Hydroxyzine vs Xanax: Which is Right for You?

The mechanism of action, suitability for long-term use, and potential for misuse or addiction differ between Hydroxyzine and Xanax. Hydroxyzine belongs to the antihistamine class of drugs and offers a non-addictive alternative for anxiety relief. In contrast, Xanax is a benzodiazepine (often referred to as a “Benzo”), which can be effective for short-term anxiety management but carries a higher risk of dependence and misuse with prolonged use, even when taken as prescribed. Each drug requires a specific prescription and dosage guided by a healthcare provider to ensure safe use.

Understanding the differences between Hydroxyzine vs Xanax​ can help you decide on treatment options. If you’re wondering if Hydroxyzine is like Xanax​, keep reading as we explore the similarities and differences and answer common questions about these drugs.

Differences Between Hydroxyzine and Xanax

While both Hydroxyzine (brand name Vistaril) and Xanax are used to manage anxiety, there are some primary differences between them. For example, they’re in different drug classes, they work differently, one is effective longer than the other, and there’s a different risk for abuse or addiction between them. They also have slightly different side effects, withdrawal symptoms, and additional uses each might be suitable for. 

Exploring the differences can help you decide which medication might be better for your specific needs. 

Drug class

Mechanism of action

The mechanism of action for Hydroxyzine vs. Xanax is another difference between these two popular drugs. By blocking histamine receptors in the brain, Hydroxyzine creates a calming effect that can help reduce anxiety. 

Xanax, however, works by increasing the activity of GABA, a neurotransmitter in the brain that promotes relaxation and slows brain overactivity.

Duration of action

Two things to keep in mind when you’re looking for a medication and developing a treatment plan include: how long it takes to work and how long relief lasts. Most people find that Hydroxyzine has a longer onset of action but that the effects of each dose can last up to 6 hours.

Xanax begins working much more quickly. Most people who take it start to feel the effects within about 20 – 30 minutes, and they typically find relief for between 4 – 6 hours. Some experience relief in as little as 5 – 10 minutes after taking Xanax. For this reason, it’s often the drug of choice for those with acute anxiety episodes.

Addiction potential

One of the most significant and serious differences between Hydroxyzine and Xanax is their potential for addiction.

“Xanax is a very potent calming medication. It works fast and for a short period of time (several hours), which makes it a high risk for dependence. Patients may build a tolerance where they start needing higher doses to get the same effect. When someone stops Xanax suddenly after continuous use, they can have very uncomfortable withdrawal symptoms. This can lead to a cycle of continuous Xanax use.”

Talkspace therapist Dr. Dion Metzger, MD

Side effects

Withdrawal

Whenever you stop taking a drug, it’s essential to consider potential withdrawal symptoms. For most people, there’s a lower risk of  Hydroxyzine withdrawal, which makes it somewhat safer for extended use (although Hydroxyzine is typically only used as a temporary solution for anxiety relief). 

On the other hand, Xanax withdrawal can be more severe. When not done carefully, reducing Xanax dosages may cause insomnia, irritability, seizures, and rebound anxiety. You must talk to your doctor before you stop taking Xanax — they can help you come up with a taper plan that can reduce the chance and severity of withdrawal symptoms. 

Additional uses

Most medications serve more than one purpose, and Hydroxyzine and Xanax are no exception. However, these two differ in the additional uses they treat. Hydroxyzine is frequently prescribed not only for anxiety but also for allergies, nausea, and sleep disturbances. Xanax, on the other hand, is primarily used for anxiety and panic disorders but is sometimes prescribed off-label for conditions like insomnia or any situation requiring short-term sedation or relaxation.

These extra benefits might influence which medication fits your lifestyle and health needs best.

Similarities Between Hydroxyzine and Xanax

Despite their differences, Hydroxyzine and Xanax do have several similarities. Understanding how they’re similar, what their shared properties are, and what therapeutic benefits they have can offer insight into why these drugs are used.

Used for anxiety treatment

Hydroxyzine and Xanax can both effectively treat anxiety with the proper dosage of each medication. Hydroxyzine is more commonly used to treat generalized anxiety disorder (GAD), whereas Xanax is often reserved for acute anxiety episodes or panic attacks.

