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.
Vistaril is a prescription medication which is approved for the treatment of anxiety by the Food and Drug Administration (FDA) in the U.S.
It’s the branded version of a generic drug called hydroxyzine. These two drugs contain the exact same active ingredient, so we’ll refer to them interchangeably throughout this article.
This drug is actually an antihistamine, which is somewhat unique, considering that most of the anxiety medications we’ve previously reviewed such as fluoxetine belong to a class of drugs called Selective Serotonin Reuptake Inhibitor (SSRI). Antihistamines are typically prescribed to treat allergy symptoms.
In this article we’ll review medical studies conducted on Vistaril to determine if it’s safe and effective for the treatment of anxiety, as well as explain how it works. We’ll also highlight a natural anxiety alternative available over-the-counter (OTC) that patients may want to consider and speak with their doctor about.
Vistaril For Anxiety
For a medication to be approved by the FDA, it has to be effective on average for treating the stated health condition. Since Vistaril is approved for the treatment of anxiety, that means it will help the majority of patients.
A clinical study on Vistaril for anxiety published in the French L’Encéphale medical journal found it was more effective than a placebo pill to a statistically significant degree, both after 1 week and after 4 weeks. This study was published in 1994, proving how long Vistaril has been used to treat anxiety.
This is a good result, considering that many prescription medications take weeks to reach their full efficacy. Vistaril appears to work quickly.
A more recent medical review published in 2020 evaluated five different clinical trials on Vistaril for anxiety. The researchers found that the drug was more effective for generalized anxiety disorder (GAD) than placebo, and that it was similarly effective to other first-line treatments for anxiety such as benzodiazepines.
It’s worth noting that much of the medical research proving Vistaril’s efficacy is on patient populations with GAD, which is a less severe form of anxiety than a condition like panic disorder.
We were only able to find one clinical study testing Vistaril on patients with panic disorder. It was a case report, meaning the study documented the positive effects of the treatment on one patient. While this is a good early sign, we don’t believe it’s enough information to suggest that Vistaril is effective for panic disorder overall.
We can conclude from the above-linked research that Vistaril is effective for treating anxiety.
Vistaril Side Effects
Like many pharmaceutical pills, Vistaril confers a risk of side effects that patients and their doctors have to balance against the benefits.
The medical study from 1994 linked in the previous section compared the side effects of Vistaril against placebo. Overall, 52% of Vistaril patients experienced side effects, versus 35% of placebo. This is a relatively high side effect rate.
Sleepiness was 14% more common in the group taking Vistaril, dry mouth was 9% more frequent and weight gain was 2% more frequent.
One benefit of Vistaril compared with many types of anxiety medications like SSRI is the side effect profile seems relatively mild. The FDA label for the medication even notes that side effects reported with use of Vistaril are “usually mild and transitory in nature.”
Vistaril’s label contains no “black box” warning, which is the most severe warning required by the FDA, and which is quite common in anxiety medications. Our recent review of another anxiety medication called venlafaxine highlighted how that medication carried a black box warning indicating it may increase suicide risk.
Overall it seems as though Vistaril’s side effect profile is much less concerning in comparison with other popular anxiolytic (anti-anxiety) prescription drugs.
How Does Vistaril Work?
We believe it’s important for patients to understand how their medications work, as we believe it may give them a better understanding of what type of medications work well for their condition(s).
While medical studies haven’t entirely clarified why Vistaril is effective for anxiety, it’s been theorized in medical reviews 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 Vistaril seems to normalize this process somewhat. In patients with low levels of serotonin, Vistaril may normalize serotonin levels, but this is entirely theoretical at this point.
The above-linked medical review suggests that Vistaril’s anxiolytic effect is caused by its “suppression of certain subcortical regions”. This suggests that overactivity in these regions is the cause of some patients’ anxiety.
Generic Vs. Branded Version
Hydroxyzine is the name of the generic drug, and the branded version is called Vistaril.
These two names refer to the exact same chemical compound, and so patients are often curious about whether one is likely to be more effective than the other.
We typically recommend patients speak with their doctor about the generic version of a drug because it’s typically cheaper, and should be just as effective.
An extensive medical review published in the PLOS Medicine journal compared the efficacy of generic versus brand-name drugs, and found that generic drugs were just as effective on average.
This result makes sense, given that generic and brand-name drugs are the same compound, but it’s useful to see these results verified in clinical research.
Vistaril For Sleep
Many antihistamines, Vistaril included, may cause drowsiness as a side effect. Taking Vistaril to improve sleep would be an off-label use of the drug and not one we recommend. We would consider the potential sedative effect of the drug as a secondary benefit for patients with sleep disorders, but not a cause for sole use of the drug.
While there are a few case reports and studies on Vistaril for treating insomnia in very specific circumstances, we haven’t found any research proving the medication is effective for healthy patients with insomnia.
A review of pharmacotherapy for insomnia reported that “there are few data to support [Vistaril’s] efficacy or safety for this indication.”
We typically 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 during pregnancy review article. Patients with more extreme sleep conditions might require a prescription sleep medication, but we believe that patients with more minor sleep conditions should speak with their doctor about melatonin.
Atarax Vs. Vistaril
Atarax is a prescription medication with the same base chemical compound as Vistaril. Atarax contains hydroxyzine hydrochloride as the active ingredient, while Vistaril contains hydroxyzine pamoate. Patients are often curious about whether one drug is more effective than the other.
We cannot find any medical research testing the two compounds against one another, and since both were approved by the FDA we would consider them equivalently effective.
Vistaril is formulated as a liquid and capsule while Atarax is formulated as a liquid and tablet.
Atarax appears to have been discontinued at least in the U.S. market, but not for safety reasons. The manufacturer may have discontinued production for business reasons.
According to StatPearls, which is one of the largest free medical databases in the U.S., the Vistaril dosage for adults typically ranges from 25 mg to 100 mg, and is taken three to four times daily. This equates to a wide total daily dose range of 75 mg to 400 mg.
Patients taking Vistaril for its anti-allergenic effect typically are prescribed a lower dose than those taking it to reduce anxiety.
Doctors will typically start patients on a lower dose of the medication and only increase dosage if the patient isn’t benefitting. If a patient that can achieve the desired effects at a lower dose, that’s generally safer because higher doses of medications generally increase the risk of side effects.
Vistaril User Reviews
Vistaril has been reviewed over 200 times on Drugs.com, which is an online resource where patients can publish their experience taking prescription medication. We cannot verify the accuracy or authenticity of any user reports from this site.
Vistaril’s average rating for treating anxiety on Drugs.com is 5.4/10, which is relatively low.
The top positive review is published by a user named “NatS” who claims the drug was a safer option for them than benzodiazepine drugs:
“I’ve been taking Vistaril for anxiety on and off for years. More consistently for the past two years, it truly does help with anxiety, and is far safer than Benzo’s. I got hooked on benzos and had to withdrawal over a year- that was fun (insert sarcasm).”
The top negative review is written by a used named “Manny” who claims the drug caused uncomfortable side effects:
“This does little if nothing for me. Causes severe dry mouth which can lead to tooth decay.”
We would like to note that we didn’t come across any reports of tooth decay as an adverse event in medical studies, and we don’t believe that an antihistamine would have the capacity to cause tooth decay, so we consider this association unlikely.
Natural Alternative for Anxiety
In most of our articles we like to highlight a more natural alternative to pharmaceutical medication, that patients may wish to speak to their doctor about.
In some cases, if the health condition is less severe, it seems to make logical sense to try a natural product first such as a vitamin or supplement which may have lower risk of side effects than pharmaceutical medication. We’re not suggesting that dietary supplements are as effective as prescription medications, just that they may be a good option for mild-to-moderate conditions.
Ashwagandha is a plant that’s often prepared into a root extract to treat anxiety, and this supplement has been shown in numerous medical studies to be safe and effective as an anxiolytic.
A recent clinical study published in the well-respected Medicine journal evaluated the stress-relieving effect of ashwagandha extract at a daily dosage of 240 milligrams (mg). The study is placebo-controlled and double-blind which is the gold standard in medical research for objective and unbiased data.
The researchers found that ashwagandha use reduced anxiety to a statistically significant degree, caused reductions in morning cortisol levels (which is a stress hormone that gets dysregulated in anxiety disorder), and even increased testosterone in males.
A meta-study of herbal treatments for psychological disorders concluded the same: ashwagandha can reduce stress and cortisol levels in anxious patients.
When choosing an herbal supplement, we recommend only purchasing from companies that publish independent test results proving their products are accurately labeled and have safe levels of contaminants like heavy metals.
The supplement industry is much less standardized and regulated than the pharmaceutical industry, so it’s important to vet any suppliers thoroughly. Companies that won’t provide test results proving their products are safe are not worth trusting in our opinion.