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Hydroxyzine vs Xanax: uses, dosages, and side effects

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Medically reviewed by

November 4, 2021

If you’re struggling with anxiety or sleeping problems, you may be wondering if medication can help. Two immediate-acting options that you may have heard about are hydroxyzine and Xanax. Both can be prescribed either on their own or to bridge the gap until other medications, like selective serotonin reuptake inhibitors (SSRIs), start working and provide symptom relief. When considering hydroxyzine vs Xanax, it’s important to know the key differences between these two medications. Then discussing the pros and cons of each with your doctor, prescribing nurse, or a Minded provider can help you determine which medication is best for your needs.

 

Read on to learn more about hydroxyzine vs Xanax, including:

  • What you need to know about taking hydroxyzine for sleep and using hydroxyzine for anxiety
  • How Xanax works for sleep and anxiety
  • Hydroxyzine dosage for sleep vs Xanax dosage for sleep
  • Hydroxyzine dosage for anxiety vs Xanax dosage for anxiety
  • How long it takes for Xanax to work and how long it takes for hydroxyzine to work
  • How long does Xanax last? How long does hydroxyzine last?
  • Hydroxyzine side effects vs Xanax side effects

 

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 and throughout any treatment.

Hydroxyzine vs Xanax: an overview

While both hydroxyzine and Xanax can be prescribed to help with anxiety and/or sleep difficulties, they work in different ways inside your body and brain.

 

Because hydroxyzine is an antihistamine, it has drying (anticholinergic) effects and sedative properties. Hydroxyzine works by lessening the effects of histamine, a chemical produced by your body that causes the physical symptoms of allergic reactions (such as hives, hay fever, or itching). Hydroxyzine’s sedating effects make it helpful in treating sleep problems, as well as anxiety.

 

Xanax, on the other hand, is a benzodiazepine. Benzodiazepines work by targeting a neurotransmitter (a type of tiny molecule in your brain that relays messages between nerves) called gamma-aminobutyric acid (GABA). These medications slow down your brain’s activities by attaching to the brain’s GABA neuroreceptors, causing you to feel calm and/or drowsy.

 

Benzodiazepines—like Xanax—are typically prescribed for short-term use (usually weeks or months). You may have heard there is a risk of developing a physical or psychological dependence on benzodiazepines—which could turn into an addiction. But this risk is higher in people who already have a history of a substance use disorder as well as people who do not take these medications as prescribed. With that in mind, the Drug Enforcement Administration has classified benzodiazepines as controlled substances.

 

Under temporary authorization in effect during the COVID-19 public health emergency, the psychiatrists and nurse practitioners at Minded can prescribe (depending on the state you live in) controlled medications like Xanax to eligible subscribers in appropriate situations using a video visit.

 

So how do you know whether hydroxyzine vs Xanax is right for you? Taking a closer look at each medication can help you decide which may be the better choice for your anxiety or insomnia treatment plan.

Hydroxyzine vs Xanax: a closer look at hydroxyzine

Hydroxyzine is a prescription antihistamine that is used to treat anxiety. It also can be used to treat:

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

What makes hydroxyzine different from other antihistamines is that while many of these types of medications, like Benadryl and Zyrtec, are available over-the-counter, hydroxyzine is a prescription medication.

Hydroxyzine pamoate vs hydroxyzine HCL

Hydroxyzine is sometimes listed as hydroxyzine pamoate (hydroxyzine pam) or hydroxyzine hydrochloride (hydroxyzine HCL). Hydroxyzine pamoate is available as a generic or under the brand name Vistaril. The brand name of hydroxyzine HCL, Atarax, is discontinued, but the generic form of this medication still is available.

Hydroxyzine dosages

Hydroxyzine comes in capsule, tablet, and liquid forms.

 

Hydroxyzine pamoate (Vistaril):

Capsules

  • 25 mg
  • 50 mg

Liquid

  • 25 mg/5 ml

 

Hydroxyzine hydrochloride (hydroxyzine HCL):

Tablets

  • 10 mg
  • 25 mg
  • 50 mg

Liquid

  • 10 mg/5 ml

 

Hydroxyzine for anxiety is usually taken in multiple doses throughout the day:

  • Adults: between 50 and 100 mg, taken up to 4 times per day
  • Children ages 6 and older: between 50 and 100 mg, divided into smaller doses throughout the day, as needed
  • Children younger than 6 years: 50 mg, divided into smaller doses throughout the day, as needed

 

The recommended dose for hydroxyzine for sleep varies, depending on age and each person’s reaction to the medication. For adults, however, the typical hydroxyzine dosage for sleep ranges from 25 mg to 100 mg, taken before bed, either with or without food. While these are the recommended doses, some people may need higher doses to achieve symptom relief.

