Hydroxyzine for Anxiety: Usage, Side Effects, and More

By Alicia Wooldridge, MD
Medically reviewed checkmarkMedically reviewed
June 24, 2022

More than 30 percent of adults will experience an anxiety disorder at some point in their lives, making them the most common mental health condition in the United States.

Many people experience anxiety and do not take medications.

However, living with any type of acute or long-term anxiety disorder can significantly affect quality of life.

There are many different types of medications used to treat anxiety.

One common prescription medication that your doctor may use for anxiety is hydroxyzine, a type of antihistamine.

In this article we’ll explore how hydroxyzine treats anxiety, common side effects, precautions, and how to know when to see a doctor.

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Hydroxyzine for Anxiety

Hydroxyzine is a first-generation antihistamine that has been used for many years.

Histamine is a chemical that your body releases as part of its immune response, which then stimulates histamine receptors.

When histamine receptors are stimulated, it can cause symptoms like:

  • Anxiety, panic attacks, and tension
  • Flushing from the dilation of veins
  • Coughing
  • Lung and gastrointestinal contraction (such as asthma, intestinal cramping, or diarrhea)
  • Hives, rashes, and other anaphylaxis symptoms

Because it is an antihistamine, hydroxyzine suppresses the effects of histamine.

It is prescribed for:

  • Itching from hives or contact dermatitis
  • Symptoms of anxiety, including generalized anxiety disorder (GAD)
  • Tension
  • Panic attacks
  • Sedation before general anesthesia

Hydroxyzine is in the same class of drugs as diphenhydramine (Benadryl), which is also a first-generation antihistamine, and cetirizine (Zyrtec), which is a second generation H-1 antihistamine that works in a similar way. 

All these medications act on H-1 histamine receptors.

H-1 receptors are found all over the body, including:

  • Uterine lining
  • Central nervous system (CNS)
  • Cardiac tissue
  • Gastrointestinal tissues
  • Vascular cells
  • Smooth muscle of the lungs
  • Immune cells

Hydroxyzine is not typically used long-term for anxiety, but may be prescribed as a way to relieve symptoms while longer-acting medications become effective.

It may also be used for people who do not have chronic anxiety, but only need occasional relief during stressful moments or episodes.

By blocking the effect of histamine, it can decrease the anxiety-related effect that too much histamine can stimulate.

Hydroxyzine, unlike other antihistamines, also affects serotonin, a brain chemical that helps with feelings of calm, stability, and balance.

Because hydroxyzine can help your brain retain more serotonin, it might have a longer effect on feelings of anxiety and mood.

If insomnia or sleep problems are related to anxiety, hydroxyzine may be doubly impactful by having a sleep-inducing effect while also supporting serotonin levels.

How quickly does hydroxyzine work?

In most cases, patients will start to see effects within 15-30 minutes.

The maximum impact is usually felt within 2 hours of taking a dose.

Side effects may also be felt just as quickly, such as drowsiness.

Until you know how hydroxyzine affects you, you should not drive a vehicle or operate machinery.

Is Hydroxyzine Habit-Forming?

Many types of anxiety medications may be habit-forming.

These include benzodiazepines like Xanax, which is a controlled substance because of the significant risk of addiction, dependence, and potential abuse.

Unlike Xanax, hydroxyzine is not addictive, and will not lead to dependence.

It is not a controlled substance, though it still requires a prescription from a medical provider.

Hydroxyzine Side Effects

Common side effects

Common side effects of hydroxyzine are usually milder for lower doses, and may be more noticeable with a higher dose. They also may wear off as your body adjusts to the medication.

They include:

More serious side effects

Pairing hydroxyzine with other medications or substances that can affect brain chemicals or cause drowsiness, like alcohol, could lead to more serious effects.

Serious side effects of hydroxyzine can include:

  • Seizures
  • Fever
  • Unintentional tremoring, trembling, or shaking
  • Rash or redness of the skin
  • Pus-filled or blister-like sores

Stop taking hydroxyzine if you experience severe reactions, and tell your healthcare provider right away. 

Tell your doctor about other prescription medications, over-the-counter medicines, and supplements or herbs that you are taking, since they all have the potential to interact with drugs, including hydroxyzine.

Hydroxyzine Common Dosage

Hydroxyzine is available as a generic, either as hydroxyzine hydrochloride or hydroxyzine pamoate.

Hydroxyzine pamoate is also available under a name brand as Vistaril.

All these medications have the same active ingredient. 

Hydroxyzine’s dosage depends on your symptoms.

It can be taken as needed, and does not require consistent dosing for effectiveness.

However, hydroxyzine is not meant to be a long-term medication for anxiety relief.

It is typically used for acute relief of anxiety episodes, or to provide support until a longer-acting medication begins to work.

Hydroxyzine is not preventive, but is meant to be taken only as needed.

