Vistaril (hydroxyzine) vs Xanax (alprazolam): Comparing medications

Vistaril (hydroxyzine) vs Xanax (alprazolam): Comparing medications

Vistaril and Xanax can both help relieve symptoms of anxiety quickly. Vistaril can be a better choice than Xanax if you have a history of substance misuse since there is less risk of addiction.

Reviewed by:
Divya Khosla, MD
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May 19, 2024
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If you’ve been diagnosed with anxiety and are considering medication to treat your symptoms, two names you may have come across are Vistaril and Xanax. What’s the difference? Both are FDA-approved to treat anxiety in the short-term, but they are very different drugs that work in different ways.

In this article we’ll explain how each of them works, their benefits and disadvantages, as well as other anxiety medications.


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Differences between Vistaril and Xanax

Vistaril is the brand name for the hydroxyzine and Xanax is the brand name for alprazolam. Vistaril and Xanax are both different types of medications that come in different forms and dosages. Another key difference is that Xanax has a higher risk of misuse than Vistaril and is classified as a controlled substance.

The chart below outlines some of the key distinctions between these drugs for easy reference, but read on for a detailed explanation of their side effects and their relative efficacy, as well as a list of other anxiety medications.  

                                                                                                                               
Vistaril Xanax
Formulation Hydroxyzine Alprazolam
Classification Antihistamine and histamine antagonist Benzodiazepine and GABA modulator
Controlled substance No Yes
Available forms Capsules (25, 50, 100 mg), and tablets (10, 25 mg, 50, 100 mL) Immediate release tablets (0.25 mg, 0.5 mg, 1 mg, and 2 mg), extended release tablets (0.5 mg, 1 mg, 2 mg, and 3 mg)
How often is it taken? Up to four times daily Up to three times daily
Common side effects Sedation, dry mouth, tremors Sedation, fatigue, depression, dizziness, ataxia, slurred speech, weakness, forgetfulness, confusion, hyperexcitability, and mania
Habit-forming No Yes

What conditions do they treat?

Both Vistaril and Xanax are prescribed to treat anxiety, but they do so in different ways.  

Vistaril is a brand name of hydroxyzine pamoate, an antihistamine. This drug is an antihistamine, which means it manages the levels of a chemical called histamine that is produced by your immune system. It's not completely clear how hydroxyzine directly improves anxiety, but it possibly increases serotonin to help with mood and it's antihistamine properties contribute to sedation. Hydroxyzine is FDA-approved to treat several different types of anxiety disorders, as well as allergies. It’s also prescribed off-label for insomnia. (Off-label means an unapproved use of a drug, for which it can still be effective based on scientific evidence.)

Xanax is a brand name for alprazolam, which is a benzodiazepine. Xanax works by binding to specific receptors in the brain that are sensitive to a neurotransmitter called GABA that helps calm down the activity of neurons, which can prevent feelings of anxiety. Xanax enhances GABA’s effect on these receptors. Xanax is FDA-approved for the treatment of generalized anxiety disorders (GAD) and panic disorders (PD).  

Related article: Can you take Xanax for sleep?

How quickly do they work?

Vistaril and Xanax differ in their chemical composition, but both medications can potentially start improving symptoms within 15 minutes. But it's important to choose which medication might be a better fit for you with your doctor.

It’s important to note that individual responses to these medications can vary. Some people may experience quicker or slower onset of action, and the effectiveness of the drugs may depend on factors such as dosage, metabolism, and the severity of the anxiety or panic symptoms being treated. Always follow your doctor’s guidance regarding the use of these medications, and report any concerns or unusual reactions.

Learn more about how long Vistaril (hydroxyzine) takes to work

Is hydroxyzine as effective as Xanax?

Both medications have shown clinical improvement for anxiety. It's important to discuss which medication might be a better fit based upon your current symptoms with your doctor.  However Xanax, it might not be the best choice of anxiety treatment for everyone, in part because of its side effects and habit-forming potential. Xanax is a controlled substance and has a potential for physical dependence so it isn’t right in some circumstances, especially if you have struggled with substance use in the past.  

If you’re pregnant or breastfeeding, Vistaril and Xanax should both be used with caution. Talk with your psychiatrist or OB/GYN for more information to see what you should do in your situation.


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What are the side effects?

Common side effects of hydroxyzine include:

  • Sedation  
  • Dry mouth  
  • Tremor  

Meanwhile, some common side effects of Xanax include:

  • Sedation
  • Fatigue
  • Depression  
  • Dizziness  
  • Slurred speech
  • Weakness
  • Forgetfulness
  • Confusion
  • Mania

Some people don’t want to take Xanax because of these side effects and because, as a benzodiazepine, it can be habit-forming and cause withdrawal symptoms if you stop taking it.  

Both medications are not typically recommended for long term use due to their potential increased risk of developing dementia in the elderly population.

