Hydroxyzine (Vistaril) is a commonly prescribed medication used to treat physical and mental health conditions, including allergies, anxiety, and sleep disorders. It is available in its generic form and is commonly known by two brand names: Vistaril and Atarax.
It’s important to note that Atarax was discontinued in the U.S. in 2021 due to business reasons—not safety concerns. While the brand name Atarax is no longer available, the generic version, Hydroxyzine Hydrochloride, still is.
Both Vistaril and Atarax share the same active ingredient in different formulations, but they have distinct uses, formulations, and side-effect profiles. Understanding these differences can help you determine which medication may be best suited for your needs.
| Drug | Generic version | Conditions treated | Main side effects | Key considerations |
| Vistaril | Hydroxyzine Pamoate | Anxiety, allergic urticaria, allergies, nausea or vomiting, pain, pruritus, sedation, tension | Drowsiness, dizziness, blurred vision, constipation, dry mouth | Can treat symptoms of anxiety and anxiety disorders in some people; used short-term |
| Atarax | Hydroxyzine Hydrochloride | Allergies, anxiety, hives, nausea or vomiting, sedation, sleep disorders | Blurred vision, constipation, dizziness, drowsiness, dry mouth | Commonly used to treat itching from allergic reactions and dermatological conditions |
Similarities Between Vistaril and Atarax
There are some basic similarities between Vistaril and Atarax. The most obvious one is that they share the same active ingredient, Hydroxyzine — but there are others, too, like similar uses and near-identical side effects.
Shared active ingredient (hydroxyzine)
Vistaril and Atarax medications both contain the active ingredient Hydroxyzine, which is in the class of drugs known as antihistamines. These drugs work by blocking the action of histamine in the body to reduce allergic reactions and similar symptoms. Since Hydroxyzine acts on the central nervous system (CNS), it also results in sedative effects. These effects are why and how Hydroxyzine helps manage anxiety and promote sleep in some people.
Overlapping uses
While their branding differs, Vistaril and Atarax have similar uses:
- Anxiety: Hydroxyzine is often prescribed as a short-term treatment for anxiety. Research shows it’s an effective and safe option for managing symptoms of generalized anxiety disorder (GAD). Unlike benzodiazepines (commonly known as “benzos”), Hydroxyzine provides relief without the risk of addiction.
- Allergies: Both drugs are effective at reducing allergy symptoms such as itching, runny nose, and hives, offering relief from common allergic reactions.
- Sleep disorders: Due to its sedative effects, Hydroxyzine is sometimes prescribed off-label to address insomnia or sleep disturbances, especially when related to anxiety or allergies.
Comparable side effects
Since Vistaril and Atarax share the same active ingredient, hydroxyzine, their side effects are largely the same. However, the severity of these side effects can vary depending on several factors, including the individual, the condition being treated, the dosage, other mental health conditions (comorbidities), or any additional medications being taken.
Here are some common side effects of hydroxyzine:
- Dizziness
- Drowsiness
- Dry mouth
- Fatigue
- Headache
For some individuals, these side effects may feel more intense. Therefore, it’s important to consult with your doctor before making any changes to your dosage. Your doctor can help ensure that adjustments are safe and tailored to your unique needs.
Differences Between Vistaril and Atarax
While Vistaril and Atarax are Hydroxyzine derivatives and, thus, share many similarities, they also have some notable differences. For example, branding, formulation, availability, and how they’re typically used can all vary.
The differences between Atarax and Vistaril can influence which drug might be best for specific conditions. Understanding the distinctions between these medications can help you — and your healthcare provider — make a more informed decision about which treatment option might be better to address your needs.
Here’s a closer look at the unique characteristics and differences of these two medications.
Distinctions in branding and formulation
The branding and formulation of Vistaril and Atarax highlight their differing therapeutic focuses. Even though they use the same active ingredient, the difference in branding alone highlights each medicine’s strength in addressing particular conditions. These differences affect how the drugs are understood and when they might be prescribed by healthcare professionals.
Key differences:
- Atarax was commonly used for allergies and dermatological conditions like itching and hives. Its formulation — Hydroxyzine Hydrochloride — may be better suited for treating these conditions in some people.
- Vistaril is primarily known and marketed for its efficacy in treating mental health conditions like anxiety disorders. Its formulation — Hydroxyzine Pamoate — is effective in targeting the central nervous system (CNS), which makes it very suitable for treating anxiety.
Form
The form of Hydroxyzine used in Vistaril and Atarax plays a key role in how each medication works, which impacts its effectiveness for different conditions. Differences in solubility and metabolism influence whether the drug primarily targets the central nervous system (CNS) or peripheral systems, which affects how it alleviates specific symptoms.
