Table of ContentsView AllTable of ContentsWhat Is Hydroxyzine?What Is Xanax?Main DifferencesWhich Is Better?Which Is More Tolerable?PrecautionsHow to Take Them

Table of ContentsView All

View All

Table of Contents

What Is Hydroxyzine?

What Is Xanax?

Main Differences

Which Is Better?

Which Is More Tolerable?

Precautions

How to Take Them

More than 30% of adults in the United States experience an anxiety disorder at some point in their lives.Finding the right treatment can significantly diminish the effects of anxiety on a person’s daily life. However, the right treatment isn’t the same for everyone.

A healthcare provider can help determine appropriate options for you. Numerous prescription medications are available to treat anxiety, such as Vistaril (hydroxyzine) andXanax(alprazolam).

Both hydroxyzine and alprazolam are commonly prescribed to relieve symptoms of anxiety, but they work in different ways and have varying side effects.

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Woman in green t-shirt sitting at the table in the living room and holding bottle of pills in her hand

The Food and Drug Administration (FDA) has approved hydroxyzine for the following uses:

Hydroxyzine is approved for use in adults and children. Healthcare providers typically don’t recommend this medication as a first-choice treatment for anxiety in children or adolescents because other types of medications are more effective or cause fewer side effects.

Healthcare providers may prescribe medications for a purpose or condition other than what it is FDA-approved for. This is called off-label prescribing. Some common off-label uses for hydroxyzine are:

How Do Antihistamines Work for Anxiety?

Hydroxyzine also blocks other receptors in the brain and body, including certainserotoninreceptors. Blocking these receptors is thought to help reduce symptoms of anxiety.Serotonin is important in regulating mood and behavior, among other functions.

Other antihistamines (such as diphenhydramine, the main ingredient in Benadryl) cause sedation and itch relief but not antianxiety effects. Hydroxyzine is the only antihistamine that’s FDA-approved for anxiety.

Xanax is a medication that belongs to thebenzodiazepinedrug class. It contains the active ingredient alprazolam.

Xanax comes as an oral tablet.Other forms of generic alprazolam are available, including an extended-release (ER) tablet, a concentrated oral liquid solution, and an orally disintegrating tablet.

The FDA has approved Xanax for the following uses in adults:

Xanax may also be used off-label forinsomnia.

Xanax is an effective treatment for GAD but has downsides that limit its use, such as dependence, misuse, and withdrawal.

In many cases, benzodiazepines like Xanax are prescribed in addition to another anxiety medication that you take every day, such as aselective serotonin reuptake inhibitor (SSRI).

How Do Benzodiazepines Work for Anxiety?

How Are They Different?

One of the major differences is that Xanax is associated with more risks than hydroxyzine. Xanax carries risks foraddiction, misuse, and dependence.

The table below compares other differences and similarities between Vistaril and Xanax.

