Hydroxyzine: Uses, Dosage, and Safety

Naomi Carr
Dr. Jennie Stanford
Written by Naomi Carr on 09 July 2025
Medically reviewed by Dr. Jennie Stanford on 10 July 2025

Hydroxyzine is an antihistamine medication with many uses, including the treatment of itching due to allergic reactions and anxiety conditions. Hydroxyzine is a safe medication and is unlikely to cause a risk of addiction, abuse, or dependence. However, it should be used as prescribed to prevent adverse effects and overdose.

Key takeaways:
  • Hydroxyzine is an antihistamine, available as a generic medication or as a branded medication called Vistaril.
  • It can be used to treat anxiety, itching due to allergic reactions, insomnia, and for sedation before and after surgery.
  • Hydroxyzine can cause adverse effects and overdose, so it should be taken as prescribed.
Hydroxyzine: Uses, Dosage, and Safety

What is hydroxyzine?

Hydroxyzine is an antihistamine that can be used in the treatment of various symptoms and conditions due to its numerous effects. Hydroxyzine is available in generic form or as a brand-name medication called Vistaril, in tablets, capsules, oral suspension, or syrup. Capsules and tablets are available in strengths of 10 mg, 25 mg, and 50 mg.

How hydroxyzine works

Hydroxyzine works by blocking histamine action at the H1 receptor, as an H1 receptor inverse agonist. Histamine is involved in various functions, including allergic reactions and itching. As an antihistamine, hydroxyzine helps to treat allergic reactions.

Hydroxyzine is a first-generation antihistamine that crosses the blood-brain barrier, unlike second-generation antihistamines, such as fexofenadine. Antihistamines that cross the blood-brain barrier affect the central nervous system (CNS) and are more likely to cause drowsiness and sedation.

Hydroxyzine has also been shown to produce muscle relaxation, pain relief, and anti-nausea effects.

Medical uses

Hydroxyzine is approved for use in the treatment of:

It can be used to treat these conditions in children and adults, although use in older adults is not recommended.

Research also indicates that hydroxyzine can be used as an adjunctive medication with 5-HT3 receptor antagonists such as palonosetron to help reduce the severity of opioid withdrawal symptoms.

Dosage guidelines

Recommended doses for anxiety and tension are as follows:

  • Adults: 50-100 mg four times per day
  • Children over the age of 6: 50-100 mg in divided doses
  • Children under the age of 6: 50 mg in divided doses

Recommended doses for itching are as follows:

  • Adults: 25 mg three or four times per day
  • Children over the age of 6: 50-100 mg in divided doses
  • Children under the age of 6: 50 mg in divided doses

Recommended doses for use as a pre- or post-operative sedative are as follows:

  • Adults: 50-100 mg
  • Children: 0.6 mg per kg of body weight

Precautions and contraindications

Precautions and contraindications for hydroxyzine use include:

  • Children should be given lower doses than adults.
  • All treatments should start at the lower end of the dosing range, titrating the dose upward to achieve the desired effect, while monitoring for side effects.
  • Use in geriatric populations is not recommended, but if treatment is indicated, hydroxyzine should be commenced in very low doses, and caution and close monitoring are advised.
  • Pregnant or breastfeeding mothers should not take hydroxyzine.
  • Hydroxyzine is not recommended for long-term use in the treatment of anxiety.
  • Hydroxyzine should not be given to people with a history of heart conditions or should be used with extreme caution if necessary, as it can cause increased risks of QT prolongation.
  • People with liver or kidney impairments should take hydroxyzine with caution.
  • Because hydroxyzine causes drowsiness, it is advised not to drive or use heavy machinery while taking the medication or until its effects are known.

Side effects

Hydroxyzine can cause side effects, particularly at the start of a new treatment or when the dose is increased. Typically, side effects will reduce on their own within a short time and are often mild in nature. However, if side effects persist or become concerning, a doctor should be consulted.

Common side effects of hydroxyzine include:

  • Drowsiness
  • Headache
  • Dry mouth
  • Confusion
  • Constipation
  • Dizziness

Side effects that should be reported to a doctor include:

  • Seizures
  • Uncontrollable shaking or tremors
  • Rash, blisters, or sores
  • Swelling and redness
  • Fever
  • Hallucinations

Hydroxyzine interactions: What other drugs will affect it?

Hydroxyzine has a depressant effect on the CNS. Because of this, using other CNS depressants, such as opioids, benzodiazepines, and alcohol, with hydroxyzine can lead to oversedation and harmful effects.

Addiction and dependency: Myths and facts

Hydroxyzine is not considered an addictive substance, as it has little potential for abuse and dependence. It is not a controlled substance and is safe for use in adults and children. Hydroxyzine does not cause euphoric effects or a “high”, and it is unlikely to lead to tolerance and dependence. As such, it typically does not cause withdrawal symptoms when treatment is stopped. However, people who misuse substances may abuse hydroxyzine because of its anxiolytic and sedative effects or to enhance the effects of other substances.

As an anxiolytic medication, hydroxyzine is safe. Alternative anxiety treatment includes benzodiazepines, which are Schedule IV controlled substances, as they have potential for abuse and addiction. In contrast to hydroxyzine, benzodiazepines are only recommended for short-term use.

However, compared to other treatments for allergic reactions, some people may prefer second-generation antihistamines, as they are less likely to cause drowsiness and sedation.

