Hydroxyzine for Anxiety: Benefits, Dosage, and Side Effects

If you’ve been considering using the prescription medication hydroxyzine for anxiety, or if you just want to know more about the topic for research purposes, then you are in the right place. Hydroxyzine, pronounced hye-DROKS-i-zeen is a antihistamine medication that is commonly prescribed to soothe anxiety symptoms, but does that make it a good anxiety solution amongst all the alternatives? ^[1]

Here, we are going to look at what Hydroxyzine is exactly, investigate how it works, unpack the effectiveness and safety of hydroxyzine for anxiety purposes, take a closer look at its optimal dosages, and discuss potential side effects.

By comparing it to other anxiety treatments, you should be able to get a clear picture about hydroxyzine as an anxiety remedy, without any of the fluff.

Hydroxyzine: An Overview

Hydroxyzine is a long-standing medication when it comes to usage for anxiety management. It is a sedating antihistamine that belongs to the piperazine class of drugs ^[2]. FDA-approved uses of Hydroxyzine include treating anxiety, itching, agitation, as a sedative before surgery, emotional stress, and tension ^[3]. There are some instances of Hydroxyzine also being used to help with nausea, including that due to motion sickness ^[4].

Hydroxyzine is available under the brand names Atarax (hydroxyzine hydrochloride), Vistaril (hydroxyzine pamoate), ANX, Hyzine, and Rezine.

How hydroxyzine works for anxiety

The science behind hydroxyzine is interesting;

Essentially, in healthy adults, hydroxyzine may effectively treat an acute aggravation of panic disorder ^[5]. Hydroxyzine works to relieve anxiety attacks by significantly affecting two major chemicals in the human body, known as serotonin and histamine ^[5]:

• Serotonin: Serotonin is a chemical that controls mood. By efficiently interacting with this chemical and increasing serotonin levels in the brain, hydroxyzine relieves anxiety attacks and therefore is commonly used to treat generalized anxiety disorder, such as the type associated with insomnia
• Histamine: As an antihistamine, hydroxyzine treats allergy symptoms by blocking the natural substance called histamine that the body produces during an allergic reaction, which can also make you fall asleep; this (again) explains how hydroxyzine assists with anxiety and insomnia

Hydroxyzine is commonly used as a ‘last line’ defense against anxiety when other medications like benzodiazepines (diazepam,alprazolam, triazolam, etc) are not proving effective.

In 2002, study of 369 participants were studied and a conclusion was drawn that hydroxyzine was (is?) both safe and effective as an alternative to benzodiazepines for those living with anxiety ^[6]. Another study of 130 participants who suffered from generalized anxiety disorder (GAD) found that a hydroxyzine dose of 50mg a day could produce “a statistically and clinically significant anxiolytic effect” ^[7].

Different case studies also show that hydroxyzine has successfully been used to help symptoms of panic attacks, and compared to the benzodiazepine lorazepam, hydroxyzine showed a “greater and more rapid cognitive improvement” ^[8].

Forms of hydroxyzine

There are two formulations of hydroxyzine available:

• Hydroxyzine hydrochloride (Atarax)
• hydroxyzine pamoate (Vistaril)

While both formulations work (mostly) the same, people taking the medication might find that their symptoms respond to one more than the other, with hydroxyzine hydrochloride more typically prescribed for anxiety.

Hydroxyzine is used either by mouth (orally) or injection into a muscle ^[4].

Hydroxyzine Dosage for Anxiety

Like with most prescription drugs, Hydroxyzine is individually prescribed to patients with anxiety based on their age, health condition, and symptoms, and the dosages are calculated accordingly.

For reference purposes, however, the typical recommended hydroxyzine dose to relieve anxiety symptoms in adults is 50mg to 100mg up to four times daily ^[3].

The recommended hydroxyzine dosage is 50mg daily in divided doses for children under six years, while for children over six years, the dose is 50mg to 100mg per day in divided doses. If the hydroxyzine treatment is an injection, subsequent doses may be taken by mouth ^[3].

It is important not to exceed the recommended prescribed dose. Inform your doctor if your symptoms do not improve or worsen.

Potential Side Effects of Hydroxyzine

Common side-effects when regularly taking hydroxyzine for anxiety (or other) purposes, include ^[2]:

• Dry mouth
• Headaches
• Drowsiness
• Shakiness (tremors)
• Itchiness and rashes

More serious side-effects of Hydroxyzine, that require immediate medical attention if experienced, include ^[2]:

• Fast and irregular heartbeat
• Trouble controlling body movements
• Severe dizziness
• Convulsions
• Mental confusion (hallucinations)
• Fever with bad skin rash and swelling (allergic reaction)

While fairly rare, there are some instances of potentially life-threatening side-effects to hydroxyzine, such as irregular heartbeats (QT prolongation, Torsade de Pointes) and severe allergic reactions (rash, hives, red, swollen, blistered, or skin peeling). Please seek immediate medical help if you have tightness in the chest or throat, trouble breathing, swallowing, or talking, and swelling of the mouth, face, lips, tongue, or throat following hydroxyzine consumption ^[3].

