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Hydroxyzine

The word “antihistamine” probably brings to mind TV commercials featuring people with red eyes, runny noses, and other allergy symptoms. But some antihistamines—such as hydroxyzine—may be prescribed to help with a much wider range of conditions, including anxiety and insomnia.

by

Ros Lederman

Medically reviewed by

Lloyd Sederer, MD

February 11, 2022

Hydroxyzine

fast facts.

Pronunciation

hai-draak-suh-zeen

Drug class

Antihistamine

Other names

Vistaril®

Used for

Allergies, Anxiety, Difficulty sleeping, Itching, Nausea, Skin rash, Vomiting

About

Hydroxyzine

What is hydroxyzine?

Hydroxyzine is a prescription antihistamine that is used to treat anxiety and insomnia.

Antihistamines—including hydroxyzine—work by decreasing the effects of histamine. Histamine is a chemical in your body that produces an allergic reaction.

Even though many antihistamines are available over-the-counter (meaning you can purchase them without a prescription), hydroxyzine is a prescription medication.

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

Hydroxyzine for anxiety

In addition to being an antihistamine, hydroxyzine is also a serotonin antagonist, meaning it works in a way that is similar to selective serotonin reuptake inhibitors (SSRIs), which are another type of medication that can be used to treat anxiety. Serotonin is a neurotransmitter that helps balance your mood and impacts feelings of optimism, satisfaction, contentment, and overall well-being. Hydroxyzine increases the amount of serotonin in your brain by stopping it from being reabsorbed into the neurons (nerves in your brain).

When taken for anxiety, the hydroxyzine dosage is usually divided into multiple doses per day. Adults typically take 50 to 100 mg, four times per day, though some people might need higher doses for symptom relief. The maximum recommended dose for children under the age of 6 is no more than 50 mg daily (taken divided into smaller doses).

While you can take hydroxyzine with or without food, if you find that taking it without food upsets your stomach, you may want to try taking it with food. Hydroxyzine can be taken daily at regularly scheduled times or as-needed. Your doctor, prescribing nurse, or Minded professional will provide you with information on when and how frequently to take this medication—and the maximum amount that can be taken in a day.

Hydroxyzine for sleep

Hydroxyzine is sometimes also prescribed to help with difficulty sleeping or insomnia. Just as other antihistamines—such as Benadryl—may make you feel drowsy when you take them, hydroxyzine works in the same way.

While the recommended hydroxyzine dosage for sleep will vary depending on your age and how your body reacts to the medication, the typical adult dose ranges from 25 to 100 mg. This should be taken before bed and can be taken with or without food. Your doctor, prescribing nurse, or Minded professional will work with you to determine the right dose for your needs.

Hydroxyzine for allergies

Because it is an antihistamine—like Benadryl—hydroxyzine is sometimes prescribed to relieve symptoms of allergic reactions. However, hydroxyzine and Benadryl should not be used together.

Hydroxyzine typically helps with skin-related symptoms of an allergic reaction, such as itching or hives. Benadryl, on the other hand, usually helps with red/watery eyes, sneezing, and runny noses.

Hydroxyzine side effects, warnings, and interactions


Hydroxyzine side effects

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 which 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.


Hydroxyzine and blood pressure

In some cases, hydroxyzine can cause low blood pressure. While this side effect was not noted during initial clinical trials before it was approved by the FDA, it has been reported since.


Hydroxyzine interactions

Hydroxyzine and alcohol

You should not drink alcohol while taking hydroxyzine. As with many medications, alcohol can increase the negative side effects—such as sedation—and decrease the benefits. Alcohol can also impair both judgment and memory, which can result in an accidental overdose if you unknowingly take a higher dose of hydroxyzine than what is prescribed.

Symptoms of a hydroxyzine overdose include:

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


Hydroxyzine warnings

Hydroxyzine and pregnancy

If you are pregnant or planning on becoming pregnant, it is important that you discuss your anxiety or insomnia treatment plan with your doctor. Typically, hydroxyzine should not be taken during the first trimester of pregnancy or right before or during labor. However, it can be taken during the second and third trimesters.

Taking hydroxyzine while breastfeeding is not recommended. This is because the medication may be passed to your baby through breast milk.

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Frequently asked questions about hydroxyzine


How long does it take for hydroxyzine to work?

Generally, hydroxyzine is fast-acting compared to selective serotonin reuptake inhibitors (SSRIs). While you may begin to feel its effects within hours of taking hydroxyzine, sometimes your symptoms may start to improve as quickly as 15 to 30 minutes after taking it.


How long does hydroxyzine last?

The effects of hydroxyzine typically last 3 to 4 hours.


Is hydroxyzine the same thing as Xanax?

While hydroxyzine and Xanax are both fast-acting medications that can be taken in multiple doses throughout the day to treat anxiety, they are not in the same class of medication. Xanax is a benzodiazepine (like Ativan). Benzodiazepines are controlled substances that, if not taken as prescribed, may come with a risk of developing a dependence or abusing them. Hydroxyzine, however, is not a controlled substance and does not have a risk of dependence or abuse.

For more information:


Does hydroxyzine make you sleepy?

Hydroxyzine is sometimes prescribed to help with sleep difficulties or insomnia. Feeling drowsy or sleepy after taking hydroxyzine is a common side effect.

For more information:


Does hydroxyzine cause weight gain?

While antihistamines generally may cause weight gain, weight gain is not listed as either a common or rare side effect of hydroxyzine.

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Is hydroxyzine right for you?

Visit Minded and get a free assessment to find out if hydroxyzine could work as your anxiety or insomnia treatment.

Minded offers online appointments with board-certified psychiatrists and nurse practitioners. Appointments are usually available within a week. If you already have a hydroxyzine prescription, Minded can help you refill or renew it online. Our team of professionals also can assist with adjusting your dosage or advising you about other medications that might be a good fit for your needs.

For more information:
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