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Hydroxyzine for Anxiety: How It Works, Side Effects, and Dosages

If you’re considering treating your anxiety with medication, you must be pondering upon questions like does Hydroxyzine help with anxiety? Hydroxyzine is a medication that treats anxiety and the symptoms of allergic reactions.

Over 30% of US adults experience anxiety disorders, making it the most common mental health condition. Hydroxyzine can be effective in certain situations, although it is not always the first-choice treatment for anxiety. In the episode of ‘The HealingUs Podcast,’ Dr. Ed Ratush discusses psychiatry in the context of anxiety treatment, emphasizing the importance of genuine patient relationships. He explores mindfulness techniques and the role of technology in assessing and improving quality of life. Dr. Ratush also highlights ongoing advancements in anxiety treatment practices in the U.S. behavioral health industry and the personal commitment required for growth.

In this article, we’ll discuss how does Hydroxyzine help with anxiety, common side effects, precautions, and how to know when to see a doctor.

What is Hydroxyzine?

Hydroxyzine is a sedating antihistamine used for short-term treatment of anxiety and trouble sleeping. It is a generic prescription medication approved by the FDA. While Hydroxyzine is not typically the first choice for treating anxiety—those being antidepressants like SSRIs or SNRIs (e.g., paroxetine, sertraline, escitalopram)—it can provide relief from generalized anxiety disorder (GAD) and insomnia until other treatments become effective.

Additionally, Hydroxyzine reduces activity in the central nervous system, making it useful as a sedative for treating anxiety and tension. However, it is intended for short-term use only, typically no longer than 4 months.

FDA-approved uses of Hydroxyzine 

Hydroxyzine is a prescription antihistamine classified as a histamine H1 antagonist with sedating properties, similar to diphenhydramine (Benadryl). It is FDA-approved for:

  1. Treating anxiety (generalized anxiety disorder or GAD)
  2. Treating chronic itching due to allergies (hives, contact dermatitis)
  3. Helping with sleep (as a sedative) before surgery

In some cases, it may also be used as an antiemetic to treat an upset stomach or vomiting, though it is not specifically FDA-approved. Hydroxyzine is available in Hydroxyzine hydrochloride (Atarax) and Hydroxyzine pamoate (Vistaril). However, Atarax is no longer sold.

How does Hydroxyzine help with anxiety?

Researchers aren’t exactly sure how Hydroxyzine works to treat anxiety, but it seems to affect two main chemicals: histamine and serotonin. But does Hydroxyzine help with anxiety? It does help by blocking histamine activity, which causes drowsiness, and can help with insomnia linked to anxiety. It also affects serotonin, a neurotransmitter that helps balance mood, potentially boosting its levels in the brain to reduce anxiety.

Hydroxyzine’s antihistamine properties reduce itchiness related to allergies, but this can also make you sleepy, similar to taking Benadryl or NyQuil. Its serotonergic activity at the 5HT2 receptors in the brain may contribute to its anti-anxiety effects.

Treating anxiety through Hydroxyzine

Hydroxyzine is approved for treating anxiety in adults. Anxiety is a natural stress response, but if feelings of anxiety are extreme or last longer than 6 months, it may indicate an anxiety disorder. This condition can cause frequent and severe anxiety that interferes with daily life. 

There are different types of anxiety disorders, and symptoms vary based on type. General symptoms include: 

  • Trouble concentrating
  • Trouble falling asleep 
  • Fast heart rate 
  • Shallow breathing 
  • Restlessness 

The exact cause of anxiety is unknown, as is how Hydroxyzine works explicitly to treat it. It’s believed that the medication affects certain brain chemicals that influence mood and overall well-being.

Hydroxyzine Dosage: Types, Strength & Condition 

The dosage of Hydroxyzine oral tablets prescribed by your doctor depends on:

  • The severity of the condition
  • Age 
  • Medical History

Depending on the condition you’re treating with Hydroxyzine, your doctor will initially prescribe a specific dosage strength. They will adjust it over time to find the right amount for you. The dosage includes:

  • Dosage for anxiety
  • Dosage for sedation
  • Dosage for itching
  • Children’s dosage

Hydroxyzine Forms

Hydroxyzine comes in 2 forms: 

  • Capsules (25 mg and 50 mg) 
  • Liquid (1 teaspoon equals 25 mg)

Shake the liquid before measuring with a medicine cup or spoon for accuracy. You can take Hydroxyzine without food, but eating might help if it upsets your stomach.

  • For adults, the usual dose of Hydroxyzine is 50-100 mg up to four times daily, starting from 10 mg daily
  • Children under 6 years can take up to 50 mg daily in divided doses
  • Older children ( above 6 years)  may take 50-100 mg daily
  • If you’re over 65, your doctor may start with a lower dose due to potential side effects

Hydroxyzine Side Effects

Hydroxyzine’s side effects are generally mild, and most people don’t find them troublesome. Common side effects include:

  • Blurred vision
  • Dizziness
  • Drowsiness
  • Dry mouth
  • Headaches

These side effects are typically temporary, but if they persist, consult your doctor.

Due to its potential to cause drowsiness, avoid driving or operating heavy machinery until you know how Hydroxyzine affects you.

Like any medication, serious side effects can occur. Seek immediate medical help if you experience:

  • Hallucinations
  • Tremors or convulsions
  • Nausea and vomiting
  • Stupor
  • Signs of an allergic reaction, such as trouble breathing, hives, skin rash, or facial swelling

Warning For Hydroxyzine

Do not use Hydroxyzine if you are allergic to it or if:

To ensure this medicine is safe for you, inform your doctor if you have:

  • Blockage in your digestive tract (stomach or intestines)
  • Bladder obstruction or other urination problems
  • Glaucoma
  • Heart disease or slow heartbeats
  • Personal or family history of long QT syndrome
  • An electrolyte imbalance (such as high or low levels of potassium in your blood) or recently had a heart attack

It is not known whether Hydroxyzine passes into breast milk or if it could harm a nursing baby. Talk to your doctor before breastfeeding while using this medicine. Do not give this medicine to a child without medical advice.

FAQs: Does Hydroxyzine help with anxiety

  • Does Hydroxyzine make you sleepy? 

Hydroxyzine can cause drowsiness due to its soothing effects, which may help with anxiety and sleep disorders.

  • How long does it take for Hydroxyzine to start working? 

Hydroxyzine typically starts working within 30 to 60 minutes after ingestion for anxiety and within 15 to 30 minutes for allergies.

  • Is Hydroxyzine safe to take during pregnancy? 

Hydroxyzine should be used cautiously during pregnancy, as it may pose risks to the unborn baby. Consult a doctor for guidance.

  • Is Hydroxyzine habit-forming? 

Hydroxyzine is not considered habit-forming, but it should be used as directed by a healthcare provider to avoid dependency.

  • What if I miss a dose?

If you miss a dose of Hydroxyzine, take it as soon as you remember. But if it’s close to the time you usually take your dose, skip the missed dose and take it as scheduled.


Hydroxyzine, prescribed for anxiety in both children and adults, is an affordable and fast-acting medication. It’s commonly used alongside drugs like escitalopram (Lexapro). 

While “Does Hydroxyzine help with anxiety?” is a common question, its drowsiness side effect can aid anxiety-related insomnia, though it may affect mental alertness in other situations.

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