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Medication

Hydroxyzine (Vistaril)

Vistaril is the original brand name of hydroxyzine pamoate, a prescription antihistamine that has both allergy-relief and anti-anxiety applications. Atarax, another former brand name, refers to hydroxyzine hydrochloride. Although Atarax has been discontinued in the United States, hydroxyzine is still widely available in generic form.

Learn About Hydroxyzine Treatment

Connect with a psychiatric clinician online or in person for an evaluation. If appropriate, hydroxyzine (Vistaril) may be considered as part of a treatment plan.

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What Conditions Does Vistaril (Hydroxyzine) Treat?

FDA-Approved Uses:

  • Allergic conditions including itching, hives, and rash
  • Symptomatic relief of anxiety and tension associated with psychiatric conditions

Off-Label Uses:

How Psychiatric Medication Prescription Decisions Are Made

1

Find a psychiatric clinician who meets your needs

Option 1

You can start by searching our psychiatrist directory to find a qualified provider who is accepting patients.

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Option 2

You may also choose to locate a nearby clinic and schedule your first appointment in person.

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2

Step 2: Meet one-on-one for a comprehensive psychiatric evaluation

During your first session, a psychiatric clinician will evaluate your symptoms, medical history, and treatment goals. If appropriate, they may discuss whether a medication such as vortioxetine could be included in your care plan. Treatment decisions always prioritize safety, clinical best practices, and your individual needs.

3

Step 3: Begin treatment and ongoing monitoring

After a personalized treatment plan is created, your provider will monitor your progress and adjust the plan as needed. If medication is part of your care, then, if clinically appropriate, your provider may handle prescription renewals online during or after regular follow-ups as clinically appropriate in accordance with LifeStance treatment protocols.

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Struggling with Panic Attacks or Insomnia?

Struggling with Panic Attacks or Insomnia?

Everyone’s experience with panic attacks or insomnia is different. A psychiatrist may help you find the right treatment path—whether that includes Hydroxyzine (Vistaril) or another option that fits your needs. Discuss medication options with your treating provider.

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FAQs About Hydroxyzine (Vistaril)

Vistaril is a brand name for hydroxyzine pamoate capsules and some versions of hydroxyzine hydrochloride (HCl).

Atarax and Vistaril are both brand names for hydroxyzine. Vistaril typically refers to hydroxyzine pamoate (in capsule form), and Atarax refers to hydroxyzine hydrochloride (HCl). Atarax was discontinued in the U.S. in 2021 for business reasons, but generic hydroxyzine HCl remains available.

Yes. Hydroxyzine is a first-generation antihistamine. It is used to treat itching, hives, and other allergic conditions and is sometimes prescribed for anxiety due to its calming effects.

No. Hydroxyzine is not a controlled substance and is not known for being addictive when taken as prescribed by a clinician.

Hydroxyzine reduces central nervous system activity, likely via blocking histamine receptors which can ease restlessness and tension. It is generally prescribed for short-term or as-needed relief of anxiety.

Hydroxyzine often causes drowsiness and sedation, which is why it is also sometimes prescribed off-label for insomnia.

Try to avoid alcohol while on hydroxyzine. Combining hydroxyzine with alcohol or other sedating medications can intensify drowsiness and increase risks such as impaired alertness or respiratory depression.

Hydroxyzine is not generally considered safe for use during pregnancy. It is not typically recommended in early pregnancy. It’s important to discuss the risks and benefits of any medication for both the mother and baby with your healthcare provider.

The effects are relatively short acting. Many people experience relief within 30 to 60 minutes of taking a dose, with benefits lasting up to several hours.

Hydroxyzine is sometimes prescribed off-label to help with insomnia due to its sedating properties.

Hydroxyzine may be used off-label to manage acute panic symptoms, particularly when benzodiazepines are not recommended.

Hydroxyzine is usually considered for short-term or intermittent use. If used for a longer term, a qualified healthcare provider should regularly monitor an individual’s usage to ensure safety and effectiveness.

Hydroxyzine can cause common side effects such as drowsiness, dry mouth, dizziness, blurred vision, headache, and fatigue. Because of its sedating effect, it is sometimes prescribed for insomnia or used before medical procedures. Rare but more serious side effects may include confusion, irregular heartbeat, tremors, or seizures. Hydroxyzine is not known for being addictive when taken as prescribed by a clinician. However, stopping suddenly may bring back anxiety or sleep symptoms. Some individuals report changes in sexual function, though these are less frequent than with antidepressants.

Hydroxyzine is not strongly associated with weight gain. However, increased appetite, reduced activity due to sedation, or fluid retention may contribute to weight changes for some individuals. If significant weight changes occur, they should be discussed with a prescribing clinician to rule out other causes and adjust the treatment plan if needed.

The cost of hydroxyzine (Vistaril) depends on the strength and number of tablets prescribed. As of publication date, current listings show prices starting at about $23.10 for 100 capsules of the 25 mg pamoate formulation.

Generic hydroxyzine tablets are available and may vary in price depending on strength, pharmacy, and location. Insurance coverage, copays, and discount programs may also affect the final out-of-pocket cost.

If you have insurance, your out-of-pocket cost will depend on your supporting diagnosis and plan type (e.g., commercial, Medicare, Medicaid) and may include a copay or coinsurance.

