Hydroxyzine (Vistaril)

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Generic name: hydroxyzine (hye DROKS i zeen)

• Hydroxyzine Pamoate
  • Capsules: 25 mg, 50 mg, 100 mg
• Hydroxyzine HCl
  • Tablets: 10 mg, 25 mg, 50 mg
  • Syrup: 10 mg/5mL
  • Solution: 25 mg/mL, 50 mg/mL

Brand name: Vistaril®

• Capsules: 25 mg, 50 mg

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All FDA warnings are at the end of this fact sheet. Please consult them before taking this medication.

What Is Hydroxyzine And What Does It Treat?

Hydroxyzine is an antihistamine. It is approved for the treatment of anxiety. However, hydroxyzine is also used to treat difficulty sleeping, nausea, vomiting, itching, skin rash, and allergies.

Symptoms of anxiety include:

• Feeling nervous
• Feeling fearful
• Excessive worrying
• Difficulty sleeping
• Difficulty concentrating
• Irritability

What Is The Most Important Information I Should Know About Hydroxyzine?

Do not drive a car or operate machinery until you know how this medication affects you because you may notice that you feel tired or dizzy.

Hydroxyzine is not a controlled substance. It does not have the risk of addiction like some other medications used to treat anxiety e.g., lorazepam (Ativan®), alprazolam (Xanax®), clonazepam (Klonopin®), and other benzodiazepines.

Are There Specific Concerns About Hydroxyzine And Pregnancy?

If you are pregnant or planning to become pregnant, notify your health care provider to best manage your medications. People living with anxiety disorders who wish to become pregnant face important decisions. It is important to discuss this with your doctor and caregivers.

Hydroxyzine should not be used in the first trimester of pregnancy. Studies that were done with mice, rabbits, and rats found an increased risk of birth defects. The risk to humans in the first trimester is unclear due to lack of well-controlled studies in humans. Hydroxyzine may be used in the second and third trimesters of pregnancy, but it should not be used during or just prior to labor. Use of hydroxyzine during labor may increase seizure risk in infants, decrease fetal heart rate, and increase side effects when combined with narcotics.

Regarding breastfeeding, use is not recommended since hydroxyzine does pass into breast milk. Infants who have received other antihistamines have experienced drowsiness, irritability, or unusual excitement. In addition, it may lower milk production in the mother.

What Should I Discuss With My Health Care Provider Before Taking Hydroxyzine?

• Symptoms of your condition that bother you the most
• If you have thoughts of suicide or harming yourself
• Medications you have taken in the past for your condition, whether they were effective or caused any adverse effects
• If you experience side effects from your medications, discuss them with your health care provider. Some side effects may pass with time, but others may require changes in the medication.
• Any other psychiatric or medical problems you have, including obstructive sleep apnea or abnormal heartbeat
• All other medications you are currently taking (including over the counter products and herbal and nutritional supplements) and any medication allergies you have, including allergies to cetirizine (Zyrtec®) or levocetirizine (Xyzal®)
• Other non-medication treatment you are receiving, such as talk therapy or substance abuse treatment. Your provider can explain how these different treatments work with the medication.
• If you are elderly or are prone to falls
• If you are pregnant, plan to become pregnant, or are breastfeeding
• If you drink alcohol or use drugs
• If you have a heart condition known as a prolonged QT interval

How Should I Take Hydroxyzine?

Hydroxyzine may be taken with or without food. Take with food if you experience an upset stomach.

Hydroxyzine may be taken every day at regular times or on an as needed (“PRN”) basis. Typically, your health care provider will limit the number of doses you should take in one day.

Your health care provider will determine the dose and method of taking the medication that is right for you based upon your response.

If you take the medication every day (instead of ‘as needed’), use a calendar, pillbox, alarm clock, or cell phone alert to help you remember to take it. You may also ask a family member or friend to remind you or check in with you to be sure you are taking your medication.

What Happens If I Miss A Dose Of Hydroxyzine?

If you miss a dose of hydroxyzine, take it as soon as you remember, unless it is closer to the time of your next dose. Discuss this with your health care provider. Do not double your next dose or take more than what is prescribed.

What Should I Avoid While Taking Hydroxyzine?

Avoid drinking alcohol and using illegal drugs while you are taking hydroxyzine. They may decrease the benefits (e.g., worsen your condition) and increase the adverse effects (e.g., sedation) of the medication.

What Happens If I Overdose With Hydroxyzine?

If an overdose occurs call your doctor or 911. You may need urgent medical care. You may also contact the poison control center at 1-800-222-1222.

Symptoms of overdose include severe drowsiness, dry mouth, difficulty urinating, headache, rapid heartbeat, confusion, impaired coordination, slow reflexes, seizures, or coma.

A specific treatment to reverse the effects of hydroxyzine does not exist.

What Are The Possible Side Effects Of Hydroxyzine?

Common side effects

• Dizziness, drowsiness, fatigue, dry mouth
• Urinary retention, blurred vision, confusion, irritability
• Headache

Rare/Serious side effects

• Allergic reaction (difficulty breathing; hives; swelling of your lips, tongue or face)
• Increased heart rate, unsafe heart beat (long QT on ECG), confusion, hallucinations
• Priapism (an erection in males that does not go away after 4 hours)
• Skin rash known as acute generalized exanthematous pustulosis (AGEP)

Are There Any Risks For Taking Hydroxyzine For Long Periods Of Time?

To date, there are no known problems associated with the long-term use of hydroxyzine. It is a safe and effective medication when used as directed.

A physician should reassess periodically the usefulness of the drug for the individual patient.

What Other Medications May Interact With Hydroxyzine?

The following medications may increase the levels and effects of hydroxyzine:

• Other antihistamines, such as diphenhydramine (Benadryl®) and cetirizine (Zyrtec®)
• Other medications with anticholinergic effects, such as benztropine (Cogentin®)
• Other medications that can cause drowsiness, such as zolpidem (Ambien®)
• Other medications that increase the heart’s QT interval such as amitriptyline (Elavil®), citalopram (Celexa®), and methadone

How Long Does It Take For Hydroxyzine To Work?

Symptoms of anxiety or insomnia may improve within hours of the first dose of medication.

Summary of Black Box Warnings

Hydroxizine does not have any black box warnings.

Last Reviewed: January 2024

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Important Disclosure: This information is being provided as a community outreach effort of the American Association of Psychiatric Pharmacists. This information is for educational and informational purposes only and is not medical advice. This information contains a summary of important points and is not an exhaustive review of information about the medication. Always seek the advice of a physician or other qualified medical professional with any questions you may have regarding medications or medical conditions. Never delay seeking professional medical advice or disregard medical professional advice as a result of any information provided herein. The American Association of Psychiatric Pharmacists disclaims any and all liability alleged as a result of the information provided herein.

©2023 The American Association of Psychiatric Pharmacists (AAPP) and the National Alliance on Mental Illness (NAMI). AAPP and NAMI make this document available under the Creative Commons Attribution-NoDerivatives 4.0 International License. Last Updated: January 2016.