Comparing Hydroxyzine vs. XanaxVistaril(hydroxyzine pamoate)Xanax(alprazolam)Medication classAntihistamineBenzodiazepineFDA-approved usesAnxiety; skin itching; sedation before or after surgeryAnxiety; panic disorderIs it a controlled substance?NoYes, a Schedule IV controlled substance due to potential for abuse, misuse, and addictionHow long does it take to start working for anxiety relief?15 to 60 minutes after you take a dose15 to 30 minutes after you take a doseMost common side effectsDry mouth; drowsiness; dizzinessDrowsiness; light-headedness; problems with memory, concentration, or coordinationWhich Is Better for Treating Anxiety?Hydroxyzine and Xanax are similarly effective for treating anxiety, according to a review of numerous clinical studies.Therefore, healthcare providers may consider other factors, such as potential risks and side effects, when recommending one over the other.Neither medication is considered a first-line treatment for anxiety. Instead, they are usually prescribed when other medications aren’t helping enough or aren’t tolerable.Also, other anxiety medications, including SSRIs and serotonin-norepinephrine reuptake inhibitors (SNRIs), can take a few weeks to start working to treat generalized anxiety. In the meantime, your healthcare provider may recommend a fast-acting medication like hydroxyzine or Xanax for short-term relief from anxiety symptoms.Some people may continue taking hydroxyzine or Xanax on an as-needed basis for anxiety-related sleep problems or at times when their anxiety symptoms are worse than usual.First-Line Treatments for AnxietyThe first type of medication typically prescribed for generalized anxiety disorder is a selective serotonin reuptake inhibitor (SSRI) or serotonin-norepinephrine reuptake inhibitor (SNRI).SSRIs and SNRIs have a long track record of safety and effectiveness. Examples of SSRIs areCelexa (citalopram), Zoloft (sertraline), Lexapro (escitalopram), and Paxil (paroxetine). SNRIs include Effexor XR (venlafaxine) or Cymbalta (duloxetine).If either of these medications is not helping or causes unmanageable side effects, a healthcare provider may switch you to another anxiety medication. Another option is Lyrica (pregabalin).Which Is More Tolerable?Both hydroxyzine and Xanax have the potential to cause side effects. Xanax generally causes more side effects than hydroxyzine, but individual responses can vary.Both hydroxyzine and Xanaxcan cause:Dry mouthDrowsinessInvoluntary movements, such as tremorItchy skinAllergic reactionsDrowsiness is most noticeable when you first start taking these medications. This effect may go away or become less noticeable for those who take them regularly.Other Side Effects With HydroxyzineSome examples of other side effects that hydroxyzine can cause are:Changes in heart rhythmHeadacheHallucinationsRashHivesHydroxyzine can also cause a serious skin condition called acute generalized exanthematous pustulosis (AGEP).Symptoms include fever, skin redness or discoloration, with smallpustulescovering large areas of the skin. If you notice these changes in your skin, you should contact your prescriber immediately and stop taking your medication.Other Side Effects With XanaxIn addition to the list above, examples of other Xanax side effects include:Dizziness or light-headednessFatigueSexual side effectsRestlessnessDifficulty concentrating, memory impairment, and confusionJaundice (yellowing of the skin or eyes due to liver damage)Weakness and loss of coordinationConstipationTrouble urinatingRespiratory depression(slow, shallow breathing that may be life-threatening) especially if this medication is combined with alcohol oropioidsWithdrawal, if you suddenly stop taking Xanax after regular or long-term usePrecautionsThere are many safety factors to consider when choosing a treatment for anxiety. Your prescriber will help weigh the pros and cons of these medications for your situation.Xanax carries risks for abuse and addiction, but hydroxyzine does not.Because hydroxyzine and Xanax can cause drowsiness, you shouldn’t drive or operate heavy machinery after taking either medication. Alcohol is not recommended while taking them, either.In addition, caution is advised before taking either drug with other medications that make you sleepy, such as pain medications.Hydroxyzine PrecautionsHydroxyzine may not be safe for everyone. A healthcare provider may not prescribe it for you if the following conditions or factors apply:Pregnancy or nursingHeart problems, such aslong QT syndrome, heart rhythm abnormalities, a recent heart attack, or certain types of heart failureKidney problemsAge 65 or older, due to the risk of dizziness, falling, and resulting injuryPast allergic reaction to hydroxyzine,Zyrtec (cetirizine), or Xyzal (levocetirizine)Other InteractionsIn addition, hydroxyzine may not be safe for people taking medications that raise the risk of a serious heart rhythm problem called QT prolongation.4 Hydroxyzine Interactions You Should KnowXanax PrecautionsXanax may not be safe for everyone. A healthcare provider may not recommend Xanax if any of the following conditions or factors affect you:History ofdrug abuse, alcohol use disorder, orsubstance use disorderBreathing problems, such as sleep apnea (sleep disorder causing breathing to stop and restart)Pregnancy, with newborns of people taking Xanax while pregnant needing to be monitored for sedation and withdrawal symptomsNursing, in which breastfeeding should be stopped in people taking Xanax and the patient being advised on other feeding options (such as formula) or to discuss stopping XanaxOther mental health conditions, such as bipolar disorderLiver problemsAge 65 or older, due to the risk of dizziness, falling, and resulting injuryPast allergic reaction to alprazolam or other benzodiazepineRisk of DependenceXanax carries risks for abuse andaddiction, but hydroxyzine does not. Xanax may cause physical dependence, especially if you take higher doses of it or take it for a long time.Once your body becomes dependent on a medication, which can happen even if you take it exactly as prescribed, severe withdrawal effects can occur if you suddenly stop taking Xanax.If you have been taking Xanax and want to stop, consult a healthcare provider to plan a slow taper. They will recommend slowly reducing your dose over several weeks to months before stopping it completely.Other InteractionsIn addition, Xanax may not be safe for people taking drugs or substances that cause drowsiness. The combination of Xanax and opioids can raise the risk of serious side effects or overdose.Medications that inhibit (block) an enzyme in the body called CYP3A4 can also interact with Xanax.Before taking Xanax or hydroxyzine, tell your prescriber or pharmacist about all other medication you’re taking and inform them about anyalcohol use.How to Take Hydroxyzine and XanaxDosages for hydroxyzine and Xanax vary. Your dosage will be based on your unique situation and health history. Be sure to follow your provider’s instructions.Hydroxyzine Dosage for AnxietyVistaril (hydroxyzine pamoate) is available as an oral capsule. It has three strengths: 25 milligrams (mg), 50 mg, and 100 mg. Hydroxyzine pamoate is also available as an oral liquid that you must shake well before each use. The liquid strength is 10 mg per 5 milliliters.For treating anxiety in adults, the usual dosage of Vistaril is 50–100 mg up to four times per day as needed.Hydroxyzine may be used for children with anxiety. The maximum dose for children under 6 is 50 mg per day, given in divided doses. The usual dose for children ages 6 and older is 50–100 mg in divided doses.Your provider may recommend a lower dosage if you’re an older adult or have kidney problems.You may take it with or without food, but not with alcohol.Xanax Dosage for AnxietyXanax is available as an oral tablet. It comes in four strengths: 0.25 mg, 0.5 mg, 1 mg, and 2 mg.For short-term treatment of GAD in adults, the starting dosage of Xanax is 0.25 to 0.5 mg, taken three times per day.Depending on how the medication affects you, your provider may increase your dose every three to four days. The maximum total dose of Xanax is 4 mg, given in divided doses, as needed, throughout the day.Your provider may recommend a lower dosage if you’re an older adult or have liver problems.You may take Xanax with or without food but not with alcohol. Due to the risks associated with this medication, it is commonly prescribed only for short-term use at the lowest effective dose.SummaryAnxiety disorders are common but can be effectively treated with medications. Healthcare providers consider various factors when choosing between hydroxyzine and Xanax for anxiety treatment, but neither one is typically the first choice.SSRIs or SNRIs are preferred for long-term management, with hydroxyzine and Xanax sometimes prescribed for short-term relief.Both medications can cause side effects like drowsiness and dry mouth, but hydroxyzine generally carries fewer risks than Xanax. Alprazolam is a controlled substance with potential for misuse and dependence. However, individual responses can vary, and a healthcare provider will weigh the pros and cons based on the specific situation.

