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Hydroxyzine improves the quality of life in itch patients

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eMediNexus    14 December 2022

Itch is a clinical symptom of various clinical conditions that negatively impact different aspects of patients well-being. Almost 60-90% of adults with psoriasis and atopic dermatitis (AD) suffer from itching, which has been identified as one of the most troublesome symptoms of the disease1.

 

Itch accompanied by pain is a commonly reported symptom, which takes a huge toll on a patient’s quality of life.  Both itch and pain can lead to a significant reduction in the quality of life and sleep of patients 2,3. A study was conducted to assess the impact of itch and pain on sleep in patients with AD and psoriasis. The results showed that itch in AD or psoriasis has a substantial link with insomnia and sleep quality. Itch-related sleep disturbance is a significant mediator of the association between itch severity and psychological and somatic symptoms1. Another study has shown that health-related quality of life impairment in chronic urticaria cases leads to a significant lack of energy, social isolation, and emotional disturbances. In fact, compared to other dermatological causes, itch in the case of chronic urticaria has a higher impact on the patient’s daily activities and physical discomfort4.  

 

Antihistamines are standard therapy for the management of chronic itch. Hydroxyzine hydrochloride is the first-generation agent, which has been shown to possess more or equal efficacy compared with other antihistaminic5. A study showed that hydroxyzine hydrochloride, when used in patients with chronic itch associated with chronic urticaria and atopic dermatitis, led to progressive improvement within 12 weeks of intervention6. Hence, the use of hydroxyzine in itch patients is associated with a significant improvement in quality of sleep.

 

The early onset of action of hydroxyzine is an additional benefit of the drug in treating itch and associated symptoms. Oral hydroxyzine is rapidly absorbed from the GI tract, with clinical action seen within 15 to 30 minutes, while maximal clinical activity develops in 2 hours, with an approximate duration of action of 3 to 4 hours7.

 

Besides, hydroxyzine is a potent agent in suppressing skin conditions such as wheals and flares8. Hydroxyzine has a long t1/2(14-25 Hrs) and vast distribution in the body. Its suppressive effect on the wheal and flare following a single dose of hydroxyzine is also highly prolonged. The large volume of distribution in the elderly suggests the possibility of enhanced H1-receptor activity in elderly patients with itch9.

 

It is suggested that hydroxyzine can be safely used in children between 0-5 years for required period of time10. Small doses with short-term use can not cause any adverse effects in breastfed infants. However, long-term use may cause drowsiness and other effects in the infant11.

 

The adverse effects of hydroxyzine are mild and temporary, such as commonly occurring dry mouth and drowsiness. Hydroxyzine is well-tolerated in patients6.

 

The European Guideline on Chronic Pruritus has recommended the use of hydroxyzine hydrochloride as the first choice of treatment of itch owing to its different benefits, such as antipruritic, anxiolytic, and sedative6.

 

It can be concluded that hydroxyzine has a beneficial effect in improving night-time sleep quality and thus improves patients’ quality of life.

 

Clinical Tips

  • Itch is associated with a negative influence on sleep and quality of sleep.
  • Hydroxyzine is an antihistamine H1 antagonist used in the treatment of itch, wheal, and flare triggered by histamine.
  • Hydroxyzine has a long duration of action.
  • Hydroxyzine has a rapid onset of action (15-30 minutes), hence beneficial in providing immediate relief to the patient.

 

Reference

  1. Kaaz K, Szepietowski J, Matusiak. Influence of itch and pain on sleep quality in atopic dermatitis and psoriasis. Acta Dermato Venereologica. DOI: 10.2340/00015555-3065.
  2. Jeon C, Yan D, Nakamura M, Sekhon S, et al. Frequency and management of sleep disturbance in adults with atopic dermatitis: a systematic review. Dermatol. Ther. 2017; 7: 349-364.
  3. Gowda S, Goldblum OM, McCall WV, Feldman SR. Factors affecting sleep quality in patients with psoriasis. J Am Acad Dermatol. 2010; 63: 114-123.
  4. Balp MM, Khalil S, Tian H, et al. Burden of chronic urticaria relative to psoriasis in five European countries. J Eur Acad Dermatol Venereol. 2018; 32: 282-290.
  5. Rhoades RB, Leifer KN, Cohan R, Wittig HJ. Suppression of histamine-induced pruritus by three antihistaminic drugs. J Allergy Clin Immunol. 1975; 55:180-185.
  6. Thomas J, Saple DG, Jerajani HR, Netha NRG, et al. Real-world, non-interventional, observational study of hydroxyzine hydrochloride in chronic pruritus: a prospective, non-comparative study. Dermatol Ther. 2019; 9: 299-308.
  7. Stanley FM. Oral sedation in Sedation. Fifth edition, 2010.
  8. Maciel-Guerra H, Penha MA, Jorge MFS, Liborio R da S, et al. Suppression of wheal and flare in histamine test by the main H1 antihistamines commercialized in Brazil. An Bras Dermatol. 2018; 93:233-237.
  9. Simons KJ, Watson WTA, Chen XY, Simons FER. Pharmacokinetic and pharmacodynamic studies of the H1-receptor antagonist hydroxyzine in the elderly. Clinical Pharmacology & Therapeutics. 1989; 45:9-14.
  10. Gober HJ, Li KH, Yan K, Bailey AJ, et al. Hydroxyzine use in preschool children and its effect on neurodevelopment: A population-based longitudinal study. Front Psychiatry. 2021; 12:721875.
  11. Drugs and lactation database. LactMed. 2006. National Library of Medicine (US)

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