Hydroxyzine for anxiety- Is it effective?

hydroxyzine for anxiety
Medically reviewed by Dr. Devindra Bhatt


As the Roman philosopher Seneca wisely said, “We suffer more in imagination than in reality.” For millions grappling with anxiety, however, that imagined suffering feels all too real. Historically, anxiety treatment relied on herbs and tonics, but the 21st century saw the rise of antihistamines like hydroxyzine. Anxiety is a common problem that affects many people worldwide, making it hard to enjoy life fully. One treatment option is Hydroxyzine, a medication that can help with anxiety. But how well does it work? 

Hydroxyzine boasts some success stories. A recent study found it as effective as certain antidepressants for short-term anxiety relief. Imagine a college student facing finals – hydroxyzine could provide temporary calm to weather the storm. However, hydroxyzine’s effectiveness wanes over time, and drowsiness is a common side effect. It’s not a magic bullet, but for some, it can be a valuable and helpful tool in managing anxiety’s grip. Remember, a doctor can create a personalized treatment plan to address the root of your anxiety, and hydroxyzine may play a supporting role in that journey.

Is Hydroxyzine for Anxiety Effective?

Hydroxyzine can be a valuable tool in managing anxiety, but it’s not a one-size-fits-all solution. Remember, there are various approaches to anxiety management, and finding the right one can help you move beyond simply coping and start thriving. Initially an antihistamine, it emerged as a potential medicine against anxiety due to its calming properties. But is it truly effective for anxiety? Let’s break it down.

Short-Term Effects

According to studies, hydroxyzine can significantly lessen generalized anxiety disorder (GAD) symptoms in as little as one week. If someone were continuously tense, hydroxyzine might offer momentary solace, improving their ability to function in daily situations.  

Not a Long-Term Solution

While effective initially, hydroxyzine’s effectiveness seems to diminish over time. This makes it a better option for managing occasional anxiety or providing temporary relief while waiting for other medications to kick in.

The Drowsiness Dilemma

A common side effect of hydroxyzine is drowsiness. While this can be helpful for sleep-related anxiety, it can also hinder daily activities.

Dealing with Anxiety? Consult now to get a prescription for Hydroxyzine

How to use Hydroxyzine Hcl for anxiety?

You may be recommended one of two dosage forms for hydroxyzine—a liquid or a capsule. Usually, the Hydroxyzine dose comes in 25 mg and 50 mg pills. One teaspoon (5 mL) of the liquid equivalent of 25 mg.

When measuring a dose from a liquid form, shake the bottle well before doing so. To ensure precision, use a measuring spoon or medicine cup. Although it’s unnecessary, eating before taking a dose of hydroxyzine might assist if you find it making you feel queasy.

Adults are permitted to take hydroxyzine 50–100 mg up to four times per day for panic attacks. For adults, the starting dosage is 10 mg per day. The maximum single dose is 100 mg, and the maximum dose of hydroxyzine in 24 hours is 400 mg. Children should take far less: the suggested maximum for those over six years old is 50 to 100 mg daily in divided doses, while for those under six years old, the maximum is 50 mg daily across numerous doses.  

Similarly, even though studies have not revealed any particular issues with hydroxyzine use in patients over 65, your doctor may start you on a lower dose of medicine and gradually increase it to the recommended adult level if you fall into this age group. This is merely because elderly patients are more likely to experience undesirable drug side effects.

Generally speaking, you should always adhere to your doctor’s dosage guidelines for all medications. If you have any queries, such as whether you should take more or less than your doctor prescribed initially, speak with them.

Your doctor may advise you to take hydroxyzine as needed, for example, if you’re feeling tense or nervous, or they may tell you to take it regularly throughout the day. If you take hydroxyzine at prescribed intervals as prescribed by your doctor, using a pillbox or setting an alarm could help you remember to take your doses. 

Hydroxyzine might be the solution you are looking for your anxiety. Consult now for a diagnosis and prescription.