Which Is Better for Treating Anxiety?

Hydroxyzine and Xanax are similarly effective for treating anxiety, according to a review of numerous clinical studies.

Therefore, healthcare providers may consider other factors, such as potential risks and side effects, when recommending one over the other.

Neither medication is considered a first-line treatment for anxiety. Instead, they are usually prescribed when other medications aren’t helping enough or aren’t tolerable.

Also, other anxiety medications, including SSRIs and serotonin-norepinephrine reuptake inhibitors (SNRIs), can take a few weeks to start working to treat generalized anxiety. In the meantime, your healthcare provider may recommend a fast-acting medication like hydroxyzine or Xanax for short-term relief from anxiety symptoms.

Some people may continue taking hydroxyzine or Xanax on an as-needed basis for anxiety-related sleep problems or at times when their anxiety symptoms are worse than usual.

First-Line Treatments for AnxietyThe first type of medication typically prescribed for generalized anxiety disorder is a selective serotonin reuptake inhibitor (SSRI) or serotonin-norepinephrine reuptake inhibitor (SNRI).SSRIs and SNRIs have a long track record of safety and effectiveness. Examples of SSRIs areCelexa (citalopram), Zoloft (sertraline), Lexapro (escitalopram), and Paxil (paroxetine). SNRIs include Effexor XR (venlafaxine) or Cymbalta (duloxetine).If either of these medications is not helping or causes unmanageable side effects, a healthcare provider may switch you to another anxiety medication. Another option is Lyrica (pregabalin).

