Does Hydroxyzine Work for Anxiety? What to Know Before You Start
This content is for informational purposes and not a substitute for medical advice. Quick Answer: Hydroxyzine is an FDA-approved antihistamine that can effectively treat anxiety symptoms, often working within 15-30 minutes. While it’s not habit-forming like some anxiety medications, it’s typically prescribed for short-term use and isn’t considered a first-line treatment. Your doctor might recommend… Read more
Reviewed by The PsychPlus Team
September 12, 2025
This content is for informational purposes and not a substitute for medical advice.
Quick Answer: Hydroxyzine is an FDA-approved antihistamine that can effectively treat anxiety symptoms, often working within 15-30 minutes. While it’s not habit-forming like some anxiety medications, it’s typically prescribed for short-term use and isn’t considered a first-line treatment. Your doctor might recommend it when other medications aren’t suitable or while waiting for longer-term treatments to take effect.
If you’re struggling with anxiety, you’ve probably heard about different medications that might help. Hydroxyzine is one option that’s been around for decades – but you might wonder if it actually works and whether it’s right for you. Let’s break down everything you need to know in simple terms.
What Is Hydroxyzine and How Does It Help with Anxiety?
An overview of its uses and FDA approval
Hydroxyzine is a prescription medication that has been in use since the 1950s [1]. The FDA approves it for the treatment of anxiety and tension, as well as conditions like allergies and itching. It’s commonly available under brand names such as Vistaril (hydroxyzine pamoate) and Atarax (hydroxyzine hydrochloride).
Although primarily classified as an antihistamine, hydroxyzine also has calming effects on the nervous system. The FDA specifically approves it for the “symptomatic relief of anxiety and tension associated with psychoneuroses,” making it a recognized option for managing anxiety.
Hydroxyzine hydrochloride is a piperazine-derived antihistamine. Its sedative effect makes it especially helpful for individuals with anxiety-related insomnia. In addition to its antihistamine properties, hydroxyzine also has alpha-adrenergic blocking activity, which may contribute to its overall calming effect.
Why it’s different from other anxiety medications
Unlike many anxiety medications, hydroxyzine is not a controlled substance, meaning it has low risk of addiction or physical dependence [2]. This sets it apart from drugs like Xanax or Valium.
Mechanism of Action Hydroxyzine works differently than SSRIs and benzodiazepines, it primarily blocks histamine receptors in the brain and has weak effects on serotonin receptors. This may help reduce anxiety without the addiction risks associated with other medications.
Summary of Research Findings on GAD and Hydroxyzine A Cochrane review included five randomized controlled trials with 884 participants and found hydroxyzine to be more effective than placebo in treating generalized anxiety disorder (GAD). Its efficacy, acceptability, and tolerability were comparable to other anxiolytics like benzodiazepines and buspirone. However, hydroxyzine was linked to higher rates of drowsiness. The review noted a high risk of bias in the included studies [3].
A further 3-month double-blind study found that hydroxyzine (50 mg/day) significantly reduced anxiety symptoms in adults with generalized anxiety disorder compared to placebo, with improvements in response and remission rates. Its efficacy was comparable to bromazepam, but with fewer side effects, particularly less drowsiness. The findings support hydroxyzine as a safe and effective non-benzodiazepine treatment option for GAD, provided it is prescribed thoughtfully and the individual responds well to it [4].
How Fast Does Hydroxyzine Work for Anxiety?
Onset and duration of effects
One of hydroxyzine’s biggest advantages is how quickly it works. While everyone is different, most individuals report feeling its effects within 30 minutes after taking it [5]. The strongest effects usually last 1-2 hours, though you might feel some calming effects for 4-6 hours total.
This fast action makes hydroxyzine especially helpful for sudden anxiety episodes or when you know you’re about to face a stressful situation, like a medical procedure or public speaking.
When to take it for best results
Timing matters with hydroxyzine. Since hydroxyzine can cause drowsiness, many people find it works best when taken:
- In the evening if anxiety keeps you awake
- 30 minutes before a known stressful event
- At times when you don’t need to drive or operate machinery
You can take hydroxyzine with or without food. If it upsets your stomach, try taking it with a small snack.
Common Dosages and How to Take It Safely
Dosage ranges for adults and children
Doctors usually prescribe hydroxyzine for anxiety at these doses [6]:
| Patient Group | Typical Dose Range | Frequency | Notes |
| Adults | 50 to 100 mg | Up to 4 times daily | Start with lower dose; adjust based on response |
| Children (≥6 years) | 50 to 100 mg daily | Divided doses | Doctor will set based on age and weight |
| Children (<6 years) | Up to 50 mg daily | Divided doses | Use with caution; follow pediatric guidance |
| Older Adults (65+) | Often <50 mg | Lower frequency | Increased risk of sedation and side effects |
| Pre-surgery (sedation) | 50 to 100 mg (single dose) | One-time | Often given 1 hour before procedure |
Your doctor might start you on a lower dose to see how you respond to this medication. Most people take 50 to 100 mg when they need it for anxiety, up to four times a day.
