Vistaril vs. Xanax: Differences, similarities, and which is better for you

Drug overview & main differences | Conditions treated | Efficacy | Insurance coverage and cost comparison | Side effects | Drug interactions | Warnings | FAQ

Vistaril and Xanax are two brand-name medications used for the treatment of short-term anxiety. Anxiety disorders affect approximately 40 million Americans, making it one of the most common mental illnesses. Unfortunately, statistics show only about 40% of patients seek treatment for their anxiety despite the fact that it is highly treatable.

There are a variety of types of treatment for anxiety. Cognitive-behavioral therapy focuses on identifying, understanding, and changing your thinking and behavioral patterns to help you better cope with your anxiety. Alternative treatments such as yoga, meditation, and acupuncture have proven effective for some in alleviating anxiety. Treatment with medication remains a predominant mode of treatment for anxiety.

There are several classes of medications indicated in the treatment of anxiety including selective serotonin reuptake inhibitors (SSRIs), selective norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants, and benzodiazepines. Your healthcare provider may recommend a combination of treatment types based on your symptoms.

What are the main differences between Vistaril and Xanax?

Vistaril (hydroxyzine pamoate) is a piperazine class sedating antihistamine used commonly in the treatment of transient anxiety symptoms. Vistaril is a prescription-only drug. It blocks the H1 histamine receptor. Its exact mechanism for relieving anxiety is unknown, though we do know that blocking the H1 receptor in the central nervous system leads to sedation, antiemetic, analgesic, and skeletal muscle relaxant effects. Vistaril (What is Vistaril?), and its generic form, are available in oral capsules in strengths of 25 mg, 50 mg, and 100 mg. It is also available in a liquid suspension of 25 mg/5 ml.

Xanax (alprazolam) is a benzodiazepine used commonly in the treatment of short-term anxiety and generalized anxiety disorder. Other benzodiazepines include Ativan (lorazepam), Klonopin (clonazepam), and Valium (diazepam). Xanax is a prescription-only drug and is also categorized as a controlled substance by the Drug Enforcement Agency (DEA). Xanax works through the central nervous system (CNS) by inhibiting reticular pathways responsible for many types of emotional responses, including anxiety. Xanax (What is Xanax?), and its generic forms, are supplied on regular and orally disintegrating tablets in strengths of 0.25 mg, 0.5 mg, 1 mg, and 2 mg. An extended-release tablet is available in strengths of 0.5 mg, 1 mg, 2 mg, and 3 mg. There is also a concentrated liquid formulation in a concentration of 1 mg/ml.

Main differences between Vistaril and Xanax
	Vistaril	Xanax
Drug class	H1 histamine blocker	Benzodiazepine
Brand/generic status	Brand and generic available	Brand and generic available
What is the generic name?	Hydroxyzine pamoate	Alprazolam
What form(s) does the drug come in?	Oral capsule	Oral, orally disintegrating, and extended-release tablets, concentrated liquid
What is the standard dosage?	25 mg capsule once daily	1 mg tablet twice daily
How long is the typical treatment?	As needed for anxiety episodes	As needed for anxiety episodes
Who typically uses the medication?	Children and adults	Adults

Conditions treated by Vistaril and Xanax

Vistaril is indicated in the treatment of anxiety, tension, and psychomotor agitation in conditions of emotional distress. Due to its actions on histamine receptors, Vistaril is also indicated in treating pruritus (itching) due to conditions of chronic urticaria, contact dermatitis, and atopic dermatitis. Vistaril is used in the treatment of nausea and vomiting due to both pregnancy and post-operative causes. It is also approved to provide sedation for procedures.

Vistaril is also used off-label for some indications. Off-label use refers to drugs being used for indications not approved by the Food and Drug Administration (FDA). Vistaril is used off-label for the temporary treatment of insomnia due to its somnolence effects. It is also used off-label to treat seasonal allergic rhinitis (season allergies).

Xanax is indicated in the treatment of transient symptoms of anxiety as well as generalized anxiety disorder (GAD). It is also indicated in the treatment of panic disorder. Xanax can be used off-label to relieve anxiety and mood disorders related to premenstrual dysphoric disorder (PMDD).