First-Line Treatments for Anxiety

The first type of medication typically prescribed for generalized anxiety disorder is a selective serotonin reuptake inhibitor (SSRI) or serotonin-norepinephrine reuptake inhibitor (SNRI).SSRIs and SNRIs have a long track record of safety and effectiveness. Examples of SSRIs areCelexa (citalopram), Zoloft (sertraline), Lexapro (escitalopram), and Paxil (paroxetine). SNRIs include Effexor XR (venlafaxine) or Cymbalta (duloxetine).If either of these medications is not helping or causes unmanageable side effects, a healthcare provider may switch you to another anxiety medication. Another option is Lyrica (pregabalin).

The first type of medication typically prescribed for generalized anxiety disorder is a selective serotonin reuptake inhibitor (SSRI) or serotonin-norepinephrine reuptake inhibitor (SNRI).

SSRIs and SNRIs have a long track record of safety and effectiveness. Examples of SSRIs areCelexa (citalopram), Zoloft (sertraline), Lexapro (escitalopram), and Paxil (paroxetine). SNRIs include Effexor XR (venlafaxine) or Cymbalta (duloxetine).

If either of these medications is not helping or causes unmanageable side effects, a healthcare provider may switch you to another anxiety medication. Another option is Lyrica (pregabalin).

Both hydroxyzine and Xanax have the potential to cause side effects. Xanax generally causes more side effects than hydroxyzine, but individual responses can vary.

Both hydroxyzine and Xanaxcan cause:

Drowsiness is most noticeable when you first start taking these medications. This effect may go away or become less noticeable for those who take them regularly.

Other Side Effects With Hydroxyzine

Some examples of other side effects that hydroxyzine can cause are:

Hydroxyzine can also cause a serious skin condition called acute generalized exanthematous pustulosis (AGEP).

Symptoms include fever, skin redness or discoloration, with smallpustulescovering large areas of the skin. If you notice these changes in your skin, you should contact your prescriber immediately and stop taking your medication.

Other Side Effects With Xanax

In addition to the list above, examples of other Xanax side effects include:

There are many safety factors to consider when choosing a treatment for anxiety. Your prescriber will help weigh the pros and cons of these medications for your situation.

Xanax carries risks for abuse and addiction, but hydroxyzine does not.

Because hydroxyzine and Xanax can cause drowsiness, you shouldn’t drive or operate heavy machinery after taking either medication. Alcohol is not recommended while taking them, either.

In addition, caution is advised before taking either drug with other medications that make you sleepy, such as pain medications.

Hydroxyzine Precautions

Hydroxyzine may not be safe for everyone. A healthcare provider may not prescribe it for you if the following conditions or factors apply:

Other Interactions

In addition, hydroxyzine may not be safe for people taking medications that raise the risk of a serious heart rhythm problem called QT prolongation.

4 Hydroxyzine Interactions You Should Know

Xanax Precautions

Xanax may not be safe for everyone. A healthcare provider may not recommend Xanax if any of the following conditions or factors affect you:

Risk of Dependence

Xanax carries risks for abuse andaddiction, but hydroxyzine does not. Xanax may cause physical dependence, especially if you take higher doses of it or take it for a long time.

Once your body becomes dependent on a medication, which can happen even if you take it exactly as prescribed, severe withdrawal effects can occur if you suddenly stop taking Xanax.

If you have been taking Xanax and want to stop, consult a healthcare provider to plan a slow taper. They will recommend slowly reducing your dose over several weeks to months before stopping it completely.

In addition, Xanax may not be safe for people taking drugs or substances that cause drowsiness. The combination of Xanax and opioids can raise the risk of serious side effects or overdose.

Medications that inhibit (block) an enzyme in the body called CYP3A4 can also interact with Xanax.

Before taking Xanax or hydroxyzine, tell your prescriber or pharmacist about all other medication you’re taking and inform them about anyalcohol use.

