Hydroxyzine is a sedative antihistamine useful for short-term treatment of anxiety and insomnia. Its ability to promote relaxation renders it a beneficial choice in anxiety-induced situations like plane rides.
Anxiety is a serious disorder that impacts more than 20% of the population — probably more who go undiagnosed. It’s normal to seek safe treatments, and hydroxyzine may be right for your unique situation (especially if you don’t want to take a daily medication).
Hydroxyzine provides relief from generalized anxiety disorder (GAD) or insomnia. For many individuals, sleep and anxiety improve together.
We’re typically successful in addressing the root cause of insomnia and anxiety for our patients in a holistic way, but there are instances where medications will be helpful or necessary, too. We always try to choose treatments which will have the greatest benefit with the least amount of harm.
Of the medications that are prescribed for anxiety and insomnia, hydroxyzine is one of the more benign ones.
The PrimeHealth clinic in Denver, Colorado, is your one-stop shop for nervous system rebalance. We have helped hundreds of people like you with anxiety and sleep disorders by combining conventional and alternative treatments that best suit your situation.
What Is Hydroxyzine?
Hydroxyzine is an FDA-approved prescription drug antihistamine that treats allergic reactions (particularly itching), anxiety, and insomnia (trouble sleeping).
If one of my patients suffers with insomnia and anxiety, we first begin with lifestyle changes, integrative therapies, and herbal supplementation to address their concerns. But if I can tell their quality of life has decreased and their concerns aren’t responding to our treatment protocol, I may consider prescribing hydroxyzine for them in the short term.
This drug is available in several forms:
- Tablet
- Syrup
- Capsule
- Injection
Important: Other antihistamines, such as over-the-counter Benadryl (diphenhydramine), do not help with anxiety.
This prescription medication is covered by most insurance plans, such as Medicare. Hydroxyzine’s effectiveness has not been evaluated after 4 months of treatment, so your prescriber may only recommend it in the short term (or for infrequent use).
Hydroxyzine can be found under the brand name Vistaril (hydroxyzine pamoate) or as the generic drug hydroxyzine hydrochloride (formerly marketed as Atarax). Atarax was likely discontinued due to the affordability and availability of generic hydroxyzine, not due to safety concerns.
Store this medicine at room temperature, away from light and moisture.
Is it bad to take hydroxyzine every day for anxiety? It’s okay to take hydroxyzine multiple times every day for anxiety, as long as you’re not using the medication for more than 4 months. Some sources claim hydroxyzine is less effective when used every day, due to tolerance buildup.
Many people with situational anxiety choose to take hydroxyzine only when a situational trigger is imminent. For instance, if you’re nervous about getting on a plane, you may choose to take this medication to calm your anxiety while flying — but don’t necessarily need it during a typical work day.
Comparative Benefits of Hydroxyzine
Hydroxyzine provides quick relief and is not classified as a controlled substance, which typically indicates a lower potential for abuse and addiction.
First-line psychiatry treatments for anxiety or insomnia include:
- SSRI (selective serotonin reuptake inhibitor) antidepressants
- Benzodiazepines such as alprazolam (Xanax) or lorazepam (Ativan)
- Buspirone
- Trazodone
SSRIs are technically classified as a non-addictive medication. However, they’re very difficult to stop taking and come with a large risk of side effects and severe withdrawal symptoms.
Benzodiazepines provide quick relief but have a higher risk of addiction and abuse and are generally recommended for short-term use or in specific situations where rapid anxiety relief is necessary.
Buspirone is a non-addictive medication that is often preferred for the long-term management of anxiety due to its lower risk of dependence.
In general, I’m very slow to prescribe any long-term medications (including hydroxyzine) to my patients until we’ve exhausted non-pharmaceutical routes to resolving their anxiety. All medications come with a risk of side effects and drug interactions, and I find that patients have more sustainable long-term success when we use the least medication possible.
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How to Recognize Anxiety
You can recognize anxiety — and your need for treatments like hydroxyzine — if you know the symptoms of anxiety.
Common anxiety symptoms include:
- Nervousness
- Tension
- Panic attacks
- Uncontrollable worry
- Trouble concentrating
- Ruminating thoughts
- Feelings of impending danger
- Rapid breathing (hyperventilation)
- Increased heart rate
- Sweating
- Trembling
- Trouble sleeping
- Gastrointestinal problems
Types of anxiety include generalized anxiety, agoraphobia, selective mutism, separation anxiety, and many more.
If you think you are experiencing anxiety and desire treatment, talk to your healthcare provider about prescribing hydroxyzine, as well as alternatives that may work better for your unique situation.
How Hydroxyzine Treats Anxiety
Researchers have not officially confirmed how hydroxyzine treats anxiety and insomnia. However, there’s a common sense theory.
Hydroxyzine increases serotonin levels in your brain and blocks histamine activity in the rest of your body. Serotonin is a neurotransmitter that helps balance your mood, and antihistamines lead to drowsiness.
According to multiple studies, hydroxyzine blocks 5-HT2A receptors in the brain, allowing for a build up of serotonin, associated with anxiety regulation and stress responses.
Similar to antidepressants like citalopram (Celexa), sertraline (Zoloft), escitalopram (Lexapro), and fluoxetine (Prozac), hydroxyzine makes more serotonin available in your brain, helping regulate anxiety.
Hydroxyzine is probably best for people with sleep-related anxiety or anxiety-related insomnia — since it helps with both issues.
How quickly does hydroxyzine work for anxiety? Most people start to feel hydroxyzine’s effects (including drowsiness) within 15-30 minutes of taking it. It may take up to 2 hours to feel the full impact.
