Hydroxyzine vs. Benadryl: Differences, Similarities, and Which One is Better For You

In this article:

• Main differences
• Conditions treated
• Efficacy
• Coverage and cost
• Side effects
• Interactions
• Warnings
• FAQs

In this article

• Main differences
• Conditions treated
• Efficacy
• Coverage and cost
• Side effects
• Interactions
• Warnings
• FAQs

Hydroxyzine and Benadryl are two medications that may be effective options for alleviating certain allergy symptoms. They are both classified as antihistamines, which work by blocking histamine receptors in the body. As a result, they help block the effects of histamine, a substance produced by the immune system that causes the symptoms of allergic reactions.

Although both drugs work similarly, hydroxyzine and Benadryl are different in many ways. For example, hydroxyzine is a generic prescription drug, while Benadryl is a brand-name over-the-counter (OTC) drug. In addition, they may differ in potential uses, side effects, and costs. Consult a healthcare provider to determine the most appropriate option based on your condition. 

Read on to learn more about the similarities and differences between hydroxyzine and Benadryl. 

RELATED: What is hydroxyzine? | What is Benadryl?

What are the main differences between hydroxyzine and Benadryl?

Both hydroxyzine and Benadryl are first-generation antihistamines. However, hydroxyzine is the generic name for Vistaril. It is a medication that can only be obtained with a prescription from a doctor or healthcare provider. 

Hydroxyzine is typically taken as an oral capsule up to four times daily or every six hours in adults. Although it’s mainly used in adults, hydroxyzine is also approved for children six and older. The hydroxyzine dosage for children typically depends on the child’s weight, and it must be accurately calculated by a healthcare professional.

Benadryl is a brand-name drug known by its generic name diphenhydramine. It is widely recognized as an OTC drug for immediate relief from allergy symptoms. In other words, it is easily accessible without a prescription. Benadryl is available in many dosage forms, such as capsules, chewable tablets, and topical creams. 

Benadryl is commonly taken orally every four to six hours for symptoms. It is generally recommended for adults and children six and older. However, its topical versions can be safely used in children over the age of two. In addition, children aged 2 to 5 may use the oral formulations under the guidance of a healthcare provider, although the specific age recommendations can vary by dosage form.

Main differences between hydroxyzine and Benadryl
	Hydroxyzine	Benadryl
Drug class	Antihistamine  First-generation	Antihistamine  First-generation
Brand/generic status	Brand and generic versions available	Brand and generic versions available
What is the generic or brand name?	Brand: Vistaril Generic: Hydroxyzine	Brand: Benadryl Generic: Diphenhydramine
What form(s) does the drug come in?	Capsules, tablets, liquid solutions, syrups, injections	Capsules, tablets, liquid solutions, syrups, chewable tablets, injections, creams, sprays
What is the standard dosage?	Adults: 25 mg three or four times daily for itching. Dosage varies depending on the use Children: Varies by age or weight depending on the use	Adults: 25 mg to 50 mg every 4 to 6 hours Children: Varies by age
How long is the typical treatment?	Short-term	Short-term
Who typically uses the medication?	Adults and children 6 and older	Adults and children 6 and older

RELATED: Hydroxyzine dosage | Benadryl dosage

Conditions treated by hydroxyzine and Benadryl

Hydroxyzine and Benadryl are used to treat allergy symptoms, namely itching from hives or other allergic conditions. They can also treat symptoms of allergic rhinitis or hay fever, such as sneezing and runny or stuffy nose. However, Benadryl may be more likely to be recommended over hydroxyzine for these symptoms.

In addition to chronic urticaria (itching), hydroxyzine is also approved for the treatment of anxiety disorders. For example, it may be used to manage tension and anxiety associated with generalized anxiety disorder. Because of its sedative properties, hydroxyzine may also be used for sedation before or after general anesthesia for a procedure.

Benadryl, on the other hand, is not approved for anxiety. However, in addition to allergy relief, it may also be used as a short-term sleep aid for insomnia. 

