Inside. Children. For the symptomatic treatment of allergic pruritus. At the age of 3 to 6 years: 1 mg / kg / day to 2.5 mg / kg / day in several doses. At the age of 6 years and older: 1 mg / kg / day to 2.0 mg / kg / day in divided doses. For premedication - 1 mg / kg at night before anesthesia. The number of tablets is calculated by the doctor depending on the child's body weight in accordance with the recommended doses. Adults. For symptomatic treatment of anxiety: a standard dose of 50 mg per day, divided into 3 divided doses (1/2 tablet (12.5 mg) in the morning, 1/2 tablet (12.5 mg) in the afternoon, and 1 tablet (25 mg) at night) ... In severe cases, the dose may be increased to 12 tablets (300 mg) per day. For symptomatic treatment of allergic pruritus: an initial dose of 1 tablet (25 mg) before bedtime, if necessary, the dose can be increased to 1 tablet (25 mg) 3-4 times a day. For premedication in surgical practice: 2-8 tablets (50-200 mg) at night before anesthesia. A single maximum dose for an adult should not exceed 8 tablets (200 mg), the maximum daily dose is not more than 12 tablets (300 mg). Application for special groups of patents. The dose is selected by the doctor individually, taking into account the response to the treatment in the range of recommended doses. Use in the elderly. In elderly patients, treatment begins with half the dose. For symptomatic treatment of anxiety: 1/2 tablet (12.5 mg) in the morning and tablets (12.5 mg) in the evening. For symptomatic treatment of allergic pruritus: the initial dose is 1/2 tablet (12.5 mg) before bedtime, if necessary, the dose can be increased to 1/2 tablet (12.5 mg) 3-4 times a day. For premedication in surgical practice; 1-4 tablets (25-100 mg) at night before anesthesia. Use in patients with renal failure and impaired liver function. Patients with severe and moderate renal insufficiency, as well as with hepatic insufficiency, need a dose reduction. In patients with hepatic impairment, it is recommended to reduce the daily dose by 33%. In patients with severe and moderate renal failure, a dose reduction is recommended due to a decrease in the excretion of the main hydroxyzine metabolite, cetirizine. It is necessary to reduce the dose of hydroxyzine or increase the interval between doses in proportion to the decrease in creatinine clearance, for example: half of the daily dose for moderate renal failure and a quarter of the daily dose for severe renal failure.

Hypersensitivity to any of the drug components, cetirizine and other piperazine derivatives, aminophylline or ethylenediamine. Porphyria. Children under 3 years old. Pregnancy, childbirth and breastfeeding. Hereditary galactose intolerance, lactase deficiency or glucose-galactose malabsorption syndrome (since the tablets contain lactose). History of QT interval prolongation.

From the nervous system. Very often: drowsiness; often: headache, lethargy; infrequently: dizziness, insomnia, tremors; rarely: convulsions, dyskinesia. Mental disorders. Uncommon: agitation, confusion; rarely: hallucinations, disorientation. On the part of the organ of vision. Rarely: violation of accommodation, visual impairment. From the side of the heart. Rarely: tachycardia; frequency unknown: prolongation of the QT interval on the electrocardiogram, ventricular tachycardia of the "pirouette" type. From the respiratory system of the chest and mediastinal organs. Very rare: bronchospasm. From the gastrointestinal tract. Often: dry mouth; infrequently: nausea; rarely: vomiting, constipation. From the liver and biliary tract. Rarely: violations of liver function tests; frequency unknown: hepatitis. General disorders. Often: fatigue; rarely: hyperthermia, malaise. From the kidneys and urinary tract. Rarely: urinary retention. On the part of the skin and subcutaneous tissues. Rarely: itching, rash (erythematous, maculopapular), urticaria, dermatitis; very rare: angioedema, increased sweating, fixed drug erythema, acute generalized exanthematous-pustular rash, erythema multiforme, Stevens-Johnson syndrome. From the immune system. Rarely: hypersensitivity; very rare: anaphylactic shock. From the side of the vessels. Rarely: lowering blood pressure. The following side effects were observed when taking cetirizine, the main metabolite of hydroxyzine, thrombocytopenia, aggression, depression, tic, dystonia, paresthesia, oculogyric crisis, diarrhea, dysuria, enuresis, asthenia, edema, weight gain and can be observed when taking hydroxyzine.