How does hydroxyzine work for anxiety?

Hydroxyzine (Atarax), a brand name for hydroxyzine pamoate, is an antihistamine that regulates histamine levels produced by the immune system. Histamine is known for its role in allergic reactions, and antihistamines are commonly used to alleviate allergy symptoms.

While hydroxyzine pamoate is effective in reducing anxiety symptoms, its antihistamine properties can also induce drowsiness. It acts on the brain’s subcortical regions, which are responsible for regulating emotions. Anxiety, a symptom of various conditions, can also manifest as a standalone disorder, including generalized anxiety disorder (GAD), panic disorder (PD), and social anxiety disorder.

FDA-approved for anxiety treatment, hydroxyzine is also prescribed off-label for other anxiety disorders, based on scientific evidence. Studies indicate its efficacy in treating anxiety symptoms surpasses that of a placebo. However, its effectiveness may diminish over time due to tolerance development, leading to its classification as a short-term treatment.

Unlike some anxiety medications like Xanax (alprazolam), hydroxyzine pamoate is not habit-forming or a muscle relaxant, making it a non-controlled substance. It can induce a sense of calmness and relaxation without causing withdrawal symptoms upon cessation.

How long does hydroxyzine take to work?

How long hydroxyzine takes to work is a widespread concern that may be on your mind if you’re thinking about ordering it online or starting any new prescription medicine to manage your anxiety. 

Hydroxyzine relieves anxiety symptoms more rapidly than certain other drugs, such as benzodiazepines and SSRIs, which might take weeks to work. It can take up to 1-2 hours for some people to fully experience its benefits; for others, it may take only 15-30 minutes.

In addition to being an antihistamine, hydroxyzine also functions as a serotonin antagonist, which accounts for its quick onset. This implies hydroxyzine directly stops the action in your brain, providing noticeably speedier impacts instead of progressively changing the brain’s serotonin levels over time (like an SSRI).

When determining if a drug is appropriate for your entire treatment plan, it is crucial to consider other factors, no matter how alluring fast symptom alleviation may appear. For instance, being mindful of any possible or typical adverse effects is essential.

Can I take two hydroxyzine 25 mg at the same time? 

Your doctor would likely prescribe 50 mg to 100 mg of hydroxyzine in divided doses to relieve anxiety. This means that you will take doses ranging from 12.5 mg to 25 mg two to four times a day. Adults with anxiety should take up to 100 mg of the medication up to four times a day. So it depends on the dosage you are prescribed. You are advised to follow your doctor’s prescribed regimen. 

Cold clammy hands, Palpitation, sweating, these all may be symptoms of Anxiety. Consult now and discuss the hydroxyzine dose that works best for you.

What precautions should be taken while using hydroxyzine for anxiety?

People who have specific medical disorders or variables affecting their health may not be able to use hydroxyzine, such as:


Older adults should be cautious when using hydroxyzine due to an increased risk of side effects. Older patients may be prescribed a lower dosage and require close monitoring by their doctor if necessary. Common side effects in this age group include confusion, constipation, and dry mouth.

Convulsions or seizures

Some individuals have reported convulsions after taking hydroxyzine, although this side effect was not observed in clinical trials. Consult your doctor if you have a history of convulsions or seizures or are at risk for these conditions.


Hydroxyzine can cause confusion and attention-related issues, which may be more pronounced in individuals with dementia. Your doctor can determine if hydroxyzine is safe for you.

Heart problems

Hydroxyzine can affect the QT interval of the heart rhythm, particularly in individuals with existing heart conditions or those taking medications for heart rhythm. Inform your doctor of any heart issues before starting hydroxyzine.

Kidney or liver problems

Individuals with kidney or liver problems may require a lower hydroxyzine dosage, as their bodies may not metabolize the drug effectively, leading to an increased risk of side effects.

