Hydroxyzine Pamoate (Vistaril): Uses, Side Effects, Dosage

Hydroxyzine pamoate (the generic version of Vistaril) is in the class of drugs known as antihistamines. Hydroxyzine has anticholinergic and sedative properties and is often prescribed to treat hives, itching, dermatitis, and allergic skin reactions. The drug works by reducing central nervous activity, so it’s also sometimes used as a treatment for tension or anxiety. 

If you’re considering taking hydroxyzine for anxiety, you must understand how this medication works. Keep reading to learn what this drug is, how it can effectively treat anxiety and other conditions, how it makes you feel, what side effects or drug interactions you should be aware of if you take it, and more. 

What is Hydroxyzine Pamoate?

Hydroxyzine pamoate, commonly known by its brand name Vistaril, is a prescription-only antihistamine similar to the over-the-counter drugs diphenhydramine (Benadryl) and cetirizine (Zyrtec). 

The difference between hydroxyzine and other antihistamines is that hydroxyzine affects serotonin levels and has been found successful in treating anxiety in studies. However, it’s important to point out that hydroxyzine is generally not used as a first-line treatment for generalized anxiety disorder (GAD).

How does hydroxyzine pamoate work?

Hydroxyzine’s mechanism of action involves inhibiting certain reactions in the body that cause allergy symptoms. 

Medications like hydroxyzine act on H-1 histamine receptors to suppress histamines released during allergic reactions — histamine simulation can have an anxiety-related effect. The drug has sedative properties that can reduce activity in the central nervous system, helping alleviate anxiety and tension. 

How does hydroxyzine pamoate make you feel?

While people can react differently to medication based on factors like dosage and personal response to a drug, most report feeling calm, drowsiness, or sleepiness after taking hydroxyzine — this is due to the sedative effect the drug has. For more information on its effect, learn how long it takes for hydroxyzine to work.

Remember, everyone’s body reacts differently to medication, so while some people may find relief using hydroxyzine for anxiety, others might not have the same results.

Hydroxyzine Pamoate Uses

For those not familiar with the drug, it’s common to wonder what is hydroxyzine used for? 

Developed to block histamines and treat severe itching that’s caused by allergies, hydroxyzine is also FDA-approved for short-term use to treat anxiety. Anxiety is a pervasive mental health condition that affects millions worldwide. The American Psychiatric Association notes that an estimated 30% of adults will have an anxiety disorder at some point.    

Research found a significant reduction in generalized anxiety disorder symptoms among participants taking hydroxyzine compared to placebo users. 

Off-label uses

While it’s primarily known for its effectiveness in treating anxiety and allergies, hydroxyzine uses can also include a few off-label applications, too. 

Off-label means the medication is not FDA-approved for treatment but has been observed to work by healthcare providers or through research studies.

Treatment for insomnia: The sedative characteristics of hydroxyzine can be effective in treating insomnia. In studies, the drug promoted relaxation and facilitated better sleep quality when given in high doses and used short-term. Long-term use of hydroxyzine for insomnia has not been studied enough for any claims of efficacy or safety to be made.

Symptom management in alcohol withdrawal: In the past, hydroxyzine has been used to reduce the symptoms of alcohol withdrawal. While it can effectively reduce symptoms like tremors and agitation, which often accompany sudden cessation from alcohol consumption, other medications are more commonly used and are likely more effective, according to some research.

Assessing the advantages and disadvantages is important before taking any medication.  

Pros & Cons of Hydroxyzine Pamoate

ProsConsProven efficacy for anxiety or allergies.

Potential side effects including constipation, confusion, dry mouth, and fatigue or extreme drowsiness.  Safety profile generally favorable compared to similar medications on the market — most people experience mild, if any, side effects.Not recommended for people who are pregnant or older than 65.Safe for use in children.Can cause irregular heartbeat when taken with other medications.

“Hydoxyzine is non-habit forming, making it a great choice for patients with concerns of dependence on medications.”

– Talkspace psychiatrist Dr. Muhammad Munir, MD, DFAPA

Side Effects of Hydroxyzine Pamoate

Like any medication, hydroxyzine can have common side effects. Potential reactions to hydroxyzine can differ from person to person, so it’s not guaranteed that everyone will experience the following side effects of hydroxyzine pamoate.

Mild side effects

While beneficial for many people dealing with anxiety disorders, potential side effects cannot be ignored. Mild side effects associated with taking hydroxyzine can include: 

Sleepiness

Dizziness

Skin reaction, allergic reaction, or skin rash

Dry mouth

Fatigue

Headache 

Constipation

Confusion 

These are typically transient problems that diminish with time.