 

Your doctor or prescribing nurse will work with you to determine your best hydroxyzine dose for anxiety problems.

 

Hydroxyzine can be taken daily at regularly scheduled times or on an “as-needed” basis. Your prescribing doctor or nurse will provide you with instructions on when and how frequently to take this medication—and the maximum amount that should be taken in a day.

 

While you can take hydroxyzine with or without food, if you get an upset stomach from taking it without food, you may want to then try it with food.

 

If you accidentally 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 the next dose, just take the next dose.

How long does it take for hydroxyzine to work?

Compared to SSRIs, hydroxyzine is a faster-acting anxiety medication for symptom relief. It might take a few weeks for noticeable symptom relief when taking SSRIs. With hydroxyzine, you may notice that anxiety or insomnia symptoms start to improve within hours (or sooner) of taking the first dose.

Hydroxyzine vs Xanax: hydroxyzine side effects

Common side effects of hydroxyzine include:

  • Blurred vision
  • Confusion
  • Dizziness
  • Drowsiness
  • Dry mouth
  • Fatigue
  • Headache
  • Irritability
  • Urinary retention (a condition that occurs when your bladder cannot fully empty)

 

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

hydroxyzine side effects

 

Rare or serious side effects of hydroxyzine include:

  • Abnormal heartbeat and/or increased heart rate
  • Allergic reaction (symptoms of this could include: difficulty breathing; hives; or swelling in your lips, tongue, or face)
  • Confusion
  • Hallucinations
  • Priapism (an erection lasting longer than 4 hours)
  • Skin rash (medically referred to as acute generalized exanthematous pustulosis, or AGEP)

 

Seek medical attention immediately if you experience these or any other serious side effects.

Warnings

It is important to tell your doctor, prescribing nurse, or Minded professional about any and all medications and supplements you are taking in order to determine if hydroxyzine may cause you to have negative (or positive, like increasing blood levels) interactions with them.

Hydroxyzine and pregnancy

Because some medications can affect your baby during pregnancy or while breastfeeding, always discuss your anxiety treatment plan with your doctor if you are pregnant, planning to become pregnant, breastfeeding, or planning to breastfeed.

 

While hydroxyzine should not be taken during the first trimester of pregnancy or right before or during labor, it may be taken during the second and third trimesters. Discuss this option with your prescribing doctor or nurse.

 

Taking hydroxyzine while breastfeeding is not recommended because it can be passed on to your baby through your breast milk.

Hydroxyzine and alcohol

Drinking alcohol while taking hydroxyzine is not recommended. Not only can alcohol decrease the benefits of hydroxyzine (and other medications), it also can increase its negative side effects, such as sedation. And because alcohol can impair your judgment and memory, it accidentally can result in you taking a higher dose of hydroxyzine than what you have been prescribed, which could lead to an overdose.

 

Symptoms of a hydroxyzine overdose include:

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

 

Seek medical care right away if you are experiencing these or other symptoms of a hydroxyzine overdose.

Hydroxyzine vs Xanax: a closer look at Xanax

Xanax is the brand name of the generic drug alprazolam. It is approved to treat generalized anxiety disorder (GAD) and panic disorder.

 

Xanax also can be prescribed for “off-label” use to treat sleep difficulties. Off-label use is when a medication is prescribed for a condition not approved by the FDA to treat. This is a common and acceptable medical practice.

Alprazolam (Xanax) dosages

Xanax is available in multiple forms and doses:

Xanax tablet

  • 0.25 mg
  • 0.5 mg
  • 1 mg
  • 2 mg

Xanax XR (extended release) tablet

  • 0.5 mg
  • 1 mg
  • 2 mg
  • 3 mg

 

The dose of Xanax that you take depends, in part, on the reason you are taking this medication (like anxiety or insomnia). Like hydroxyzine, you may take Xanax in multiple doses (as prescribed) throughout the day.

 

When taken for generalized anxiety disorder (GAD), a typical starting dose of Xanax is 0.25 to 0.5 mg, taken 3 times per day. If your symptoms do not ease at this starting dose, your doctor or prescribing nurse may increase the dose every 3 to 4 days up to the maximum recommended dose of 4 mg daily (taken in divided doses).

 

The typical starting dose of Xanax when prescribed for panic disorder is 0.5 mg, taken 3 times a day. This may be increased by your healthcare prescriber every 3 to 4 days (if needed)—to no more than 1 mg daily.

