Does Vistaril (hydroxyzine) work for anxiety?

Does Vistaril (hydroxyzine) work for anxiety?

Reviewed by:
Michael Roman, MD
Staff Psychiatrist
at Talkiatry
March 29, 2024
In this article

The last thing you need if you have anxiety is something else to worry about, but if you’re considering treating your anxiety with medication, you might understandably have a lot of questions and concerns. Will the medication work? Will there be side effects? Is it habit-forming?  

One medication that might be prescribed for anxiety is Vistaril, or hydroxyzine. We’ve put together this guide to answer any questions you might have about Vistaril and how it works. Read on for everything you need to know about Vistaril as a treatment option for anxiety, whether you’ve already been diagnosed or suspect that it may be the cause of your symptoms.  


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What is Vistaril (hydroxyzine) and how does it work?

Vistaril is a brand name for hydroxyzine pamoate. This drug is an antihistamine, which means it manages the levels of a chemical called histamine that is produced by your immune system. You’ve most likely heard of antihistamines in the context of allergies, because histamine is part of the immune response that leads to allergy symptoms, and antihistamines can therefore treat symptoms of allergic reactions.

However, hydroxyzine pamoate decrease anxiety symptoms, but can potentially make you sleepy due to its antihistamine properties. It suppresses activity in the subcortical regions of the brain, which are the regions that control emotions. Anxiety can be a symptom of many conditions, but it can also be a condition itself. Different types of anxiety disorders include generalized anxiety disorder (GAD), panic disorders (PD), and social anxiety disorder.  

Vistaril is FDA-approved to treat anxiety, and it can also be prescribed off-label to treat a variety of anxiety disorders, including those mentioned above. Off-label means being prescribed in ways not specifically approved by the FDA, usually based on scientific evidence.  

A review of five studies about hydroxyzine pamoate’s effect on generalized anxiety disorder demonstrated that it is more effective at treating anxiety symptoms than a placebo was. However Vistaril’s effectiveness has been shown to decrease over time, as patients build up a tolerance to it. Because of this, it’s typically considered a short-term treatment.

One advantage of hydroxyzine pamoate over some other anxiety medications, such as Xana (alprazolam), is that it is not habit forming or a muscle relaxant and is therefore not a controlled substance. It can help you feel calm and relaxed without causing the same type of withdrawal symptoms if you decide to stop taking it.

How do you get Vistaril?

Vistaril is a prescription drug, so you’ll need to talk to a healthcare professional to get it, unlike with other over-the-counter allergy medications like Benadryl (diphenhydramine)or Zyrtec (cetirizine).

Learn more about how to get anxiety medication

Potential side effects of hydroxyzine

Vistaril’s side effects are generally mild; most people don’t find them too troublesome. These common side effects include:

  • Blurred vision
  • Dizziness
  • Drowsiness
  • Dry mouth
  • Headaches

These side effects are usually temporary, but if you’re finding that they are persistent, you should consult with your doctor.

Since Vistaril commonly makes people drowsy depending on the dose that you’re, you should plan to avoid driving or operating heavy machinery until you know how it affects you.  

As with any medication, more serious side effects are possible. If you experience any of the following symptoms, you should seek medical help immediately:

  • Hallucination
  • Tremors or convulsions
  • Nausea and vomiting
  • Stupor
  • Signs of an allergic reaction (trouble breathing, hives, skin rash, or facial swelling)

Is Vistaril safe during pregnancy or while breastfeeding?

Research on the effects of Vistaril on a pregnancy is fairly limited so it’s important to talk to your doctor about the risks and benefits of taking this medication while pregnant. A few animal studies have shown that it can increase the risk of fetal abnormalities. There is similarly limited data about whether or not Vistaril passes through breast milk. If you’re breastfeeding, consult with a maternal-fetal medicine doctor regarding safety and further medical advice.

Vistaril dosage: How much should you take?

Your doctor may prescribe you Vistaril in one of two forms: a capsule or an oral suspension (liquid). Vistaril capsules are available in 25 mg and 50 mg. In its liquid form, 1 teaspoon (5 mL) is equal to 25mg.  

If you’re using the liquid form, be sure to shake the bottle before you measure out a dose, which you should do with a medicine cup or measuring spoon to ensure accuracy. You don’t need to take Vistaril with food, but if you find that it’s giving you an upset stomach, eating before you take a dose may help.

Adults can take 50-100 mg of Vistaril up to four times daily. The dosage range starts at 10mg per day for adults. Children should take much less: If they’re under 6 years old, they can take up to 50 mg daily across several doses, and if they’re over 6 years old, then 50 to 100 mg daily in divided doses is the recommended maximum.  

Similarly, although studies have not shown any specific problems for people older than age 65 while taking Vistaril, if you are in this demographic and starting the drug, your doctor might take a cautious approach and slowly build you up to the full adult dose. This is simply because older patients are more likely to have the unwanted side effects associated with the drug.

In general, and like with all medications, you should always follow your doctor’s instructions about dosage. Consult with your doctor if you have any questions, such as if you feel like you should be taking more or less than they originally directed you to.

Your doctor may direct you to take Vistaril on an as-needed basis, such as when you’re feeling particularly anxious or tense, or they might recommend that you take it at regular times daily. If your doctor has instructed you to take Vistaril at specific times, it may be helpful to set an alarm or use a pillbox to help you remember and keep track of your doses.  