For anxiety, common dosages range from 25-100 mg up to 4 times daily for adults.

Your prescription will include specific instructions about dosage and frequency.

Follow them closely, since it is possible to overdose on hydroxyzine.

If you experience a lot of side effects, your healthcare provider may reduce the dosage.

Precautions

Hydroxyzine is not a controlled substance and is not habit-forming, but like many other medications, there are important warnings and cautions to be aware of.

Hydroxyzine can interact with many other drugs.

It should also be avoided by people who have certain medication conditions or meet other health-related criteria.

Hydroxyzine drug interactions

Hydroxyzine interacts with many medications.

This is not a complete list.

Check with your healthcare provider and pharmacist to ensure that anything you are taking, or occasionally take, does not interact with hydroxyzine.

Do not take hydroxyzine with any of the following:

  • Other antihistamines
  • Certain antidepressants, such as citalopram (Celexa) or fluoxetine (Prozac)
  • Muscle relaxers
  • Other sleeping pills, sedatives, or tranquilizers
  • Antipsychotics
  • Anti-anxiety medication
  • Anticonvulsant medication
  • Narcotic pain relievers
  • Malaria medication
  • Anti-nausea medications such as ondansetron (Zofran)
  • Certain antibiotics such as azithromycin (Zithromax), clarithromycin (Biaxin), and erythromycin (Eryc)
  • Certain cancer treatments
  • Medications for HIV/AIDS
  • Certain heart rhythm medications such as amiodarone (Cordarone, Nexterone, others), quinidine (Nuedexta), and sotalol (Sorine, Sotylize)

What to avoid

  • Do not take hydroxyzine if you are pregnant or could become pregnant. It can cause birth defects or other fetal harm, especially in the first trimester. There are safer anxiety medications for pregnancy.
  • Do not take hydroxyzine if you are allergic to any active or inactive ingredients that it contains. You should also not take it if you are allergic to cetirizine (Zyrtec) or levocetirizine (Xyzal).
  • Hydroxyzine is not safe for people who have a prolonged QT interval or a history of heart attack, heart failure, or cardiovascular disease.
  • Do not take hydroxyzine if you are breastfeeding.
  • Hydroxyzine may not be safe for people who have or have had a history of low blood levels of potassium or magnesium.
  • Adults over age 65 may experience stronger side effects with hydroxyzine. There are safer medications for anxiety in older people.

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When to See a Doctor

If you have anxiety, or wonder whether hydroxyzine could help manage your anxiety symptoms, talk to your medical provider.

Your healthcare provider will consider your medical history and other medications when they consider the best prescription to address symptoms.

If you have concerns about taking a habit-forming medication for anxiety, hydroxyzine may be a safer alternative, as long as you don’t have any contraindicated health conditions.

While other antihistamines—like diphenhydramine (Benadryl)—are similar and available over-the-counter (OTC), they do not have the same anti-anxiety benefits that hydroxyzine does.

Hydroxyzine requires a prescription from a medical provider and is not available as an OTC option.

If you’re having a mental health emergency, call 911 or go to the nearest emergency room. You can also get free 24/7 support from a suicide and crisis expert by calling or texting 988. If you’d prefer to chat online, you can chat with a suicide and crisis expert by visiting the Lifeline Chat.

How K Health Can Help

Think you might need a prescription for Vistaril (hydroxyzine)?

K Health has clinicians standing by 24/7 to evaluate your symptoms and determine if hydroxyzine is right for you.

Get started with our free assessment, which will tell you in minutes if treatment could be a good fit. If yes, we’ll connect you right to a clinician who can prescribe medication and have it shipped right to your door.

Frequently Asked Questions

How quickly does hydroxyzine work for anxiety?
For acute anxiety, relief may be felt within 15-30 minutes. The maximum effect of the drug is felt within 2 hours. Prescriptions for anxiety are often prescribed 3-4 times per day, but hydroxyzine should only be taken as needed. It will not prevent anxiety.
How does hydroxyzine help with anxiety?
It is not fully understood why hydroxyzine, but not other antihistamines, help anxiety. It is suspected that hydroxyzine's effect on two brain chemicals, serotonin and histamine, allow it to calm anxiety. By acting on serotonin, it increases the amount of this calming neurotransmitter in the central nervous system. By acting on histamine receptors, it can calm histamine-related panic and induce sleep or drowsiness.
Can hydroxyzine stop panic attacks?
Many healthcare providers prescribe hydroxyzine for anxiety or acute panic-related disorders. While there are many medications that can address panic attacks, hydroxyzine may be able to help with anxiety-driven panic attacks in as little as 15-30 minutes.
K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

Alicia Wooldridge, MD

Dr. Alicia Wooldridge is a board certified Family Medicine physician with over a decade of experience.

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