Hydroxyzine Vs Xanax for Anxiety: How Do They Compare?

What is Hydroxyzine?

Hydroxyzine (brand name Vistaril) is an anxiety medication classified as an antihistamine. It works by decreasing activity in certain key regions of the brain that regulate mood and emotions. For example, decreasing two chemicals in the brain, serotonin and dopamine, helps produce anti-anxiety effects.

Hydroxyzine is indicated for the treatment of symptomatic relief of anxiety and tension associated with psychoneurosis (anxiety related to stress). Hydroxyzine dosage forms include tablets, capsules, syrup, and solutions that range from 25 mg to 100 mg. Hydroxyzine starts to work in about 15 to 60 minutes and usually lasts about 4 to 6 hours.¹

What Is Xanax?

Xanax (alprazolam) is a benzodiazepine used for the treatment of anxiety and panic disorders. Its primary mechanism of action involves binding to GABA type-A receptors in the brain to improve mood and emotions.

Xanax is indicated for acute treatment of generalized anxiety disorder in adults. The safety and effectiveness have not been established for children, and there are precautions if pregnant or breastfeeding while taking Xanax due to the risk of adverse reactions for the baby, including sedation (excessive sleepiness), withdrawal symptoms, feeding problems, and more.

Alprazolam effects may be felt within 30 minutes of taking the medication and last for about 6 hours. It is important to note that Xanax has a boxed warning (the most serious FDA warning) regarding the risk of abuse, misuse, and addiction, along with dependence and withdrawal reactions.^2,3

What Are Hydroxyzine & Xanax Used to Treat?

Hydroxyzine is an FDA-approved medication used for anxiety (from stress), pruritus (itchiness), and sedation during anesthesia. This means that the drug’s effect has been reviewed by the FDA and determined to provide benefits and meet safety standards for the population it is approved for. Short-term use in generalized anxiety disorder is preferred because it can cause effects, such as dry mouth, impaired performance, and memory impairment that interfere with daily tasks.

Hydroxyzine should be avoided in older patients due to these effects as well as excessive tiredness. Hydroxyzine is not used for off-label conditions. Off-label use is when prescribers utilize medications to treat conditions other than those that the FDA has approved.^1,4

Xanax is FDA-approved in adults for the acute treatment of generalized anxiety disorder and the treatment of panic disorder with or without agoraphobia (e.g. fear of being in situations where escape might be difficult). Xanax is effective in producing a calming effect.

Xanax should not be used in children, and exposure during pregnancy and breastfeeding is highly monitored by health professionals. Elderly patients should use caution with Xanax due to high sedation and memory impairment, but low doses may be seen for this population. Xanax off-label uses include insomnia, premenstrual syndrome, and depression. ^2,3

The table below compares the medical and mental health conditions hydroxyzine and Xanax are used to treat:

What Are the Differences Between Hydroxyzine & Xanax?

Hydroxyzine is an antihistamine used for symptomatic relief of anxiety and tension associated with stress, and Xanax is a benzodiazepine used for the treatment of anxiety and panic disorders. Although the two medications are in different drug classes, they are both used in the treatment of anxiety. Hydroxyzine is used short-term in patients needing symptomatic relief from anxiety and has not yet been assessed for long-term use.

Xanax is typically used for an extended period of time for individuals with generalized anxiety disorder.

Lower doses are seen for Xanax due to the increased risk of misuse, abuse, dependence, and withdrawal symptoms. If a patient stops Xanax, serious life-threatening side effects, including unusual movements and responses, seizures, nervous system changes, and depression, can occur. Hydroxyzine is approved for all ages, but Xanax is limited to adults.^1,2

Here are the key differences between hydroxyzine versus Xanax:

Is Hydroxyzine or Xanax More Effective for Anxiety?

Hydroxyzine and Xanax both target chemicals in the brain to produce anti-anxiety effects. Xanax is capable of producing a larger reduction in anxiety compared to hydroxyzine. Hydroxyzine works on dopamine and serotonin to stabilize mood and regulate anxiety, while Xanax plays a crucial role in the brain chemical GABA, which leads to a calming effect.⁵

How Quickly Do Hydroxyzine & Xanax Work?

