Hydroxyzine vs Xanax: Comparison and Side Effects

By Zina Semenovskaya, MD
Medically reviewed checkmarkMedically reviewed
June 24, 2022

As the most common mental health condition, anxiety impacts more than 30 percent of American adults at least some time in their lives.

While many manage their anxiety through treatments such as therapy and lifestyle changes, for many others, medication is an effective way to address their condition and improve their quality of life.

Two common anxiety medications are hydroxyzine and alprazolam (Xanax).

Although both treat acute anxiety, each is unique.

In this article, I’ll explain the differences between these two anti-anxiety drugs, how quickly they provide relief, potential side effects, and drug interactions.

I’ll also cover the risks associated with both medications and when you should see a doctor about anxiety.

Chat with a medical professional today and see if hydroxyzine is right for you.
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Hydroxyzine vs Xanax: Which Is Better?

Hydroxyzine and Xanax are approved by the U.S. Food and Drug Administration (FDA) to treat anxiety.

While they have a similar use, they work differently.

Hydroxyzine is a first-generation H-1 receptor antihistamine, much like diphenhydramine (Benadryl), but with more pronounced sedative and anticholinergic effects and with a notable ability to treat anxiety. (Benadryl is not prescribed for anxiety purposes.)

Hydroxyzine is most often prescribed for generalized anxiety disorder (GAD) and acute episodes of anxiety. Hydroxyzine plays a role in reducing histamine response in the central nervous system.

It can also help the brain retain more serotonin for use, which is likely why it’s effective for anxiety. Serotonin helps provide feelings of calm and well-being.Hydroxyzine requires a prescription.

It is available as a generic (hydroxyzine hydrochloride) or as hydroxyzine pamoate sold under the brand name Vistaril.

Hydroxyzine is available as an oral tablet, oral capsule, or oral liquid. It can also be offered as an injectable drug, but this is less commonly prescribed for at-home anxiety use.

Dosages range from 10-100 milligrams (mg), up to four times per day as needed.You do not have to take hydroxyzine consistently to experience benefits.

It does not prevent anxiety; instead, it addresses symptoms of anxiety when they arise. Hydroxyzine is typically intended for short-term use, or less than four months.Alprazolam (Xanax) is a benzodiazepine. It is FDA-approved for the treatment of anxiety and panic disorder. 

Unlike hydroxyzine, Xanax is a controlled substance. Long-term use can lead to dependence and addiction, especially if it is taken incorrectly. It is typically prescribed for short-term use, up to four months.

Even within that timeframe, Xanax can lead to withdrawal symptoms or dependence. This is more likely to occur with higher doses, such as 4 mg or more per 24-hour period. 

Xanax is available as immediate-release or extended-release tablets, dissolvable tablets, or an oral liquid. Dosages range from 0.25-2 mg, up to three times per day as needed.

Research does not directly compare these two drugs, but according to a study that compared hydroxyzine to a drug similar to Xanax, both provide similar relief for anxiety-related symptoms.

Medical providers consider the following to determine whether Xanax or hydroxyzine is best for a patient:

  • Your medical history
  • Your medical conditions
  • Other medications, over-the-counter medicines, or supplements that you take
  • Any risks you have for drug dependence

How quickly does hydroxyzine take to work?

Hydroxyzine starts to work quickly, typically within 15-30 minutes.

The full effect of the dose is usually felt within two hours, and the calming effects are usually felt for 4-6 hours

How quickly does Xanax work?

Xanax takes effect quickly, usually within an hour of taking the medication. The calming effects typically last for 8-12 hours.

Common Side Effects

Both hydroxyzine and Xanax have adverse effects.

Some may be mild and may improve over time.

Others can be serious and should be reported to a healthcare provider.

Hydroxyzine

Hydroxyzine side effects may lessen in severity as your body gets used to the medication.

Your doctor may also lower your dose if the side effects interfere with your quality of life.

Common side effects of hydroxyzine include:

  • Sleepiness, daytime drowsiness, or fatigue
  • Nausea
  • Dry mouth
  • Dry eyes
  • Headache

Xanax

Xanax side effects are usually more noticeable at higher doses.

They include:

More Serious Side Effects

Hydroxyzine and Xanax can also cause serious side effects.

Seek emergency care or call 911 if you experience seizures, trouble breathing, or thoughts of suicide.

If you experience any other serious adverse effects, inform your doctor immediately.

Neither Xanax nor hydroxyzine are considered safe during pregnancy or breastfeeding. If you are pregnant or could be pregnant, tell your doctor before taking either medication.

Hydroxyzine can cause serious complications if you have certain medical conditions, including a prolonged QT interval. Inform your doctor if you have a history of heart attack, heart failure, or heart disease.

