Is hydroxyzine addictive?

In this article:

• Can you get addicted to hydroxyzine?
• Signs of hydroxyzine abuse
• Who should avoid using hydroxyzine?
• How to use hydroxyzine safely

In this article

• Can you get addicted to hydroxyzine?
• Signs of hydroxyzine abuse
• Who should avoid using hydroxyzine?
• How to use hydroxyzine safely

Hydroxyzine, the generic version of the brand name Vistaril, is a prescription drug and first-generation antihistamine. Hydroxyzine relieves various conditions, such as generalized anxiety disorder and nausea, and the symptoms of allergic skin reactions, such as itchiness and hives. It has also been used to decrease the severity of opioid withdrawal. Hydroxyzine can treat acute anxiety symptoms, similar to Xanax, Ativan, and Klonopin, but unlike those benzodiazepines, it is not a controlled substance.

Hydroxyzine is commonly prescribed for short-term use since it has risks (such as a fast heart rate and skin conditions) and common side effects, such as drowsiness, dry mouth, and constipation. While hydroxyzine is not addictive, it can be used for the wrong reasons.

Can you get addicted to hydroxyzine?

Experts quell a big fear people might have. “Hydroxyzine is not considered addictive or habit-forming,” says Dr. Jason Kellogg, MD, a psychiatrist and the medical director at Hotel California By The Sea’s California facilities. “It does not carry the same risk of dependence or abuse as other medications often used for these conditions.”

But that’s not the whole story. Patients need to be careful when taking or considering taking hydroxyzine. “In high doses, it does have the potential for abuse,” he continues. “While hydroxyzine itself is not addictive, psychological dependence might develop in some individuals if they come to rely on the calming effects it provides.”

The use and misuse of hydroxyzine can be compared to other allergy medications. “Benadryl, or diphenhydramine, is a good comparison, as it is a similar, first-generation antihistamine with central nervous system (CNS) effects that is used for multiple indications besides just as an antihistamine, and can also be misused without being considered truly ‘addictive,’” says Dr. Ryan Marino, MD, a medical toxicologist, emergency physician, and addiction medicine specialist, as well as an assistant professor in the departments of emergency medicine and psychiatry at Case Western Reserve University School of Medicine.

Patients may abuse or become psychologically dependent on the medication to help them feel calm and induce sleepiness. Certain factors can contribute, such as underlying anxiety disorders and chronic insomnia, according to Dr. Kellogg. 

Dr. Marino adds that people with mental health conditions aren’t the only ones at risk. “Hydroxyzine dependence can develop in anyone who is taking hydroxyzine for more than short periods of time,” he says. Hydroxyzine can reduce acute anxiety symptoms, but it’s not for long-term use, he says. “Taking it long-term for this purpose could lead to tolerance, dependence, and worsening symptoms when hydroxyzine wears off or is stopped.”

In other words, patients shouldn’t take hydroxyzine every day. Dr. Marino says doing so isn’t necessarily “bad,” but not the best or most effective option. “If you find yourself needing it every day or almost every day, then it is worth talking to your healthcare provider about other options,” he adds.

As with any medication or health condition, talking to a medical professional is best. Dr. Kellogg encourages this step, especially for patients who take hydroxyzine daily, since long-term use can lead to negative side effects. He lists drowsiness, dry mouth, and potential cognitive effects as a few examples. “A healthcare provider can monitor for adverse effects and ensure that the benefits outweigh any potential risks,” he says.

Signs of hydroxyzine abuse

Since misusing this antihistamine medication can cause problems, it’s important to be on the lookout for the signs and symptoms of hydroxyzine abuse. Dr. Kellogg and Dr. Marino share the following examples: 

• Taking more than the prescribed amount
• Taking it for other reasons than what it was prescribed for 
• Taking it without a prescription
• Excessive drowsiness
• Confusion
• Impaired motor function

Dr. Kellogg warns about the possibility of an overdose, too, which can happen if someone abuses the medicine. “Symptoms of toxicity include delirium, seizures, irregular heartbeat, and high blood pressure,” he says. “An overdose can cause the person’s lungs to fill with fluid and blood, leading to death.” 

When it comes to addressing substance abuse, hydroxyzine abuse isn’t one that typically leads to withdrawal symptoms. This is because it doesn’t produce physical dependence, Dr. Kellogg says. However, symptoms may occur when suddenly stopping hydroxyzine. “Abrupt discontinuation after long-term use might lead to a resurgence of the symptoms it was managing, such as anxiety or insomnia,” he says. Dr. Marino agrees, noting symptoms may worsen after the discontinuation of hydroxyzine. 

Who should avoid using hydroxyzine?

Some people are at a higher risk for side effects if they take hydroxyzine and should, therefore, avoid it completely. Hydroxyzine is contraindicated in patients in early pregnancy, those who have a prolonged QT interval, and those who have a hypersensitivity to any part of the medication. 

According to the Cleveland Clinic, before taking this medicine, let a healthcare professional or pharmacist know about any medical history of or current experiences with glaucoma, heart disease, irregular heartbeat, kidney disease, liver disease, a lung or breathing disease such as asthma, stomach or intestinal problems, thyroid disease, trouble passing urine, trying to get pregnant, or breastfeeding.

Hydroxyzine interactions to be aware of include CNS depressants, QT-prolonging drugs, anticholinergics, grapefruit and grapefruit juice, alcohol, caffeine, illicit drugs, and herbal supplements.

The use of hydroxyzine is considered a high-risk medication for several reasons. Dr. Marino points to drug interactions with the CNS, which, combined with other mind-altering substances, can cause problems. 

Dr. Kellogg adds that hydroxyzine is especially high-risk for older adults since it can cause them to experience sedative effects, confusion, dizziness, and falls. “In older adults, these side effects can lead to serious complications like fractures or hospitalizations,” he continues.

He also wants to warn patients with pre-existing heart or other medical conditions. “Hydroxyzine can have cardiovascular effects, including QT prolongation, which can lead to serious heart rhythm abnormalities,” he says. “The risk is higher in people with pre-existing heart conditions or those taking other medications that affect the heart.” 

If you prefer an over-the-counter allergy treatment, consider cetirizine. Studies show it has a greater safety margin than hydroxyzine and can be equally productive. 

But again, medications affect everyone differently, and it’s better to be safe than sorry. “Talk to your healthcare provider about your individual risk,” Dr. Marino emphasizes.

How to use hydroxyzine safely

The Cleveland Clinic says to take a hydroxyzine dose orally with a full glass of water and that it can be taken with or without food. If taking the liquid hydroxyzine solution with a spoon, ensure it’s one used for this medication alone and isn’t a household spoon, as the latter doesn’t provide an accurate measure. 

If you miss a dose, take it as soon as possible (but don’t take extra doses). Store hydroxyzine at room temperature and away from light.

Other tips from Dr. Kellogg include avoiding alcohol and other CNS depressants, not driving or operating heavy machinery until patients know how hydroxyzine affects them, taking the lowest effective dose, and letting their healthcare provider know about any side effects they experience. 

Additionally, if side effects arise, don’t just quit the medication cold turkey. “It is crucial to avoid abrupt discontinuation without medical advice, especially after prolonged use,” he says. “Patients should use hydroxyzine exactly as prescribed by their healthcare provider.”

If talking to a healthcare provider at that moment isn’t doable, or the concerns are more serious or urgent, calling poison control might be the best option, as mentioned by Dr. Marino. The phone number for Poison Control is 1-800-222-1222.