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).
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.
But is Vistaril as effective for anxiety relief as more common anxiety medications like SSRIs? Does it cause side effects? Is it more or less effective than the generic version? And how do real users respond to it?
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, explain whether the drug can improve sleep and compare it to its generic equivalent.
We'll also share real, unsponsored user reviews of the medication.
Does Vistaril Reduce Anxiety?
Vistaril has been studied in many clinical trials to test whether it can reduce anxiety.
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 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.
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 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 above-linked research that Vistaril is effective for treating anxiety and potentially effective for treating panic attacks.
Vistaril 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 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 for 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.
Real, Unsponsored User Review of Vistaril
One of the most popular YouTube reviews of Vistaril is published by a creator named "The Full Time Drama Queen." She shares her experience after using the drug for one week, including benefits and side effects. The video is unsponsored:
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 are the same compound, 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, as it's often cheaper and should be as effective. SingleCare reports the retail price of Vistaril to be $53.64 at the time of updating this article, while they report the retail price of generic hydroxyzine to be only $15.39.
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 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 reason 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 disorders might require a prescription sleep medication, but we believe that patients with minor sleep disorders should speak with their doctor about melatonin.
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 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.
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 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 at least in the U.S. market, but not for safety reasons. The manufacturer may have discontinued production for business reasons.
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.
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.
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.
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.