How to Take Hydroxyzine and Xanax

Dosages for hydroxyzine and Xanax vary. Your dosage will be based on your unique situation and health history. Be sure to follow your provider’s instructions.

Hydroxyzine Dosage for Anxiety

Vistaril (hydroxyzine pamoate) is available as an oral capsule. It has three strengths: 25 milligrams (mg), 50 mg, and 100 mg. Hydroxyzine pamoate is also available as an oral liquid that you must shake well before each use. The liquid strength is 10 mg per 5 milliliters.

For treating anxiety in adults, the usual dosage of Vistaril is 50–100 mg up to four times per day as needed.

Hydroxyzine may be used for children with anxiety. The maximum dose for children under 6 is 50 mg per day, given in divided doses. The usual dose for children ages 6 and older is 50–100 mg in divided doses.

Your provider may recommend a lower dosage if you’re an older adult or have kidney problems.

You may take it with or without food, but not with alcohol.

Xanax Dosage for Anxiety

Xanax is available as an oral tablet. It comes in four strengths: 0.25 mg, 0.5 mg, 1 mg, and 2 mg.

For short-term treatment of GAD in adults, the starting dosage of Xanax is 0.25 to 0.5 mg, taken three times per day.

Depending on how the medication affects you, your provider may increase your dose every three to four days. The maximum total dose of Xanax is 4 mg, given in divided doses, as needed, throughout the day.

Your provider may recommend a lower dosage if you’re an older adult or have liver problems.

You may take Xanax with or without food but not with alcohol. Due to the risks associated with this medication, it is commonly prescribed only for short-term use at the lowest effective dose.

Summary

Anxiety disorders are common but can be effectively treated with medications. Healthcare providers consider various factors when choosing between hydroxyzine and Xanax for anxiety treatment, but neither one is typically the first choice.

SSRIs or SNRIs are preferred for long-term management, with hydroxyzine and Xanax sometimes prescribed for short-term relief.

Both medications can cause side effects like drowsiness and dry mouth, but hydroxyzine generally carries fewer risks than Xanax. Alprazolam is a controlled substance with potential for misuse and dependence. However, individual responses can vary, and a healthcare provider will weigh the pros and cons based on the specific situation.

12 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.National Institute of Mental Health.Any anxiety disorder.National Institutes of Health. DailyMed.Vistaril (hydroxyzine) label.Food and Drug Administration.Orange book: approved drug products with therapeutic equivalence evaluations.Patel DR, Feucht C, Brown K, Ramsay J.Pharmacological treatment of anxiety disorders in children and adolescents: a review for practitioners.Transl Pediatr. 2018;7(1):23-35. doi:10.21037/tp.2017.08.05Garakani A, Murroug JW, Freire RC, et al.Pharmacotherapy of anxiety disorders: current and emerging treatment options. Front Psychiatry.2020;11:595584. doi:10.3389/fpsyt.2020.595584National Institutes of Health. DailyMed.Xanax (alprazolam) label.Edinoff AN, Nix CA, Hollier J, et al.Benzodiazepines: uses, dangers, and clinical considerations.Neurol Int. 2021;13(4):594-607. doi:10.3390/neurolint13040059PDR.Hydroxyzine pamoate - drug summary.PDR.Xanax - drug summary.Melaragno AJ.Pharmacotherapy for anxiety disorders: from first-line options to treatment resistance.Focus (Am Psychiatr Publ). 2021;19(2):145-160. doi:10.1176/appi.focus.20200048DeGeorge KC, Grover M, Streeter GS.Generalized anxiety disorder and panic disorder in adults.Am Fam Physician.2022;106(2):157-164.National Institutes of Health. DailyMed.Label: hydroxyzine hydrochloride solution.

