When asked to think of medications commonly used to treat anxiety, chances are high that selective serotonin reuptake inhibitors (SSRIs)—such as Lexapro and Zoloft—or benzodiazepines—like Ativan, Xanax, and Klonopin —frequently come to mind. But these are not the only kinds of medications that can effectively treat anxiety. Another option to consider is hydroxyzine, a prescription antihistamine that is approved to treat anxiety. (Hydroxyzine for sleep is also a common treatment.)

This Minded Medication Guide will take a closer look at hydroxyzine for anxiety to help you when talking with your doctor, prescribing nurse, or Minded provider to choose the right medication for your treatment plan.

Read on to learn more about this medication, including:

• What is hydroxyzine?
• How does hydroxyzine work for anxiety?
• What is the best dose of hydroxyzine for anxiety?
• What are some of the possible side effects of hydroxyzine?
• What cautions should you be aware of before, during, and after using hydroxyzine for anxiety?
• How long does it take for hydroxyzine to work for anxiety?
• How does hydroxyzine compare to other types of anxiety medications?

Minded Medication Guides, including Zoloft vs Prozac and Wellbutrin vs Lexapro, are intended as educational aids only. They are not intended as medical advice for individual conditions or treatment. They are not a substitute for a medical exam, nor do they replace the need for services provided by medical professionals. Talk to your doctor, nurse, or pharmacist before taking any prescription medication or following any treatment or regimen.

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What is hydroxyzine?

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Hydroxyzine is an antihistamine used to treat anxiety. It is also sometimes used to treat:

• Allergies
• Difficulty sleeping
• Itching
• Nausea
• Skin rash
• Vomiting

As with all antihistamines, hydroxyzine works by reducing the effects of histamine (a chemical in your body that produces an allergic reaction).

However, while many antihistamines are available over-the-counter (without a prescription), hydroxyzine is a prescription medication. You may see it listed as hydroxyzine hydrochloride (hydroxyzine HCL) or hydroxyzine pamoate (hydroxyzine pam). It may also be listed under the brand name Vistaril.

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How does hydroxyzine for anxiety work?

While hydroxyzine is an antihistamine, it is also a serotonin antagonist. In other words, taking hydroxyzine or Vistaril for anxiety works similarly to taking SSRIs—another type of medication used to treat anxiety—by making more serotonin available in your brain. As a serotonin antagonist, hydroxyzine boosts the levels of serotonin in your brain by blocking it from being reabsorbed into the nerves in your brain (called neurons). Serotonin is a neurotransmitter that plays a role in keeping your mood balanced. It also affects feelings of contentment, optimism, and satisfaction, and your overall sense of well-being.

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Hydroxyzine for anxiety

When taking hydroxyzine for anxiety, it can be prescribed in capsule, tablet, and liquid forms. As mentioned above, this medication is available as hydroxyzine hydrochloride (hydroxyzine HCL) or hydroxyzine pamoate (hydroxyzine pam). While hydroxyzine pamoate is available in both generic and branded forms (branded as Vistaril), hydroxyzine hydrochloride is only available as a generic. (The branded version of hydroxyzine HCL, called Atarax, was discontinued.)

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Hydroxyzine pamoate for anxiety

Hydroxyzine pamoate (Vistaril):

Capsules

• 25 mg
• 50 mg

Liquid

• 25 mg/5 ml

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Hydroxyzine HCL for anxiety

Hydroxyzine hydrochloride (HCL)

Tablets

• 10 mg
• 25 mg
• 50 mg

Liquid

• 10 mg/5 ml

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Best dose of hydroxyzine for anxiety

When prescribing hydroxyzine for anxiety, doctors and nurse practitioners typically recommend taking it in multiple doses throughout the day. For adults, 50 to 100 mg (taken 4 times a day) is typical, though some people may need higher doses to achieve symptom relief. For children under the age of 6 years old, no more than 50 mg per day (divided into small doses) is recommended.

Hydroxyzine can be taken daily (with or without food) at regularly scheduled times or on an as-needed basis. If you have an upset stomach after taking hydroxyzine, you may want to take it with food. Your doctor or prescribing nurse will provide you with instructions on how often and when to take this medication, as well as the maximum amount to take in a day.

If you miss a dose of hydroxyzine, either take the missed dose as soon as you remember—or, if it is closer to the time when you would take your next dose, just take the next dose.

