Does hydroxyzine for anxiety work?

What is hydroxyzine? | Hydroxyzine for anxiety | Side effects | Contraindications | Dosage | Cost

Everyone has felt anxious at some point in their lives. However, when anxiety starts to interfere with your daily life on a regular basis, you might be experiencing an anxiety disorder. In fact, anxiety is an extremely common diagnosis, affecting as many as 40 million adults in the United States alone. And while there are a number of treatment options for those living with anxiety disorders, many are prescribed anxiety medication to help manage their condition. Here’s what you need to know about the prescription drug hydroxyzine for anxiety.

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What is hydroxyzine (Vistaril, Atarax)?

Hydroxyzine, also known by its brand names Vistaril and Atarax, is an antihistamine. While antihistamines are typically prescribed for allergies, hydroxyzine is an FDA-approved anxiety treatment and can also treat conditions such as difficulty sleeping, itching and skin rashes, nausea and vomiting. 

Some antihistamines are known for their sedating effects, which has been found to be potentially beneficial to patients with anxiety who often have difficulty sleeping. In fact, hydroxyzine can even be administered before surgery, as it is known to cause sleepiness and create a calming effect on patients.

There are two formulations of hydroxyzine available,. “Hydroxyzine hydrochloride (Atarax) and hydroxyzine pamoate (Vistaril).” While both formulations technically work the same, patients might find that their symptoms respond to one more than the other, with hydroxyzine hydrochloride more typically prescribed for anxiety. 

Hydroxyzine for anxiety

Known for its calming and mild sedative effects, hydroxyzine is effective to treat anxiety for some patients. “Hydroxyzine is an antihistamine prescribed for the treatment of anxiety,” says board-certified plastic surgeon Michael K. Newman, MD. “In a healthy adult, hydroxyzine may also effectively treat an acute aggravation of panic disorder.” 

“Hydroxyzine works effectively for relieving anxiety attacks by significantly affecting two major chemicals in the human body, known as serotonin and histamine,” Clara Lawson, MD, explains.

1. Serotonin: “Serotonin is a chemical that controls mood,” Dr. Lawson says. “By efficiently interacting with this chemical, hydroxyzine relieves anxiety attacks and it is commonly used to treat generalized anxiety disorder associated with insomnia.”
2. Histamine: “And as an antihistamine, hydroxyzine treats allergy symptoms by blocking the effects caused by histamine and makes you fall asleep, which is another way it deals with anxiety and insomnia,” Dr. Lawson says.  

If a patient has previously been prescribed benzodiazepines, such as diazepam, alprazolam, triazolam, which haven’t helped with their anxiety, then hydroxyzine could be an alternative option. A 2002 study of 369 patients concluded that hydroxyzine was both safe and effective as an alternative to benzodiazepines for those living with anxiety. One study of 130 patients with generalized anxiety disorder (GAD) found that a dose of 50 mg a day could produce “a statistically and clinically significant anxiolytic effect.”

Case studies have also shown that hydroxyzine has successfully been used to help symptoms of panic attacks, and it’s been suggested that the medication showed a “greater and more rapid cognitive improvement” when compared to the benzodiazepine lorazepam.

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Hydroxyzine side effects

While some side effects are expected when taking a new medication, others may be a cause for concern. Here’s what to look out for when taking hydroxyzine. Most people taking the medication won’t experience any of these adverse effects. 

Common side effects:

• Drowsiness
• Dizziness
• Dry mouth
• Fatigue
• Upset stomach
• Reduced appetite
• Vision changes
• Urinary retention
• Irritability
• Headache
• Constipation

Rare, serious side effects:

• An allergic reaction, which may include swelling of the lips, face, or tongue, difficulty breathing, and/or hives
• Increased heart rate
• Chest pain and discomfort
• Severe clumsiness and confusion
• Hallucinations
• Priapism
• Acute generalized exanthematous pustulosis (AGEP)
• Rashes caused by sensitivity to sunlight
• Involuntary motor activity (tremor and seizures) 
• Severe drowsiness
• Faintness
• Shortness of breath 
• Nervousness
• Cough
• Difficulty swallowing
• Unusual fatigue
• Ataxia
• Slurred speech

If you experience these serious side effects related to hydroxyzine, contact a healthcare professional immediately for medical advice in case you are having an allergic reaction or overdose.

Food and drug interactions

Tell your doctor if you are taking any other supplements or medications that may cause drowsiness and sedation, such as other antihistamines, antidepressants, and narcotics, as these may increase the side effects associated with hydroxyzine.

Alcohol may increase the side effects of hydroxyzine, causing increased drowsiness, dizziness, and trouble concentrating.

Who should not take hydroxyzine for anxiety?