12 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.National Institute of Mental Health.Any anxiety disorder.National Institutes of Health. DailyMed.Vistaril (hydroxyzine) label.Food and Drug Administration.Orange book: approved drug products with therapeutic equivalence evaluations.Patel DR, Feucht C, Brown K, Ramsay J.Pharmacological treatment of anxiety disorders in children and adolescents: a review for practitioners.Transl Pediatr. 2018;7(1):23-35. doi:10.21037/tp.2017.08.05Garakani A, Murroug JW, Freire RC, et al.Pharmacotherapy of anxiety disorders: current and emerging treatment options. Front Psychiatry.2020;11:595584. doi:10.3389/fpsyt.2020.595584National Institutes of Health. DailyMed.Xanax (alprazolam) label.Edinoff AN, Nix CA, Hollier J, et al.Benzodiazepines: uses, dangers, and clinical considerations.Neurol Int. 2021;13(4):594-607. doi:10.3390/neurolint13040059PDR.Hydroxyzine pamoate - drug summary.PDR.Xanax - drug summary.Melaragno AJ.Pharmacotherapy for anxiety disorders: from first-line options to treatment resistance.Focus (Am Psychiatr Publ). 2021;19(2):145-160. doi:10.1176/appi.focus.20200048DeGeorge KC, Grover M, Streeter GS.Generalized anxiety disorder and panic disorder in adults.Am Fam Physician.2022;106(2):157-164.National Institutes of Health. DailyMed.Label: hydroxyzine hydrochloride solution.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

National Institute of Mental Health.Any anxiety disorder.National Institutes of Health. DailyMed.Vistaril (hydroxyzine) label.Food and Drug Administration.Orange book: approved drug products with therapeutic equivalence evaluations.Patel DR, Feucht C, Brown K, Ramsay J.Pharmacological treatment of anxiety disorders in children and adolescents: a review for practitioners.Transl Pediatr. 2018;7(1):23-35. doi:10.21037/tp.2017.08.05Garakani A, Murroug JW, Freire RC, et al.Pharmacotherapy of anxiety disorders: current and emerging treatment options. Front Psychiatry.2020;11:595584. doi:10.3389/fpsyt.2020.595584National Institutes of Health. DailyMed.Xanax (alprazolam) label.Edinoff AN, Nix CA, Hollier J, et al.Benzodiazepines: uses, dangers, and clinical considerations.Neurol Int. 2021;13(4):594-607. doi:10.3390/neurolint13040059PDR.Hydroxyzine pamoate - drug summary.PDR.Xanax - drug summary.Melaragno AJ.Pharmacotherapy for anxiety disorders: from first-line options to treatment resistance.Focus (Am Psychiatr Publ). 2021;19(2):145-160. doi:10.1176/appi.focus.20200048DeGeorge KC, Grover M, Streeter GS.Generalized anxiety disorder and panic disorder in adults.Am Fam Physician.2022;106(2):157-164.National Institutes of Health. DailyMed.Label: hydroxyzine hydrochloride solution.

National Institute of Mental Health.Any anxiety disorder.

National Institutes of Health. DailyMed.Vistaril (hydroxyzine) label.

Food and Drug Administration.Orange book: approved drug products with therapeutic equivalence evaluations.

Patel DR, Feucht C, Brown K, Ramsay J.Pharmacological treatment of anxiety disorders in children and adolescents: a review for practitioners.Transl Pediatr. 2018;7(1):23-35. doi:10.21037/tp.2017.08.05

Garakani A, Murroug JW, Freire RC, et al.Pharmacotherapy of anxiety disorders: current and emerging treatment options. Front Psychiatry.2020;11:595584. doi:10.3389/fpsyt.2020.595584

National Institutes of Health. DailyMed.Xanax (alprazolam) label.

Edinoff AN, Nix CA, Hollier J, et al.Benzodiazepines: uses, dangers, and clinical considerations.Neurol Int. 2021;13(4):594-607. doi:10.3390/neurolint13040059

PDR.Hydroxyzine pamoate - drug summary.

PDR.Xanax - drug summary.

Melaragno AJ.Pharmacotherapy for anxiety disorders: from first-line options to treatment resistance.Focus (Am Psychiatr Publ). 2021;19(2):145-160. doi:10.1176/appi.focus.20200048

DeGeorge KC, Grover M, Streeter GS.Generalized anxiety disorder and panic disorder in adults.Am Fam Physician.2022;106(2):157-164.

National Institutes of Health. DailyMed.Label: hydroxyzine hydrochloride solution.

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