Hydroxyzine and Xanax are both rapidly absorbed in the body. Hydroxyzine effects are usually noted within 15 to 30 minutes after oral administration and lasts 4 to 6 hours, while Xanax may be felt within 30 minutes and lasts about 6 hours.^1,3

Hydroxyzine Vs. Xanax Dosages for FDA-Approved Treatment

Hydroxyzine and Xanax come in a variety of doses and dosage forms. Hydroxyzine dosage forms include tablets, capsules, syrup, and solutions that range from 25 mg to 100 mg. Xanax dosage forms include tablets, disintegrating tablets, extended-release tablets, and an oral solution that ranges from 0.25 mg to 3 mg. Xanax comes in low doses due to the increased risk of misuse, abuse, dependence, and withdrawal symptoms, not because of the symptom severity.

Dosing is determined by the condition being treated, age, weight, and other medications and medical conditions. Patients will likely notice the first signs and possibly side effects of Hydroxyzine within 15 to 30 minutes, and it may take up to 4 to 12 hours to achieve full therapeutic effect. On the other hand, patients may notice the first signs and symptoms of Xanax within 30 minutes to an hour, and it may take 1 to 2 hours to achieve a full therapeutic effect, depending on the dosage form.^1,2

Side Effects of Hydroxyzine & Xanax

Side effects of hydroxyzine are usually mild and short-lasting. Dry mouth is a common side effect, as well as drowsiness and involuntary motor activity. Side effects of Xanax include problems with coordination, hypotension, dysarthria, changes in sex drive, drowsiness, tiredness, and appetite or weight changes.

Although Xanax has a more expansive list of side effects, both drugs are known for increasing fatigue and contributing to memory impairment. It is recommended that patients do not take it in combination with other central nervous system depressant drugs and caution about the effects of alcohol consumption.^1,2

Common Side Effects

Dry mouth, downiness, involuntary motor activity, learning and memory impairment, and poor coordination can be most commonly expected with hydroxyzine. Less frequently, patients may experience abnormal heartbeat, skin discoloration, and fainting with hydroxyzine. Common side effects of Xanax may include problems with coordination, hypotension, and drowsiness. Less frequently, patients may experience delirium and trouble breathing with Xanax. Reactions vary by individual, and serious reactions should be reported to your prescriber and pharmacist.^1,2

Common side effects from taking hydroxyzine may include:*^1,3

• Dry mouth
• Drowsiness
• Involuntary motor activity
• Learning and memory impairment
• Poor coordination

Common side effects from taking Xanax may include:*^2,4

• Problems with coordination
• Hypotension
• Trouble saying words clearly
• Changes in sex drive
• Drowsiness
• Dizziness
• Insomnia
• Memory problems

*All medications, including hydroxyzine and Xanax, have a risk of side effects, including serious side effects. This is not a complete list of side effects. You should talk with your prescriber or pharmacist about the benefits and risks of any medication before starting treatment.

Serious Side Effects

In rare situations, hydroxyzine and Xanax may cause serious side effects. If these side effects are experienced, patients should immediately seek medical care or call 911. If either medication is taken in toxic doses or in combination with other central nervous system depressants (e.g. sedatives), hydroxyzine and Xanax may cause severe breathing issues and excessive tiredness. Taking Xanax comes with warnings of abuse, misuse, addiction, withdrawal symptoms, and suicidal ideation. Patients should monitor for these serious side effects and contact a provider if noticed.

Serious side effects from taking hydroxyzine may include:*¹

• Hypersedation
• Increased respiratory depression
• Severe dizziness
• Passing out
• Abnormal heartbeat

Serious side effects from taking Xanax may include:*²

• Coma
• Death
• Delirium
• Paranoia
• Suicidal thoughts and actions
• Seizures
• Difficulty breathing

*All medications, including hydroxyzine and Xanax, have a risk of side effects, including serious side effects. This is not a complete list of side effects. You should talk with your prescriber or pharmacist about the benefits and risks of any medication before starting treatment.

Warnings & Precautions for Hydroxyzine & Xanax

Patients may be allergic to the active pharmaceutical ingredients or the inactive ingredients within hydroxyzine and Xanax. An allergy can manifest into a rash, hives, itching, blistering, trouble breathing and swallowing, and swelling of the mouth, face, and tongue. Upon recognition of these symptoms, patients should contact their provider or call 911 immediately, depending on the severity.