Read more: Best 12 Vitamins For Stress
Dosage & How to Take
You do not have to take hydroxyzine every day. Some people may benefit from taking it only when anxiety or insomnia symptoms flare up.
The optimal hydroxyzine oral dosage for anxiety and insomnia is personal. However, these are general recommendations:
- Adults: 10-100 mg, up to 4 times a day
- Children aged 6 and older: 10-100 mg per day, given in divided doses
- Children aged younger than 6: Up to 50 mg per day, given in divided doses
For help with sleeping, administer 50-100 mg of hydroxyzine within 15-30 minutes of bedtime.
Overdose Amount
The maximum single dosage is 100 mg for adults. The maximum daily dosage of hydroxyzine is 400 mg. Seek immediate medical attention if you take more than the recommended amount, even if your doctor’s recommended dosage is lower than 400 mg a day.
Precautions
You should not take hydroxyzine if you fall under the following categories:
- You are pregnant (especially during the first trimester)
- You are breastfeeding (hydroxyzine passes through breast milk)
- You are over the age of 65 (side effects seem to be worse for older individuals)
- You have a hydroxyzine allergy
- You are allergic to cetirizine (Zyrtec) or levocetirizine (Xyzal), which contain similar ingredients
- You have prolonged QT interval or a history of heart problems
Do not take hydroxyzine with alcohol or other central nervous system (CNS) depressants like diazepam (Valium) or zolpidem (Ambien). Doing so may cause CNS depression, causing the body’s nervous system to slow down.
Some individuals may benefit from taking hydroxyzine with food. Do not drive or operate heavy machinery after taking hydroxyzine.
Drug Interactions
Certain medications interact in major or minor ways with hydroxyzine. Discuss with your doctor all medications, herbal supplements, and vitamins you take. Your healthcare provider will check if there are any potential drug interactions.
Withdrawal Symptoms
Unlike some anxiety medications, hydroxyzine is not addictive, so it should not cause withdrawal symptoms after you stop taking it.
Missed Dose
If you missed a dose of hydroxyzine, you can take it later. If you’re close to the next dose, however, just skip the previous dose.
Side Effects
What are the side effects of hydroxyzine? The potential side effects of hydroxyzine include the following:
- Drowsiness (expect to need a nap if you take it during the day)
- Fainting
- Blurry vision
- Dry eyes
- Dry mouth
- Nausea
- Upset stomach
- Headache
- Itching
- Hives
- Rash
- Constipation
- Difficulty swallowing
- Irregular heart rhythm
- Swelling around the face
- Chest discomfort
Rare or serious side effects include trembling, trouble breathing, and acute generalized exanthematous pustulosis. Talk to a healthcare professional right away if you experience these or other unexpected symptoms.
Since drowsiness is a common side effect, do not drive or operate machinery when taking hydroxyzine. Talk to your doctor about how hydroxyzine affects you and what activities you should avoid after taking the medication.
Nausea and upset stomach may be prevented by taking hydroxyzine with a meal.
Is hydroxyzine addictive? Hydroxyzine is not addictive. It is not a controlled substance, but you can build a tolerance to it over time, meaning you may need to take higher doses after a few months.
Looking for a Natural Approach to Anxiety Treatment?
Hydroxyzine is an effective short-term solution for anxiety, but there are plenty of more natural anxiety treatments you can also try.
Natural remedies for anxiety include:
- Exercise
- Healthy diet
- Meditation
- High-quality sleep
- Microdosing
- Herbal teas
- Decreasing caffeine intake
- Cognitive Behavioral Therapy
- Psychedelic Therapy
- Green tea
- CBD
- Melatonin
- Acupuncture
At PrimeHealth, we help patients take control of their whole-body health, including their mental well-being, using natural methods whenever possible. Schedule your first appointment now and see the difference our medical advice can make.
Sources
- Bounds, C. G., & Nelson, V. L. (2023). Benzodiazepines. In StatPearls [Internet]. StatPearls Publishing.
- Jenkins, T. A., Nguyen, J. C., Polglaze, K. E., & Bertrand, P. P. (2016). Influence of tryptophan and serotonin on mood and cognition with a possible role of the gut-brain axis. Nutrients, 8(1), 56.
- Kawauchi, H., Yanai, K., Wang, D. Y., Itahashi, K., & Okubo, K. (2019). Antihistamines for allergic rhinitis treatment from the viewpoint of nonsedative properties. International journal of molecular sciences, 20(1), 213.
- Patel, D. R., Feucht, C., Brown, K., & Ramsay, J. (2018). Pharmacological treatment of anxiety disorders in children and adolescents: a review for practitioners. Translational pediatrics, 7(1), 23.
- Xiang, M., Jiang, Y., Hu, Z., Yang, Y., Du, X., Botchway, B. O., & Fang, M. (2019). Serotonin receptors 2A and 1A modulate anxiety-like behavior in post-traumatic stress disordered mice. American journal of translational research, 11(4), 2288.
- Williams, J. L., Everett, J. M., D’Cunha, N. M., Sergi, D., Georgousopoulou, E. N., Keegan, R. J., … & Naumovski, N. (2020). The effects of green tea amino acid L-theanine consumption on the ability to manage stress and anxiety levels: A systematic review. Plant foods for human nutrition, 75, 12-23.
- Li, M., Liu, X., Ye, X., & Zhuang, L. (2022). Efficacy of acupuncture for generalized anxiety disorder: A PRISMA-compliant systematic review and meta-analysis.Medicine, 101(49).