Xanax can worsen certain medical conditions such as sleep apnea or obstructive pulmonary disease. Again, tell your healthcare provider about any conditions you have.

Hydroxyzine

Stop taking hydroxyzine and seek medical care if you experience any of these side effects:

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

Xanax

If you experience any of the below severe side effects of Xanax, contact your medical provider immediately or seek emergency medical help:

  • Poor concentration and memory function
  • Confusion
  • Slow reaction time and decreased motor coordination
  • Increased anxiety and/or depression
  • Social phobia
  • Thoughts of suicide or self-harm

If you take Xanax regularly, do not stop taking it suddenly, as this can lead to withdrawal or serious side effects. 

Drug Interactions

Hydroxyzine and Xanax have a significant number of drug interactions.

Tell your doctor and pharmacist about all of the prescription medications, over-the-counter (OTC) drugs, and herbs or supplements that you take.

This can help prevent complications.

Hydroxyzine

Do not take hydroxyzine with the following:

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

This is not a complete list of all potential interactions.

Your pharmacist can determine if there are other interactions specific to your medications.

Xanax

Do not take Xanax with the following:

  • Triptans like sumatriptan, zolmitriptan, rizatriptan, and others
  • Tricyclic antidepressants (TCAs) like amitriptyline, nortriptyline, and others
  • Selective serotonin reuptake inhibitors (SSRI) like citalopram, escitalopram, fluoxetine, paroxetine, and others
  • SNRI antidepressants like duloxetine, venlafaxine, and others
  • Anticoagulants
  • Opioid painkillers like codeine, hydrocodone, morphine, tramadol, and others
  • Alcohol
  • Sedating antihistamines like diphenhydramine, hydroxyzine, and others
  • Anticonvulsants like gabapentin, phenobarbital, pregabalin, and others
  • Herbal supplements like St. John’s wort
  • Muscle relaxants like baclofen, cyclobenzaprine, metaxalone, and others
  • Macrolide antibiotics like azithromycin, erythromycin, and others
  • Azole antifungals
  • Contraceptives
Chat with a medical professional today and see if hydroxyzine is right for you.
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Habit Forming

Some types of medications can become habit-forming, meaning your brain becomes dependent on them.

Some people refer to this as addiction.

Hydroxyzine

Hydroxyzine is not generally habit-forming.

It has no risk of addiction or dependence, although you may notice symptoms if you stop taking it. 

Keep in mind, hydroxyzine is not preventive and is only meant to be taken as needed.

It does not address the causes of anxiety but eases anxiety symptoms during acute episodes.

Xanax

Xanax is a controlled substance because it has a high potential to be habit-forming.

This is particularly true at higher doses, if it is used longer-term, or if it is used incorrectly.

Benzodiazepines like Xanax can lead to emotional or physical dependence in some cases even if taken as directed. This can happen in as little as two weeks of daily use

When to See a Doctor

If you experience anxiety and it interferes with your daily life, talk to a healthcare provider.

They can discuss your treatment options, which may include medication, therapy, lifestyle changes, or a combination of treatments.

Also see your doctor if you take hydroxyzine or Xanax and wish to change your dosage or medication for any reason.

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.

K Health does not prescribe controlled substances such as xanax.

Frequently Asked Questions

What’s stronger, hydroxyzine or Xanax?
Medications impact people differently based on many factors, including age, other medications taken, health conditions, and genetics. The strongest anti-anxiety medication for you is not necessarily the same for someone else. A healthcare provider can assess your symptoms and identify a medication that will provide relief with the fewest potential side effects.
Does hydroxyzine work like Xanax?
While both hydroxyzine and Xanax work to address anxiety, they are different drugs with different mechanisms of action. Hydroxyzine impacts histamine receptors and serotonin, which can have a calming effect on the brain. Xanax produces a similar effect by increasing a different neurotransmitter (gamma-aminobutyric acid, or GABA) in the central nervous system.
Does hydroxyzine calm you down?
Hydroxyzine increases serotonin levels in the brain. Serotonin is a neurotransmitter that helps provide feelings of mental stability. Hydroxyzine also impacts histamine receptors, which can have a sleepy or drowsy effect on the central nervous system and brain. Both of these effects lead to a general decrease in anxiety, tension, and panic and help you feel calmer. A side effect may include feelings of daytime drowsiness or sleepiness.
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.

K Health has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references.

Zina Semenovskaya, MD

Dr. Semenovskaya specializes in emergency medicine, and received her medical degree from Weill Cornell Medical College. She is currently the medical director at Remote Emergency Medicine Consulting, LLC and splits her time working clinically as an emergency medicine attending in California and Alaska. She is the first of our doctors to be fluent in Russian.

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