How long does it take Vistaril (hydroxyzine) to work?

How long does it take Vistaril (hydroxyzine) to work?

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Michael Roman, MD
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May 23, 2024
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Hydroxyzine—which goes by the brand name Vistaril or Atarax—is an antihistamine medication. Although antihistamines are primarily used to treat allergies, hydroxyzine can also help with anxiety. In fact, the drug is FDA-approved to treat anxiety symptoms and tension related to anxiety.  

As an antihistamine, hydroxyzine blocks the effects of histamine in your body. Histamine is a chemical your body releases when you’re having an allergic reaction. However, that’s not what gives the drug anxiety-relieving properties. Hydroxyzine also suppresses some activity in the subcortical area of the brain –– a part of your central nervous system that’s related to emotions.  

Hydroxyzine is a prescription medication, but it isn’t a controlled substance that comes along with the risk of substance use disorder, unlike other common anxiety medications like Xanax (alprazolam). On top of being used for anxiety, hydroxyzine may be prescribed off-label to help people with insomnia.  

Read on to learn about how long it takes for hydroxyzine to work, signs it’s working, potential side effects, drug interactions, and more.

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Does hydroxyzine stop anxiety immediately?

Hydroxyzine doesn’t work immediately, but you will feel the effects of it pretty quickly. Since the medication is rapidly absorbed by the body, you’ll likely notice anxiety-relieving effects 15-30 minutes after you take your dose of hydroxyzine. However, it may take 2-3 hours to feel the full benefits of the medication.  

Various factors affect drug absorption and how long it takes a medication to work for you, such as age, metabolism, and pre-existing health conditions. Depending on these factors, hydroxyzine might start working either more slowly or more quickly.  

How will I know if hydroxyzine is working?

You’ll know hydroxyzine is working if you feel your anxiety levels lowering. You might find that your racing thoughts start to slow down, you can breathe easier, and the tension in your body melts away.

As with any medication, individual responses vary. Everyone’s body reacts differently. While some might experience great relief, others might feel lesser effects and another medication may work better. Additionally, dose will play a role. Some people might need a higher dose of hydroxyzine to experience symptom relief.  

What are the potential hydroxyzine side effects?

Another way to know if hydroxyzine is working is that you might start feeling some side effects.  

The most common side effects of hydroxyzine are:

  • Drowsiness/sleepiness
  • Dry mouth
  • Headache
  • Dizziness

Constipation or confusion are also potential side effects, but more so in older adults. These side effects are typically mild and short-lasting. If these or the above side effects don’t go away or worsen, report this to your doctor.  

More rare, adverse effects include:

If you experience these serious side effects, seek medical attention ASAP.

What should I avoid when taking hydroxyzine?

It’s important to be aware of drug interactions while taking hydroxyzine to minimize risks to your health.  

Hydroxyzine drug interactions include:

  • Any antihistamines (including OTC medications like diphenhydramine/Benadryl or Zyrtec)
  • Any medications that result in sedation  
  • Any medications that affect the heart’s QT interval
  • Muscle relaxants
  • Barbiturates (such as sedative-hypnotics and anticonvulsants)  
  • Opioids
  • Other anti-anxiety medications

Any of these medications might cause additional sedative effects and drowsiness, or an increased risk of serious side effects. You should also avoid alcohol while taking hydroxyzine.  

This is not an exhaustive list of drug interactions. You might not be aware if other prescriptions you take fall into any of the above categories, which is why it’s always so important to tell your doctor about all medical conditions you have and all the medications you take, including prescription meds, over-the-counter meds, and supplements.  

Additionally, you shouldn’t drive or operate any machinery until you’re sure of how this medication affects you. If it makes you very drowsy or dizzy, these actions aren’t safe.

Lastly, you should not take hydroxyzine if you’re breastfeeding. If you’re pregnant, your doctor may advise against taking hydroxyzine. Have a discussion about this with your psychiatrist and your OB/GYN about what’s right for you.  

What if it isn’t working?

If you aren’t feeling relief from hydroxyzine, do not change or increase the dosage on your own. Always follow your doctor’s guidance, and only take your medication as directed.  

There are plenty of other medications you can try if hydroxyzine isn’t the right fit for you. Some examples of other anxiety medications are:

  • Antidepressants
  • Selective serotonin reuptake inhibitors (SSRIs)
  • Serotonin and norepinephrine reuptake inhibitors (SNRIs)
  • Tricyclic antidepressants (TCAs)
  • Monoamine oxidase inhibitors (MAOIs)
  • Atypical antidepressants

If you’re looking for a psychiatrist to help you manage your anxiety, consider Talkiatry. We’re a national psychiatry practice that treats anxiety disorders and other mental health conditions. We provide virtual, in-network services so you can get the care you need from the comfort of your own home.

To get started, complete our free online assessment to get matched with a psychiatrist.

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.

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Frequently asked questions

Does Talkiatry take my insurance?

We're in network with major insurers, including:

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The best way to get a detailed estimate of your cost is to contact your insurance company directly, since your cost will depend on the details of your insurance.  

For some, it’s just a co-pay. If you have an unmet deductible it could be more.  

Call the number on your insurance card and ask about your plan’s coverage for outpatient psychiatric services.

What kind of treatment does Talkiatry provide?

At Talkiatry, we specialize in psychiatry, meaning the diagnosis and treatment of mental health conditions. Your psychiatrist will meet with you virtually on a schedule you set together, devise a treatment plan tailored to your specific needs and preferences, and work with you to adjust your plan as you meet your goals.

If your treatment plan includes medication, your psychiatrist will prescribe and manage it. If needed, your psychiatrist can also refer you to a Talkiatry therapist.

What's the difference between a therapist and psychiatrist?

Psychiatrists are doctors who have specialized training in diagnosing and treating complex mental health conditions through medication management. If you are experiencing symptoms of a mental health condition such as depression, anxiety, bipolar disorder, PTSD, or similar, a psychiatrist may be a good place to start.  

Other signs that you should see a psychiatrist include:  

  • Your primary care doctor or another doctor thinks you may benefit from the services of a psychiatrist and provides a referral    
  • You are interested in taking medication to treat a mental health condition  
  • Your symptoms are severe enough to regularly interfere with your everyday life

The term “therapist” can apply to a range of professionals including social workers, mental health counselors, psychologists, professional counselors, marriage and family therapists, and psychoanalysts. Working with a therapist generally involves regular talk therapy sessions where you discuss your feelings, problem-solving strategies, and coping mechanisms to help with your condition.

How does Talkiatry compare to face-to-face treatment?

For most patients, Talkiatry treatment is just as effective as in-person psychiatry (American Psychiatric Association, 2021), and much more convenient. That said, we don’t currently provide treatment for schizophrenia, primary eating disorder treatment, or Medication Assisted Treatment for substance use disorders.

Who can prescribe medication?

All our psychiatrists (and all psychiatrists in general) are medical doctors with additional training in mental health. They can prescribe any medication they think can help their patients. In order to find out which medications might be appropriate, they need to conduct a full evaluation. At Talkiatry, first visits are generally scheduled for 60 minutes or more to give your psychiatrist time to learn about you, work on a treatment plan, and discuss any medications that might be included.

Michael Roman, MD

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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