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Which is better for anxiety: hydroxyzine HCL vs hydroxyzine pam?

Both hydroxyzine hydrochloride (HCL) and hydroxyzine pamoate (pam) can be prescribed to treat anxiety. The main difference between the two is the form that each is available in—hydroxyzine HCL is available in tablets and liquid, while hydroxyzine pam is available in capsules and liquid.

You may prefer one form of medication over the other (tablets vs capsules), or you may find that one or the other works better for you personally. Your doctor, prescribing nurse, or Minded professional can work with you to determine which form of this medication is best for your anxiety treatment plan.

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Hydroxyzine side effects

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Common side effects of hydroxyzine include:

• Blurred vision
• Confusion
• Dizziness
• Drowsiness
• Dry mouth
• Fatigue
• Headache
• Irritability
• Urinary retention (when your bladder does not empty all the way)

Talk to your doctor or the experts at Minded if you experience any of these or other side effects.

Rare or serious side effects of hydroxyzine include:

• Allergic reaction to the medication, even though the medication generally is taken to reduce allergic reactions (symptoms of this could include: difficulty breathing; hives; and swelling in your lips, tongue, or face)
• Confusion
• Hallucinations
• Increased heart rate and/or abnormal heartbeat
• Priapism (an erection lasting longer than 4 hours)
• Skin rash (called acute generalized exanthematous pustulosis, or AGEP)

Seek medical attention right away if you experience any of these (or other) serious side effects.

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Hydroxyzine warnings

Drinking alcohol is not recommended while taking hydroxyzine. Alcohol can decrease the benefits of medications like hydroxyzine and increase their side effects (such as sedation). Alcohol also can impair memory and judgment, accidentally resulting in taking a higher dose of hydroxyzine than prescribed, which could induce an accidental overdose.

Symptoms of a hydroxyzine overdose include:

• Coma
• Confusion
• Decreased coordination
• Difficulty urinating
• Drowsiness
• Dry mouth
• Headache
• Rapid heartbeat
• Slowed reflexes
• Seizures

Always discuss your anxiety treatment plan with your doctor if you are pregnant or planning on becoming pregnant. Hydroxyzine should typically not be taken during the first trimester of pregnancy. While you may take it during the second and third trimesters, it should not be taken right before or during labor.

Because hydroxyzine can be passed to your baby through breast milk, taking it while breastfeeding is not recommended.

Tell your doctor or a Minded professional about any other medications or supplements you may be taking to determine if hydroxyzine might have any negative interactions with them.

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When taking hydroxyzine or Vistaril for anxiety, how long does it take to work?

If you're taking hydroxyzine for anxiety, you will find that it is relatively fast-acting compared to some other medications, like SSRIs. While you may have to take SSRIs for a few weeks before you start to see improvement in your anxiety symptoms, with hydroxyzine, you may notice your symptoms begin to improve quickly, often within hours of first taking it.

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How long does hydroxyzine last for anxiety?

The effects of hydroxyzine typically last 3 to 4 hours.

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SSRIs vs hydroxyzine for anxiety

While you can take selective serotonin reuptake inhibitors (SSRIs) or hydroxyzine for anxiety, there are some key differences to keep in mind.

• How quickly your anxiety symptoms begin to decrease: While you may notice that your anxiety symptoms begin to decrease hours after first taking hydroxyzine, the benefits of SSRIs may not begin to become apparent until a few weeks after you start taking them.
• How often you take the medications: Hydroxyzine is typically taken in multiple doses throughout the day. SSRIs usually are taken once daily.
• Common side effects: Both hydroxyzine and SSRIs come with a risk of side effects, but the side effects for each are different.
• Common side effects of hydroxyzine include: blurred vision, confusion, dizziness, dry mouth, fatigue, headache, irritability, urinary retention‍
• Common side effects of SSRIs include: dizziness, drowsiness, dry mouth, headache, insomnia, nervousness, sexual problems, stomach upset, weight gain, and/or weight loss‍
• Whether they can be taken during pregnancy and/or while breastfeeding: Hydroxyzine can be taken during the second and third trimesters, but not during the first trimester or right before or during labor. SSRIs may be taken during pregnancy, with the approval of an OB-GYN doctor. Neither hydroxyzine nor SSRIs should be taken while breastfeeding without first talking to your OB-GYN doctor or pediatrician.

