Disclaimer: None of the information in this article constitutes medical advice, and is just the opinion of the writer(s) and published for informational purposes only. 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) in the U.S. to treat these conditions.
Atarax is the brand-name version of a medication with a generic name of hydroxyzine. These two drugs contain the exact same active chemical compound, so we will refer to them interchangeably throughout this article. Hydroxyzine is also sold under the brand name Vistaril.
It’s uncommon for an antihistamine to be prescribed to treat anxiety, given that the majority of the anxiety medications we’ve reviewed on Illuminate Health such as Trintellix belong to a class of drugs called Selective Serotonin Reuptake Inhibitors (SSRI). Antihistamines are typically only used for allergy symptoms, and are typically available over-the-counter (OTC) without requiring a prescription. You may be familiar with brand name antihistamines like Benadryl or Claritin.
In this article we’ll review published medical research on Atarax to find out if it’s safe and effective for anxiety, as well as explain how the medication works. We’ll also highlight an herbal supplement used for anxiety that patients may wish to speak to their doctor about.
Atarax For Anxiety
Atarax has been primarily studied as an anxiety treatment, and there exist many medical trials examining how effective the drug is. Many of these same trials were also reviewed 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 prescription pills 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. What the study authors found was that the drug was effective at treating symptoms of Generalized Anxiety Disorder (GAD), and that it was similarly effective to other pharmaceutical treatments for anxiety such as benzodiazepines.
Given that benzodiazepines may have more addictive potential, this is a promising sign.
We located one case report that trialed Atarax on patients diagnosed with panic disorder. The publication documented how the drug successfully treated a patient’s panic. While this is a good early sign, we don’t believe it’s enough information to suggest that the medication is effective for panic disorder overall. We look forward to future trials with a larger patient population testing Atarax for treating panic disorder.
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.
A medical review linked earlier in this article found that 52% of Atarax patients experienced side effects while taking the drug, compared with only 35% of those taking placebo pills. More than 50% of patients experiencing side effects is a relatively high rate.
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% and 2% respectively).
Atarax’s label does not contain a “black box” warning, which is issued 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, while Atarax does seem to cause side effects in a high percentage of patients, the severity of said side effects is less worrisome when compared to other medications used to treat anxiety.
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.
Atarax Generic Vs. Branded Version
Hydroxyzine is the generic version of the drug, while the branded version is called Atarax.
It can be confusing to some patients new to prescription medication, but these two names refer to the exact same active chemical compound. Thus patients are often curious about which version they should take.
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, but this study is a useful tool to convince patients influenced by marketing that generic versions of drugs may be the more logical option.
Atarax For Sleep
Many antihistamines such as Atarax cause sleepiness as a side effect. However, we wouldn’t recommend that patients take the drug for sleep alone, because that would be an off-label use as it’s not approved by the FDA to treat sleep disorders.
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.”
Atarax Vs. Vistaril
Vistaril and Atarax contain the same base chemical compound and contain 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. Tablets may be safer for some elderly patients who have trouble swallowing capsules whole.
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 in the lower end of the range, and gradually up the dose if the patient isn’t experiencing benefit. 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.
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. We cannot verify the accuracy or authenticity of any user reports from this site.
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!”
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.
Natural Anxiety Treatment
While Atarax can successfully treat anxiety, there are also OTC supplemental options that patients may want to consider, that can treat anxiety without many (or any) side effects.
Ashwagandha is a root native to India that’s been studied extensively for anti-anxiety effects, and this supplement has been proven successful.
A recent medical study published in 2019 tested ashwagandha extract supplementation at a daily dosage of 240 mg on patients that reported high stress levels. It was a very well-designed study in our opinion, because it was placebo-controlled and double-blinded, which means that neither the participants nor the researchers knew which group was getting the active treatment and which was getting placebo. This methodology reduces the risk of biased results.
What the study authors found was that ashwagandha supplementation reduced anxiety scores to a statistically significant degree, reduced levels of cortisol (which is a stress hormone that gets dysregulated in patients with anxiety), and even increased testosterone in male subjects.
A meta-review of herbs that can treat psychological disorders found similar results after examining many individual medical trials on ashwagandha: the plant can reduce stress and cortisol levels in anxious patients.
We would recommend that patients only purchase ashwagandha from manufacturers that publish testing data proving their products are accurately labeled, as potent as advertised, and low in contaminants like heavy metals.
The dietary supplement industry in the U.S. has far fewer regulations than the pharmaceutical industry, so it’s important to vet brands extensively. Companies that won’t provide test results proving their products are safe are not worth trusting in our opinion. Testing is much cheaper than manufacturing, so there’s no excuse.