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Atarax is for itch and Vistaril is for anxiety

Many people believe that hydroxyzine HCl tablets (Atarax) are the best choice for itch and hydroxyzine pamoate capsules (Vistaril) are for anxiety or sleep. This belief is often passed down to students and shared among colleagues. But despite this widespread acceptance, there is no evidence to suggest that either salt has advantages over the other. This practice appears to be based on tradition and nothing more. Part of the confusion may be that many people don't realize that not all Vistaril products are the pamoate salts.

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 Is Vistaril (hydroxyzine) or Atarax (hydroxyzine) more effective for anxiety?

Neither Vistaril nor Atarax is recommended as a first-line treatment for anxiety, as the most recent and highest quality study suggests that selective serotonin reuptake inhibitors (SSRIs) are the preferred pharmacotherapy for social anxiety disorder in adults. Vistaril and Atarax are actually the same medication - both are brand names for hydroxyzine, an antihistamine that is also used to treat anxiety. There is no difference in effectiveness between these two brands since they contain the identical active ingredient. According to the Japanese Society of Anxiety and Related Disorders/Japanese Society of Neuropsychopharmacology: Clinical Practice Guideline for Social Anxiety Disorder (2021). SSRIs are suggested as the recommended pharmacotherapy for social anxiety disorder in adults.

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Does Vistaril (hydroxyzine) work for anxiety?

A review of five studies about hydroxyzine pamoate’s effect on generalized anxiety disorder demonstrated that it is more effective at treating anxiety symptoms than a placebo was. However Vistaril’s effectiveness has been shown to decrease over time, as patients build up a tolerance to it. Because of this, it’s typically considered a short-term treatment.

Hydroxyzine and Alcohol: A Dangerous Mix

Like many other sedating antihistamines (think Benadryl or Dramamine), hydroxyzine inhibits the action of a neurotransmitter called acetylcholine, which is responsible for memory, learning, motivation, stimulation, and motor control. As a drug class, these anticholinergic medications can cause blurry vision, confusion, urinary retention, and constipation. For that reason, hydroxyzine is generally not prescribed to folks over 65, who might be more sensitive to these effects.

Important Hydroxyzine Interactions You Should Know About

Hydroxyzine is a commonly prescribed antihistamine used to treat allergies, itching, and anxiety. Hydroxyzine can interact with various medications and substances, including central nervous system depressants, drugs that affect heart rhythm, anticholinergics (like antihistamines), and even beverages like grapefruit juice and alcohol.

Vistaril vs Atarax: Which is Better?

Unfortunately, there isn’t a clear answer regarding which drug is “better.” It depends on multiple factors and individual needs. If you’re seeking help for a mental health condition like anxiety, Vistaril (hydroxyzine) can be a good option. If you’re looking for relief from allergies or a dermatological condition, the generic version of Atarax (hydroxyzine hydrochloride) may be a more appropriate choice.

Resources

NAMI

Hydroxyzine is not a controlled substance. It does not have the risk of addiction like some other medications used to treat anxiety e.g., lorazepam (Ativan®), alprazolam (Xanax®), clonazepam (Klonopin®), and other benzodiazepines.

Philadelphia Integrative Psychiatry

While hydroxyzine can be used to treat many different types of anxiety disorders, it is used most often for generalized anxiety disorder (GAD) or panic attacks, especially when it is associated with insomnia. There are some anxiety medications that need to be taken regularly to be effective, and others — like hydroxyzine — that can be taken as needed. Hydroxyzine starts working very quickly. Most people will start to feel it kick in within 30 minutes and will feel its maximum effect at around 2 hours. The most common side effects for hydroxyzine are drowsiness and dry mouth.