What should you do if you miss a dose of Vistaril?

If you miss a dose, simply take it as soon as you remember, unless it’s closer to the time when you would be taking your next dose anyway. You don’t want to accidentally double dose. (Read on to the next section for information about taking too much hydroxyzine.)

Can you overdose on hydroxyzine?

Although hydroxyzine pamoate is not habit-forming, it’s still possible to take too much of the drug and overdose. This is why you should stick to whatever dosage your doctor has prescribed.  

Keep in mind that the risk of an overdose may be increased by other medications or substances you take, especially anything that depresses your central nervous system. This includes narcotics, such as OxyContin or Vicodin, non-narcotic painkillers, and barbiturates, such as Amytal, Nembutal (pentobarbital) or Seconal (secobarbital) Since hydroxyzine itself works by suppressing your central nervous system, taking more than one drug that works the same way can be dangerous. Be sure to talk to a healthcare professional about combining hydroxyzine with any other medications.

Similarly, if you drink alcohol while taking hydroxyzine, the effect of the alcohol will be heightened, so do so with caution.

There are some heart conditions that can be triggered exacerbated when you take hydroxyzine. If you have any sort of heart-rhythm disorder or heart disease, or if those conditions run in your family, mention it to your doctor before you begin taking hydroxyzine. The same applies for any other medications you might be taking that affect your heart or your heart rhythm.  Your doctor will be able to tell you what drug interactions to watch out for.

What are the symptoms of a hydroxyzine overdose?

The most common symptom of a hydroxyzine overdose is hypersedation—in other words, extreme drowsiness. Other symptoms of a possible overdose include:

  • Convulsions
  • Stupor
  • Nausea
  • Vomiting

If you suspect that you or someone else has overdosed on hydroxyzine, you should contact poison control or your doctor. If the person in question is not responsive, call 911 immediately.

Other ways to treat anxiety

Hydroxyzine, which is the generic name for Vistaril, has been shown to be effective for treating anxiety, especially in the short term. However, if you have anxiety, hydroxyzine is just one of many proven treatment options that exist.

If you have been diagnosed with anxiety—or suspect you may have it—and are looking for ways to deal with it, Talkiatry can help. We’re an online psychiatry practice that provides virtual in-network care. Take our quick online assessment in order to be matched with one of our psychiatrists, who can talk you through your treatment options and help you figure out what approach is best for you.  

Some of the other medicines to treat anxiety that you might discuss with a mental health professional are  antidepressants like SSRIs, SNRIs, BusPar, and benzodiazepines

SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin norepinephrine reuptake inhibitors) increase the availability of the chemical serotonin, and/or norepinephrine, in your brain. Since these are both very important in regulating mood, this can help treat symptoms of anxiety. Patients typically don’t build up a tolerance to SSRIs like they can with hydroxyzine so they’re appropriate for long-term use. Some commonly prescribed SSRIs include Celexa (citalopram), and Lexapro (escitalopram), and Prozac (fluoxetine).  SNRIs that might be prescribed for anxiety include Cymbalta (duloxetine) and Effexor (venlafaxine).  

Benzodiazepines tell your brain to produce a chemical that slows down your nervous system, and they are very effective at treating anxiety. However, benzodiazepines are a little risky: They can be habit-forming, and taking too much or taking them incorrectly can cause your nervous system to slow down to a dangerous degree. If you are prescribed a benzodiazepine, be sure to closely follow your doctor’s dosage instructions. Klonopin (clonazepam)and Xanax (alprazolam) are examples of common benzodiazepines.

BusPar (buspirone), is a medication commonly used to treat anxiety disorders. It works by affecting certain brain chemicals and receptors, helping to reduce feelings of anxiety and promoting a sense of calmness. Buspar is not a benzodiazepine and is often preferred for its lower risk of dependency and milder side effects. It is prescribed for both short-term relief of anxiety symptoms and long-term management of anxiety disorders.

The information in this article is for education and informational purposes only and should never be substituted for medical advice, diagnoses, or treatment. If you or someone you know may be in danger, call 911 or the National Suicide and Crisis Lifeline at 988 right away.

Dr. Michael Roman is currently a Staff Psychiatrist at Talkiatry. He completed his adult psychiatry residency training at the University of Pennsylvania. Dr. Roman is a board-certified Adult Psychiatrist and a diplomate of the American Board of Psychiatry and Neurology (ABPN).

Dr. Roman’s clinical practice centers primarily around medication management and psychopharmacological treatment approaches. He also specializes in a variety of psychotherapeutic modalities which he utilizes in conjunction with medication management in order to provide patients with the best possible treatment outcomes.

Dr. Roman’s curiosity for the studies of the human mind began with pursuing a bachelor’s degree in psychobiology at the University of California, Los Angeles (UCLA). He was intrigued by the way our mind, body, emotions, and behavior were intertwined to comprise our everyday life experiences. His interest in the intricacy of the human mind was deepened in medical school, and he received his medical degree from the David Geffen School of Medicine at UCLA. He completed his adult psychiatry residency training at the University of Pennsylvania.

Dr. Roman treats a wide spectrum of patients, but his primary clinical focus is treating mood disorders, ADHD, anxiety disorders, and PTSD. Dr. Roman also specializes in treating substance use disorders and possesses clinical expertise in implementing high quality motivational interviewing and motivational enhancing therapy.

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