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Anxiety

Hydroxyzine for anxiety

Hydroxyzine is one of the few medications that is both FDA-approved for anxiety and not a controlled substance, which is why prescribers who do not use benzodiazepines — including this one — reach for it. It is an antihistamine, it works within an hour, it is taken as needed, and it makes most people sleepy. That last point is its main strength and its main limit. This page explains how it works, what taking it is like, when it is the right tool, and when it is not.

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Who this is for: Adults 18–65 in Connecticut, Massachusetts, New Hampshire, Maine, Rhode Island, Virginia, and Kentucky who want an as-needed option for acute anxiety or anxious sleeplessness that is not a benzodiazepine, or who have been prescribed hydroxyzine and want to understand it.

What hydroxyzine is

Hydroxyzine is a first-generation antihistamine — a relative of the older allergy medications that cause drowsiness — and its calming effect comes from that same sedating action, together with a mild effect on serotonin. Unlike most allergy medications, its FDA-approved uses include anxiety: the label describes it for the symptomatic relief of anxiety and tension, as well as for itching and for sedation before procedures.

It is not a benzodiazepine. It does not act on the GABA system, it does not produce tolerance or dependence, there is no withdrawal syndrome, and it is not a controlled substance. Those are the reasons it is the as-needed anxiety medication of choice for prescribers who have decided, as NCNE has, not to use benzodiazepines at all.

What taking it is like

  • It works within about an hour and lasts for several hours; it’s taken as needed, not on a schedule
  • Drowsiness is the main effect, and for many people the point — it suits an anxious evening, a bad night, or the hours before something dreaded, better than a morning meeting
  • Dry mouth, blurred vision, constipation and a slightly foggy feeling the next day are common and usually mild
  • It’s sedating on top of alcohol or other sedatives, so those aren’t combined
  • It can affect heart rhythm in people with certain conditions or on certain other medications, which is asked about before it’s prescribed
  • Older adults are more prone to its side effects, and it’s used more cautiously with age

When it is the right tool, and when it is not

Hydroxyzine is for acute anxiety: the bad night, the spike, the week where everything peaks. It buys a calmer few hours without creating a habit, and that’s valuable. It isn’t a treatment for ongoing anxiety. A person who needs it most days has an anxiety problem that hydroxyzine is papering over, and the honest plan is an SSRI or SNRI, therapy, and the sleep, caffeine and alcohol conversation — with hydroxyzine kept for the occasional spike while those take effect.

It’s also not the right tool for performance anxiety, where the drowsiness works against you; propranolol is usually the better fit there. And it isn’t a sleeping tablet in the long-term sense: it can help an anxious night, but insomnia that has settled in is treated differently.

Common questions

Is hydroxyzine addictive?
No. It doesn’t act on the brain's reward system or the GABA system that benzodiazepines act on, it doesn’t produce tolerance, and there’s no withdrawal syndrome when it is stopped. It isn’t a controlled substance. That is the main reason it is used in place of a benzodiazepine.
How quickly does hydroxyzine work for anxiety?
Within about an hour for most people, lasting several hours. It is taken when needed rather than daily, so there’s no build-up period — but also no ongoing effect once it has worn off, which is why it isn’t a treatment for anxiety that is there most days.
Will hydroxyzine make me sleepy?
Usually, yes — it is a sedating antihistamine and drowsiness is its most common effect. That is helpful for an anxious evening and unhelpful before a presentation or a drive. Most people plan around it, and it is one of the reasons the timing of when you take it is discussed.
Hydroxyzine or propranolol?
Different jobs. Hydroxyzine calms the mind and the body and makes you drowsy, so it suits acute anxiety and anxious sleeplessness. Propranolol blunts the physical adrenaline response and leaves the mind clear, so it suits performance situations. Some people are prescribed both for different occasions.
Can I take hydroxyzine every day?
It is sometimes prescribed that way, but daily hydroxyzine isn’t the usual plan at NCNE. Anxiety that needs something every day is anxiety that needs treating at its root — with an antidepressant, therapy, or both — rather than sedating each afternoon. Hydroxyzine is kept for the spikes.
How do I find out whether this is right for me?
At an evaluation. NCNE's first visit is a 60-minute video appointment that covers your symptoms, history, past treatments and what you’re hoping will change; hydroxyzine is one of the options weighed there, against the alternatives and against not medicating at all. You leave with a plan you helped write, and nothing is started until you understand what it does and doesn’t do.

Sources

  • U.S. Food and Drug Administration. Prescribing information for hydroxyzine (Atarax / Vistaril) — indications, warnings and adverse reactions. DailyMed

This page is general information, not a prescription or a recommendation for you. Whether any medication is right for you, and how it would be started, adjusted or stopped, is decided at an evaluation with a prescriber who knows your history. Do not start, change or stop a medication on the strength of a webpage.

Related: Propranolol for anxiety · Anxiety at NCNE · Trazodone for sleep

If you are in immediate danger, call 911. For urgent emotional support at any hour, call or text 988(Suicide & Crisis Lifeline). Telehealth visits and this website are not an emergency service.

Want to talk through non-habit-forming options for anxiety? Book a telehealth evaluation with Laura Gabriel, PMHNP-BC, or send a message and we will respond within two business days.

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