Disclaimer: None of the information in this article constitutes medical advice. All statements are merely the opinion of the writer(s). We recommend that patients follow their doctor’s guidance in regard to prescription medication.
Atarax is a prescription drug used for the treatment of anxiety and allergic itching. It’s approved by the Food and Drug Administration (FDA) to treat these conditions.
Atarax is the brand-name version of the drug, and the generic version is called hydroxyzine. These two names refer to the exact same active chemical compound, so we will refer to them interchangeably throughout this article.
It’s uncommon for an antihistamine to be prescribed to treat anxiety, given that this class of drugs is typically only used for allergy symptoms, and is typically available over-the-counter (OTC) without requiring a prescription.
But is Atarax actually proven to be effective for anxiety reduction? Does it cause side effects? How do real users respond to the drug? And has it been discontinued?
In this article we’ll answer all of these questions and more as we review clinical studies on Atarax to determine if it's effective for anxiety and to document its side effects. We'll share a real, unsponsored review of the drug and explain if the generic version is as effective as the branded version.
Does Atarax Reduce Anxiety?
Atarax has been primarily studied as an anxiety treatment, and there exist many medical trials examining whether the drug is effective for this condition, as we documented in our hydroxyzine for anxiety reviews article.
A medical trial on Atarax for treatment of anxiety which was published in 1994 (proving how long this drug has been on the market) found that it worked better than a placebo pill both after one week and after four weeks.
Given that many anxiety medications take weeks to start working, it's a good sign that Atarax appears to work rapidly.
A more recent medical study analyzed five different medical trials on Atarax for anxiety. The study authors documented that Atarax reduced symptoms of Generalized Anxiety Disorder (GAD), and that it was similarly effective to other pharmaceutical treatments for anxiety such as benzodiazepines (benzos).
Given that benzodiazepines may have more addictive potential, this is a promising sign.
We located one case report that trialed Atarax on a patient experiencing a panic attack. Not only was Atarax effective at mitigating the active panic attack, but the patient didn't experience any panic attacks in the month following, even though he had been experiencing three panic attacks per day prior.
We will conclude from the available research that Atarax is successful for treating anxiety and may be successful for treating panic, but more research is needed on the latter condition.
Atarax Side Effects
Atarax does cause side effects, but its side effect profile appears to be less severe than many prescription anxiolytic (anxiety-reducing) drugs.
Clinical research shows that 52% of Atarax patients experienced side effects while taking the drug, compared with only 35% of those taking placebo pills. This suggests a "true" side effect rate of 17%.
Those taking Atarax were 14% more likely to experience sleepiness than those taking placebo, and those taking Atarax were also more likely to experience dry mouth and weight gain (9% more and 2% more, respectively).
Atarax’s label does not contain a “black box” warning, which is reqired by the FDA when a medication can cause severe and life-threatening side effects. As an example, we recently reviewed a prescription drug called Linzess with a black box warning indicating the drug can cause severe dehydration in children.
Overall, Atarax does cause side effects in some patients but the severity of the side effects seems less worrisome when compared to other medications used to treat anxiety.
Real, Unsponsored User Review of Atarax
One of the most popular YouTube reviews of Atarax comes from a creator named Torie Brame. She shares her experience on the medication including benefits and side effects, and the video is unsponsored.
The video is titled hydroxyzine but keep in mind that's the generic form of the drug which is the same thing:
Should I Take Generic Atarax?
Hydroxyzine is the generic version of the drug, while the branded version is called Atarax. Patients are often curious about whether one version is more effective than another.
While we can’t recommend one drug over another, we typically recommend that patients speak with their doctor about hydroxyzine rather than Atarax, because it’s typically cheaper to purchase the generic version, and it should work just as well.
An extensive medical study published in the PLOS Medicine journal compared whether branded or generic drugs were more effective, and the study authors reported that generic drugs were just as effective on average.
This result is what one would expect, considering that generic and brand-name drugs contain the same compound.
Atarax Vs. Vistaril
Vistaril and Atarax use the same base chemical compound and have a very similar formulation. Atarax has hydroxyzine hydrochloride as the active ingredient, while Vistaril has hydroxyzine pamoate. Patients are often curious about which drug has superior efficacy.
Unfortunately there doesn’t appear to be any medical studies testing the two drugs against one another. Because both were approved by the FDA, we would consider them equivalently effective and would not recommend one over the other.
Atarax is sold in liquid and capsule form, while Vistaril is formulated as a liquid and tablet. Tablet and liquid formulations may be safer for some elderly patients who have trouble swallowing capsules.
Atarax For Sleep
Many antihistamines such as Atarax cause sleepiness as a side effect. Using Atarax for treatment of sleep disorders on its own would be considered off-label and is not approved by the FDA for this purpose.