Condition	Vistaril	Xanax
Short-term/ transient anxiety	Yes	Yes
Generalized anxiety disorder	No	Yes
Panic disorder	No	Yes
Pruritus	Yes	No
Nausea/ vomiting	Yes	No
Insomnia	Off-label	No
Seasonal allergies	Off-label	No
Premenstrual dysphoric disorder	No	Off-label

Is Vistaril or Xanax more effective?

A double-blind, controlled clinical study compared the anxiolytic, sedative, amnesia, and safety effects of the ingredients of Vistaril and Xanax on pre-procedural patients. This study found that Vistaril produced essentially no effect on anxiety for these patients, compared to a moderate effect produced by Xanax. The two drugs were comparable in regards to effects in somnolence and memory, but the effects of hydroxyzine lead to a more pronounced decrease in blood pressure. While they are both effective pre-procedural drugs, Xanax may be preferred due to its more pronounced effect on anxiety and adverse event profile.

Only your doctor can decide which anxiety treatment is best for you. If you are experiencing anxiety or other symptoms of a mental health disorder, seek medical advice. Do not attempt to self-medicate or take over-the-counter medications.

Coverage and cost comparison of Vistaril vs. Xanax

Vistaril is a prescription medication that is typically covered by both Medicare and commercial insurance plans. Brand name Vistaril can cost as much as $92 out-of-pocket. With a coupon from SingleCare, you could pay as little as $4 for a 30-day supply of the generic, hydroxyzine pamoate 25 mg.

Xanax is a prescription medication that is typically covered by commercial insurance plans. Medicare drug plans may or may not cover Xanax. It is excluded from some plans. The out-of-pocket price for Xanax is an average of about $63. With a coupon from SingleCare, you could pay less than $10 for a 30-day supply of the 1 mg generic.

Use the SingleCare discount card

	Vistaril	Xanax
Typically covered by insurance?	Yes	Yes
Typically covered by Medicare Part D?	Yes	In some cases
Standard dosage	30, 25 mg capsules	60, 1 mg tablets
Typical Medicare copay	$10	Variable
SingleCare cost	$4-$12	$9-$30

Common side effects of Vistaril vs. Xanax

Anticholinergic side effects are common with both Vistaril and Xanax (forms of arrhythmia). Drowsiness, or somnolence, is a side effect of both drugs. Drowsiness can affect daily productivity and should be weighed against the benefits of treatment. Dry mouth also affects patients taking either Vistaril or Xanax. While there are remedies for dry mouth such as gum and mouth rinse, it may be very bothersome for some.

Vistaril is known to cause QT prolongation and Torsade de Pointes (forms of arrhythmia). Vistaril should be avoided in patients with a known history of QT prolongation or risk factors such as pre-existing cardiac disease, electrolyte imbalances, and drug use.

The following list is not intended to be a comprehensive list of adverse events. Consult your healthcare provider for a complete list of potential side effects.

	Vistaril		Xanax
Side effect	Applicable?	Frequency	Applicable?	Frequency
Dry mouth	Yes	Not defined	Yes	15%
Drowsiness	Yes	Not defined	Yes	41%
Tremor	Yes	Not defined	Yes	4%
QT Prolongation	Yes	Not defined	No	N/A
Headache	Yes	Not defined	Yes	13%
Hallucination	Yes	Not defined	No	N/A
Rash	Yes	Not defined	Yes	4%
Dizziness	No	N/A	Yes	2%
Hypotension	No	N/A	Yes	5%

Source: Vistaril (DailyMed) Xanax (DailyMed)

Drug interactions of Vistaril vs. Xanax

Vistaril should be avoided with both long- and short-acting beta agonists, such as albuterol or formoterol. Beta agonists are linked to the incidence of QT prolongation and Torsade de Pointes, and concurrent use with Vistaril increases the risk of these adverse events.

Vistaril and Xanax combined with opioid agonists may greatly increase the risk of severe drowsiness and somnolence. Xanax combined with opioid agonists may lead to severe respiratory depression and hypotension (low blood pressure). This can be life-threatening. Combined use with drugs such as codeine or hydrocodone can be dangerous and should be avoided.

Vistaril and Xanax should be used cautiously in patients on other antihistamines that may be sedating, such as diphenhydramine or chlorpheniramine. The additive drowsiness of these medications can cause harm to the patient.

This is not intended to be a comprehensive list of interactions for Vistaril and Xanax. Please consult your pharmacist or other healthcare professional for a complete list of interactions.