Serious side effects

In rare cases, while you’re taking hydroxyzine for anxiety or other conditions, more serious symptoms might emerge, such as:

Severe dizziness 

Headache with chest pain

Pounding, fast heart rate

Difficulty breathing

Seizure 

If you notice drastic changes in your health after starting this medication, it is critical to reach out immediately for professional medical help.

Note: This list does not cover all possible side effects; always consult a healthcare provider if concerns arise while using this drug.

Hydroxyzine Pamoate Dosage

Hydroxyzine comes in a tablet, oral solution, or syrup form. It can also be given by injection from a doctor. 

Like any medication, taking the correct dosage is important. Your healthcare provider can determine the exact dose that’s right for you, based on factors like your condition and response to therapy. Adjustments can be made depending on your response to treatment.

Dosage by condition

Standard dosing for itching or allergies ranges from 25 -100 mg per day, divided into separate doses. The dosage for anxiety can differ slightly and will always ultimately depend on your doctor’s prescription. 

Additional Considerations

Hydroxyzine can be taken with or without food. If you miss a dose, take it as soon as you realize it, unless your next scheduled intake is almost due. In that case, just resume your usual routine starting with the next dose.

Don’t double up on this medication. Do not stop taking hydroxyzine without consulting a healthcare professional because withdrawal symptoms could occur.

Interactions

If you take other medications or supplements for anxiety, you should know that some drugs can interact with hydroxyzine. For instance, combining this medication with central nervous system depressants like alcohol or benzodiazepines could amplify sedative effects.

Other antihistamines, barbiturates, muscle relaxants, and even some antidepressants also have potential adverse reactions when taken alongside hydroxyzine.

Like any medication, inform your healthcare provider about all the drugs you currently use before starting hydroxyzine.

Any of the following medications should not be used with hydroxyzine:

Alfuzosin

Amiodarone

Amisulpride

Amitriptyline

Amprenavir

Bromopride

Buprenorphine

Buserelin

Calcium Oxybate

Ceritinib

Dolasetron

Domperidone

Donepezil

Fluoxetine

Gonadorelin

Hydroxyzine

Ibutilide

Magnesium Oxybate

Mefloquine

Nilotinib

Norfloxacin

Octreotide

Protriptyline

Quetiapine

Risperidone

Ritonavir

Safinamide

Triptorelin

Vinflunine

Voclosporin

Voriconazole

Vorinostat

Ziprasidone

*Note: This list is not exhaustive — inform your doctor of all medications you’re taking, both prescription and over-the-counter.

Warnings

The Food and Drug Administration (FDA) advises that people with certain health conditions should use caution while taking hydroxyzine.  

Let your doctor know if you have a history of glaucoma, heart disease, electrolyte imbalances, or urinary retention problems. These conditions may worsen due to the drug’s side effects.

Mental health factors shouldn’t be overlooked either — depression or anxiety disorders may potentially exacerbate symptoms in some cases during a hydroxyzine treatment course.

Pregnancy and breastfeeding warnings

If you are pregnant or planning on becoming pregnant, discuss any risks associated with Hydroxyzine pamoate usage during pregnancy with your doctor. Hydroxyzine can harm unborn babies, and enough research hasn’t been done to determine breastfeeding safety. 

Opportunity for clinician quote — provide any clinical advice for warnings

Hydroxyzine Pamoate Alternatives

There are alternatives to hydroxyzine for anxiety, like Propranolol and Clonidine. Your healthcare provider might also recommend other medications depending on your health condition and medical history.

Benzodiazepines

Benzodiazepines like diazepam and clorazepate can immediately relieve acute anxiety symptoms in some people. These medications act by intensifying specific neurotransmitters in our brain, causing a soothing result that can help manage anxiety symptoms.

Selective Serotonin Reuptake Inhibitors (SSRIs)

Research suggests that selective serotonin reuptake inhibitors (SSRIs) — antidepressants — can effectively treat some anxiety disorders. SSRIs affect serotonin levels in the brain, a mood-regulating neurotransmitter. Zoloft has the least risk of side effects and is one of the most effective SSRIs known for anxiety.

Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)

Your doctor might recommend the serotonin-norepinephrine reuptake inhibitor (SNRI) venlafaxine for anxiety symptoms. SNRIs enhance serotonin and norepinephrine levels in the brain — two critical neurotransmitters involved in managing depression and anxiety disorders symptoms.

Online Hydroxyzine Pamoate Prescription 

Getting a prescription for hydroxyzine for anxiety can be easy, and it can often be done with a prescription for Hydroxyzine online. Talkspace offers convenient online psychiatry services from licensed psychiatrists who can treat and prescribe medication for anxiety. 

Reach out to Talkspace today to learn more about convenient, affordable, flexible care so you can start on the path of therapy and medication to treat your anxiety. You don’t have to allow symptoms of anxiety to take over your life any longer — help is available, and Talkspace is here for you.