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Benzodiazepines vs hydroxyzine for anxiety

Benzodiazepines—such as Xanax and Ativan and Klonopin—are another type of medication that can be used to treat anxiety. Like hydroxyzine, these medications are relatively fast-acting—your symptoms may begin to decrease within hours of taking your first dose. Also, like taking hydroxyzine for anxiety, benzodiazepines are typically taken in multiple doses throughout the day. There are, however, several important differences between hydroxyzine and benzodiazepines to consider.

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• Common side effects: Both hydroxyzine and benzodiazepines come with a risk of side effects, but the side effects for each are different.‍
• Common side effects of hydroxyzine include: blurred vision, confusion, dizziness, dry mouth, fatigue, headache, irritability, urinary retention‍
• Common side effects of benzodiazepines include: decreased coordination, difficulty concentrating, dizziness, drowsiness, fatigue, lightheadedness 
• Whether they can be taken during pregnancy and/or while breastfeeding: Hydroxyzine can be taken during the second and third trimesters, but not during the first trimester or right before or during labor. Benzodiazepines typically should not be taken during pregnancy. Neither hydroxyzine nor benzodiazepines should be taken while breastfeeding without talking to your OB-GYN doctor or pediatrician.
• How long they are usually used for: While hydroxyzine may be taken long-term, benzodiazepines are typically prescribed for short-term use (weeks or months).

Another thing to keep in mind is that even though the Drug Enforcement Administration has classified benzodiazepines as controlled substances, they are considered safe for most people who take them for anxiety. The risk of dependence or abuse is higher in people with a history of a substance use disorder as well as those who take more than the prescribed dose of the medication.

On the other hand, hydroxyzine is not a controlled substance and does not carry the same risk of dependency or abuse.

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Hydroxyzine vs Benadryl for anxiety

While hydroxyzine and Benadryl (the brand name for diphenhydramine) are both antihistamines, this does not mean they can both be used to treat anxiety. Benadryl, which is available over-the-counter (meaning it does not require a prescription) is not approved to treat anxiety—it is approved to treat hay fever, allergies, and cold symptoms. In fact, increased anxiety, agitation, and nervousness are potential side effects of Benadryl.

Additionally, while hydroxyzine is considered safe for long-term use, Benadryl may increase your risk of developing dementia if used long-term, according to a 2015 study published in CMAJ. A 2017 study published in Neurology Clinical Practice also found that there is a risk of becoming dependent on or misusing Benadryl. However, as with benzodiazepines, this risk may be higher in people who have a history of addiction.

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Final thoughts on hydroxyzine or Vistaril for anxiety

If you are looking for a fast-acting medication that can be taken long-term for anxiety treatment, it may be worth discussing hydroxyzine with your doctor, prescribing nurse, or a Minded professional. 

When comparing hydroxyzine to other common types of anxiety medications, it is important to remember that each type of medication has its own pros and cons. And while there are some similarities between the different kinds of medications, there are also some key differences. For example:

• Whether it is safe for long-term use: Like SSRIs (and generally unlike benzodiazepines), hydroxyzine can be taken long-term. 
• The number of doses taken per day: Like benzodiazepines (and unlike SSRIs), hydroxyzine is taken in multiple doses throughout the day rather than once daily.
• How quickly symptom relief may begin: Hydroxyzine is fast-acting (like benzodiazepines), with symptoms typically starting to improve within a few hours of the first dose (compared to a few weeks for SSRIs).
• Whether it is safe to drink alcohol while taking this medication: Drinking alcohol is not recommended while on hydroxyzine (the same is true of SSRIs and benzodiazepines).
• Whether this medication can be taken during pregnancy or while breastfeeding: Hydroxyzine can be taken during the second and third trimesters of pregnancy (except right before and during labor). SSRIs and benzodiazepines typically should not be taken during pregnancy. None of these medications should be taken while breastfeeding.

To find out if hydroxyzine could work for your anxiety treatment, visit Minded and get a free assessment. Minded offers online appointments with board-certified psychiatrists and nurse practitioners. If you already have a hydroxyzine prescription, Minded can help you refill or renew it online. Our team of professionals can also assist with adjusting your dosage or advising you about other medications that might be a good fit for your needs.