Risks to consider when taking hydroxyzine and Xanax include:^1,2

• Allergic reactions: For hydroxyzine and Xanax, an allergy related to the drug may manifest as a rash, hives, itching, blistering, and wheezing, among others.
• Pregnancy and breastfeeding: The excretion of hydroxyzine in human milk has not been studied, but its use while breastfeeding is discouraged. Xanax has the potential to cause neonatal sedation and withdrawal syndrome. Therefore, breastfeeding and taking Xanax while pregnant is not recommended.
• People taking central nervous system (CNS) depressants: Taking hydroxyzine or Xanax in combination with other depressants can lead to severe drowsiness.
• Depression: Xanax can make depression worse, and increased reports of suicide have been shown. Episodes of hypomania and mania have been reported in association with the use of Xanax in patients with depression.
• Impaired respiratory function: Deaths have been reported in patients with pulmonary disease who have taken Xanax.
• Driving: These medications can cause drowsiness, which can be dangerous while driving.

Potential Drug Interactions With Hydroxyzine & Xanax

Harmful interactions can occur when combining hydroxyzine or Xanax with certain substances. When hydroxyzine and Xanax are used in combination with other opioids, the risk of respiratory depression increases. The combination of Xanax and CNS depressants produces addictive depressant effects. Xanax can also interact with digoxin (heart medicine), increasing the risk of digoxin toxicity. Xanax also has a significant interaction with CYP3A inhibitors and inducers (e.g. diltiazem, simvastatin) that leads to adverse reactions and reduced efficacy.^1,2

Disclaimer: Taking certain medications, herbs, or supplements alongside hydroxyzine and Xanax can change how these medications work in your body or increase the risk of serious side effects. This article does not consider all the possible interactions. Please let your doctor, psychiatrists, and pharmacists know about all the products you currently use, such as prescription medication, nonprescription drugs, and herbal supplements. Do not start, stop, or change the dosage of any medicines without your doctor’s approval.

Which Is Right for You: Hydroxyzine or Xanax?

Deciding what medication to take depends on your needs and many other factors. These factors include but are not limited to symptoms, age, allergies, therapy-related goals, susceptibility, current medications and medication history, genetics, and conditions. Visiting with a doctor or psychiatrist can help narrow down a decision and help with treatment options. Still, if that is not feasible, your pharmacist can also help you consider the benefits and risks of each medication.

The choice between hydroxyzine and Xanax depends highly on age due to sedative qualities, susceptibility to misuse and abuse, drug interactions, lifestyle, and duration of therapy. A patient should speak with a medical professional to review these factors to make the best decision.

How to Get a Prescription for Hydroxyzine & Xanax

Getting a prescription for Hydroxyzine and Xanax requires a doctor’s visit. The doctor writes a prescription and sends it to a patient’s preferred pharmacy. Unlike Xanax, hydroxyzine is not a controlled substance because there are no addictive qualities.

Questions to Ask Your Health Team About Hydroxyzine & Xanax

Individuals might want to learn more about hydroxyzine and Xanax when seeking treatment for anxiety, particularly when inquiring about short-term use or when other options have been ineffective. Patients should seek to learn about the potential benefits, risks, and side effects of the medication when consulting with a doctor, psychiatrist, pharmacist, or therapist. The compatibility of hydroxyzine and Xanax should also be monitored with one’s medical history and current medications. Concerns about interactions with food and dietary restrictions should also be discussed.

Questions to ask your prescriber about hydroxyzine and Xanax include:

• Is it safe to take hydroxyzine or Xanax with my other medications?
• Will hydroxyzine or Xanax be covered by my insurance?
• Which one has the best results as a treatment for anxiety? Hydroxyzine or Xanax?
• Does my medical history increase my risk of side effects from either hydroxyzine or Xanax?
• How long can I expect side effects to last with hydroxyzine and Xanax?
• How often should I see you for checkups while taking hydroxyzine or Xanax?
• What are some Xanax alternatives to consider?
• What should I do if I am unsure whether anxiety medications are right for me?
• What if I accidentally overdose on Xanax?

For Further Reading

• 22 Natural Remedies for Anxiety
• Ativan Vs Xanax: Differences, Similarities, & Which to Take