A 55-year-old woman with generalised anxiety disorder has a 15-year history of alcohol dependence. Her physician wants an anxiolytic without abuse potential. Which drug class fits this requirement and has demonstrated efficacy in generalised anxiety disorder?
- A First-generation antihistamine acting at H1 receptors ✓
- B Alpha-2 adrenergic agonist acting centrally
- C 5-HT3 receptor antagonist
- D NMDA receptor antagonist
Correct answer: A. First-generation antihistamine acting at H1 receptors
Explanation
Hydroxyzine, a first-generation H1 antihistamine, has controlled-trial evidence for generalised anxiety disorder and carries no risk of tolerance or dependence, making it suitable when benzodiazepines are contraindicated, as in alcohol dependence. Its main drawback is sedation. Clonidine, the alpha-2 agonist in option B, lacks consistent anxiolytic trial support in GAD, ondansetron targets nausea, and ketamine-like NMDA antagonists are not standard anxiolytics.
Reference: Katzung's Basic and Clinical Pharmacology, 16th ed.
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