Drug	Drug class	Vistaril	Xanax
Codeine Hydrocodone Oxycodone Tramadol Fentanyl Hydromorphone	Opioid agonist	Yes	Yes
Formoterol Arformoterol Albuterol Salmeterol Vilanterol Levalbuterol	Beta agonist	Yes	No
Alfuzosin	Alpha blockers	Yes	No
Amantadine	Adamantanes	Yes	No
Amiodarone	Antiarrhythmic	Yes	Yes
Azithromycin Clarithromycin Erythromycin	Macrolide antibiotics	Yes	Yes
Ciprofloxacin	Fluoroquinolone antibiotic	Yes	Yes
Baclofen Carisoprodol Cyclobenzaprine	Skeletal muscle relaxants	Yes	Yes
Alprazolam Clonazepam Clorazepate Diazepam Flurazepam Lorazepam Temazepam	Benzodiazepines	Yes	Yes
Metronidazole	Anti Infective	Yes	No
Cetirizine Levocetirizine Loratadine Desloratadine Fexofenadine Diphenhydramine Chlorpheniramine	Antihistamines	Yes	Yes
Citalopram Escitalopram Fluoxetine	Selective serotonin reuptake inhibitors (SSRIs)	Yes	No
Fluconazole Itraconazole Ketoconazole	Antifungals	Yes	Yes

Warnings of Vistaril and Xanax

It is unknown if Vistaril crosses into breast milk, and therefore should be avoided or used cautiously in nursing mothers.

Concomitant use of Xanax with opioid agonists can cause life-threatening respiratory depression and hypotension. In some cases, it may lead to coma and/or death. If it is determined that the combination cannot be avoided, patients must be advised on the adverse events. Patients should not drive or operate heavy machinery while on these medications.

Xanax is a controlled substance and could be habit-forming. The use of Xanax carries the risk of physical dependence and substance abuse, even after a relatively short-term treatment. Your doctor may limit the amount of Xanax prescribed to reduce this risk.

Withdrawal symptoms, including seizures, may occur with dose decrease or discontinuation of Xanax. This medication should be tapered with the advice of a medical professional while they monitor the patients for signs and symptoms of withdrawal.

Frequently asked questions about Vistaril vs. Xanax

What is Vistaril?

Vistaril is a prescription histamine-1 blocker used in the short-term treatment of transient anxiety symptoms. It may also be used to treat symptoms of insomnia, itching, and allergic reaction. It is available as an oral capsule, oral suspension, and injection.

What is Xanax?

Xanax is a prescription anxiety medication used for both short-term anxiety as well as generalized anxiety disorder. It is a benzodiazepine and considered a controlled substance that has the potential to be addicting. It is available as an oral, orally disintegrating, and extended-release tablet. It is also available as a concentrated oral liquid.

Are Vistaril and Xanax the same?

Vistaril and Xanax are both used to treat short-term symptoms of anxiety, but they are not the same type of medication. Vistaril is a type of antihistamine, while Xanax is a benzodiazepine and considered a controlled substance.

Is Vistaril or Xanax better?

Xanax has been shown to have a more pronounced effect at decreasing anxiety in transient symptom situations. The somnolence and amnesia tendencies tend to be comparable between the drugs. Vistaril appears to cause low blood pressure to a larger extent than Xanax, so therefore Xanax may be preferred in many instances of transient, short-term anxiety situations.

Can I use Vistaril or Xanax while pregnant?

Vistaril is considered pregnancy category C by the Food and Drug Administration. This means there are not enough studies to establish its safety in pregnancy, and it should only be used when benefits clearly outweigh any risks. Xanax is considered pregnancy category D. This means that studies have proven that harm can come to the fetus with use during pregnancy, and its use during pregnancy is not recommended.

Can I use Vistaril or Xanax with alcohol?

Due to alcohol’s potential to cause drowsiness and slow respiratory rate, the concurrent use of alcohol with Vistaril or Xanax is not recommended.

Does Vistaril help with anxiety?

Vistaril is approved to treat short-term, transient symptoms of anxiety. Due to some of the adverse events it may cause, your doctor may choose another type of therapy for daily anti-anxiety treatment.

How long does it take for Vistaril to work?

The effects of Vistaril begin just 15 to 60 minutes after taking the dose and can last up to four to six hours.

Is Vistaril a controlled substance?

Vistaril is not a controlled substance. It does not have a significant potential for abuse or physical dependence.