Hydroxyzine (Vistaril or formerly Atarax) and Benadryl (diphenhydramine) are both sedating first-generation antihistamines. Hydroxyzine is available only by prescription and is sometimes used for anxiety, itching, or sedation before surgery. Benadryl is available over the counter and is most often used for allergies or as a short-term sleep aid.

Both contain hydroxyzine but in different salt forms. Hydroxyzine pamoate is a capsule and may be sold under the brand name Vistaril, while hydroxyzine hydrochloride (HCl) is a tablet and was sold under the brand name Atarax. Atarax was discontinued in the U.S. in 2021 for business reasons, not safety concerns. The generic form of hydroxyzine hydrochloride is still available.

Atarax (hydroxyzine hydrochloride) and Benadryl (diphenhydramine) are both antihistamines with sedating properties. Atarax was prescribed for anxiety, itching, and allergic conditions, while Benadryl is most often used for allergies and short-term sleep aid. Atarax was discontinued in the U.S. in 2021 for business reasons, though generic hydroxyzine hydrochloride is still available.

Vistaril (brand name for hydroxyzine pamoate) is a prescription antihistamine used for anxiety, allergic conditions, and pre-surgical sedation. Benadryl (diphenhydramine) is available over the counter and is primarily used for allergies and as a short-term sleep aid. Both can cause sedation, but Vistaril is prescribed for broader clinical purposes.

Hydroxyzine is an antihistamine with sedative and anti-anxiety properties, often prescribed short-term. Buspirone is a serotonergic medication approved for generalized anxiety disorder that does not cause sedation or dependence when taken as prescribed. Hydroxyzine works quickly for symptom relief, while buspirone takes longer to take effect and is better suited for long-term management of anxiety.

Hydroxyzine (Vistaril, formerly Atarax) is a first-generation antihistamine that causes sedation and is sometimes prescribed for anxiety as well as allergies. Zyrtec (cetirizine) is a second-generation antihistamine available over the counter and is much less sedating. Hydroxyzine is used in various clinical settings, while Zyrtec is typically chosen for daily allergy relief with no apparent benefit for anxiety symptoms.

Hydroxyzine is an antihistamine sometimes prescribed off-label for insomnia because of its sedating effects. Zolpidem (Ambien) is a sleep medication specifically approved for short-term insomnia treatment. Hydroxyzine is not known for being addictive and is often used when a non-controlled option is preferred, while zolpidem is more targeted for sleep but carries a risk of dependence.

photo of LifeStance provider Joshua Nathan, MD

Medically Reviewed By:

Joshua Nathan, MD
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Dr. Joshua Nathan, a Board-Certified Psychiatrist, and a Distinguished Fellow of the American Psychiatric Association, sees stigma – from others and from ourselves - as the biggest challenge in mental illness treatment. He encourages people to not judge themselves on whatever problems they are facing, and he helps them feel safe to open up and allow for healing. Dr. Nathan takes joy in helping people with mental health concerns and values the trust patients place in him. Dr. Nathan treats adults struggling with mood and bipolar disorders, depression, ADHD, anxiety challenges such as panic disorder, agoraphobia, OCD, PTSD, and more. He listens to each person’s story, observes how they are faring, and shares his understanding of what is happening, so there is a basis for starting or continuing treatment. He considers medications as one tool among many for healing and recovery in mental health. During treatment, Dr. Nathan uses an eclectic framework for understanding mental illness and coping. Trained in psychoanalysis, he finds that existential understanding helps many people reduce suffering, but cognitive-behavioral techniques are more practical in helping people move forward. Thus, he typically employs a combination of theories and techniques, guided by the patient's problems, needs, and experiences. He is also an Official ADHD Evaluator for the National Football League. Dr. Nathan earned an undergraduate degree from the University of Illinois at Urbana-Champaign, a medical doctorate from the University of Illinois at Chicago, and completed postgraduate residency training at Brown University. He works with adults of all ages, but has a special fondness for working with young and middle-age adults.

References

  1. Drugs.com. (2021). Why was Atarax discontinued? Retrieved from https://www.drugs.com/medical-answers/atarax-discontinued-3565078/

  2. Drugs.com. (n.d.). Vistaril prices, coupons, copay cards & patient assistance. Retrieved November 25, 2025, from https://www.drugs.com/price-guide/vistaril

  3. U.S. Food and Drug Administration. (n.d.). Drugs@FDA. Retrieved November 25, 2025, from https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm

  4. For a comprehensive overview of these medications’ uses and risks, see the U.S. Food and Drug Administration (FDA) drug label.

In 2007, the FDA released a black box warning that antidepressants were correlated to the risk of suicidal thinking and behavior in children, adolescents, and young adults (ages 18–24) during short-term studies of major depressive disorder (MDD) and other psychiatric conditions. Gibbons et. al (2007) also published a study that found no evidence of antidepressant treatment increasing the risk of suicide attempts among its patients (ages 18-65+). The main message is that there is an inherent relationship between depression and suicidality so close monitoring of antidepressant-treated patients (especially children, adolescents, and young adults) is always necessary. For a comprehensive overview of these medications’ uses and risks, see the U.S. Food and Drug Administration (FDA) drug label.