Although they are both reserved for short-term use, the use of hydroxyzine is limited to no longer than four months, whereas Benadryl is limited to no longer than a couple of weeks at a time. 

Condition	Hydroxyzine	Benadryl
Itching due to allergies	Yes	Yes
Allergic rhinitis	Off-label	Yes
Insomnia	Off-label	Yes
Sedation before surgery	Yes	Off-label
Anxiety	Yes	No

Is hydroxyzine or Benadryl more effective?

Hydroxyzine and Benadryl are more effective for treating allergy symptoms than using nothing (placebo). They both have relatively immediate effects due to their fact-acting nature. The most effective solution depends on the specific use, potential side effects, and cost. 

Head-to-head clinical trials comparing hydroxyzine and Benadryl are limited. In one study on how well certain allergy medications reduce itching, researchers found that diphenhydramine was quite effective. After taking diphenhydramine, people needed ten times more of an itching-causing substance to feel itchy compared to before they took the medicine. This was a better result than cyproheptadine or a placebo, which only needed five times more of the substance. However, the most effective drug tested was hydroxyzine, requiring a 750-fold increase. All medications caused drowsiness as a side effect.

Although both medications are effective, they are first-generation antihistamines with a high risk of drowsiness. Therefore, newer second-generation antihistamines are generally recommended in their place. One study found that second-generation antihistamines are safer for treating allergic rhinitis because they minimally affect the brain, reducing risks of drowsiness and impaired thinking.

Consult a healthcare provider for help making an informed decision based on your overall condition. 

Coverage and cost comparison of hydroxyzine vs. Benadryl

Making the right choice between hydroxyzine and Benadryl may depend on potential costs. Hydroxyzine is a generic medication that’s typically covered by most insurance plans, including Medicare Part D. Benadryl, on the other hand, is an OTC drug that’s not usually covered by insurance or Medicare due to its widespread accessibility. 

The cost for these antihistamines may also differ based on the pharmacy and location. Without insurance, the price can vary. In many cases, Benadryl may be a cheaper drug than hydroxyzine. However, you can save on these medications with discounts through prescription discount cards like the one from SingleCare. You can use a SingleCare hydroxyzine or Benadryl coupon for potential savings.

	Hydroxyzine	Benadryl
Typically covered by insurance?	Yes	No
Typically covered by Medicare Part D?	Yes	No
Quantity	30, 25 mg tablets	30, 25 mg tablets
Typical Medicare copay	Varies	N/A
SingleCare cost	$5	$2

Common side effects of hydroxyzine vs. Benadryl

As first-generation antihistamines, hydroxyzine and Benadryl share similar side effects. Both medications can cause drowsiness and dizziness due to their depressant effects on the central nervous system. However, hydroxyzine may produce a stronger sedative effect than Benadryl. Aside from these common effects, both medications might cause dry mouth and headaches.

Serious side effects are less common but possible. Both hydroxyzine and Benadryl may cause an irregular heartbeat, seizures, or severe dizziness in rare instances, especially in high doses. They can also cause confusion, especially in older adults. It’s important to consult a healthcare provider for other possible side effects and to get personalized advice.

	Hydroxyzine	Benadryl
Side Effect	Applicable?	Applicable?
Drowsiness	Yes	Yes
Dry mouth	Yes	Yes
Dizziness	Yes	Yes
Headache	Yes	Yes
Confusion	Yes	Yes
Constipation	Yes	Yes

Source: MedLine Plus (Hydroxyzine), MedLine Plus (Benadryl)

Drug interactions of hydroxyzine vs. Benadryl

Hydroxyzine and Benadryl have similar potential drug interactions. Both medications have sedative properties and, therefore, can interact with other medications that also have sedative effects, like opioids, muscle relaxants, and medicines for anxiety or seizures. Taking antihistamines with these types of medications may lead to severe drowsiness, slowed breathing, and coma, especially in severe cases.

Certain antibiotics and antipsychotics may also carry a risk of an irregular heart rhythm called QT prolongation. Similarly, high doses of hydroxyzine and Benadryl can also cause this condition. Therefore, it is recommended to exercise caution when using other medications that might lead to QT prolongation.

