Hydroxyzine vs. Xanax for Anxiety: How Do They Compare?

Anxiety can be debilitating, and finding the right medication to manage its symptoms can be challenging. We want to help with that.

Two commonly prescribed medications for anxiety are hydroxyzine (Vistaril®) and alprazolam (Xanax®). While both have been clinically proven effective at treating anxiety symptoms, the two prescriptions have major differences in side effects and potential for misuse and dependence.

The best way to manage your anxiety is by consulting a medical provider and equipping yourself with the most knowledge possible about potential treatment options. Learn more about how hydroxyzine compares with Xanax in the treatment of anxiety.

What is hydroxyzine (Vistaril^®)?

Hydroxyzine, the generic form of Vistaril®, is in an antihistamines class. It works by blocking histamine in the body to relieve allergy symptoms. It also decreases activity in the brain, which makes it helpful in reducing anxiety and tension in the body.¹

It is meant for short-term or acute treatment of anxiety. The recommendation is to only use hydroxyzine for up to four months at a time. Brain fog and dementia are studied risks of long-term use of hydroxyzine.²

Hydroxyzine is fast acting and will take effect in 15 to 30 minutes. Drowsy and sedating effects can last from four to six hours.³ Dosage for treating anxiety in adults is anywhere from 25mg to 100mg at a time, up to four times per day.⁴

What is alprazolam (Xanax^®)?

Alprazolam, the generic form of Xanax®, belongs to a class of medications called benzodiazepines. It works by decreasing excitement in the brain to treat anxiety and panic disorders.⁵ It is prescribed for short-term relief of anxiety or panic, and it is not recommended for long-term use because of the risk of dependence and potential withdrawal symptoms.⁶

Effects of alprazolam usually appear within an hour of ingestion. Sedation and calming effects can last up to eight hours for most people. However, it can still be detected in the system for two to five days.⁷

The average dosing for an adult to treat anxiety is 0.25mg to 0.5mg, up to three times a day.⁸

What’s the difference between hydroxyzine and Xanax^®?

Hydroxyzine and Xanax® are similar in that they both have sedating and calming effects that are useful for treating anxiety and panic disorders. A major difference is that Xanax is a controlled substance with a high potential for dependence and withdrawal symptoms.⁹

Hydroxyzine is prescribed for a wider variety of conditions beyond anxiety including allergies, nausea, vomiting, and as a sedation tool before surgery.¹⁰

How effective are hydroxyzine and Xanax for treating anxiety?

Hydroxyzine has been clinically studied extensively and has yielded positive results for participants. Against placebo, hydroxyzine has been shown effective as far back as the 1960s in treating anxiety.¹¹ One study emphasized that hydroxyzine was as effective as benzodiazepines and could serve as a viable alternative.¹²

In a review of 21 clinical studies, Xanax has been shown to be significantly more effective than placebo and as or more effective than other benzodiazepines.¹³

How do the side effects compare for hydroxyzine and Xanax?

The side effects of hydroxyzine and Xanax have some overlap but also some major differences.

Hydroxyzine side effects include:¹⁴

• Dry mouth

• Constipation

• Confusion

• Dizziness

• Headache

Xanax side effects include:¹⁵

• High potential for misuse and dependence

• Dizziness

• Drowsiness

• Headache

• Talkativeness

• Sexual dysfunction

• Appetite changes and/or weight changes

• Nausea

• Dry mouth

• Memory loss

• Irritability

Can you take hydroxyzine with Xanax for anxiety?

It is generally not recommended to take hydroxyzine and alprazolam (Xanax®) together¹⁶ because of the increase in certain side effects. Particularly, the use of the two medications together could increase dizziness, drowsiness, loss of motor control, impairment in judgment, and difficulty concentrating.¹⁷

Are hydroxyzine and Xanax available over the counter?

Neither hydroxyzine¹⁸ nor Xanax¹⁹ are available over the counter. Both medications require a prescription from a licensed medical provider, but as a controlled substance, Xanax prescriptions are more limited than hydroxyzine prescriptions. Telehealth providers have greater restrictions on prescribing controlled medications due to their higher risk of misuse and dependence.²⁰

Hydroxyzine (Vistaril^®) vs. Alprazolam (Xanax^®) Comparison Chart

How RedBox Rx can help

RedBox Rx makes receiving medication treatment for anxiety easy and affordable.

Benefits of RedBox Rx include:

• Transparent, affordable, flat rates for medications starting at $25/month.

• $25 consultation with a U.S. licensed medical professional.

• No insurance required. FSA and HSA eligible.

• No office wait times or scheduling issues typical with physical medical practices.

• FREE shipping directly to you. Monthly and quarterly subscriptions available.

Get started on your anxiety treatment journey with our assessment.