Hydroxyzine and Xanax: Uses, differences, and side effects

In this article:

• Main differences
• Conditions treated
• Efficacy
• Cost
• Side effects
• Interactions
• Warnings
• FAQs

In this article

• Main differences
• Conditions treated
• Efficacy
• Cost
• Side effects
• Interactions
• Warnings
• FAQs

Hydroxyzine and Xanax are medications used to treat anxiety and other conditions. Hydroxyzine is classified as an antihistamine and works by blocking histamine receptors. This drug also has sedative properties, exerting a calming effect on the central nervous system. Xanax contains the active ingredient alprazolam and is classified as a benzodiazepine medicine. It works by enhancing the effects of gamma-aminobutyric acid (GABA), a chemical in the brain that helps calm nervous system activity and reduce anxiety. Continue reading to learn more about hydroxyzine and Xanax for mental health. 

What are the main differences between hydroxyzine and Xanax?

Hydroxyzine, an antihistamine, is commonly known by the brand names of Atarax (hydroxyzine hydrochloride) and Vistaril (hydroxyzine pamoate), although Atarax is no longer available as a brand-name drug. According to the Prescribers’ Digital Reference (PDR), both forms of hydroxyzine (hydroxyzine hydrochloride and hydroxyzine pamoate) are considered equivalent. 

Xanax is a benzodiazepine. It is a brand-name medication, and the generic is called alprazolam. Xanax is a controlled substance, which means it has the potential for abuse and dependence. 

Conditions treated by hydroxyzine and Xanax 

Hydroxyzine is used to relieve anxiety and tension. It can also treat itching from allergic conditions such as chronic urticaria (hives). Hydroxyzine can also be used as a sedative before or after a procedure or surgery. It is sometimes used off-label (for uses the U.S. Food and Drug Administration (FDA) has not approved) for other uses, such as short-term treatment of insomnia or to relieve seasonal allergy symptoms.

Xanax is an anxiety medication. It is used to treat generalized anxiety disorder (anxiety) in adults. It can also be used to treat panic disorder (an anxiety disorder that causes frequent and unexpected panic attacks) with or without agoraphobia in adults. Agoraphobia is the intense fear of being in a situation where it might be difficult to escape or get help. Xanax is sometimes used off-label for other conditions, such as premenstrual dysphoric disorder (PMDD). 

*See more specific descriptions above table

Is hydroxyzine or Xanax more effective?

When comparing hydroxyzine to Xanax for anxiety symptoms, which is better? There is a lack of data comparing the two drugs directly. One study looked at hydroxyzine versus Xanax as a premedication before surgery. This particular study found Xanax to be more effective than hydroxyzine for decreasing anxiety before a procedure. 

Clinical guidelines for the diagnosis and management of generalized anxiety disorder and panic disorder in adults note that hydroxyzine is considered a second-choice treatment for anxiety rather than a first choice. Selective serotonin reuptake inhibitor antidepressants (SSRIs), however, are considered a first choice in treating anxiety and panic disorder. The guidelines note that benzodiazepines, such as Xanax, are effective for anxiety. Still, there are problems with tolerance, dependence, and side effects, and even when used in combination with an antidepressant, they do not improve long-term outcomes. Therefore, benzodiazepines are generally recommended for short-term use rather than long-term use.

Experts also note that therapy—such as cognitive behavioral therapy—is considered as effective as medication for anxiety and panic disorder. A combination of therapy, medication, and other measures, such as physical activity and relaxation techniques, may be the best option for you.

Both drugs take a similar amount of time to start working if that is a deciding factor, although Xanax may begin to work slightly faster. Hydroxyzine starts working quickly, within 15 to 60 minutes, as does Xanax, which starts working in 15 to 30 minutes. 

Various considerations must be taken into account when determining the best medication for an individual. Only your healthcare professional can determine which medicine is appropriate for you, taking many individual factors into account, such as your health conditions, medical history (including history of substance abuse), possible adverse effects and drug interactions, and other precautions. Consult your healthcare provider for medical advice about your condition and treatment. 

Coverage and cost comparison of hydroxyzine vs. Xanax 

Insurance and Medicare prescription plans generally cover hydroxyzine as well as generic formulations of Xanax. Brand-name Xanax may not be covered, or the out-of-pocket costs will generally be higher if it is covered.

For patients paying without insurance, a typical prescription of hydroxyzine costs around $35. However, a free SingleCare discount can decrease the price to as low as $3.

If you are paying without insurance for brand-name Xanax, a typical prescription will cost about $257, but using a free SingleCare discount and filling your prescription for generic alprazolam can reduce the price to as low as $5.

As plans vary, you can contact your insurance provider for specific coverage information and out-of-pocket costs.