“Hydroxyzine is not as potent as Xanax and does not have a risk for dependence. This would be a better choice for patients with a history of substance dependence. It is also commonly used to manage milder acute anxiety symptoms. In contrast, Xanax is more potent and typically reserved for short-term use in situations where its strength is necessary, such as managing severe panic symptoms during air travel. In such cases, Xanax is usually taken shortly before or during the flight.”

Talkspace therapist Dr. Dion Metzger, MD

Sedative properties

These drugs each offer sedative effects, which means they’ll promote relaxation and reduce tension. This is an important consideration to note since sedation generally leads to drowsiness, which can be challenging if you’re trying to complete daily activities. 

Fast onset of action

Both anxiety medications work relatively quickly. Xanax can work in as little as 20 – 30 minutes for most people, and Hydroxyzine doesn’t take much longer — the effects can usually be felt in about 30 – 45 minutes, depending on the dose and individual response.  

Short-term use

Both Hydroxyzine and Xanax are typically prescribed for short-term use, but for slightly different reasons. Hydroxyzine’s short-term use is mainly due to its sedative side effects, which can impact daily activities over time. Xanax, on the other hand, is limited to short-term use because of its higher risk of dependency and misuse. 

Side effect overlap

There are some common side effects that might be experienced when taking Xanax or Hydroxyzine. Some people feel drowsy, dizzy, or fatigued with the use of these medications. It’s crucial to monitor the side effects of any drug you’re taking, especially if you’re driving, using heavy machinery, or need to be fully alert.

FAQs About Hydroxyzine and Xanax

Before deciding to take Hydroxyzine or Xanax, you should consider their use, effectiveness, and potential risks. Below are frequently asked questions and answers designed to help clarify misconceptions about these drugs. 

If you’re unsure which option is right for you, explore these FAQs as a starting point and then talk to your healthcare provider or psychiatrist about finding relief for your anxiety.

Is Hydroxyzine a controlled substance?

No, Hydroxyzine is not a controlled substance. This means there’s considered no potential for abuse or addiction, which can make it a safer option for anxiety management if you’re concerned about misuse or addiction. 

Does Hydroxyzine feel like Xanax?

Hydroxyzine can produce calming effects similar to Xanax, but it lacks the euphoric sensation that some people may experience with Xanax due to its action on the brain’s GABA receptors. Hydroxyzine is often described as less intense while still effective for managing mild to moderate anxiety.

Does Hydroxyzine work as well as Xanax?

Hydroxyzine can be effective for managing certain types of anxiety, such as generalized anxiety disorder (GAD). However, because Hydroxyzine has a slower onset of action compared to Xanax, it is less suitable for treating acute or urgent anxiety episodes, such as panic attacks. Xanax, with its fast-acting properties, is often preferred in situations requiring immediate relief.

What calms you down like Xanax?

If you’re looking for medication alternatives that calm you down like Xanax, options like Ativan (lorazepam), Klonopin (clonazepam), or Valium (diazepam) may be prescribed by a doctor. These are benzodiazepines, similar to Xanax, and work in a similar way to help reduce anxiety. 

Non-benzodiazepine options like Hydroxyzine, Buspirone, or natural approaches like deep breathing, meditation, and progressive muscle relaxation can help calm anxiety. However, always consult your doctor for the best alternative based on your needs.

Which Medication is Right for You?

Choosing between Hydroxyzine and Xanax depends on several factors, like your individual needs, medical history, and the severity of your symptoms. 

When Hydroxyzine may be better:

• Generalized anxiety disorder
• Sleep disturbances related to anxiety
• There’s a history of substance abuse

When Xanax may be better:

• Short-term relief of acute anxiety attacks
• Panic disorders that demand immediate relief

Talk to your healthcare provider or a mental health professional to figure out the most appropriate and effective prescription and treatment plan for your needs. 

Get Professional Guidance with a Prescription

Finding the right medication for anxiety can be a lengthy process. It involves careful consideration and discussions with your doctor about the benefits and risks associated with each option. Hydroxyzine and Xanax both offer advantages, but which one is best for you depends on your circumstances, condition, and medical history.

Reach out to Talkspace today to connect with an online psychiatrist about Hydroxyzine or Hydroxyzine alternatives.