometimes anxiety is natural, adequate, and useful. Everyone feels anxious, restless or stressed in certain situations, especially if they have to do something unusual or prepare for it. For example, giving a speech in front of an audience or passing an exam. A person may feel anxious when walking down an unlit street at night, or when lost in a strange city. This type of anxiety is normal and even useful, as it prompts you to prepare a speech, study the material before an exam, and think about whether you really need to go out at night all alone. In other cases, anxiety is unnatural, pathological, inadequate, harmful. It becomes chronic, constant and begins to appear not only in stressful situations, but also for no apparent reason. Then anxiety not only does not help the person, but, on the contrary, begins to interfere with him in his daily activities. The line between a “normal” stress response and a pathological anxiety disorder is often quite blurred, and it is difficult for a person to know when to seek professional help. These subsyndromal anxiety disorders are the most difficult to diagnose and often remain untreated, while having an extremely negative impact on the quality of life of the patient and those around him. It is believed that treatment options should be considered when anxiety about everyday events is beyond the patient's control. The following disorders may also be a reason for prescribing therapy: nervousness, fussiness, impaired concentration, irritability, sleep disturbance, symptoms of autonomic dysfunction. The main approaches to the treatment of anxiety disorders are: • psychotherapy • pharmacotherapy For treatment purposes, you can use simple relaxation methods (muscle relaxation, calm breathing, distraction). Friendly and encouraging conversation also helps improve the condition. The main groups of drugs for the treatment of anxiety disorders: • Benzodiazepine tranquilizers • Antidepressants: – selective serotonin reuptake inhibitors, – tricyclic antidepressants • Neuroleptics • Non-benzodiazepine tranquilizers Benzodiazepines – quickly relieve sleep disorders and anxiety symptoms. Among the disadvantages of treatment with benzodiazepines, the following should be mentioned: “recoil” syndrome (rapid resumption or transient increase in symptoms after discontinuation of the drug), the risk of addiction and the formation of drug dependence, impaired cognitive functions (attention, concentration, memory), and impaired coordination. Therefore, drugs of the benzodiazepine group should not be taken for more than 2–4 weeks. Tricyclic antidepressants are powerful drugs that effectively relieve all anxiety and depressive symptoms (affecting both physical and mental manifestations of anxiety) and sleep disorders. Can be used for long-term treatment and prevention of anxiety. Tricyclic antidepressants have more pronounced side effects (dry mucous membranes, constipation, cardiovascular disorders, transient cognitive impairment). This worsens tolerability and increases the list of contraindications for their use in the treatment of anxiety, especially in patients with concomitant somatic diseases. Selective serotonin reuptake inhibitors are relatively safe, have a minimal range of side effects, are not addictive, and therefore can be used as long-term maintenance treatment. Their relative disadvantage is the long “waiting” period before the onset of the clinical effect of the drug (from 2 to 4 weeks). In addition, antidepressants in this group have side effects such as increased appetite and weight gain, nausea, loose stools, constipation, sweating, sleep disturbances, and sexual functions (libido and orgasm). In some cases, a positive effect in the treatment of anxiety is achieved with the use of antipsychotics. Typically, small doses of these drugs are used. However, when antipsychotics are prescribed, weakness, decreased blood pressure, menstrual irregularities, weight gain, colostrum secretion, and decreased libido may occur. Finally, international recommendations list another drug for the treatment of anxiety – hydroxyzine (Atarax). It is characterized by a rapid onset of effect, absence of addiction and drug dependence, does not impair cognitive functions, and has antipruritic and antiemetic effects. Hydroxyzine is neither a benzodiazepine