In their lifetimes, everyone has experienced anxiety. Anxiety disorders, the most prevalent mental illness in the country for people over the age of 18, affect over 40 million adults.
The Food and Drug Administration (FDA) has given the antihistamine hydroxyzine its seal of approval for the treatment of anxiety. Its mechanism of action is somewhat unique, as most of the anxiety medications we’ve previously reviewed like Lexapro a member of the SSRI (Selective Serotonin Reuptake Inhibitor) drug subclass.
In order to assess whether hydroxyzine is likely to be effective for treating anxiety and to describe its mechanism of action, we will review the medical research on the drug in this article. There’s a good chance that you or a close friend or family member has an anxiety disorder if you’ve found your way to this article.
What Is Hydroxyzine?
In general, hydroxyzine is an antihistamine that is similar to over-the-counter (OTC) medicines like Benadryl and Zyrtec which are used to treat allergies and cold symptoms like runny nose and itchy or watery eyes.
Although it’s regarded as belonging to the same class as these drugs, it actually has some distinctive qualities that we’ll discuss below that make it a viable option for the treatment of anxiety.
Only those with a prescription can buy hydroxyzine; it is not sold over the counter.
How Does Hydroxyzine Function?
The function of a patient’s medications should be explained to them.
Although hydroxyzine’s ability to treat anxiety is still not fully understood, it has been proposed that it works by blocking receptors in the brain that control serotonin metabolism.
Patients with anxiety disorders frequently have irregular serotonin metabolism because it is a neurotransmitter that affects mood and sedation; hydroxyzine appears to somewhat normalize this process.
According to the medical review that is linked above, the “suppression of certain subcortical regions” is what gives hydroxyzine its anti-anxiety effects. This implies that the patient’s anxiety is brought on by overactivity in these areas.
Hydroxyzine Dosage For Anxiety
You might have noticed if you’ve read some of our other articles that some anxiety medications, like hydroxyzine, must be taken on a regular basis in order to be effective.
It’s not a long-term solution, even if hydroxyzine is the only anxiety medication you take. It is usually prescribed for a short period of time in addition to a daily dose of a longer-acting anti-anxiety drug like Buspar or Celexa. Up until the longer-term medication starts to take effect, hydroxyzine can ease anxiety. The only time hydroxyzine should be taken is when symptoms start to show.
Remember to follow the directions on your prescription because, like all prescription drugs, hydroxyzine should only be taken as directed by your doctor. Adults should take a dose of 50 mg to 100 mg up to 4 times per day, with or without food, though some people may start with a lower dose. Children should take a total of 50 mg daily in divided doses if they are under the age of 6, and a total of 50 mg to 100 mg daily in divided doses if they are over the age of 6.
In accordance with how you react to the drug (i.e., side effects), your provider may adjust your dose.
Side Effects Of Hydroxyzine
Like the majority of pharmaceutical drugs, hydroxyzine has potential side effects that patients and their doctors must weigh against the advantages.
In the earlier-mentioned study from 1994, hydroxyzine’s side effects were contrasted with those of a placebo. In comparison to 35% of placebo patients, 52% of hydroxyzine patients reported overall side effects.
In the hydroxyzine group, sleepiness was 14% more frequent, weight gain was 2% more frequent, and dry mouth was 9% more frequent.
In comparison to many popular classes of anxiety medications, such as SSRI, hydroxyzine has the advantage that its side effect profile appears to be relatively low. Even the FDA label states that the side effects associated with hydroxyzine use are typically minor and transient in nature.”
Hydroxyzine is a common ingredient in anxiety medications but does not carry the “black box” label warning that the FDA mandates be present on the labels of medications with serious side effect risks. The medication Zoloft, which is frequently prescribed for anxiety and panic disorders, carries a black box warning indicating it may increase the risk of suicide, as was highlighted in our article on Zoloft reviews.
Compared to another widely used anxiolytic (anti-anxiety) drugs, hydroxyzine’s side effect profile appears to be much less concerning overall.
Inform your doctor if you are currently taking any benzodiazepines, opioids, or sleep aids, such as Ambien or Lunesta, as doing so may affect how well both hydroxyzine and the drugs interact. Examples of these drugs include Vicodin, OxyContin, and Xanax. While you are taking hydroxyzine, your healthcare provider may want to lower the dosage of these drugs.