 

When taking Xanax off-label for insomnia, it should be taken once before bedtime. The Xanax dosage for sleep will vary depending on the individual and should be taken as directed by your doctor or prescribing nurse.

 

Because elderly people may be more susceptible to the side effects of Xanax, they might best begin at a lower starting dose of 0.25 mg, taken 2 or 3 times daily.

 

The safety and efficacy of Xanax use for children have not been studied. It usually is not prescribed to people under the age of 18.

 

Like hydroxyzine, Xanax can be taken every day, at regularly scheduled times, or it can be taken on an as-needed basis. Your prescribing doctor or nurse will give you instructions on when and how frequently to take this medication, as well as the maximum amount that you should not exceed in a day.

 

You may take Xanax with or without food. However, if you get an upset stomach from taking it without food, you might want to try taking it with food. Taking Xanax with food also slows the absorption of the medication, which leads to more steady levels of it in your blood.

 

If you accidentally miss a dose of Xanax, you can take the missed dose as soon as you remember, or, if it is closer to the time when you would take your next dose, take the next dose.

 

As mentioned above, there is some risk of Xanax (or other benzodiazepines) becoming habit-forming, developing into a physical or psychological dependence on the medication. While this risk is higher in people with a history of substance use disorder, it is very important to only take Xanax as prescribed by your doctor, nurse, or Minded provider.

How long does it take for Xanax to work?

As with hydroxyzine, whether you are taking Xanax for insomnia or anxiety, you may begin to notice that your symptoms start to improve within hours of taking the first dose. Its peak concentration in your blood typically occurs 1 to 2 hours after taking it.

Hydroxyzine vs Xanax: Xanax side effects

Common side effects of Xanax include:

  • Difficulty with coordination
  • Dizziness
  • Drowsiness
  • Fatigue
  • Lightheadedness
  • Trouble concentrating

 

These side effects typically decrease during the first few weeks of taking Xanax.

 

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

xanax side effects

 

Rare or serious side effects of Xanax include:

  • Extreme dizziness or tiredness
  • Feelings of depression or decreased interest in day-to-day life
  • Headaches
  • Increased heart rate
  • Irritability
  • Memory impairment
  • Passing out (fainting)
  • Restlessness
  • Severe allergic reaction and facial swelling, which can occur even on the first dose
  • Shortness of breath
  • Thoughts of self-harm or suicide
  • Difficulty expressing words

 

In some cases, people who take benzodiazepines to help with sleep might perform activities—such as eating, making phone calls, even driving—while they are either asleep or not fully awake. In these cases, they do not remember having done these activities once they are fully awake. 

 

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

Warnings

Xanax comes with an FDA “Black Box” warning. This means that the FDA has identified serious safety risks that may come from taking this medication. While Black Box warnings are meant to make patients aware of these serious safety warnings, the actual risk may be low (or even rare), and is a judgment made by your prescribing doctor or nurse.

 

The Black Box warning for Xanax states that benzodiazepines may have serious interactions when taken with opioid or other sedative medications. If Xanax is taken with these medications, that may cause slow and/or difficult breathing—and can be fatal when high doses are consumed.

 

Tell your doctor or a Minded professional about any other medications or supplements you are taking to determine if Xanax may have any interactions with them.

 

And always take Xanax as prescribed, in order to lower your risk of developing a dependence on this medication.

Xanax and pregnancy

It is important to discuss your anxiety treatment plan with your doctor or prescribing nurse if you are planning on becoming pregnant or breastfeeding because taking Xanax while you are pregnant may harm your baby. This medication also can be passed to your baby through your breast milk.

 

Because Xanax can cause withdrawal symptoms if you suddenly stop taking it, it is also important to work with your prescribing doctor or nurse to come up with a plan to carefully go off of this medication, if that is what is needed.

Xanax and alcohol

As with hydroxyzine, you should not drink alcohol while taking Xanax. Alcohol can increase Xanax side effects (such as sedation) and decrease the benefits of the medication. Because alcohol impairs judgment and memory, drinking also can increase the risk of accidental overdose if you unintentionally take a higher dose of Xanax than what is prescribed for you.

 

Symptoms of a Xanax overdose include:

  • Coma
  • Confusion
  • Difficulty with coordination
  • Slowed reflexes

 

An overdose of Xanax can be fatal. Seek medical care immediately if you are experiencing symptoms of an overdose.

Hydroxyzine vs Xanax: What’s the difference?

Which works faster: hydroxyzine or Xanax?

