Hydroxyzine vs. Xanax: What’s the difference?
- Hydroxyzine and Xanax (alprazolam) are used to treat anxiety.
- Hydroxyzine is also used to treat itching caused by various allergic reactions, for inducing sedation prior to or after anesthesia and to treat nausea, vomiting, and alcohol withdrawal.
- Xanax is also used to treat panic attacks.
- Hydroxyzine and Xanax belong to different drug classes. Hydroxyzine is an antihistamine with anticholinergic (drying) and sedative properties and Xanax is an anti-anxiety medication in the benzodiazepine class.
- A brand name for hydroxyzine is Vistaril.
- Side effects of hydroxyzine and Xanax that are similar include drowsiness and dry mouth.
- Side effects of hydroxyzine that are different from Xanax include tiredness, sleepiness, dizziness, problems with coordination, drying and thickening of oral and other respiratory secretions, upset stomach, confusion, nervousness, irritability, blurred or double vision, tremors, seizures, loss of appetite, and nausea.
- Side effects of Xanax that are different from hydroxyzine include fatigue, memory problems, speech problems, constipation, changes in weight, addiction (dependency), headache, and constipation.
- Suddenly stopping Xanax after prolonged use can lead to withdrawal symptoms including insomnia, headaches, nausea, vomiting, lightheadedness, sweating, anxiety, fatigue, and seizures (in severe cases).
What is Hydroxyzine? What is Xanax?
Hydroxyzine is an antihistamine with anticholinergic (drying) and sedative properties that is used to treat itching caused by various allergic reactions. Hydroxyzine also is used to treat anxiety and tension, and inducing sedation prior to or after anesthesia. Hydroxyzine also is used to treat nausea, vomiting, and alcohol withdrawal.
Xanax (alprazolam) is an anti-anxiety medication used for the treatment of anxiety disorders and panic attacks. Xanax is in the benzodiazepine drug family that also includes diazepam (Valium), clonazepam (Klonopin), lorazepam (Ativan), flurazepam (Dalmane), and others. Xanax and other benzodiazepines act by enhancing the effects of gamma-aminobutyric acid (GABA) in the brain. GABA is a neurotransmitter (a chemical that nerve cells use to communicate with each other) that inhibits activity in the brain. It is believed that excessive activity in the brain may cause anxiety or other psychiatric disorders.
What are the side effects of hydroxyzine and Xanax?
Common side effects of hydroxyzine are:
- Disturbed coordination
- Drying and thickening of oral and other respiratory secretions
- Stomach distress
Other important side effects include:
- Dry mouth
- Blurred vision
- Double vision
- Loss of appetite
Hydroxyzine should be used with caution (if at all) in persons with narrow-angle glaucoma, prostatic hypertrophy (enlarged prostate gland), hyperthyroidism, cardiovascular disease, hypertension, and asthma.
The most common side effects of Xanax taken at lower doses are:
Other side effects include:
- Memory problems
- Speech problems
- Changes in weight
- Addiction (dependency)
- Dry mouth
What are the withdrawal symptoms of Xanax?
Withdrawal Addiction is more likely to occur at high doses given over prolonged periods. Abrupt discontinuation of alprazolam after prolonged use can lead to symptoms of withdrawal such as:
Seizures can occur in more severe cases of withdrawal. Consequently, patients on alprazolam for extended periods of time should slowly taper the medication under a doctor's supervision rather than abruptly stopping the medication.
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What is the dosage of hydroxyzine vs. Xanax?
- Hydroxyzine has its maximal effect about 30 to 60 minutes after it is taken. Its effects last for 4 to 6 hours.
- The recommended dose for treating itching (pruritus) is 25 mg given 3 or 4 times daily by mouth or by intramuscular injection.
- When used for sedation, the recommended dose is 50 to 100 mg orally or 25 to 100 mg by intramuscular injection.
- Anxiety and tension are managed with 50 to 100 mg in 4 divided doses or 50-100 mg intramuscular injection in 4 or 6 divided doses.
- Alcohol withdrawal is treated with a 50-100 mg injection and may be repeated every 4 to 6 hours as needed.
- The dose for nausea and vomiting is 25 to 100 mg by injection.
- Hydroxyzine can be taken with or without food.
- The starting dose for treating anxiety is 0.25-0.5 mg 3 to 4 times daily using immediate-release tablets. The dose may be increased every 3-4 days to a maximum dose of 4 mg daily.
- The starting dose for treating panic attacks is 0.5 mg 3 times daily. Doses can be increased every 3-4 days but by no more than 1 mg daily.
- The effective dose for preventing panic attacks may be as high as 10 mg daily for some patients. The starting dose when using extended-release tablets to treat panic disorder is 0.5 mg once daily and the average dose is 3-6 mg once daily.
- Alprazolam may be taken with or without food.
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What drugs or supplements interact with hydroxyzine and Xanax?
Hydroxyzine adds to (exaggerates) the sedating effects of alcohol and other drugs that can cause sedation such as the benzodiazepine class of anti-anxiety drugs. These drugs include
- diazepam (Valium),
- lorazepam (Ativan),
- clonazepam (Klonopin), and
- alprazolam (Xanax).
Hydroxyzine also adds to the sedating effects the narcotic class of pain medications and its derivatives, for example
- oxycodone and acetaminophen (Percocet),
- hydrocodone/acetaminophen (Vicodin),
- hydromorphone (Dilaudid),
- codeine, and
- propoxyphene (Darvon).
Hydroxyzine also adds to the effects of the tricyclic class of antidepressants, for example
Hydroxyzine also adds to the effects of certain antihypertensive medications, for example, clonidine (Catapres), and propranolol (Inderal). Hydroxyzine can also intensify the drying effects of other medications with anticholinergic properties, for example
- dicyclomine (Bentyl),
- bethanechol (Urecholine),
- amitriptyline (Elavil, Endep), and
- chlorpromazine (Thorazine).
When using these drugs, the dose of hydroxyzine may require reduction.\
- Ketoconazole (Nizoral), itraconazole (Sporanox), nefazodone (Serzone), cimetidine (Tagamet), and fluvoxamine (Luvox) increase concentrations in the blood of alprazolam and therefore may increase the side effects of alprazolam.
- Alprazolam interacts with alcohol and medications (for example, barbiturates, and narcotics) that suppress activity in the brain by suppressing activity more and causing sedation.
- Carbamazepine and rifampin reduce the effect of alprazolam by increasing metabolism and elimination of alprazolam in the liver.
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Are hydroxyzine and Xanax safe to use while pregnant and breastfeeding?
- A limited number of studies of hydroxyzine in pregnant women suggests that there may be a relationship between its use in the first trimester of pregnancy and congenital abnormalities in the fetus. Therefore, hydroxyzine should be avoided during the first trimester of pregnancy.
- It is not known if hydroxyzine is excreted into breast milk. In general, antihistamines are not recommended for use during breastfeeding because they can cause stimulation or seizures in newborns.
- Benzodiazepines, such as alprazolam, can cause fetal abnormalities and should not be used in pregnancy.
- Alprazolam is excreted in breast milk and it can affect nursing infants. Therefore, women who are should not take alprazolam while breastfeeding.