Is Hydroxyzine ( Vistaril/Atarax) Safe To Take For Anxiety?

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Hydroxyzine is a medication that belongs to the class of antihistamines, which are drugs that block the effects of histamine, a chemical that causes allergic reactions and inflammation in the body. Hydroxyzine is available in two forms: hydroxyzine hydrochloride (Orgatrax) and hydroxyzine pamoate (Vistaril). Both forms are used to treat anxiety, as well as other conditions such as itching, nausea, and insomnia.

Hydroxyzine was first synthesized in 1956 by Union Chimique Belge, a Belgian pharmaceutical company. It was initially marketed as Atarax, a brand name that is no longer available in the US. Hydroxyzine was approved by the FDA in 1957 for the treatment of anxiety and pruritus (itching). Since then, it has been widely used for various indications, such as preoperative sedation, motion sickness, alcohol withdrawal, and post-traumatic stress disorder.

The exact mechanism of action of hydroxyzine for anxiety is not fully understood, but it is believed to involve two neurotransmitters: histamine and serotonin. Histamine is a chemical that mediates allergic responses and inflammation, as well as regulates sleep and arousal. Serotonin is a chemical that affects mood, appetite, and cognition. Hydroxyzine blocks the receptors for histamine (H1) and serotonin (5-HT2A) in the brain, which may reduce anxiety and induce sedation. Hydroxyzine also has some anticholinergic effects, which means it inhibits the activity of acetylcholine, another neurotransmitter that controls muscle movement and memory.

Hydroxyzine has been studied for its efficacy and safety in the treatment of various anxiety disorders, such as generalized anxiety disorder (GAD), panic disorder, social anxiety disorder, and obsessive-compulsive disorder. The results have been mixed, with some studies showing positive effects and others showing no difference from placebo or other medications. However, most of the studies have been small, short-term, or of low quality, which limits their generalizability and reliability.

One of the most recent and rigorous studies was a meta-analysis published in 2018 1, which pooled the data from 12 randomized controlled trials involving 1,511 patients with GAD. The meta-analysis found that hydroxyzine was significantly more effective than placebo in reducing anxiety symptoms, with a moderate effect size. However, hydroxyzine was not superior to other active treatments, such as benzodiazepines or antidepressants. The authors concluded that hydroxyzine may be a useful option for patients with mild to moderate GAD who do not respond to or tolerate other medications.

The dosing of hydroxyzine for anxiety depends on several factors, such as the severity of symptoms, the patient’s age, weight, and medical history, and the form of hydroxyzine used. The usual recommended dose range is 25 to 100 mg per day 2, divided into three or four doses. The maximum daily dose is 400 mg 3. Hydroxyzine can be taken with or without food 4. The onset of action is usually within 15 to 30 minutes after oral administration 5.

The most common side effects of hydroxyzine are drowsiness, dry mouth, dizziness, blurred vision, headache, and nausea 2 3 4. These side effects are usually mild and transient, but they may impair the patient’s ability to drive or operate machinery. Therefore, caution is advised when using hydroxyzine in situations that require alertness or coordination.

Some serious but rare side effects of hydroxyzine include seizures, irregular heartbeat, severe allergic reactions (such as rash, swelling, or difficulty breathing), and mental or mood changes (such as agitation or confusion) 2 3 4. These side effects require immediate medical attention and may warrant discontinuation of hydroxyzine.

Hydroxyzine is contraindicated in patients who are allergic to it or any of its ingredients 2 3 4. It is also contraindicated in patients who have certain medical conditions that may be worsened by hydroxyzine or its anticholinergic effects. These conditions include narrow-angle glaucoma (a type of eye disease), urinary retention (difficulty urinating), pyloroduodenal obstruction (a blockage in the stomach or intestine), porphyria (a blood disorder), or severe liver disease 2 3 4.

Hydroxyzine may interact with other medications that affect the central nervous system (such as opioids, alcohol, or antihistamines), the heart (such as beta-blockers or antiarrhythmics), or the liver (such as cimetidine or ketoconazole) 2 3 4. These interactions may increase the risk of side effects or reduce the effectiveness of hydroxyzine or the other medications. Therefore, it is important to inform the doctor of all the medications, supplements, and herbal products that the patient is taking before starting hydroxyzine.

Hydroxyzine has some advantages over other medications for anxiety, such as:

• It is relatively safe and well-tolerated, with few serious side effects or withdrawal symptoms 1 5.
• It is not habit-forming or addictive, unlike benzodiazepines 5.
• It is inexpensive and widely available, as it is available in generic form 5.
• It has a fast onset of action and a short half-life, which means it works quickly and does not stay in the body for too long 5.
• It may have additional benefits for patients who also suffer from allergies, itching, nausea, or insomnia 5.

Hydroxyzine also has some disadvantages compared to other medications for anxiety, such as:

• It may cause sedation and cognitive impairment, which may interfere with daily functioning and quality of life 1 5.
• It may not be effective for severe or chronic anxiety disorders, or for patients who have comorbid depression or bipolar disorder 1 5.
• It may lose its effectiveness over time due to tolerance or tachyphylaxis (a rapid decrease in response to a drug) 5.
• It may interact with other medications that affect the central nervous system, the heart, or the liver 2 3 4.
• It may be contraindicated in patients who have certain medical conditions that may be worsened by hydroxyzine or its anticholinergic effects 2 3 4.

Hydroxyzine is an antihistamine that can be used to treat anxiety disorders, especially generalized anxiety disorder. It works by blocking the receptors for histamine and serotonin in the brain, which may reduce anxiety and induce sedation. Hydroxyzine has some advantages over other medications for anxiety, such as safety, availability, and cost. However, it also has some disadvantages, such as sedation, cognitive impairment, and potential interactions and contraindications. Hydroxyzine may be a useful option for patients with mild to moderate anxiety who do not respond to or tolerate other medications. However, it should be used with caution and under the guidance of a doctor.

1: Guaiana G., Barbui C., Cipriani A. Hydroxyzine for generalized anxiety disorder. Cochrane Database of Systematic Reviews 2018; Issue 12. Art. No.: CD011511.

2: Hydroxyzine (Oral Route) Description and Brand Names - Mayo Clinic

3: Hydroxyzine Uses, Dosage & Side Effects - Drugs.com

4: Hydroxyzine (Vistaril) for Anxiety: How It Works, Side Effects, and Dosage - GoodRx

5: Hydroxyzine For Anxiety: Is It Effective? | hers