Hydroxyzine vs. Xanax: What’s the Difference?

Published February 6th, 2021 by Erik Rivera
Fact Checked by
Camille Freking
Medically Reviewed:
Dr. Gerardo Sison
Updated Date: Mar 13th, 2021

Chronic anxiety is estimated to affect approximately 40 million American adults, or almost 20 percent of the population. Some patients can manage their anxiety symptoms through lifestyle changes like exercise and meditation, while others may need to use prescription medications to manage their mental health.  There are many different short-term treatment options for anxiety, including drugs like hydroxyzine and Xanax. Many patients take hydroxyzine or Xanax while waiting for longer term medications to take effect, but when it comes to hydroxyzine vs Xanax, what’s the difference?

Conditions Treated

Hydroxyzine pamoate is FDA-approved for the treatment of mild anxiety disorders and itching that is caused by allergic reactions. It's also used to induce sedation prior to or after anesthesia. Xanax is FDA-approved for the treatment of generalized anxiety disorder and panic disorder.

Anxiety

The body naturally responds to stress with feelings of anxiety. Although this is a normal response to stress, people who experience anxiety on a regular basis to the point that it begins to affect their quality of life may be diagnosed with an anxiety disorder. Anxiety disorders are characterized by feelings of extreme anxiety that last at least six months or longer and interfere with daily activities. 

Symptoms of anxiety may include: 

  • Increased heart rate 
  • Difficulty concentrating
  • Insomnia
  • Rapid breathing 
  • Restlessness 

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How The Drugs Work

Hydroxyzine and Xanax belong to two different classes of drugs. Hydroxyzine is classified as an antihistamine while Xanax is classified as a benzodiazepine. Antihistamines like hydroxyzine are most commonly associated with the treatment of allergic reactions because they work by blocking the actions of histamine, a natural substance that your body produces in response to an allergen. Signs and symptoms of allergies include itching, sneezing, and hives. Unlike other antihistamines, hydroxyzine is also known to have an effect on the levels of serotonin in the body, which can help reduce feelings of anxiety.

By contrast,  benzodiazepines like Xanax work by acting on a neurotransmitter in the brain known as gamma-aminobutyric acid (GABA). The body uses GABA to help regulate sleep patterns and control feelings of anxiety and calm. Xanax binds to the brain’s GABA receptors and increases the activity of the neurotransmitter, causing activity in the brain and central nervous system to slow down.  As a result, people start to feel less anxious. 

Use and Dosage

Hydroxyzine and Xanax both start working relatively quickly to treat anxiety in patients who are using the drugs for this purpose. Both drugs are intended for short-term use and are often prescribed in conjunction with an antidepressant or anxiety medication that is intended for long term use, such as Lexapro or Celexa. These medications are taken every day but may take up to four weeks before they take effect, so hydroxyzine and Xanax can help patients manage their anxiety symptoms in the interim period. 

When taken for anxiety in adults, hydroxyzine is typically prescribed at a dose of 50 mg to 100 mg taken up to four times per day. The medication typically starts to work within about 30 minutes and reaches its full effect over a period of two hours. 

The immediate-release form of Xanax is prescribed in a dose ranging from 0.25 mg to 2 mg and is typically taken three times per day. The extended-release form of Xanax is prescribed in a dose ranging from 3 mg to 6 mg and is taken once per day. Xanax typically begins working in about an hour regardless of whether you take the immediate-release or extended-release version of the drug. 

Side Effects

Hydroxyzine

Common side effects of hydroxyzine include:

  • Dry mouth 
  • Drowsiness
  • Headache
  • Itching
  • Tremors

Other serious adverse effects associated with hydroxyzine can include:

  • Allergic reactions
  • Abnormal heart rhythm changes
  • Abnormal heart rate changes
  • Confusion
  • Nausea
  • Vomiting
  • Hallucinations

Xanax Offers

Xanax

Common side effects of Xanax may include:

  • Difficulty with coordination
  • Low blood pressure
  • Slurred speech
  • Increased libido
  • Drowsiness
  • Increased salivation
  • Constipation
  • Increased appetite

Serious side effects of Xanax are associated with depression of the central nervous system. Serious side effects associated with Xanax include:

  • Slowed breathing
  • Respiratory failure
  • Serious allergic reactions
  • Seizures
  • Manic episodes

Risks and Warnings

Hydroxyzine and Xanax are both associated with some risks and warnings for use. Between the two medications, Xanax is significantly more likely to cause problems in patients due to its fast-acting nature, high risk of abuse and dependence, and potential for withdrawal and overdose. 