Common side effects of hydroxyzine vs. Xanax 

Common side effects of hydroxyzine include:

• Dry mouth 
• Confusion 
• Constipation 
• Dizziness 
• Headache 

Common side effects of Xanax include:

• Drowsiness or sleepiness
• Dizziness or lightheadedness
• Headache
• Irritability
• Talking excessively
• Difficulty concentrating
• Dry mouth 
• Increased salivation
• Sexual problems
• Stomach problems like nausea or constipation
• Changes in appetite or weight
• Difficulty urinating
• Joint pain 

With any drug, allergic reactions may occur in rare cases. Get emergency medical help if you have any of the following symptoms of an allergic reaction:

• Hives 
• Itching
• Trouble breathing or swallowing
• Swelling of the face, lips, tongue, or throat

Additionally, in rare cases, hydroxyzine may cause a serious skin reaction. If you have any of the following symptoms, you should stop taking hydroxyzine and consult your healthcare provider: sudden skin redness, a rash that spreads, white or yellow pustules, or blistering or peeling skin.

This is not a full list of side effects, and others may occur. Consult your healthcare provider for more information about side effects.

Drug interactions of hydroxyzine vs. Xanax 

Before you take hydroxyzine or Xanax, tell your healthcare provider about all the medications you take, including prescription and over-the-counter drugs, vitamins, and supplements. 

Hydroxyzine and Xanax have many of the same drug interactions. Note that using a benzodiazepine such as Xanax along with an opioid pain medication can result in extreme sedation, breathing problems, coma, and death. Other drugs and substances that cause central nervous system (CNS) depression, meaning a slowing down of brain activity, can have the same effect—such as muscle relaxants, medications that help with sleep, and alcohol. Be sure to consult with your healthcare provider before mixing any medications or substances with hydroxyzine or Xanax.

The table below lists some common drug interactions but is not a complete list. Consult your doctor for more information about drug interactions and how they may affect you. 

Warnings of hydroxyzine and Xanax 

Before you take hydroxyzine or Xanax, tell your healthcare provider if you have any medical conditions, including if you have any heart problems, are pregnant, trying to become pregnant, or breastfeeding. 

Both drugs can cause drowsiness. If you take hydroxyzine or Xanax, you should avoid alcohol. Do not drive or operate machinery until you know how the medication affects you.

Additional Xanax warning: Xanax has a black box warning, the most serious warning required by the FDA. The warning states:

• Using a benzodiazepine (like Xanax) along with an opioid can result in extreme sedation, breathing difficulty, coma, and death. The combination should only be taken together if there are no other options, and patients who take this combination of drugs will be closely monitored.
• Benzodiazepines have a risk of abuse, misuse, and addiction, which can lead to overdose or death.
• You should not stop taking Xanax suddenly or abruptly because doing so could cause life-threatening withdrawal reactions. If you want to stop taking Xanax, consult your healthcare provider for a tapering schedule so you can slowly and safely stop taking the medicine.

Frequently asked questions about hydroxyzine vs. Xanax 

What is hydroxyzine?

Hydroxyzine is an antihistamine medication commonly known as Atarax or Vistaril. It has several uses, including anxiety, itching due to allergic conditions, and sedation before or after a procedure. 

What is Xanax?

Xanax is a benzodiazepine medication with the active ingredient alprazolam. It is used to treat anxiety and panic disorder. Xanax is a controlled substance, so it has the potential for abuse and dependence. 

Are hydroxyzine and Xanax the same?

Hydroxyzine and Xanax are not the same. They are in different drug categories and have other differences, such as in their uses, dosing, and side effects. 

Is hydroxyzine or Xanax better?

Your healthcare provider can only determine the appropriate treatment for you because there are many individual factors to consider. 

Can I use hydroxyzine or Xanax while pregnant?

The hydroxyzine prescribing information notes that it should not be used in early pregnancy. Likewise, the Xanax prescribing information has a pregnancy warning. However, with Xanax, the warning states that taking Xanax later in pregnancy can cause the baby to have sedation and breathing problems as well as withdrawal symptoms like shaking and excessive crying. 

Let your healthcare provider know if you are pregnant, planning to become pregnant, or breastfeeding. Do not start any new medications unless under the supervision of a healthcare provider.

Can I use hydroxyzine or Xanax with alcohol?

You should avoid alcohol when taking hydroxyzine or Xanax. These drugs cause a slowing of the nervous system, as does alcohol. Therefore, together, the effects could be potentiated. The result could be anywhere from sedation and driving impairment to as severe as slowed breathing, coma, and death.

Is hydroxyzine good for severe anxiety?

Hydroxyzine is sometimes used to treat anxiety, but it’s generally considered a second-choice treatment of anxiety. Generally, SSRIs are typically recommended, along with therapy, for anxiety. Consulting with a healthcare provider is essential to determine the most appropriate treatment for severe anxiety.

What is better than Xanax for anxiety?

Other common anxiety treatments include SSRI or SNRI antidepressants or other types of antidepressants such as buspirone, along with therapy and other measures to help control anxiety. Some people take beta blockers to help with physical symptoms of anxiety like shaking, high blood pressure, and fast heart rate. There are many treatment options available in terms of anti-anxiety medicine. Consult your healthcare provider for medical advice.