Interactions and Precautions

Using certain medications, herbs, or supplements alongside hydroxyzine can change how hydroxyzine works in your body, possibly increasing the risk of serious side-effects. It is impossible to list all of the possible interactions so please consult with a medical professional and make them aware of all the products you currently use; including prescription medications, nonprescription drugs, and herbal supplements ^[3]. Try not start, stop, or change the dosage of any medicines without your medical professional’s approval.

Hydroxyzine can interact adversely with a range of other medications, including ^[9]:

• Other antihistamines: Caution is recommended due to the risk of rapid heartbeat when diphenhydramine (Benadryl) and cetirizine (Zyrtec) are combined with hydroxyzine.
• Benzodiazepines: Benzodiazepines have anxiolytic, hypnotic, anticonvulsive, and muscle-relaxing properties. They are primarily used for anxiety and insomnia (poor sleep). Using hydroxyzine may enhance the depressant effects.
• Barbiturates: They are used as a general anesthetic for sedation. When used with hydroxyzine, an enhanced depressant effect or excessive sedation may occur.
• Benztropine (Cogentin): This medication treats Parkinson’s disease. It may increase the heartbeat when combined with hydroxyzine.
• Zolpidem (Ambien): This medication is used to treat sleep problems. It may increase the depressant effects when combined with hydroxyzine.
• Drugs that increase heart rate: Caution is recommended when quinidine, procainamide, amiodarone, sotalol, amitriptyline, methadone, antipsychotics, and antibiotics are used with hydroxyzine due to rapid, irregular heart rate.

Hydroxyzine vs. Alternative Treatments for Anxiety

For individuals with sub-optimal response (meaning partial or no response) to initial hydroxyzine management of anxiety symptoms, medical practitioners have been known to suggest adjunctive cognitive-behavioral therapy (CBT). CBT typically takes a ‘problem-solving’ approach to anxiety, leaving the subject with a suite of mental management tools for their anxiety.

There are other psychotherapies that can be used if CBT is not appropriate, such as relaxation therapy, supportive psychotherapy, or mindfulness therapy ^[10].

Similarly, there is actually evidence suggesting that combining psychotherapy (CBT, etc) and certain anxiety medications (like hydroxyzine) might be more effective than either treatment alone.

But research generally shows that psychotherapy is more effective than drugs, and that adding drugs may help temporarily reduce anxiety symptoms but does not significantly improve outcomes from psychotherapy alone ^[3].

Alternative Medications to Hydroxyzine For Anxiety

For the purposes of anxiety, there are several prescription and non-prescription medications that are solid alternatives to hydroxyzine, including:

• Selective serotonin reuptake inhibitors (SSRIs): SSRIs are typically used as first-line treatment for generalized anxiety symptoms. SSRIs are considered to be effective, having less sedation, mental side-effects, and risk of dependence than other anti-anxiety drugs such as benzodiazepines ^[11][12].
• Serotonin-norepinephrine reuptake inhibitors (SNRIs): SNRIs are also a preferred initial treatment of generalized anxiety symptoms. SNRIs increase the amount of serotonin and norepinephrine (noradrenaline) neurotransmitters in the brain, regulating arousal and alertness ^[11].
• Gabapentin: Gabapentin is commonly prescribed “off-script” for anxiety, and can be used by those who only show a partial response to initial treatment with first-line treatments like SSRIs and SNRIs. Gabapentin reduces the release of excitatory neurotransmitters, which can result in a calming and sleepy effect ^[13].
• Benzodiazepines: The benzodiazepine family of drugs includes diazepam (Valium), clonazepam (Klonopin), lorazepam (Ativan), flurazepam (Dalmane) and the most popular, Xanax. Benzodiazepines like Xanax act on the brain and central nervous system (CNS) to produce a calming effect ^[14]. Typically this involves boosting the effects of a natural chemical called gamma-aminobutyric acid (GABA), which is made in the brain. Benzodiazepines used to be considered a front-line anxiety medication, but due to addiction risks and wide-spread history of abuse, are prescribed by medical practitioners cautiously and only in very specific circumstances.

Natural Alternatives to Hydroxyzine

Prescription medications and psychotherapy aren’t the only effective anxiety treatments; there are now several natural alternatives to hydroxyzine that provide a range of options for those wanting to steer clear of prescription medications.