Hydroxyzine For Sleep
As we mentioned in the section on this medication’s side effects, increased sleepiness is a common side effect of antihistamines, including hydroxyzine. The off-label use of hydroxyzine for sleep improvement is not one we advise.
There are a few case reports and studies that show hydroxyzine is effective for treating insomnia in very specific situations, but it doesn’t seem like there is any research demonstrating this for healthy patients with insomnia.
As we noted in our article on whether melatonin is safe, we frequently advise using it as a first-line treatment for sleep problems due to its extreme safety and lack of toxic effects. Patients with more severe sleep issues might need a prescription sleep aid, but those with milder issues should talk to their doctor about melatonin.
What Are Natural Alternative For Anxiety?
In the majority of our articles, we like to highlight a more natural treatment option for the health condition, which patients may want to discuss with their doctor.
When a health condition is milder, it may make sense to try a natural product first, like a vitamin or supplement, as these may carry a lower risk of side effects than prescription drugs.
Ashwagandha is a plant that is frequently made into a root extract to treat anxiety, and this supplement has been proven to be effective as an anxiolytic in numerous medical studies.
The effectiveness of ashwagandha extract at a dosage of 240 mg was examined in a recent clinical trial that was reported in the Medicine journal. The study is double-blind and placebo-controlled, which is the gold standard in medical research for obtaining unbiased and objective data.
The authors of the study discovered that ashwagandha supplementation significantly decreased anxiety, decreased morning cortisol levels (a stress hormone that is misregulated in anxiety disorders), and even increased testosterone in males.
When choosing an herbal supplement, we advise only buying from suppliers who publish independent test results demonstrating their products are accurately labeled and have safe levels of contaminants like heavy metals. Since the supplement industry is much less standardized and regulated than the pharmaceutical industry, it is crucial to thoroughly investigate any potential suppliers. We advise staying away from a company if they won’t provide test results showing that their products are secure.
People Who Shouldn’t Take Hydroxyzine For Anxiety
Heart Rhythm Anomalies
According to a 2015 review, hydroxyzine may cause “serious heart rhythm anomalies”; as a result, it should only be used under a doctor’s supervision if the patient already has a high risk of arrhythmia or is currently taking medication that raises the risk of QT prolongation or lowers heart rate. A slow or irregular heartbeat, a heart attack, heart failure, heart disease, or low blood levels of potassium or magnesium are just a few examples of heart issues you should mention to your doctor or healthcare provider if you have a family history of them or have ever experienced them yourself.
Patients should not take hydroxyzine because it may contain phenylalanine if they have phenylketonuria, a rare inherited condition that results in elevated blood levels of the brain-damaging amino acid phenylalanine (Phe).
Adults Over 65
Due to potential side effects, hydroxyzine may not be suitable for patients over the age of 65. If you fall within this age range, talk to your doctor about alternative medications like hydroxyzine.
Driving And Operating Machinery
Patients should avoid driving or operating machinery until they fully understand how hydroxyzine affects them because it may have sedative and sleep-inducing side effects.
Before taking hydroxyzine, pregnant or planning pregnant women should inform their doctor. According to research, taking hydroxyzine during the first trimester of pregnancy increases the risk of fetal defects, and hydroxyzine has been shown to have teratogenic effects in animal studies. Before taking any new medication, pregnant and postpartum patients must speak with their doctors.
While the first trimester of pregnancy should not be used, the second and third trimesters may be; however, to make sure hydroxyzine is used safely, speak with your doctor before beginning any medication. The use of hydroxyzine during pregnancy is typically not advised due to the lack of controlled data regarding its use in pregnant humans.
Other potentially dangerous side effects of hydroxyzine during pregnancy include hypotension, myoclonus, depression of the central nervous system (CNS), and hypoxia. The aforementioned symptoms, as well as extrapyramidal symptoms, movement disorders, neonatal hypoxic conditions, and urinary retention, can be brought on by the use of hydroxyzine in late pregnancy, during labor, and immediately afterward. The baby may be affected by hydroxyzine use during labor in a variety of ways, including an increase in the child’s risk of seizures and a decrease in the fetal heart rate.
According to studies, taking hydroxyzine during pregnancy or while breastfeeding may cause trace amounts of the medication to pass into the baby’s milk. Extended use could reduce milk production and possibly result in the baby’s drowsiness and other symptoms.
