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.
Hydroxyzine, often referred to as hydroxyzine hydrochloride/HCL (tablet and liquid version) or hydroxyzine pamoate (capsule and liquid version) is a prescription antihistamine medication that's FDA-approved for the treatment of anxiety.
But can an antihistamine reduce anxiety? Does it have any dangerous side effects? Can the drug treat sleep disorders as well? And is the brand-name version more effective?
In this article we'll answer all of these questions and more, as we analyze research studies on hydroxyzine to determine if it's safe and effective for treating anxiety and sleep disorders.
We'll also document side effects of the drug, explain whether the branded version is more effective, and discuss whether or not you need to abstain from alcohol while using hydroxyzine.
Key takeaways:
- Clinically shown to reduce anxiety scores
- Equally effective to benzos in one study
- Highly favorable side effect profile compared to harsher anxiety drugs in our opinion
Does Hydroxyzine Reduce Anxiety?
Hydroxyzine has been approved by the FDA since 1956, so there are a large number of clinical trials testing its effectiveness for anxiety reduction.
A clinical trial on hydroxyzine for anxiety found that at a daily dose of 50 milligrams (mg), it was more effective than placebo to a statistically significant degree, both after 1 week and after 4 weeks.
A medical review published in the Evidence-Based Practice journal evaluated results from five clinical trials on hydroxyzine for anxiety.
The researchers found that hydroxyzine was more effective for generalized anxiety disorder (GAD) than placebo, and was similarly effective to other first-line anxiety treatments such as benzodiazepines (benzos).
A 2011 case report documented hydroxyzine used in the treatment of panic disorder in one patient.
The patient was administered hydroxyzine while actively experiencing a panic attack, and the drug not only caused the panic attack to subside, but the patient didn't experience panic attacks for over a month after that single dose.
While this is useful information, we don’t believe it’s enough data to suggest that hydroxyzine is effective for panic disorder overall.
We can conclude from the above-linked research that hydroxyzine is effective for anxiety, which is unsurprising as the medication is approved by the FDA for that indication.
Does Hydroxyzine Cause Side Effects?
Like most pharmaceutical medications, hydroxyzine carries a risk of side effects that patients and their doctors have to balance against the benefits.
A medical review compared the side effects of hydroxyzine against placebo. Overall side effects were reported in 52% of hydroxyzine patients versus 35% of patients taking placebo, suggesting a "real" side effect rate of 17%.
Sleepiness was 14% more common in the hydroxyzine group, weight gain was 2% more common and dry mouth was 9% more common.
The benefit of hydroxyzine compared with more common types of anxiety medications like selective serotonin reuptake inhibitors (SSRIs) is that its side effect profile seems relatively mild.
The FDA label even notes that side effects reported with use of hydroxyzine are “usually mild and transitory in nature.”
Hydroxyzine's FDA label has no “black box” warning, which is a warning required by the FDA on labels of medications with serious side effect risks, and this type of warning is quite common in anxiety medications.
Our Zoloft reviews article highlighted how that medication, which is often prescribed for anxiety and panic disorders, carries a black box warning indicating it can increase suicide risk.
We consider hydroxyzine's side effect profile to be favorable compared to other anxiolytic (anti-anxiety) medications that we've reviewed to date on Illuminate Health.
Does Hydroxyzine Improve Sleep?
As we reported in the side effects section of this article, hydroxyzine may increase sleepiness.
Taking hydroxyzine to treat sleep disorders is an "off-label" use of the drug, because the medication is not currently approved by the FDA for the treatment of sleep disorders.
While there are a few case reports and studies on hydroxyzine for insomnia in very specific circumstances, we can't find any research proving it’s effective for healthy patients with insomnia.
A review on pharmacotherapy for insomnia concluded the following in regard to the use of hydroxyzine for sleep:
“there are few data to support its efficacy or safety for this indication.”
We tend to recommend melatonin as a first-line treatment for sleep, because it’s extremely safe and non-toxic as we highlighted in our is melatonin safe article.
Patients with more extreme sleep disorders may necessitate a prescription sleep medication, but patients with minor sleep disorders could consider speaking with their doctor about melatonin (which does not interact with hydroxyzine according to the drug's label).
Does Hydroxyzine Interact With Alcohol?
Patients are often curious about whether hydroxyzine has a negative interaction with alcohol or requires that users abstain from alcohol use, given that some anti-anxiety drugs have this interaction.
While the drug's FDA label does not state that alcohol use must be stopped while on the drug, it cautions that "the effect of alcohol may be increased."
This suggests that hydroxyzine has a potentiating effect on alcohol, and that users should avoid driving or operating any heavy machinery after using both hydroxyzine and alcohol.
Given this warning, we would recommend that patients with alcohol use disorders or even moderate alcohol use speak with their doctor about alternative anxiety drugs that do not have negative interactions with alcohol.
Is the Brand-Name Version Better?
Hydroxyzine is the name of the generic drug, and the branded version is called Vistaril.
As we referenced in our Vistaril reviews article, we typically recommend that patients speak with their doctor about the generic version of a drug, because prices may be lower but efficacy should be similar.
A medical review published in the PLOS Medicine journal analyzed millions of data points to compare the effectiveness of generic versus brand-name drugs, and concluded that generic drugs were equally effective.
This result is unsurprising given that generic and brand-name drugs contain the same active compound, but it's useful to see it confirmed in clinical research.
This suggests that hydroxyzine should be just as effective as brand-name Vistaril, but may be cheaper.
The retail price of Vistaril (brand-name version) is currently around $15 according to GoodRx.
The retail price of hydroxyzine (generic version) is currently under $7 at Cost Plus Drugs.
How Does Hydroxyzine Work?
It’s important for patients to understand how their medications work.
While researchers haven’t entirely confirmed hydroxyzine's mechanism of action, it’s been suggested that the drug is an antagonist at receptors in the brain that influence serotonin metabolism.
Serotonin is a neurotransmitter that influences mood and sedation, so patients with anxiety disorders may have irregular metabolism of this compound, and hydroxyzine seems to normalize this process.
The above-linked medical review suggests that hydroxyzine’s anti-anxiety activity is also caused by its “suppression of certain subcortical regions.”
This suggests that overactivity in these regions contributes to the patient’s anxiety.
Hydroxyzine Dosage
According to a 2017 medical review, hydroxyzine's dosage in adults typically ranges from 25 mg to 100 mg, and is taken in three to four daily doses.
This equates to a total daily dose range between 75 mg and 400 mg.
Those prescribed hydroxyzine for allergies may use a dose lower than 75 mg.
Typically, a doctor will prescribe a dose on the lower end of the range (like 100 mg total daily dose) to test the patient's response.
If the patient responds favorably to a relatively low dose, this may not only be cheaper for the patient in the long run, but may also minimize the risk of side effects, because that risk tends to scale with dose.
Our Mental Wellness Picks
Brightside Health is our top overall mental wellness pick.
It's a highly-rated online therapy platform, and 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.
Pique Japanese Sencha Green Tea is our top natural mood support pick.
Green tea has been clinically shown to have an antidepressant effect and also to significantly reduce stress levels.
Pique's tea is 100% organic and free of any unhealthy ingredients.