The potential sedative effect of Atarax may be a secondary benefit for patients with both anxiety and sleep disorders, but the drug can only be prescribed to treat anxiety or allergic itching.
There does exist some medical research suggesting that Atarax can successfully treat insomnia in hospital settings, but we haven't found any studies proving that the medication is effective for healthy, non-anxious patients with insomnia.
A meta-study of drugs used for insomnia reported the following: “there are few data to support [Atarax’s] efficacy or safety for this indication.”
According to StatPearls, which is a free medical database maintained by the National Library of Medicine in the U.S., Atarax’s dosage generally ranges between 25 milligrams (mg) and 100 mg, and is taken three to four times daily. This equals a broad total daily dose range of 75 mg to 400 mg.
Patients using Atarax for allergies generally take a lower dose than those taking the medication for anxiety.
Doctors will typically prescribe a dose at the lower end of the range, and gradually increase the dose if the patient isn’t experiencing improvements. If a patient can achieve symptom reduction or elimination at a lower dose, they’re less likely to experience side effects than someone taking the drug at a higher dose.
How Does Atarax Work?
Medical studies haven’t cleared up the exact mechanism of action of Atarax, but it’s been proposed in medical reviews that the medication antagonizes receptors in the brain that influence serotonin levels.
Serotonin is a neurotransmitter that is directly linked with mood, emotional state and sedation, so researchers propose that patients with anxiety disorders may have irregular metabolism of serotonin. Since Atarax normalizes levels of this neurotransmitter, it may be effective for patients whose anxiety is caused by dysfunctional serotonin metabolism.
The medical study linked above proposes that Atarax’s anxiolytic effect is also caused by its “suppression of certain subcortical regions.” This suggests that some patients have anxiety caused by overactivity in specific brain regions, which Atarax can successfully treat.
Was Atarax Discontinued?
According to a recent research review, Atarax has been discontinued and is not available for sale in the U.S. It may be available in other countries. It’s unclear why the medication was discontinued, and it’s not due to safety concerns.
The FDA did not require that this drug be pulled from the market, so it seems more likely that the manufacturer simply removed Atarax from the market for business reasons.
We would not recommend purchasing Atarax in jurisdictions where it’s not sold by the manufacturer, because this will increase the risk of a patient receiving fake or altered medication.
Both of the other versions of this drug (hydroxyzine and Vistaril) appear to be available for sale in the U.S. at the time of updating this article.
Our Mental Wellness Platform Recommendation
We recommend a platform called Brightside to patients dealing with mental health issues. It's an online therapy and medication platform that connects patients with licensed doctors and therapists from the comfort of their home.
A medical review published in the Clinical Psychology & Psychotherapy journal found that online therapy was equally effective to in-person therapy for treating depression, anxiety and PTSD. Therapy may be a good first option for patients who want to avoid the side effects of medication.
Brightside also can connect patients with licensed psychiatrists that can prescribe medication. Some patients choose only therapy, some choose only medication, and some choose both. The brand reports that 86% of members feel significantly better within 12 weeks of treatment.
Patients with and without health insurance can use Brightside. For many patients with health insurance, treatment is entirely covered by insurance.
The cost for medication without health insurance is capped at $95/month and the cost for therapy without health insurance is capped at $299/month.
Interested patients can check out Brightside at this link to the brand's website.
Atarax User Reviews
Atarax has been reviewed over 100 times on Drugs.com; a website which allows patients to publish their experience of prescription drugs.
Interestingly, the average rating of Atarax for allergies is much higher (8.4 out of 10) than the drug’s rating for anxiety (5.8 out of 10). The drug’s overall rating is 6.2 out of 10.
The top positive review of Atarax for anxiety is written by a user named “Sleepymama” who claims the drug helped reduce anxiety symptoms during their pregnancy:
“I love this medication. I was prescribed atarax at 35 weeks pregnant for insomnia and panic attacks/GAD. I was having crazy nightmares before I started taking it as well. The first few times I took it, it made me very tired but eventually that stopped happening- it makes it easy for me to fall asleep but not overly tired, and I’m not groggy in the morning.”
The top negative review of Atarax for anxiety comes from a user named “Sam” who gave the drug a 2/10 rating and claims the drug made them too sleepy:
“I took 1/2 tablet for the first time around 6:15 pm and I was out cold by 7 pm. I slept until 7:45 am and had to get up for an appointment. I could barely drag myself out of bed and if I hadn’t only been going 2 miles from home, I wouldn’t have been able to drive myself. I came home and slept on and off til about 3 pm, when I finally started to feel more like normal. I guess you could say it helped my anxiety, because you can’t feel anxious if you’re unconscious!”