nor a phenothiazine. The non-benzodiazepine anxiolytic Atarax (hydroxyzine) is a derivative of diphenylmetane, an antagonist of histamine H1 receptors. Hydroxyzine has been successfully used in a variety of areas of medicine: as a means of controlling tobacco smoking [1]; in pediatric dentistry [2]; for its intended purpose – for the treatment of anxiety neurosis (even in the era of the existence of such a nosological form) and for “mild” depression [3]; for behavioral and learning disorders in children [4]. Due to its antihistamine properties, hydroxyzine was used in allergology, to treat itching [5], and for urticaria pigmentosa (mastocytosis) in children [6]; in oncology [7]; in burn patients [8], in narcology [9] and in many other conditions. Recently, there has been interest among researchers in the use of hydroxyzine in patients with generalized anxiety disorder (GAD). The prevalence of this pathology and the associated burden of social consequences in the current scientific literature appear to be quite significant. According to one review [E.G. Starostina. Generalized anxiety disorder and anxiety symptoms in general medical practice. Rus. honey. magazine 2004; 12, 22 (222): 1277], with reference to numerous foreign works, “GAD is among the top ten diseases with the greatest temporary disability and according to this indicator is on the same level with ischemic heart disease, diabetes, joint diseases, peptic ulcer disease, and among mental disorders – with depression or even ahead of it.” In a double-blind, placebo-controlled study for the treatment of generalized anxiety disorder [10], the anxiolytic activity of Atarax at a dose of 50 mg (in 3 doses of 12.5 mg in the morning and afternoon plus 25 mg in the evening) was shown, which was manifested in a statistically significant, rapid and a significant reduction in anxiety symptoms already at the end of the 1st week of treatment, which persisted for another 1 week after cessation of treatment (n=110; course duration 4 weeks; Hamilton scale score - A). In this case, there was no phenomenon of “rebound” or return of anxiety. In another double-blind multicenter study [11], in which, along with placebo control, the benzodiazepine drug Bromazepam was also used, it was shown that hydroxyzine used for 3 months was statistically significantly different from placebo and was as effective as the comparison drug . Moreover, with benzodiazepine, side effects of severe drowsiness were observed twice as often as with hydroxyzine (n = 334; dose of hydroxyzine 50 mg/day in 3 divided doses; bromazepam - 6 mg/day in 3 divided doses; improvement on the Hamilton-A scale >50 %; p<0.03 at the end of the 6th week and p<0.001 - after 12 weeks; the number of patients who responded to treatment: 40% at the 6th and 60% at the 12th week, respectively). Another study [12] showed the effectiveness of Atarax (50 mg in 3 doses), comparable to that of the control buspirone (20 mg in 3 doses), with a statistically significant difference between Atarax and placebo on the 28th day of treatment (p <0.015) . There was no rebound phenomenon with abrupt withdrawal of both drugs (n=244; age 18–65 years). Another advantage of hydroxyzine is that, unlike benzodiazepines, it does not depress cognitive abilities [13] (triple crossover, double-blind clinical trial; comparing a single dose of 50 mg of hydroxyzine with a single dose of 2 mg of lorazepam and placebo; n = 9; healthy volunteers; 3-day interval before cross-over; assessment of cognitive functions 2-5 hours after taking comparator drugs). Some studies have shown a positive effect of hydroxyzine on cognitive function [14] (comparison with lorazepam; double-blind multicenter clinical trial; n = 30; GAD, Atarax 100 mg in 3 divided doses, lorazepam 4 mg in 3 divided doses; Beck score 28 -th day of treatment). Unlike lorazepam, with the same anxiolytic activity, hydroxyzine restored cognitive function to normal limits. Similar results were obtained in another, less evidence-based study - an open RCT [A.E. Bobrov et al. Journal neurol. and psychiatrist. them. S.S. Korsakov. 