Both hydroxyzine and Xanax are relatively fast-acting medications compared to some of the other types of the anti-anxiety medications available, such as SSRIs. When considering hydroxyzine vs Xanax, however, hydroxyzine may have a slight edge over Xanax in terms of how quickly you might begin to notice symptom relief.

 

You may start to notice your symptoms lessen as soon as 15 to 30 minutes after taking hydroxyzine. On the other hand, it may take 1 to 2 hours for peak blood concentrations of Xanax to build up in your body.

 

How long does hydroxyzine last vs Xanax?

The effects of hydroxyzine typically last 3 to 4 hours, while the effects of Xanax last 4 to 6 hours.

 

Hydroxyzine vs Xanax: side effects

While hydroxyzine and Xanax have a few potential side effects in common, they each come with their own more common side effects:

hydroxyzine vs xanax side effects


Can you take hydroxyzine and Xanax together?

Hydroxyzine and Xanax should not be taken together. Taking them together can increase the side effects of both medications.

Hydroxyzine vs Xanax: withdrawal

While hydroxyzine is considered safe for long-term use, Xanax (and other benzodiazepines) are typically prescribed for shorter-term use. Hydroxyzine typically does not cause withdrawal symptoms if you stop taking it. If you plan to stop it, you should still only do under your doctor or prescribing nurse’s instructions. Xanax, however, can cause symptoms of withdrawal, especially if you stop taking it suddenly.

 

Symptoms of Xanax withdrawal include:

  • Anxiety
  • Changes in blood pressure
  • Difficulty sleeping
  • Dizziness
  • Fast heart rate
  • Irritability
  • Nausea
  • Seizures
  • Tremors

 

Seek medical attention immediately if you experience signs of withdrawal from Xanax.

 

To avoid withdrawal when going off Xanax, it is important to work with your doctor, prescribing nurse, or a Minded professional to develop a plan to gradually taper the dose of this medication.

Final thoughts on hydroxyzine vs Xanax

Even though these are two different types of medications, hydroxyzine and Xanax have several similarities.

 

Both hydroxyzine and Xanax are:

  • Approved to treat anxiety
  • Used off-label to help with sleep difficulties/insomnia
  • Fast-acting (usually provide symptom relief within hours, compared to weeks for SSRIs)
  • Taken in multiple doses throughout the day for anxiety—or before bed when used for sleep

 

On the other hand, when considering hydroxyzine vs Xanax, there are several key differences to be aware of.

 

Key differences between hydroxyzine and Xanax

Whether each can be taken during pregnancy and/or while breastfeeding:

  • Hydroxyzine may be taken during the second and third trimesters (except right before or during labor). It should not be taken while breastfeeding.
  • Xanax should not be taken during pregnancy or while breastfeeding.

How long they are typically prescribed for:

  • Hydroxyzine is considered safe for long-term use.
  • Xanax (and other benzodiazepines) are usually prescribed for short-term use (typically weeks or months).

Whether they can cause dependency or withdrawal if stopped suddenly:

  • Hydroxyzine usually does not cause withdrawal if stopped suddenly.
  • Xanax can cause withdrawal symptoms if stopped suddenly. It should be tapered under the supervision of a doctor or prescribing nurse.

 

Your doctor, prescribing nurse, or the experts at Minded can help you decide which medication, hydroxyzine vs Xanax, may be the better choice for your anxiety or insomnia treatment.

 

‍Sources referenced:

https://www.mayoclinic.org/drugs-supplements/hydroxyzine-oral-route/description/drg-20311434

https://www.nami.org/About-Mental-Illness/Treatments/Mental-Health-Medications/Types-of-Medication/Alprazolam-(Xanax)

https://www.health.harvard.edu/mind-and-mood/benzodiazepines_and_the_alternatives

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6007645/

https://www.dea.gov/sites/default/files/2020-06/Benzodiazepenes-2020_1.pdf

https://www.nami.org/About-Mental-Illness/Treatments/Mental-Health-Medications/Types-of-Medication/Hydroxyzine-(Vistaril-Atarax)

https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm?event=overview.process&ApplNo=010392

https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm?event=overview.process&ApplNo=040604

https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm?event=overview.process&ApplNo=040010

https://my.clevelandclinic.org/health/diseases/15427-urinary-retention

https://www.mayoclinic.org/drugs-supplements/alprazolam-oral-route/proper-use/drg-20061040

https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=388e249d-b9b6-44c3-9f8f-880eced0239f

https://health.clevelandclinic.org/what-does-it-mean-if-my-medication-has-a-black-box-warning/

https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=c271f97f-040e-492b-9194-2c8b74675a95


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