Hydroxyzine: An Antihistamine Labeled for Anxiety

What hydroxyzine is

MedlinePlus places hydroxyzine in the antihistamine class. It blocks histamine, the body substance behind many allergy symptoms, and it also reduces activity in the brain. It comes as hydroxyzine hydrochloride (tablets and a liquid) and hydroxyzine pamoate (capsules). Both are sold as generics.

It has a different chemistry from benzodiazepines: the label says it is unrelated to them. One review calls it the only antihistamine FDA-approved for use in anxiety and notes that hydroxyzine is commonly used as an alternative to benzodiazepines, which does not mean it suits every person. Our medicines list shows where it sits among other options.

What the label approves it for

The wording on these older labels is dated, so here it is with a plain translation.

• Anxiety: "symptomatic relief of anxiety and tension associated with psychoneurosis," an old term, and as an add-on when anxiety shows up alongside a physical illness.
• Itching: allergic conditions such as chronic hives and atopic or contact dermatitis, and itching driven by histamine.
• Sedation: as a sedative before and after general anesthesia.

How long the anxiety evidence goes

The label says the effectiveness of hydroxyzine as an anxiety medicine for long-term use, meaning more than 4 months, has not been assessed by systematic clinical studies. It tells physicians to reassess from time to time whether it is still useful for the person.

A review reports that a Cochrane analysis in generalized anxiety disorder found hydroxyzine better than placebo and comparable to benzodiazepines and buspirone, but those authors raised concerns about a high risk of study bias and about sedation. The same review says there have not been randomized trials in social anxiety disorder or panic disorder. We do not describe those as established uses here.

How it is thought to work, and what it can feel like

The label does not give a settled mechanism for anxiety. It says the action may be due to suppressing activity in certain regions under the cortex of the brain, and it describes antihistamine effects as well. It adds that hydroxyzine does not act as a cortical depressant.

It tends to act fairly quickly. The label says clinical effects are usually noted within 15 to 30 minutes after a dose by mouth. Drowsiness is the effect many people notice, and the label says it is usually temporary and may fade within a few days of continued use or with a lower dose. Your prescriber decides what is right for you.

Side effects and warnings

Hydroxyzine has no boxed warning on its label, but several cautions matter, especially for your heart.

• Prolonged QT interval: hydroxyzine is contraindicated in people with this finding. QT prolongation and a dangerous rhythm called torsade de pointes have been reported, mostly in people with other risk factors such as heart disease, electrolyte problems or other medicines that affect rhythm.
• Medicines that affect heart rhythm: the label advises caution with drugs known to prolong QT, naming examples among antipsychotics, antidepressants such as citalopram and fluoxetine, certain antibiotics, and others. Bring a full medicine list to your prescriber.
• Allergy: it is contraindicated if you have had a hypersensitivity reaction to hydroxyzine, cetirizine or levocetirizine.
• Sedation and driving: the label warns against driving or operating dangerous machinery while taking it. It says other sedating medicines, including narcotic pain medicines and barbiturates, can be strengthened, and that alcohol's effects may be increased.
• Common effects: dry mouth and drowsiness. MedlinePlus also lists headache, dizziness and confusion, especially in older adults.
• Serious effects: shaking, seizures, and a rare serious skin reaction called acute generalized exanthematous pustulosis, which can involve fever and many small pustules on red, swollen skin. The label says a rash or any sign of allergy needs your prescriber's attention right away.

Older adults, pregnancy and breastfeeding

The label says sedating drugs may cause confusion and over-sedation in older people. MedlinePlus says older adults should not usually take hydroxyzine, because it is not as safe as other medicines that can be used for the same condition. If this applies to you or a parent, raise it directly.

The hydroxyzine label says it must not be used in early pregnancy, and that it should not be given to people who are breastfeeding. If you are pregnant, could become pregnant or are breastfeeding, tell your prescriber before taking hydroxyzine.

Can hydroxyzine be managed online in Pennsylvania and New York

The label does not require a clinic setting for tablets or capsules, but the heart history questions are important, and a video visit cannot check heart rhythm. Your prescriber may want a recent heart tracing or your records. Whether it is an option for you is a decision for you and your prescriber. Ask us whether our psychiatrist can help, using our medication inquiry form.

A licensed psychiatrist on our team treats anxiety by secure video for people physically located in Pennsylvania or New York during each visit. See online anxiety treatment and online psychiatry in Pennsylvania. Our therapists do not prescribe, and they see clients in Pennsylvania, West Virginia, Arizona, Colorado and Florida, not New York. Ask us about fees and insurance.

If you are in crisis, call or text 988, or call 911. Locascio Wellness does not provide emergency services. Our crisis resources page lists more options.