1988; 2] outpatients with GAD; (n=50). The course of treatment is 4 weeks, plus 2 weeks of follow-up. Features of Atarax - rapid onset of action, good tolerability, lack of dependence and depression of the central nervous system, make it an alternative drug to benzodiazepines in children and adolescents. In a study conducted at the Children's Psychiatry Center [15], Atarax was prescribed for various forms of mental illness in children and adolescents with symptoms of anxiety, irritability and insomnia-type sleep disorders, and its effectiveness was assessed. The study included 50 patients aged 5 to 18 years with various forms of mental illness, who were undergoing outpatient observation and treatment at the Children's Psychiatry Center. At the end of the 4th week of therapy, there was a decrease in the manifestations of anxiety and various fears noted earlier - falling asleep in the dark, staying at home in the absence of parents, fears of animals, noise of household appliances. In one case, a 5-year-old boy could stay at home with a nanny without his parents - a pronounced affective reaction was previously noted. In addition, all patients' sleep improved already in the second week of therapy, tearfulness, moodiness, and irritability were reduced. Simultaneously with the reduction of anxiety, the mood improved in 7 patients with a mixed anxious and depressive reaction caused by an adaptation disorder and with a mixed anxiety and depressive disorder, which was associated not with the direct antidepressant effect of Atarax, but with the comorbid dependence of anxiety and depression: anxiety was reduced - depression went away. Hydroxyzine (Atarax) has its obvious advantages over benzodiazepine anxiolytics in the treatment of anxiety disorders; it does not produce “rebound” phenomena, does not depress cognitive function and does not cause pathological dependence. References 1. Turle G. An investigation into the therapeutic action of hydroxyzine/Atarax in the treatment of nervous disorders and the control of tobacco–habit. Brit J Psychiat 1958; 104: 82 rub. 33. 2. Lang L. An evaluation of the efficacy of hydroxyzine (atarax–vistaril) in controlling the behavior of child patients. J–Dent–Child 1965; 32, 4: 253–8) 3.R.Middlefell, K.Edwards Hydroxyzine/Atarax in the relief of tension associated with anxiety neurosis and mild depressive states. Brit J Psychiat 1959; 105:792–4. 4. Segal L, Tansley A. A clinical trial with Hydroxyzine (Atarax) on a group of maladjusted educationally subnormal children.J Mental–Science; Br J Psychiat from 1963; 1957; 103:677–81. 5. Rhoades R, Leifer K, Cohan R, Wittig H. Suppression of histamine-induced pruritus by three antihistaminic drugs. J Allergy Clin Immunol, 1975 Mar.; 55, 3: 180–5. 6. Kettelhut B, Berkebile C, Bradley D, Metcalfe D. A double-blind, placebo-controlled, crossover trial of ketotifen versus hydroxyzine in the treatment of pediatric mastocytosis. J Allergy Clin Immunol 1989 May; 83, 5: 866–70) 7. Broder L, Lean N, Hilsenbeck S. A randomized blinded clinical trial comparing delta–9–tetrahydrocannabinol (THC) and hydroxizine (HZ) as antiemetics (AE) for cancer cancer (CT). PROC–AM–ASSOC–CANCER–RES; 1982; 23: 514. 8. Vitale M, Fields–Blache C, Luterman. A Severe itching in the patient with burns. J burn care & rehabilitation 1991; 12, 4: 330–3. 9. Kaim S, Klett C, B. Rothfeld. Treatment of the acute alcohol withdrawal state: a comparison of four drugs. Agressologie: revue internationale de physio-biologie et de pharmacologieappliquees aux effets de l'agression, 1968; 9, 2: 305–8. 10. Ferreri M, Hantouche T, M. Billardon. Interet de l'hydroxizynedans des troubles d'anxiete generalalisee: etude controlee en double aveugle versus placebo. L'encephale 1994; 20: 785–91. 11. Llorka P. et al. Efficiency and safety of hydroxysyne in the treatment of generalized anxiety disorder: a 3–month double–blind study. J Clin Psychiatry 2002; 63:1020–7. 12. Lader Scotto J. A multicenter double–blind comparison of hydroxizine, buspirone and placebo in patient with generalized anxiety disorder. Psychopharmacology 1998; 139:402–6. 13. De Brabander A, Deberdt W. Effect of hydroxizyne on attention and memory. Human Psychopharmacology 1990; 357–62. 14. Samuelian J, Billardon M, Guillou N. Retentissmentsur les functions cognitives de deuxtraitmentsanxiolitiques chez des patients souffrantd'anxietegeneralisee. L'encephale 1995; 21: 147 15. Rezakov A.A. Experience of using hydroxyzine (atarax) in children and adolescents. “PHARMIndex-Practik” issue 10; 2006, pp. 37–39