“First of all, hydroxyzine shouldn’t be taken without a doctor’s consultation and prescription,” Dr. Lawson says. “The prescribed dose will depend on an individual’s age, the severity of symptoms, particular medical problem and the time allowed between the doses.” There are several other instances when hydroxyzine may not be the right choice for you.

Heart rhythm anomalies

A 2015 review suggested that hydroxyzine may cause “serious heart rhythm anomalies”; if a patient already has a high risk of arrhythmia, or currently takes medication that increases the risk of QT prolongation or reduces their heart rate, hydroxyzine use should be closely monitored, and only taken under the supervision of a medical professional. It’s also important to inform your doctor or healthcare provider if you have a family history of, or have ever had, heart problems such as a slow or irregular heartbeat, a heart attack, heart failure, or heart disease, or low blood levels of potassium or magnesium. 

Phenylketonuria

Patients with phenylketonuria, a rare inherited condition causing increased levels of the amino acid phenylalanine (Phe) in the blood, which affects the brain, shouldn’t take hydroxyzine, as the medication may contain phenylalanine.

Adults over 65

Hydroxyzine may not be suitable for patients over the age of 65, due to the side effects it may cause. Speak to your doctor about alternative medications like hydroxyzine if you are in this age range.

Allergies

Patients with known allergies to over-the-counter allergy medicine like Zyrtec (cetirizine), Xyzal (levocetirizine), Benadryl (diphenhydramine), and other antihistamines should notify their healthcare provider before taking hydroxyzine, as it may cause a similar allergic reaction.

Driving and operating machinery

It’s important that patients do not drive a car or operate machinery until they know how the medication affects them, as hydroxyzine could cause drowsiness and sedative effects.

Pregnancy

Pregnant women and those who are planning on becoming pregnant should tell their doctor before taking hydroxyzine. Studies have found that taking hydroxyzine during the first trimester of pregnancy can increase the risk of fetal defects, and when studied in animals, hydroxyzine was found to have a teratogenic effect. It’s crucial that pregnant and postpartum patients consult their healthcare providers before taking any new medication. 

While hydroxyzine should not be used during the first trimester of pregnancy, use during the second and third trimesters might be possible; consult your healthcare provider before taking hydroxyzine to ensure it is used safely. As there is a lack of controlled data regarding the use of hydroxyzine in pregnant humans, its use during pregnancy is generally contraindicated.    

Hydroxyzine has also been found to cause potentially serious symptoms during pregnancy such as central nervous system (CNS) depression, hypotension, myoclonus, and hypoxia. Use of hydroxyzine in late pregnancy and use during and immediately post-labor can cause the previously mentioned symptoms, along with extrapyramidal symptoms, movement disorders, neonatal hypoxic conditions, and urinary retention. When used during labor, hydroxyzine might impact the baby in a number of ways, from increasing the risk of seizures in the child to decreasing the fetal heart rate. 

Studies have found that taking hydroxyzine while pregnant or breastfeeding may result in small doses of the medication being passed through breast milk to the baby. Prolonged use may decrease milk supply, and potentially cause drowsiness and related symptoms on the baby.

Hydroxyzine dosages for anxiety

Hydroxyzine is available in a number of brands including Vistaril, Atarax, Vistaril IM, Hyzine, Vistaject-50, Rezine, and under the generic name hydroxyzine.

“The suggested dosage for people taking oral hydroxyzine to help manage anxiety and tension is 50 to 100 milligrams (mg) four times a day,” says Dr. Newman. “Hydroxyzine is most effective between 30 and 60 minutes after administration, and the effects might continue up to four to six hours.” 

As the medication is fairly fast-acting, it can be particularly useful to patients who are experiencing panic attacks as a result of generalized anxiety disorder. However, as the effects of the medication will wear off after several hours, patients may be prescribed the drug to take on a regular basis, to help keep their symptoms under control.

In patients experiencing panic attacks relating to an anxiety disorder or insomnia from anxiety, 50 mg to 100 mg may be administered once, rather than on a regular basis.

If you miss a dose of hydroxyzine, take the missed dose as soon as you remember unless it is almost time for your next dose.

Hydroxyzine is intended for short-term use only (typically four months or fewer). Ask your prescribing physician how long you should take hydroxyzine and how to stop taking it to avoid withdrawal symptoms.

How much does hydroxyzine cost?

The cost of hydroxyzine varies depending on the brand of medication and where you acquire your prescription from.

Hydroxyzine Hcl

Without insurance, hydroxyzine Hcl usually costs $34.99. With a SingleCare coupon for hydroxyzine Hcl, the prescription could be as low as $7.99.

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Vistaril 

Without insurance, Vistaril usually costs around $115.99 for 100 capsules. However, with SingleCare coupons, the cost might be as low as $2.99.

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