Before taking hydroxyzine, patients should let their doctor know if they have any known allergies to over-the-counter antihistamines like Benadryl (diphenhydramine), Zyrtec (cetirizine), or Xyzal (levocetirizine), as these medications may cause a similar allergic reaction.
Is Hydroxyzine Addictive?
Some benzodiazepines, such as valium, are used to treat anxiety., Xanax) can develop into a habit and cause dependence. This indicates that as the medication becomes increasingly necessary for your body to function normally, you may start to experience withdrawal symptoms if you suddenly stop taking it.
The case with hydroxyzine is different. Actually, hydroxyzine isn’t a controlled substance like benzodiazepines are. Ask your healthcare professional if hydroxyzine might be a good option for you if you suffer from anxiety and worry about dependence or addiction.
How To Save On Hydroxyzine?
The medication hydroxyzine, which comes in both brand-name and generic forms, can be purchased in a variety of ways for a lower price.
- Save with GoodRx. With the aid of GoodRx, you can cut the cost of generic versions by over 79% off the average retail price.
- Save with patient assistance programs. If you’re uninsured or underinsured, you may be eligible for hydroxyzine’s patient assistance program, which offers the medication free of cost.
Generic Vs. Brand Name Version
The brand name for the generic medication is Vistaril, and its generic name is Hydroxyzine.
It is only a matter of business and marketing strategy that these two names refer to the exact same chemical compound.
Because the generic version of a drug is frequently less expensive, we frequently advise patients to take it.
Given that brand-name and generic medications contain the same chemical, this result is not surprising, but it was still helpful to see it reported in clinical research.
Customer Review On Hydroxyzine
- “For me and my anxiety, hydroxyzine has been a lifesaver. I feel like a zombie when I take Xanax because it’s far too powerful for me. My feelings of calm, control, and reason were immediately improved by hydroxyzine. It has helped save lives. It exists, which is wonderful. Just because the medication doesn’t work well for a person’s symptoms doesn’t mean it is bad.”
- “As a veteran, I have been given the diagnoses of PTSD, depression, and anxiety. I was admitted to the VA hospital for treatment of a severe case of hypervigilance and insomnia, during which time I was given this sleeping aid. I was able to sleep for almost 30 hours because it worked. “
- “This drug is wonderful. For my insomnia and panic attacks/GAD, Atarax was prescribed to me at 35 weeks pregnant. Before I started taking it, I was also having bizarre nightmares.”
- “The FDA should investigate this drug because too many doctors are prescribing it to treat bipolar disorder and depression, which it does not treat. “
- “This has been given to me three times for PTSD, sleep, and anxiety. None of these things works for me, and I really don’t like it. Although I am aware that they do it to avoid benzos, I would much rather experience actual relief. I don’t have any addictive tendencies, and anxiety and panic have worn me out. I’m supposed to take this, but I never do.”
How quickly does hydroxyzine begin to work?
Rapid action is the hallmark of hydroxyzine. Most people will begin to feel its effects within 30 minutes, and they will reach their peak in around 2 hours. While it’s great that it starts working right away, keep in mind that many of its potential side effects can also be felt right away.
When can I resume drinking if I’m not taking hydroxyzine anymore?
You should wait at least 48 to 60 hours (2 to 2.5 days) after stopping hydroxyzine before resuming alcohol consumption. But before you start drinking, be aware of the dangers of switching from hydroxyzine to alcohol, especially if you have been taking hydroxyzine to treat anxiety. Alcohol can make you feel more anxious, especially if you drink it frequently or in large amounts. Ask your doctor to assess the effects of drinking while taking your new medication to rule out other medications that are used to treat anxiety that may also interact with alcohol.
Is taking hydroxyzine safe while pregnant?
Early in pregnancy, hydroxyzine use is not advised because it could harm the fetus. If you think you might be pregnant or are planning a pregnancy, speak with your healthcare provider. Other choices that are risk-free for you while pregnant might be available.
One of the most secure treatments for anxiety is hydroxyzine, which also has an effective anti-anxiety effect. It does not have a black box warning and does not carry a risk of serious side effects, such as suicide risk, that are typical of SSRI medications.
But keep in mind that hydroxyzine can make you drowsy, which can be problematic if you’re trying to drive or otherwise perform tasks that require concentration. It may be helpful for people who have anxiety-related insomnia, though.
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