What to do if you miss a dose
If you’re taking hydroxyzine regularly and miss a dose:
- Take it as soon as you remember, if it’s not close to your next dose
- Skip the missed dose, if it’s almost time for your next one
- Never double up on doses to make up for a missed one
Remember, many people use hydroxyzine “as needed” rather than on a schedule. If that’s how your doctor prescribed it, you don’t need to worry about missed doses.
Side Effects and Safety Considerations
Common and serious side effects
Like all medications, hydroxyzine can cause side effects. The most common ones include [7]:
- Drowsiness (the most common side effect)
- Dry mouth
- Dizziness
- Headache
- Blurred vision
- Fatigue
Most people find these side effects get better after a few days as their body adjusts. The drowsiness that bothers some people might actually help if anxiety keeps you awake at night.
Who should avoid hydroxyzine
Hydroxyzine can cause issues that require immediate medical attention, such as irregular heartbeat, seizures, or severe allergic reactions [8].
You should avoid hydroxyzine if you:
- Have heart rhythm problems (e.g., QT prolongation)
- Are pregnant or breastfeeding
- Are allergic to hydroxyzine or similar medications
- Take medications that affect heart rhythm
Everyone responds differently to medications, so it’s important to consider all current prescriptions and medical conditions before starting hydroxyzine.
Caution is especially advised when combining hydroxyzine with antipsychotics like risperidone. Both drugs have alpha-adrenergic blocking effects, which may increase the risk of priapism, a prolonged, painful erection. A case report described a 35-year-old man who developed priapism requiring emergency treatment after taking hydroxyzine with risperidone [9]. Although symptoms lessened after stopping hydroxyzine, a milder episode occurred again.
Always inform your doctor about all medications you’re taking. Avoid alcohol while using hydroxyzine, as it can dangerously increase sedation and drowsiness.
How It Compares to Other Anxiety Medications
Hydroxyzine vs. benzodiazepines and SSRIs
Clinical research indicates that hydroxyzine demonstrates comparable efficacy to certain benzodiazepines in the short-term management of anxiety, with the advantage of a lower risk for dependence or abuse. Hydroxyzine is not a controlled substance, is generally well tolerated, and has a rapid onset of action (within 30 minutes), making it useful for acute anxiety episodes. Unlike benzodiazepines, it does not typically produce withdrawal symptoms or require tapering.
Benzodiazepines, while potentially more potent anxiolytics for severe anxiety and sometimes faster-acting, carry risks of tolerance, dependence, and withdrawal. They are typically reserved for short-term or treatment-resistant cases of anxiety due to these concerns. Additionally, benzodiazepines may cause less sedation at lower doses compared to hydroxyzine.
Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac) and sertraline (Zoloft), are often considered first-line treatments for chronic anxiety, while also addressing depression. They require several weeks to achieve full efficacy but are effective for long-term symptom management and are also beneficial for co-occurring depression. Hydroxyzine may be used as a short-term adjunct while awaiting the therapeutic onset of SSRIs or for intermittent management of anxiety flare-ups.
Use and Limitations of Hydroxyzine
While hydroxyzine is not habit-forming and is considered safe for short-term use, it is generally not recommended for long-term daily use. Tolerance may develop over time, and its sedating effects can interfere with functioning. Additionally, its efficacy beyond four months has not been well studied. Clinically, hydroxyzine is often used as a bridging agent while waiting for SSRIs to take effect or for short-term management of acute anxiety symptoms.
Research shows hydroxyzine works about as well as some benzodiazepines for anxiety, but without the addiction risk [10]. Here’s how they compare:
Is it habit-forming or safe for long-term use?
Hydroxyzine is typically not habit-forming and doesn’t cause physical dependence in most individuals [2]. However, it’s generally not recommended for long-term daily use because:
- People can develop tolerance (as it becomes less effective over time)
- The effectiveness for anxiety longer than 4 months hasn’t been studied
- The sedating effects may interfere with daily activities
Many doctors prescribe hydroxyzine to help with anxiety symptoms while waiting for SSRIs to start working, or for short-term situations when anxiety flares up.
Tips for Talking to Your Doctor
What to ask before starting hydroxyzine
When discussing hydroxyzine with your health care provider, ask:
- Is this the best medication for my type of anxiety?
- How long should I take it?
- Can I take it with my other medications? What about supplements?
- What time of day is best for my lifestyle?
- When should I call if side effects don’t improve?
Be honest about your anxiety symptoms, when they happen, and what you’ve already tried. This helps your doctor decide if hydroxyzine is right for you. Also, don’t underestimate the importance of being attuned with, and knowing your body.
Combining it with other treatments or therapy
Hydroxyzine often works best as part of a complete treatment plan. Your doctor might suggest combining it with:
- Therapy: Including mindfulness, cognitive-behavioral therapy (CBT), acceptance commitment therapy (ACT), Eye Movement Desensitization and Reprocessing (EMDR), and exposure therapy for anxiety [11-14].