Drug	Drug Class	Hydroxyzine	Benadryl
Vicodin (hydrocodone) OxyContin (oxycodone) Ultram (tramadol) Duragesic (fentanyl)	Opioid	Yes	Yes
Valium (diazepam) Xanax (alprazolam) Ativan (lorazepam) Klonopin (clonazepam)	Benzodiazepine	Yes	Yes
Neurontin (gabapentin) Lamictal (lamotrigine) Topamax (topiramate) Depakote (divalproex sodium)	Anticonvulsant	Yes	Yes
Flexeril (cyclobenzaprine) Robaxin (methocarbamol) Soma (carisoprodol) Lioresal (baclofen)	Muscle relaxant	Yes	Yes
Prozac (fluoxetine) Zoloft (sertraline) Lexapro (escitalopram) Cymbalta (duloxetine)	Antidepressant	Yes	Yes
Nardil (phenelzine) Parnate (tranylcypromine) Marplan (isocarboxazid)	Monoamine oxidase inhibitor (MAOI)	Yes	Yes
Zithromax (azithromycin) Biaxin (clarithromycin) Erythrocin (erythromycin)	Macrolide antibiotic	Yes	Yes
Zyprexa (olanzapine) Seroquel (quetiapine) Risperdal (risperidone) Abilify (aripiprazole)	Antipsychotic	Yes	Yes

This is not a complete list of drug interactions. Please consult your doctor before taking these medications.

Warnings of hydroxyzine and Benadryl

Hydroxyzine and Benadryl are generally safe medications when taken as directed. However, they may carry certain warnings and precautions. 

Older adults may be more sensitive to side effects, such as drowsiness and dizziness, and might be at increased risk for falls. Both medications should be used with caution in this group, as older people may be more likely to have health conditions that may affect the metabolism of drugs, including kidney or liver disease. 

People with heart disease or heart failure should use hydroxyzine and Benadryl with caution. These medications may have negative side effects on the heart, which could be particularly harmful in people with heart conditions. 

These medications are not listed under the Controlled Substances Act, which means they’re not considered habit-forming. However, long-term use may lead to tolerance and dependence.

Benadryl carries a risk of stimulation or paradoxical excitement, particularly in children. Instead of making children sleepy, Benadryl may sometimes make children more energetic and unable to settle down.

Before using hydroxyzine or Benadryl, refer to the U.S. Drug and Food Administration’s (FDA) drug monograph for the most up-to-date drug information and to understand the full list of warnings.

Frequently asked questions about hydroxyzine vs. Benadryl

Are hydroxyzine and Benadryl the same?

Hydroxyzine and Benadryl are not the same medication. Although both are part of the same class of antihistamines, they differ in their active ingredients, potential uses, and costs. Hydroxyzine is a generic prescription drug, while Benadryl is a brand-name OTC drug. 

Is hydroxyzine or Benadryl better?

Determining whether hydroxyzine or Benadryl is better depends on the medication’s use. Both drugs treat similar conditions, like allergies and hives, but a healthcare provider may prefer one based on side effects and patient response. Hydroxyzine is sometimes noted to have a higher sedative effect than Benadryl and is often prescribed for anxiety, which is not a typical use of Benadryl.

Can I use hydroxyzine or Benadryl while pregnant?

Hydroxyzine is classified under FDA pregnancy category C, while Benadryl is category B. Therefore, Benadryl is a lower-risk drug for pregnant women but should only be recommended if needed. Hydroxyzine and Benadryl may cause side effects in young children and infants who are breastfeeding. Always consult a healthcare provider before using an antihistamine while pregnant or breastfeeding. 

Can I use hydroxyzine or Benadryl with alcohol?

Combining hydroxyzine or Benadryl with alcohol is generally not recommended. Both medications can cause drowsiness and sedation, and when taken with alcohol, these effects could be enhanced, leading to potentially dangerous levels of impairment. Consult a pharmacist or healthcare provider for more detailed information and medical advice before mixing these substances.