Key differences:
- Hydroxyzine Hydrochloride (used in Atarax): This water-soluble formulation primarily acts on peripheral histamine receptors, making it especially effective for treating allergic reactions and dermatology concerns like hives.
- Hydroxyzine Pymoate (used in Vistaril): This fat-soluble formulation more efficiently crosses the blood-brain barrier, enhancing its sedative and anti-anxiety effects.
Market availability
Vistaril and Atarax availability has evolved over time, with the most notable change being the discontinuation of Atarax in the U.S. in 2021. While Atarax (Hydroxyzine Hydrochloride) is no longer available under its brand name, generic versions of Hydroxyzine Hydrochloride continue to be accessible. This means that the medication can still be used to treat allergic reactions and dermatological concerns despite the branding change.
It’s important to note that Atarax’s discontinuation was not due to safety concerns but rather business decisions made by the manufacturer. For further information about why Atarax was discontinued, consult your doctor or pharmacist.
On the other hand, Vistaril remains widely available in both its branded form and as a generic, making it a convenient option for treating anxiety and sleep-related issues.
“Both are prescription antihistamine medications, primarily used to treat allergic reactions and are available in various strengths. Your psychiatrist may prescribe Vistaril to manage anxiety or sleep disturbances, often in combination with other medications.”
Talkspace psychiatrist, Dr. Muhammad Munir
FAQs About Vistaril and Atarax
As you compare Vistaril vs Atarax, it’s common to have questions or concerns. Below are answers to some of the more common questions about these two similar yet different drugs. Hopefully, they can provide you with the clarity and confidence to make your decision.
Why was Atarax discontinued?
Atarax was discontinued in the United States not due to safety or efficacy concerns but likely due to a decline in demand for the branded medication, making it less economically viable. While Atarax itself is no longer available in the U.S., Hydroxyzine Hydrochloride, the generic version— which contains the same active ingredient and offers the same effectiveness—continues to be accessible.
Is hydroxyzine hydrochloride (Atarax) or pamoate (Vistaril) better for anxiety?
Medications don’t necessarily work the same way on two different people. What works for one person may not be effective at all for another. That said, when treating anxiety, most people find Hydroxyzine Pamoate (Vistaril) to be more effective since the formulation has enhanced sedative and anxiolytic properties. Hydroxyzine Hydrochloride (previously marketed as Atarax) is often prescribed for treating allergies or allergic reactions.
Consult your healthcare provider for expert information on dose administration and potential interactions to determine which treatment is best for your condition.
Which is Better for You?
Unfortunately, there isn’t a clear answer regarding which drug is “better.” It depends on multiple factors and individual needs. If you’re seeking help for a mental health condition like anxiety, Vistaril (hydroxyzine) can be a good option. If you’re looking for relief from allergies or a dermatological condition, the generic version of Atarax (hydroxyzine hydrochloride) may be a more appropriate choice.
If you’re considering any type of drug to help you manage your anxiety, it’s crucial that you talk to your doctor or another mental health professional and ask for a personalized recommendation based on your medical history and symptoms. It’s possible that your doctor may even suggest Hydroxyzine alternatives, depending on your needs.
Get Professional Guidance with a Prescription
Choosing between Vistaril vs. and the generic version of Atarax requires careful attention to your symptoms and needs. You should work with your healthcare provider or a psychiatrist to determine the most effective treatment plan for your condition. During your discussion with your provider, ask about the differences between Hydroxyzine and Xanax to learn about other anxiety treatments.
If you want to manage anxiety or any other mental health concerns, online psychiatrists can offer convenient, affordable, and accessible help. Talkspace provides an online platform that makes it simple to connect with a licensed mental health professional, all from the comfort of your home. Under the guidance of an online psychiatrist you trust, you can explore whether a Hydroxyzine prescription is a good option for you.
Connect with an online Talkspace psychiatric provider today to discuss Hydroxyzine and other treatment options.
Sources:
- Llorca PM, Spadone C, Sol O, et al. Efficacy and safety of hydroxyzine in the treatment of generalized anxiety disorder. The Journal of Clinical Psychiatry. 2002;63(11):1020-1027. doi:10.4088/jcp.v63n1112. https://pubmed.ncbi.nlm.nih.gov/12444816/. Accessed January 19, 2025.
- Comparing Atarax vs Vistaril. Drugs.com. https://www.drugs.com/compare/atarax-vs-vistaril. Accessed January 19, 2025.
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