They also have the potential to build a tolerance which means that a higher dosage may be necessary to treat symptoms with time, but only Xanax has the addiction potential. Here are some other alternative to Xanax to consider.  

When you discuss potentially taking either of these medications with your psychiatrist, one thing to keep in mind is potential drug interactions. Because both Xanax and hydroxyzine have a sedative effect, it’s not recommended to take them at the same time as any opioids, or any substance that might cause sleepiness or drowsiness, like sleeping aids or alcohol. Doing so can be very dangerous. Be sure to tell your doctor about any other medications you’re taking to ensure that the combination is safe for you.

Other treatment options for anxiety  

Xanax and Vistaril are by no means the only methods available for treating anxiety. Many other options exist, both prescription and non-prescription medication.  

Medication alternatives to Xanax and Vistaril include:

  • Other benzodiazepines, such as Klonopin (clonazepam), Ativan (lorazepam), and Valium (diazepam). Like Xanax, they can be very effective and quick, but also like Xanax, they carry the risk of dependence.  
  • SSRIs, or selective serotonin reuptake inhibitors. Patients typically don’t build up a tolerance to SSRIs like they can with hydroxyzine, and they are not habit-forming like benzodiazepines are. Some commonly prescribed SSRIs antidepressants include sertraline (Zoloft), citalopram (Celexa), escitalopram (Lexapro), and fluoxetine (Prozac).  
  • SNRIs, or serotonin-norepinephrine reuptake inhibitors. SNRIs that might be prescribed for anxiety include duloxetine (Cymbalta) and venlafaxine (Effexor).

Non-prescription options for treating anxiety include:

  • Regular exercise is a highly effective non-medical solution to preventing and treating anxiety and improving overall mental well-being. Whether it’s going for a walk, hitting the gym, or practicing yoga, finding activities that you enjoy and can sustain over time can have significant benefits for managing anxiety symptoms.
  • Good sleep hygiene is essential for overall well-being, including mental health, and plays a significant role in managing anxiety. Sleep hygiene refers to a set of practices and habits that promote healthy and restful sleep. Some easy ways to practice good sleep hygiene include going to bed at a consistent time every day, creating a relaxing bedtime routine, and trying to limit screen exposure for an hour or two before bedtime.  
  • Therapy, including cognitive behavioral therapy (CBT), is often considered a cornerstone of treatment for anxiety disorders, either as a standalone approach or in conjunction with medication. It offers a holistic and personalized approach to treating anxiety, addressing not only the symptoms but also the underlying factors contributing to anxiety disorders. It can be a valuable resource for individuals seeking lasting relief from anxiety and improving their quality of life.

If you’re interested in getting help for anxiety, you can take Talkiatry’s online assessment to get matched with one of our doctors.  We’re a national psychiatry practice that provides in-network virtual care.

FAQ

Here are more answers to your questions.

What is hydroxyzine?

Hydroxyzine is an antihistamine medication used to relieve symptoms of anxiety and tension, as well as to treat itching due to allergic reactions. It works by blocking the effects of histamine in the body, leading to sedation and relaxation. You might encounter it under the brand name Vistaril.  

What is Xanax?  

Xanax is a benzodiazepine medication primarily prescribed for the treatment of anxiety disorders and panic disorders, but comes with negative consequences, like the potential for addiction and misuse. It works by enhancing the effects of a neurotransmitter called gamma-aminobutyric acid (GABA) in the brain, resulting in calming effects on the central nervous system.  

Which one is better for anxiety?

Whether hydroxyzine or Xanax is better for treating anxiety depends on your circumstances and preferences. If you’re interested in trying one of these drugs, you should discuss it with a mental health professional.  

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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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.

About
Divya Khosla, MD

Dr. Divya Khosla, MD, is a board certified Adult Psychiatrist and board eligible Child and Adolescent Psychiatrist. She received her undergraduate degree from Case Western Reserve University in Cleveland, Ohio, and her medical degree from Ross University, completing all of her clinicals in Maryland, D.C., and NYC. She completed her adult psychiatry residency at The Ohio State University in Columbus, Ohio. Then she returned to the east coast, where she completed her child and adolescent psychiatry fellowship at Nassau University Medical Center in East Meadow, New York.

Dr. Khosla has participated in a variety of innovative academic clinical research, and has presented research at annual national meetings of the American Psychiatric Association. Her robust clinical experience with varying demographics at different clinical sites around the country has allowed her to treat patients in an evidence-based way, tailoring treatment to an individual’s specific needs.

Although Dr. Khosla’s practice focuses on medication management, she also implements supportive therapy and motivational interviewing in sessions to allow for a more comprehensive approach to treatment. Her clinical interests include depression, bipolar disorder, anxiety disorders, post-traumatic stress disorder, panic disorder, and ADHD.

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