Low blood pressure

Blood pressure can be lowered by hydroxyzine, which could be dangerous for people who already have low blood pressure. Before beginning hydroxyzine, review your medical history with your doctor, particularly any episodes of low blood pressure.

Allergic reaction

Do not take hydroxyzine oral tablets if you have had an allergic reaction to hydroxyzine or any of its components. Consult your doctor for alternative options.

Pregnancy and breastfeeding

Hydroxyzine is not safe during pregnancy or breastfeeding. Consult your doctor for more information on alternative medications.

Are you worried about whether Hydroxyzine is suitable for your Anxiety? Consult now to get a personalized treatment plan.

When should I see a doctor?

You should see a doctor if you experience the following:

  • Severe or persistent anxiety symptoms
  • Side effects from hydroxyzine, such as confusion, rapid heartbeat, or difficulty breathing
  • If you are facing sedation, dizziness, seizures, nausea and vomiting
  • Worsening of your condition despite taking hydroxyzine
  • Concerns about the effectiveness or safety of hydroxyzine
  • Need for a higher dosage or additional treatment options
  • New or unusual symptoms that may be related to your anxiety or hydroxyzine use

FAQs about hydroxyzine for anxiety

What should you do if you miss a dose of hydroxyzine?

If you need to remember to take a dose, take it as soon as you remember unless it is almost time for you to take your next dose. It is not desirable to inadvertently take two doses.

Does hydroxyzine make you sleepy?

Yes, one of the adverse effects of hydroxyzine is drowsiness. Its calming qualities make it a famous choice. The degree of drowsiness varies from person to person. Continue to refrain from driving and other potentially dangerous activities until you are sure of how this drug will affect you. This drug will intensify the effects of alcohol and other CNS depressants.

Is hydroxyzine safe for older patients?

Older adults may need to take extra precautions and have their doses of hydroxyzine adjusted due to the increased risk of age-related liver, renal, or heart issues, as well as undesired side effects (such as sleepiness or confusion). Lower dosages are often prescribed for older adults, and close monitoring by a healthcare provider is recommended.

What Is the best time to take hydroxyzine?

It takes hydroxyzine 15 to 30 minutes to begin acting. If you take it just once a day, it’s best taken right before bed. It is also acceptable to consume it without food. Because hydroxyzine causes drowsiness, it is occasionally prescribed off-label for sleep.

Who can take hydroxyzine for anxiety?

Hydroxyzine may be suitable for individuals with anxiety disorders who do not have certain medical conditions or risk factors. However, it is typically avoided in older adults due to the high risk of side effects. 

Can hydroxyzine stop panic attacks?

Hydroxyzine may help alleviate symptoms of panic attacks by reducing anxiety and promoting relaxation. It is not typically considered a first-line treatment for panic attacks but may be used in some instances. Numerous drugs can treat panic attacks; hydroxyzine may be able to provide relief in as short as 15 to 30 minutes for panic attacks caused by worry.

Your Doctors Online uses high-quality and trustworthy sources to ensure content accuracy and reliability. We rely on peer-reviewed studies, academic research institutions and medical associations to provide up-to-date and evidence-based information to the users.

  • Guaiana, Giuseppe, Corrado Barbui, and Andrea Cipriani. “Hydroxyzine for generalised anxiety disorder.” Cochrane Database of Systematic Reviews 12 (2010).
  • Ferreri, M., and E‐G. Hantouche. “Recent clinical trials of hydroxyzine in generalized anxiety disorder.” Acta Psychiatrica Scandinavica 98 (1998): 102-108.
  • Wenstrup, Susie, Paul Hogan, and Ivan Gonzalez. “Is hydroxyzine effective in reducing anxiety symptoms in adults?.” Evidence-Based Practice 23.10 (2020): 33.
  • De Brabander, A., and W. Deberdt. “Effect of hydroxyzine on attention and memory.” Human Psychopharmacology: Clinical and Experimental 5.4 (1990): 357-362.

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