Drowsiness

Hydroxyzine and Xanax have a calming effect that can cause drowsiness or sleepiness, which means that patients should not operate heavy machinery or drive under the influence of the medications until they understand how they feel while taking the drugs. Negative drug interactions associated with central nervous system depression can occur when hydroxyzine or Xanax are taken with medications like sleeping pills, muscle relaxers, narcotic pain medication, or drugs used for the treatment of anxiety, depression, or seizures. Patients should avoid using alcohol or narcotic drugs when taking hydroxyzine or Xanax.

Allergic Reactions

Despite the fact that hydroxyzine is commonly prescribed to treat allergic reactions, it is possible for patients to have a severe allergic reaction to hydroxyzine. Some patients are also allergic to the active or inactive ingredients in Xanax. If you think you are experiencing an allergic reaction, seek medical treatment right away. Symptoms of an allergic reaction include:

  • Trouble breathing or swallowing
  • Swelling of lips, tongue, or face
  • Rash or hives
  • Rapid heartbeat

Dependence and Withdrawal

Xanax and benzodiazepines like it are known to be habit forming and present a risk of abuse and dependence,  particularly when used for extended periods of time or in higher doses than prescribed. Xanax is classified as a Schedule IV controlled substance by the DEA for this reason. Due to its potential to cause physical and/or psychological dependence, Xanax can cause withdrawal symptoms if use of the medication is stopped abruptly.  Hydroxyzine is not habit forming, is not a controlled substance, and does not present the same risk of abuse and dependence.

Individuals who have been taking Xanax for two weeks or more should not stop using the drug or reduce their dose without the guidance of a healthcare professional in order to prevent withdrawal symptoms.  The longer you have taken the medication, the more likely you are to experience symptoms of withdrawal. Common withdrawal symptoms include:

  • Sweating
  • Insomnia
  • Cramps
  • Vomiting
  • Convulsions
  • Tremors

Severe dependence on Xanax can cause severe and potentially dangerous withdrawal symptoms, particularly when use of the medication is stopped abruptly. Serious signs of withdrawal include: 

  • Seizures
  • Panic attacks
  • Tremors
  • Hallucinations

Use in Pregnancy

Both Xanax and hydroxyzine come with warnings against use during pregnancy. Both drugs may increase the risk of birth defects when used during the first trimester of pregnancy. Hydroxyzine is considered safe for use during the second and third trimesters of pregnancy but should not be taken shortly before or during delivery, as it can cause an increased risk of seizures in infants and cause a drop in fetal heart rate. Xanax is not considered safe for use at any point during pregnancy, as taking the medication during the second or third trimesters increases the potential for withdrawal symptoms or floppy infant syndrome. Withdrawal symptoms include difficulty breathing, trouble eating on their own, and dehydration, while floppy infant syndrome is associated with weak muscles in the first weeks of an infant’s life.

Summary

Hydroxyzine and Xanax are two short-term treatment options that are used to treat anxiety while waiting for a more appropriate long term medication to kick in. Both drugs act quickly to relieve anxiety symptoms. Xanax is a controlled substance associated with a higher risk of abuse and addiction, so it should be used with caution, particularly in patients who have a history of substance abuse. Both Xanax and hydroxyzine are available in a generic version that is covered by most types of insurance. Seek medical advice before use of benzodiazepines and antihistamines like hydroxyzine (Vistaril), alprazolam (Xanax), or similar prescription drugs including hydroxyzine hydrochloride (Atarax), clonazepam (Klonopin), and lorazepam (Ativan). However, patients can save on the cost of all FDA-approved medications, regardless of their insured status, with a pharmacy discount card from USA Rx.

Sources:
https://www.webmd.com/drugs/2/drug-9824/xanax-oral/details 
https://americanaddictioncenters.org/overdose 
https://www.webmd.com/anxiety-panic/guide/generalized-anxiety-disorder
https://www.healthline.com/health/anxiety/xanax-during-pregnancy#safety 
https://www.webmd.com/drugs/2/drug-7681/hydroxyzine-hcl-oral/details

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