YANA Mental Health

Hydroxyzine (Atarax, Vistaril) for Sleep: Usage, Dosage, & Effectiveness

Getting the right amount of sleep each night is essential to help maintain energy and mood during the day. However, over 35% of adults in the U.S. don’t hit the recommended seven hours of sleep each night. 

Difficulty falling asleep or staying asleep can be caused by a number of external factors, including mental health conditions such as anxiety. Luckily, there are medications available that can help you sleep while also alleviating some of the symptoms of anxiety.

Atarax and Vistaril are the brand name versions for Hydroxyzine, an antihistamine with sedative properties, which is a commonly prescribed drug for individuals who have trouble sleeping. Here’s everything you need to know about using Hydroxyzine.

What Is Hydroxyzine (Atarax, Vistaril)?

Hydroxyzine (Atarax, Vistaril) belongs to a class of medications called antihistamines. Histamines are chemicals created by your immune system that respond to allergens (such as certain foods, pollen, or pet dander) which can cause coughing, itching, or sneezing. Antihistamines block the production of histamines to help prevent these symptoms.

There are two different generations of antihistamines. First-generation antihistamines were approved by the FDA in the 1930s and they cross the blood-brain barrier, which often causes drowsiness. Hydroxyzine is a first-generation antihistamine.

Second-generation antihistamines were not approved until the 1980s, and they do not cross the blood-brain barrier and generally do not cause drowsiness. Claritin (loratadine) and Zyrtec (cetirizine) are examples of second-generation antihistamines.

Hydroxyzine (Atarax, Vistaril) for Sleep

The sedative, or drowsy, properties of Hydroxyzine (Atarax, Vistaril) is the main reason why it is commonly prescribed to help people with sleep disorders such as insomnia. Additionally, since it has calming effects, it is often paired with other medications as an anaesthetic before surgery.

While Hydroxyzine is commonly prescribed for treating insomnia, this is an off-label use that is not yet approved by the Food and Drug Administration (FDA). There is also little clinical data to confidently suggest the efficacy of this medication for treating insomnia.

Hydroxyzine (Atarax, Vistaril) for Anxiety

Hydroxyzine (Atarax, Vistaril) is approved for the treatment of generalized anxiety disorder (GAD). GAD is marked by persistent feelings of worry or fear. While it’s not entirely clear how this medication works to alleviate anxiety, it is believed to affect the levels of serotonin in the brain.

In an evaluation of several studies, it was found that Hydroxyzine was similar in efficacy to other common anxiety medications such as benzodiazepines or buspirone. However, it was associated with higher rates of drowsiness and lethargy due to its sedative effects.

Anxiety and insomnia are closely intertwined, making Hydroxyzine useful for individuals who struggle with both. Anxiety is linked to excessive hyperarousal due to excessive worry, which can make it difficult for people with anxiety to fall asleep and stay asleep.

People with diagnosed anxiety disorders are also more likely to have higher sleep reactivity, which is the degree to which stress disrupts a normal sleeping cycle.

Hydroxyzine (Atarax, Vistaril) for Depression

Hydroxyzine (Atarax, Vistaril) is not approved by the FDA for treating depression, nor is there sufficient evidence to suggest that it is an appropriate treatment for this mental health condition. However, it may be prescribed to help with the sleeplessness or anxiety associated with depression.

Depression is a mood disorder marked by persistent feelings of sadness, hopelessness, or lack of pleasure that occurs on most days for at least a period of two weeks.

What Dose of Hydroxyzine (Atarax, Vistaril) Should I Take for Sleep?

The correct dosage for taking Hydroxyzine (Atarax, Vistaril) can be determined by your doctor. To help improve sleep, adults should take 50-100 mg daily.This medication can be taken with or without food. It can also be taken daily, or just on an as-needed basis. Your provider will help you determine what’s right for you.

If you happen to miss a dose of regularly scheduled Hydroxyzine, don’t panic. Just take it as soon as you remember, unless it is too close to the time of your next dose. Never double up your dose to make up for a missed one.

Side Effects of Hydroxyzine (Atarax, Vistaril)

As with any medication, there is risk for developing some side effects. Most of the side effects of Hydroxyzine (Atarax, Vistaril) are not serious.

Common side effects include:

  • Drowsiness
  • Dizziness
  • Headaches
  • Dry mouth
  • Urinary retention
  • Confusion
  • Irritability

Rare, but serious, side effects are also possible. These include:

  • Allergic reaction (difficulty breathing, swelling of face or lips, hives)
  • Abnormal heart rate
  • Confusion or hallucinations
  • Priapism (an erection that lasts longer than four hours)

Hydroxyzine (Atarax, Vistaril) Dependence

Hydroxyzine (Atarax, Vistaril) does not come with habit-forming characteristics that are often associated with similar medications. This makes it appealing for many individuals, as it can be taken with a low risk of addiction.

However, it is still possible to become physically dependent on this medication, and it may lead to withdrawal symptoms if stopped abruptly. Symptoms of withdrawal look different for everyone, but common ones include irritability, headaches, nausea, and increased heart rate.

It’s essential to follow your doctor’s instructions for taking Hydroxyzine. Additionally, don’t stop taking this medication without first speaking to your provider, as they can help you gradually taper off the drug to lessen symptoms of withdrawal.

Drug Interactions with Hydroxyzine (Atarax, Vistaril)

When taking more than one medication at the same time, the risk for negative interactions may increase. While Hydroxyzine (Atarax, Vistaril) has less interactions compared to more commonly prescribed anti-anxiety medications, there are still a few to look out for.

Taking the following medications alongside Hydroxyzine may increase its effects:

  • Other antihistamines, such as Zyrtec (cetirizine)
  • Other medications that can cause drowsiness, such as muscle relaxants
  • Medications with anticholinergic effects, such as Cogentin (benztropine) 

In Conclusion

Hydroxyzine (Atarax, Vistaril) is an antihistamine that crosses the blood-brain barrier, meaning it can cause drowsiness. Because of this, it is often prescribed off-label to help individuals with sleep disorders such as insomnia.

This medication can also be used to help alleviate the symptoms of anxiety, and it is also prescribed to lessen the physical reactions to allergens, such as itching or coughing.

When taking Hydroxyzine for sleep, it is important to follow your doctor’s instructions carefully. 

If anxiety or depression is causing you to have trouble sleeping, YANA may be able to help you get back on track.

YANA is a virtual mental health service that matches you with a licensed doctor to deliver you quick, discreet, and personalized mental healthcare for anxiety, depression, and insomnia. If a medication such as Hydroxyzine is prescribed, it can get sent directly to your front door.

It’s mental healthcare on your own time, on your own terms. Click here to learn more about the difference that YANA can make.


Sleep Statistics – Facts and Data About Sleep 2020 | Sleep Foundation

Antihistamines: Definition, Types & Side Effects | Cleveland Clinic

Pharmacotherapy for Insomnia in Primary Care | NCBI

Hydroxyzine for generalised anxiety disorder | National Library of Medicine

The impact of stress on sleep: Pathogenic sleep reactivity as a vulnerability to insomnia and circadian disorders | NCBI

Hydroxyzine (Oral Route) Proper Use | The Mayo Clinic

Hydroxyzine (Vistaril, Atarax) | National Alliance on Mental Illness

Getting High on Hydroxyzine: Why People Abuse Vistaril | NorthPoint Recovery

Anticholinergic Drugs | Parkinson’s Foundation

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