It is necessary to take into account the potentiating effect of hydroxyzine when used together with drugs that depress the central nervous system, such as narcotic analgesics, barbiturates, tranquilizers, hypnotics, alcohol. In this case, their doses should be selected individually. Simultaneous use with monoamine oxidase (MAO) inhibitors and anticholinergics should be avoided. The drug interferes with the pressor effect of epinephrine and the anticonvulsant activity of phenytoin, and also interferes with the action of betahistine and drugs - choliesterase inhibitors. It was found that the use of cimetidine at a dose of 600 mg twice a day increases the concentration of hydroxyzine in serum by 36% and reduces the maximum concentration of the metabolite cetirizine by 20%. The effect of atropine, belladonna alkaloids, cardiac glycosides, antihypertensive drugs, blockers of H2-histamine receptors do not change under the action of hydroxyzine. Hydroxyzine is an inhibitor of the CYPD6 isoenzyme and in high doses can cause drug interactions with substrates of the CYP2D6 isoenzyme. Since hydroxyzine is metabolized in the liver, an increase in its concentration in the blood can be expected when used simultaneously with inhibitors of microsomal liver enzymes. Since hydroxyzine is metabolized by alcohol dehydrogenase and the isoenzyme CYP3A4 / 5, it is possible to increase the concentration of hydroxyzine in the blood plasma when used simultaneously with drugs that potentially inhibit the isoenzyme CYP3A4 / 5 (telithromycin, clarithromycin, delavirdine, styripenthol, ketoconazolazolomazole, some inhibitors , including atazanavir, indinavir, nelfinavir, ritonavir, saquinarine, lopinavir / ritonavir, saquinavir / ritonavir, and tipranavir / ritonavir). However, inhibition of one metabolic pathway can be partially compensated by the work of another. The concomitant use of hydroxyzine with drugs that can potentially cause arrhythmias may increase the risk of prolongation of the QT interval and the occurrence of pirouette-type ventricular tachycardia.

Symptoms observed after a significant overdose of the drug are associated with excessive m-anticholinergic blocking effect, suppression or paradoxical stimulation of the central nervous system. These symptoms include nausea, vomiting, tachycardia, pyrexia, drowsiness, impaired pupillary reflex, tremors, confusion, or hallucinations. Subsequently, depression of consciousness, respiration, convulsions, a decrease in blood pressure, arrhythmia may develop. Possible aggravation of the coma and cardiopulmonary collapse. It is necessary to control the state of the respiratory tract, the state of respiration and blood circulation using ECG monitoring, to ensure adequate oxygenation. Cardiac activity and blood pressure must be monitored for 24 hours after symptoms disappear. In case of a violation of the mental status, it is necessary to exclude the intake of other drugs or alcohol, if necessary, the patient should be inhaled with oxygen, administered naloxone, dextrose (glucose) and thiamine. If it is necessary to obtain a vasopressor effect, norepinephrine or metaraminol is prescribed. Epinephrine should not be used. In the case of ingestion of a significant amount of the drug, gastric lavage can be performed with previous endotracheal intubation. It is possible to use activated carbon, but there is insufficient evidence of its effectiveness. There is no specific antidote. Hemodialysis is not effective. Literature data indicate that in the case of the development of severe, life-threatening, intractable m-anticholinergic effects that cannot be stopped by other drugs, it is possible to use a therapeutic dose of physostigmine. Physostigmine should not be used solely to awaken the patient. If the patient has been taking tricyclic antidepressants, physostigmine may cause seizures and irreversible cardiac arrest. Physostigmine should also be avoided in patients with cardiac conduction disorders.