Atarax and alcohol

Drinking alcohol is prohibited while taking Atarax medication

During therapy with the drug, drinking alcohol is prohibited, as alcohol enhances the effect of the drug and provokes adverse reactions. That is, the central nervous system is depressed, the state of intoxication increases, blood pressure decreases, and allergic reactions appear. With all this, there is a high risk of severe intoxication of the body, which can lead to death.

Can antipsychotics be prescribed to children?

Inappropriate and unnecessary

Unfortunately, I often notice that the number of antipsychotics prescribed by psychiatrists for other purposes is growing, especially among children receiving government assistance in psychoneurological dispensaries and psychiatric hospitals. However, it is worth reminding antipsychotic drug lovers that psychotic disorders (psychoses such as schizophrenia) usually arise in adulthood and affect only a small proportion of children and adolescents. However, off-label antipsychotics most often target aggressive and disruptive behavior associated with attention deficit hyperactivity disorder (ADHD). What's really concerning now is that many of these antipsychotic prescriptions come amid emerging evidence that there are serious side effects that may be much more severe in children than in adults taking antipsychotics.

Catch up and overtake America

We still lag behind America in treating children with antipsychotics; we have practically only one antipsychotic approved for children and adolescents - risperidone, while the United States already has five. Indeed, the FDA has approved five drugs—risperidone, aripiprazole, olanzapine, quetiapine, and paliperidone—for the treatment of adolescents ages 13 to 17 years. I note that there is bureaucracy in all countries and it will take more than one year to allow the use of a particular drug, while evidence-based medicine has already gone far ahead, for example, judging by scientific publications, agomelatine can be prescribed to children, but is not allowed by protocols and standards approved by the Ministry of Health. A simple conclusion suggests itself: what if we forget about neuroleptics altogether and try to treat mentally ill children with drugs of other classes, for example, NMDA receptor blockers, such as rimantadine or amantadine, of course, if there are indications (tension, excitement, etc.), fortunately The Ministry of Health has allowed these medications to be given to people suffering from influenza A.

Should autism be treated with antipsychotics?

The FDA has approved risperidone and aripiprazole for the treatment of "behavioral problems associated with autism spectrum disorder" in children aged five to six years (aripiprazole is not yet approved in our country to prescribe aripiprazole to children, so no psychiatrist, especially in the public health system, will will prescribe your child aripiprazole, which has far fewer side effects than risperidone. The question is, are our children any worse than American children? Both drugs have been found to reduce irritability, aggression, self-harm, tantrums and mood swings in children with autism In one of the largest studies to date, risperidone reduced behavioral symptoms and reduced the rigid interests and repetitive behaviors typical of autism, but did not have the same effect as aripipiprazole on social and communication deficits, one of the core symptoms of autism.

Antipsychotics are not prescribed for ADHD and aggressive behavior in children

Doctors often prescribe antipsychotics to children and adolescents with conduct disorder, oppositional defiant disorder, or ADHD, even though the drugs are not approved to treat these conditions. In a review of eight randomized controlled trials conducted from 2012 to 2008, researchers concluded that modern antipsychotic drugs slightly reduced aggressive tendencies in children with disruptive behavior disorder, but their effects were only small. A review of the off-label use of these antipsychotics found that the evidence supporting their effectiveness in children newly diagnosed with ADHD was "low or very low."

Who needs it?

From 2002 to 2009, prescriptions for atypical antipsychotics increased 65%, from 2.9 million to approximately 4.8 million. According to a 2012 study published in JAMA Psychiatry, a staggering 90% of these prescriptions are off-label. ADHD and disruptive behavior disorders account for about 38% of all antipsychotic medications in children and adolescents.

Side effects of new antipsychotics

Modern antipsychotics have been called “atypical” to distinguish them from first-generation antipsychotics (classical antipsychotics such as haloperidol and aminazine). Initially, new antipsychotics were positioned as a safer alternative to their predecessors. However, it is now clear that atypical antipsychotics are associated with a variety of serious side effects, such as weight gain, diabetes, high cholesterol and cardiovascular disease. In a study of 116 children with early-onset schizophrenia who took risperidone, they gained an average of 2 kg. after taking the medication for eight weeks, while children taking olanzapine gained an average of 3 kg, prompting a safety review board to stop taking olanzapine early. Children taking the new antipsychotic medications are also three times more likely to develop type 2 diabetes than children not taking these medications. In addition, both classes of antipsychotics carry a risk of tardive dyskinesia, a neurological disorder that causes involuntary movements of the facial muscles. A 2008 study found that this neurological disorder occurs in approximately 4% of patients taking atypical antipsychotics, compared with 5.5% taking classic antipsychotics.