- Lifestyle changes: Nutrient dense balanced meals, appropriate exercise, meditation, and stress management. All of these practices affect processes in the body that influence anxiety [15-16].
- Sleep hygiene: Getting sufficient sleep is imperative for managing anxiety from a multisystemic lens. Quality sleep is needed to regulate all the body’s processes, having a profound impact on anxiety and well-being [17-18].
- Circadian Rhythm and Nature: Obtaining direct sunlight exposure in the earlier part of your day (the morning ideally) supports various biological processes in the body that support mood regulation [19]. Being immersed in nature also supports stress reduction via various biological processes (including reduced inflammation, improved immunity and lower levels of cortisol) [20].
- Meaningful Connections & Purpose: Having community and connection is important for regulating anxiety, as is having purpose in life.
- Other medications: Like SSRIs for long-term management
Studies show that hydroxyzine doesn’t interfere with therapy or SSRI effectiveness like some other medications might [21].
Final Thoughts: Is Hydroxyzine Right for You?
Hydroxyzine can be a helpful tool for managing anxiety, especially when you need quick relief without the risks of controlled substances. While it’s not typically a first-choice or long-term solution, it fills an important role for many people dealing with anxiety symptoms.
The key is working with your doctor to find the right approach for your specific situation. Whether hydroxyzine becomes part of your short-term strategy or helps while other treatments take effect, understanding how it works helps you make informed decisions about your mental health care.
If you’re looking for anxiety treatment, consider reaching out to a mental health professional who can help you explore all your options, including hydroxyzine if it’s appropriate for your situation.
FAQs
Is hydroxyzine safe to take every day?
While hydroxyzine is relatively safe for daily use, most doctors recommend it for short-term or as-needed use. Daily long-term use can lead to tolerance, meaning it becomes less effective over time. Talk to your doctor about the best schedule for your needs and whether other anxiety treatments might be better for ongoing symptoms.
Can you drink alcohol while taking hydroxyzine?
No, it is not advised that you consume alcohol while taking hydroxyzine. Both alcohol and hydroxyzine can induce drowsiness, and combining them can lead to dangerous levels of sedation, confusion, and breathing problems. Always avoid alcohol when taking this medication.
How long does it take to feel better?
Hydroxyzine typically starts working within 15-30 minutes after taking it, with the strongest anxiety relief occurring in the first 1-2 hours. However, some calming effects might last 4-6 hours. This makes it helpful for situations where you need quick anxiety relief.
Wondering if hydroxyzine is right for your anxiety?
Connect with a licensed provider at PsychPlus to explore personalized anxiety treatment options, including fast-acting medications like hydroxyzine and long-term care strategies that fit your needs.
References
- U.S. Food and Drug Administration. (2024). Hydroxyzine prescribing information. AccessData.FDA.gov.
https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/088617Orig1s043,088618Orig1s043,088619Orig1s044lbl.pdf - Drug Enforcement Administration. (2024). Controlled substances schedules. U.S. Department of Justice. https://www.deadiversion.usdoj.gov/schedules/schedules.html
- Guaiana, G., Barbui, C., & Cipriani, A. (2010). Hydroxyzine for generalised anxiety disorder. Cochrane Database of Systematic Reviews, (12).
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006815.pub2/full - Llorca, P. M., et al. (2002). Efficacy and safety of hydroxyzine in the treatment of generalized anxiety disorder: a 3-month double-blind study. Journal of Clinical Psychiatry, 63(11), 1020-1027. https://pubmed.ncbi.nlm.nih.gov/12444816/
- Pfizer Inc. (2023). Vistaril (hydroxyzine pamoate) prescribing information.
https://www.pfizermedical.com/vistaril/dosage-admin - American Psychiatric Association. (2023). Practice guideline for the treatment of patients with anxiety disorders.
https://psychiatryonline.org/doi/10.1176/appi.books.9780890424841 - European Medicines Agency. (2015). New restrictions to minimise risks of heart rhythm effects with hydroxyzine-containing medicines.
https://medicinesauthority.gov.mt/file.aspx?f=866 - Schlit, A. F., et al. (2017). Risk of QT prolongation and torsade de pointes associated with exposure to hydroxyzine. Pharmacology Research & Perspectives, 5(3), e00309.
https://bpspubs.onlinelibrary.wiley.com/doi/10.1002/prp2.309 - Elfessi Z, Jhawar A, Martino J. Priapism Associated With the Addition of Hydroxyzine to Risperidone: A Case Report. J Pharm Pract. 2024 Jun;37(3):758-760.
https://pubmed.ncbi.nlm.nih.gov/35737351/ - Ferreri, M., & Hantouche, E. G. (1998). Recent clinical trials of hydroxyzine in generalized anxiety disorder. Acta Psychiatrica Scandinavica, 98(S393), 102-108.
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