Hydroxyzine overdose

Taking too much hydroxyzine can result in overdose. This can result in extreme sedation, as well as other adverse effects:

  • Seizures
  • Nausea and vomiting
  • Impaired cognitive functioning
  • Loss of consciousness

If a hydroxyzine overdose is suspected, contact a medical professional or 911 immediately.

Treatment for a hydroxyzine overdose may include stomach pumping, intravenous fluids, and careful monitoring. There is no antidote for hydroxyzine overdose, so treatment involves managing symptoms and ensuring medical stability.

Tips for safe use and monitoring

Always take hydroxyzine exactly as prescribed. If you miss a dose, take it when you remember, unless it is close to the next dose time. If it is almost time for the next dose, skip the missed dose and take the next one as prescribed. Never take a double dose to make up for missed doses or take hydroxyzine in higher doses or more frequently than prescribed.

Keep medications in a safe and secure location, away from children and pets.

When to contact a healthcare provider

People taking hydroxyzine should contact a medical professional if they notice concerning side effects, such as fever, seizures, or hallucinations or if an overdose is suspected.

People who are prescribed hydroxyzine should have regular follow up visits with the prescribing clinician to monitor the effectiveness of the medication and any adverse effects that occur. Treatment can be altered if needed, such as adjusting the dose or changing to a different medication.

FAQs

Common questions about hydroxyzine

Is hydroxyzine an effective anxiety medicine?

Hydroxyzine can be an effective anxiolytic.

Is hydroxyzine effective as a sleep aid?

Hydroxyzine can be effective as a short-term sleep aid. Its sedative effects can help people fall asleep faster and improve sleep quality, especially when insomnia is related to anxiety. Studies show hydroxyzine reduces the time it takes to fall asleep and may increase total sleep time. However, it is not approved as a primary treatment for insomnia in all countries, and long-term use is not recommended due to the potential for reduced effectiveness and side effects like next-day drowsiness.

Does hydroxyzine act as a “happy pill” or make you feel euphoric?

Hydroxyzine does not produce a “high” or feelings of intense happiness. Instead, it provides a calming effect by reducing anxiety and promoting relaxation. While some people may feel mild mood improvement due to reduced anxiety or better sleep, hydroxyzine does not have antidepressant or euphoric properties and is not considered habit-forming or addictive.

How fast does hydroxyzine work?

The effects of hydroxyzine emerge within 15-30 minutes.

Is hydroxyzine the same as Xanax?

No, hydroxyzine is not the same as Xanax. Hydroxyzine is a first-generation antihistamine with sedative and anti-anxiety properties, while Xanax (alprazolam) is a benzodiazepine used primarily for anxiety and panic disorders. Unlike Xanax, hydroxyzine is non-addictive, does not cause physical dependence, and is generally considered safer for short-term use in anxiety. Xanax works faster and is more potent, but carries a higher risk of misuse and withdrawal symptoms.

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Resources:

  1. Teva Pharmaceuticals. (Revised 2014). Hydroxyzine Hydrochloride. FDA. Retrieved from
  2. Pfizer Inc. (Revised 2016). Vistaril (Hydroxyzine Pamoate) Capsules and Oral Suspension. FDA. Retrieved from
  3. Hydroxyzine. (n.d). Guide to Pharmacology. Retrieved from
  4. National Library of Medicine. (Revised 2017). Hydroxyzine. Medline Plus. Retrieved form
  5. Erlendson, M.J., D'Arcy, N., Encisco, E.M., Yu, J.J., Rincon-Cruz, L., Peltz, G., Clark, J.D., & Chu, L.F. (2017). Palonosetron and Hydroxyzine Pre-Treatment Reduces the Objective Signs of Experimentally-Induced Acute Opioid Withdrawal in Humans: A Double-Blinded, Randomized, Placebo-Controlled Crossover Study. The American Journal of Drug and Alcohol Abuse43(1), 78–86. Retrieved from
  6. National Alliance on Mental Illness. (Revised 2024). Hydroxyzine (Vistaril). NAMI. Retrieved from
  7. Ferreri, M., Hantouche, E.G., & Billardon, M. (1994). Value of Hydroxyzine in Generalized Anxiety Disorder: Controlled Double-Blind Study Versus Placebo. L'Encephale20(6), 785–791. Retrieved from
  8. Rickels, K., & Moeller, H. J. (2019). Benzodiazepines in anxiety disorders: Reassessment of usefulness and safety. The world journal of biological psychiatry : the official journal of the World Federation of Societies of Biological Psychiatry, 20(7), 514–518.
  9. Burgazli, C. R., Rana, K. B., Brown, J. N., & Tillman, F. (2023). Efficacy and safety of hydroxyzine for sleep in adults: Systematic review. Human Psychopharmacology, 38(2), e2864.

Activity History - Last updated: 10 July 2025, Published date:


Reviewer

Dr. Jennie Stanford

MD, FAAFP, DipABOM

Jennie Stanford, MD, FAAFP, DipABOM is a dual board-certified physician in both family medicine and obesity medicine. She has a wide range of clinical experiences, ranging from years of traditional clinic practice to hospitalist care to performing peer quality review to ensure optimal patient care.

Activity History - Medically Reviewed on 08 July 2025 and last checked on 10 July 2025

Medically reviewed by
Dr. Jennie Stanford

Dr. Jennie Stanford

MD, FAAFP, DipABOM

Reviewer

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