Many foods, minerals and dietary supplements have similar properties to prescription anxiety medications like hydroxyzine, in terms of lowering the negative effects of stress and anxiety.

The major difference is that natural anxiety solutions are less likely to have detrimental side-effects, and usually carry a lower risk of dependence or addiction. They are also more widely available, as you do not need a prescription, and almost all are beneficial to your health in more areas than one ^[15].

Here are some notable natural remedies for anxiety that you can consider trying:

Lavender (Silexan)

Silexan is a branded extract of lavender oil created by Wilmar Schwabe GmbH, a German pharmaceutical company. Fundamentally, Silexan is a standardized essential oil of L. angustifolia (lavender) flowers prepared by steam distillation ^[16].

Research involving Silexan shows that “uniquely prepared, pharmaceutical quality lavender oil” (i.e. potent silexan) can improve symptoms of mild anxiety. Two recent studies found lavender oil capsules to be just as effective as commonly prescribed benzodiazepine Lorazepam and the antidepressant Paroxetine ^[17].

The anxiolytic (anti-anxiety) properties of lavender/silexan seemingly come from the antagonization of NMDA and GABA-related receptors in the central nervous system that influence muscle contraction, as well as inhibition of the serotonin transporter. In this way, the mechanism of action for Silexan seems to be similar to anxiolytic and antidepressant drugs like SSRIs and Benzodiazepines ^[18].

The major upside to lavender/silexan over other anti-anxiety medications is the almost complete lack of abuse potential in healthy recreational users of the lavender extract ^[19]. Downsides can include the affectionately-titled “lavender burps” which are potential mild gastrointestinal issues, and recent studies showing that chemicals in lavender oil are potential endocrine disruptors with varying effects on receptors for two hormones — estrogen and androgen ^[20].

You can read all about Silexan in our in-depth article here.

GABA

Gamma-Aminobutyric Acid, or GABA, is a naturally-occurring amino acid that acts as a neurotransmitter within the brain. GABA has been shown in numerous studies to have a calming effect, and GABA deficiency is believed to play a part in several anxiety disorders ^[21].

Studies using GABA supplementation have found that it may have positive effects on stress and anxiety levels ^[22], which would help block the symptoms associated with anxiety in a similar way to benzodiazepines without the associated addiction risk.

L-theanine

L-theanine is an amino acid well known for its relaxing properties ^[23]. Studies have shown that L-theanine may decrease the severity of stress-related symptoms in test subjects, while also increasing cognitive performance ^[24].

Taking L-theanine, then, may help some people counteract the nerves that come with anxiety, while also providing better focus and clearer thought.

L-theanine can be taken in supplement form, and is also present in green, black and oolong teas, as well as some mushrooms.

Natural Anxiety Supplements

If you’re looking for a more specialized all-natural alternative to anxiety medications that promotes overall relaxation, calmness, and improved cognitive function then you should consider PerformZen Calm Performance Formula.

PerformZen is a natural supplement designed to help public speakers overcome glossophobia symptoms, and maintain their composure and mental focus when they have to deliver a speech under pressure!

PerformZen works by boosting GABA, which is a neurotransmitter that promotes calmness ^[25]. It also contains magnesium and vitamin B6, which combine together to improve cognitive performance ^[26].

Additionally, PerformZen contains L-theanine, theacrine, and Ginkgo Biloba, which are natural ingredients that promote calmness and provide a boost in clean energy.

So is Hydroxyzine a good solution for Anxiety vs. alternatives?

It’s clear that hydroxyzine presents a valid path for those battling anxiety, with benefits that include a low(er) risk of dependency then similar pharmaceuticals, established effectiveness, and minimal side-effects.

Considering that anxiety disorders are the most prevalent psychiatric disorder in the world, currently affecting over 40 million adults in the United States, any effective solution to anxiety is a good thing ^[27].

However the downsides of Hydroxyzine, or just the inconvenience in regularly fulfilling prescriptions for the medication may leave some looking for a natural alternative. We, of course, suggest looking at PerformZen as we have hundreds of happy customers who previously used medications like hydroxyzine and propranolol off-script; but after using PerformZen are now satisfied converts!

There is also other alternatives listed above, including CBT and other forms of psychotherapy; all of which have proven extremely effective in the fight against anxiety.

Hydroxyzine for Anxiety Frequently Asked Questions

Here are some common questions and answers about hydroxyzine for anxiety purposes. Rather then keep our responses solely in emails and private discourse, we figured it’s a good idea to share the questions and the subsequent answers here so that we can refer anyone with questions to this section in future: