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.
Vistaril is a prescription medication which is approved for the treatment of anxiety by the Food and Drug Administration (FDA).
The generic version of this drug is called hydroxyzine, and we'll use these terms interchangeably throughout this article, since they refer to the same active chemical compound.
Vistaril is 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 inhibitors (SSRIs). Antihistamines are typically prescribed to treat allergy symptoms.
But is Vistaril as effective for anxiety relief as SSRIs? Does it cause side effects? Is it more or less effective than the generic version? And how do real users rate and describe its effects?
In this article we’ll answer all of these questions and more, as we review clinical studies on Vistaril to determine how effective it is for treating anxiety, document its side effects, and explain whether the drug can improve sleep.
We'll also compare Vistaril to its generic equivalent and feature unsponsored patient reviews of the drug.
Does Vistaril Reduce Anxiety?
The anti-anxiety effects of Vistaril have been studied in many clinical trials.
A clinical study on Vistaril for anxiety published in the French L’Encéphale journal found it was more effective than a placebo pill to a statistically significant degree, both after 1 week and after 4 weeks.
This is a good result, considering that many prescription medications take weeks to reach their full efficacy. Vistaril appears to work quickly.
A 2020 medical review evaluated results from five clinical trials on Vistaril for anxiety.
The researchers found that Vistaril 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 ("benzos").
We were only able to find one clinical study testing Vistaril in an indvidual with panic disorder.
It was a case report, meaning the study documented how Vistaril resolved panic disorder in 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 available research that Vistaril is effective for treating anxiety, which is unsurprising given that the medication is approved by the FDA for that indication.
Does Vistaril Cause Side Effects?
Like many pharmaceutical drugs, Vistaril confers a risk of side effects that patients and their doctors have to balance against the benefits.
The clinical study published in the French journal linked in the previous section compared the side effects of Vistaril against placebo.
Overall, 52% of Vistaril patients experienced side effects, versus 35% of those taking placebo pills.
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 SSRIs 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 for anxiety medications.
Our recent review of another anxiety medication called venlafaxine highlighted how that medication's black box warning indicated it may increase suicide risk.
Real People Try Vistaril
A YouTube creator named "The Full Time Drama Queen" shared her experience after one full week of using Vistaril:
A TikTok creator named "KjAnxiety" claims to have experienced side effects from Vistaril:
@kjanxiety Its a gift and a curse #anxiety #mentalhealth #hydroxyzine #vistaril #anxietytok #headmeds ♬ original sound - cottonmouth
Is Vistaril Generic as Effective?
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.
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 as branded drugs on average.
This result makes sense, given that generic and brand-name drugs contain the same active drug ingredient, but it’s useful to see these results verified in clinical research.
We would recommend that patients speak with their doctor about hydroxyzine instead of Vistaril, because it has a cheaper retail price and should be equally effective.
The retail price of Vistaril is currently over $18 according to GoodRx.
The retail price of hydroxyzine is currently $7.10 at Cost Plus Drugs.
Does Vistaril Improve 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 as it is not FDA-approved for insomnia.
We would consider the sedative effect of the drug to be a potential secondary benefit for patients with anxiety and sleep disorders.
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 in healthy patients with insomnia.
A review on 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 disorders might require a prescription sleep medication, and should speak with their doctor about what's appropriate.
Patients Review Vistaril
Drugs.com is a website that allows prescription medication patients to rate and review the drugs they're taking.
We cannot verify the accuracy or authenticity of any reviews on this site.
At the time of updating this article, Vistaril has been reviewed over 190 times on Drugs.com, with an average review rating of 5.3 out of 10 for anxiety.
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 user 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 don't consider it likely that there's a causative effect here.
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 for anxiety.
We cannot find any medical research testing the two drugs against one another, and since both were approved by the FDA to treat anxiety we would consider them equivalently effective.
Vistaril is formulated as a liquid and capsule while Atarax is formulated as a liquid and tablet. Capsules may be difficult to swallow and present a choking hazard for some elderly patients.
Atarax appears to have been discontinued in the US, but not for safety reasons. The manufacturer may have discontinued production for business reasons.
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Vistaril Dosage
The dosing range for Vistaril was documented in a 2017 medical review.
Vistaril dosage for adults typically ranges from 25 milligrams (mg) to 100 mg, and is taken three to four times daily. This equates to a total daily dose range from 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 may start patients on a lower dose of the medication and only increase dosage if the patient isn’t benefitting.
If a patient can achieve the desired effects at a lower dose, that can be safer because higher doses of medications generally increase the risk of side effects.
How Does Vistaril Work?
We believe it’s important for patients to understand how their medications work, as 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.