Atarax for neuroses and panic attacks

Neuroses are a fairly common diagnosis. This is a reversible neuropsychic disorder, which is provoked by constant stress, chronic fatigue, tension and anxiety. Neuroses are often accompanied by panic attacks. A panic attack is a state of sudden and extremely intense attack of fear or anxiety. Refers to neurotic diseases.

For such conditions, the doctor may prescribe Atarax. The main purpose of this tranquilizer is to calm and relieve anxiety. The product must be used strictly as prescribed by the doctor in the prescribed dosage and regularity. Atarax suppresses the activity of certain areas of the brain, relieving tension and panic attacks.

The effect of atarax on depression

Marya

784 views

September 28, 2021

I have been treated for depression for a long time and without success. The last time the doctor prescribed atarax, stopping Phenibut. I felt even worse and I returned the phenibut myself after 5 days. The doctor increased the dose of Atarax and left Phenibut. I've been taking this for two days, but there is no improvement. Can this treatment work over time, or, since everything is bad, is it not suitable? Before this, treatment with the following drugs did not work for me: - serenata with phenibut (7 months of treatment there was apathy, all feelings disappeared, decreased libido, after stopping taking it, gradually on the doctor’s recommendation, the terrible condition returned and I could not go to the psychiatrist again for a year), - azafen and phenibut (from the beginning of taking the condition worsened and was bad all the time, for more than a month, although sometimes it became better without pills, there were good days), - mirtazapine (from half a pill a nightmare began to happen to me - rage, aggression, tears, something happened panic attack, passed within a day), - Grandaxin, Phenibut and Picamilon (I started taking this during a more or less calm period, so at first everything was fine, then it started to get worse, the doctor stopped Picamilon and increased Grandaxin to 3 tablets a day, and it started nightmare, terrible aggression constantly), - atarax (at first the doctor prescribed 1 tablet in the evening, after stopping phenibut, from the next day I practically didn’t live at all, in the morning tears began, unwillingness to live, weakness, I couldn’t do anything, I didn’t go anywhere, I couldn’t plan something to improve the situation, then after 5 days I thought of returning Phenibut, 3 tablets a day, it became not so bad, but still bad, after increasing the dose of Atarax to 3 tablets, there has been no improvement for two days, although they write that atarax acts immediately. My symptoms: anxiety, depression, reluctance to live, frequent tears, hysterics, fits of rage, aggression, apathy, inability to take any action. All this has always been with me, it seems to me, since childhood, it worsened in adolescence, after 30 years I started doing yoga, and the symptoms went away for more than 7 years, they returned in 2017 after the birth of a child. After treatment with serenata, feelings for all of the above disappeared, only feelings of grief and anger remained. And I also have nervous overeating (my doctor, it seems to me, doesn’t pay any attention to these complaints at all), I eat even when I don’t feel like it, I have no appetite, it doesn’t taste good - it doesn’t feel mentally better for long, especially from anything fatty and spicy , flour. Physically, this worsens the condition - I have constant heartburn, pain in the stomach and sides, heaviness in the stomach, nausea, I am constantly gaining weight, to make it easier, I drink activated charcoal and laxative teas. It seems to me that my doctor does not understand the seriousness of what is happening to me. And I can’t describe everything “in colors,” because I might cry, and I can’t express emotions in front of strangers; if I cry, I’ll never be able to communicate with this doctor.

The question is closed

depression

psychiatrist

atarax

treatment doesn't help

Analogs of the drug Atarax

In the pharmacy you can find the following analogues of the drug: Hydroxyzine, Phenazepam, Grandaxin, Anvifen.

Analogs of the drug Atarax

Remember that the prescription of an analogue or replacement of one drug with another is made exclusively by the attending physician, who can correlate the nature of the disease, the desired effect of taking the drug, contraindications, adverse reactions and dosage.

Atarax is sometimes compared to Phenibut. But this is not entirely true.

Atarax or Phenibut?

Phenibut is a nootropic drug that improves cognitive abilities and has a mild tranquilizing effect. This drug effectively relieves anxiety, psycho-emotional stress, and improves sleep. But Atarax is a tranquilizer, most often used to relieve itching, reduce anxiety and psychomotor agitation.