Hydroxyzine Pamoate

Published April 25th, 2020 by Bridget Reed
Fact Checked by
Erik Rivera
Medically Reviewed:
Camille Freking
Updated Date: Jul 10th, 2021

If you’re one of millions of Americans suffering from allergies, including seasonal allergies, each year, you may never have heard of hydroxyzine pamoate, but you’ve likely heard of the brand name version of the medication, Vistaril. While hydroxyzine pamoate isn’t as well known as some other antihistamine medications, it has a ton of useful applications. Hydroxyzine pamoate is used to treat a wide variety of conditions ranging from anxiety disorders to allergic reactions, hives, contact dermatitis, and more. Some people find that they have multiple medical conditions that can be effectively treated by hydroxyzine pamoate, since the medication treats common conditions. Hydroxyzine pamoate has many practical applications and is an affordable, accessible drug for the majority of Americans.


Hydroxyzine pamoate is an antihistamine with sedative, anxiolytic, and antiemetic effects. The medication works by reducing the activity of the histamines,  a naturally occurring substance in the body. Hydroxyzine pamoate is available under the brand name Vistaril, which is a prescription medication used to treat anxiety and tension, nausea and vomiting, and severe itching (pruritus) from allergic conditions, including chronic hives (urticaria) and contact dermatitis. 

Conditions Treated

Hydroxyzine pamoate has a wide variety of clinical applications. Hydroxyzine pamoate is commonly used to treat the conditions listed below, but less common applications, including renal impairment, vomiting, and alcohol withdrawal have also been treated. Hydroxyzine pamoate is a highly useful medication due to its expansive list of treated conditions.

Allergies and Skin Conditions
Hydroxyzine pamoate is most frequently used to alleviate allergies and allergic reactions, as the medication is an antihistamine that blocks the body’s natural production of the substances that cause allergic reactions (histamines).  Hydroxyzine pamoate is most frequently used to treat skin reactions caused by allergens, including chronic hives (urticaria), severe itching (pruritus), and contact dermatitis. Hydroxyzine pamoate can also be used to treat general itching or inflammation of the skin due to an allergic reaction.

The other major application of hydroxyzine pamoate is the treatment of anxiety. While researchers don’t know exactly how hydroxyzine pamoate works to treat anxiety, they do understand that the medication changes the effects of two different chemicals in our bodies: histamine and serotonin. Hydroxyzine pamoate produces a calming effect as it blocks histamines, giving you the feeling of drowsiness or sleepiness that sometimes accompanies other antihistamine medications, like benadryl. What sets hydroxyzine pamoate apart from other antihistamines is that the medication also has an effect on serotonin, a chemical which affects mood. This unique effect of hydroxyzine pamoate on serotonin is the reason why the medication is the only antihistamine used to treat anxiety.

Although hydroxyzine pamoate is capable of treating many different anxiety disorders, it is most commonly used to treat generalized anxiety disorder (GAD). When used for the treatment of anxiety, hydroxyzine pamoate is taken on a daily basis at room temperature and is often combined with another medication, such as Celexa. Unlike other medications used to treat anxiety and panic disorder, such as Ativan or Klonopin, hydroxyzine pamoate is not a controlled substance and it carries a lower risk of addiction and dependence than some other medications.

Difficulty sleeping
Because hydroxyzine pamoate has a calming and sedative effect, the medication is sometimes used to treat insomnia in people who have difficulty sleeping. Unlike Ambien, Lunesta, and other prescription sleeping aids, hydroxyzine pamoate is not a controlled substance and does not have the same risk of addiction as some other medications used to treat occasional insomnia. Hydroxyzine pamoate is used on an as-needed basis when used to treat sleeping issues. 

Hydroxyzine pamoate is sometimes used In surgical settings to treat anxiety and nausea that can occur prior to anesthesia. As an antihistamine, hydroxyzine pamoate has a calming effect on the central nervous system, or CNS. 
Interstitial cystitis
One of the lesser known applications of hydroxyzine pamoate is the treatment of a painful bladder condition known as interstitial cystitis, which hydroxyzine pamoate is FDA-approved to treat. Interstitial cystitis is characterized by a number of bladder symptoms, including urinary frequency, urinary urgency, recurrent pelvic pain, pelvic pressure, and discomfort in the bladder and pelvic region. Patients who suffer from interstitial cystitis will often use hydroxyzine pamoate in tandem with other medications, such as Urogesic Blue, to treat interstitial cystitis symptoms. The medication affects mast cell degranulation, which is thought to play a role in interstitial cystitis symptoms among patients who also have a history of allergies, migraines, and irritable bowel syndrome. When used to treat interstitial cystitis, hydroxyzine can help reduce nocturia (night time urination), daytime frequency, and painful urination and sexual intercourse.  

How it Works

When it comes to treating allergic reactions, hydroxyzine pamoate works to ease the symptoms of allergic reactions by blocking the natural substances, called histamines, that your body produces during an allergic reaction. Histamines can cause itching, hives, sneezing, and just about any other miserable allergy symptom you can think of which would otherwise need to be treated with cetirizine or levocetirizine. Hydroxyzine pamoate binds to histamine receptors, just like anticholinergic agents, in the body, preventing the cells from releasing the chemical messages that cause sneezing, itching, and increased mucus production.
When used to treat anxiety, hydroxyzine pamoate works by altering the effects of histamine and serotonin, two naturally occurring chemicals in the body. Doctors and researchers do not understand the exact mechanism that makes hydroxyzine pamoate effective for treating anxiety, but it is generally agreed that the medication helps to balance out the levels of serotonin in the brain. The calming effect produced by the antihistamine is enhanced by hydroxyzine pamoate’s effect on serotonin, helping to reduce anxiety.


Thanks to a large number of manufacturers of the generic name of the medication, hydroxyzine pamoate is generally covered by Medicare and most insurance plans. Cost depends on the form and the dosage, but the medication can generally be acquired for less than one dollar per pill (and sometimes significantly less). Use of a pharmacy discount card or paying the cash price can also lower the cost for uninsured individuals or those whose insurance does not cover hydroxyzine pamoate. The table below compares the costs associated with a 30-day supply of both generic hydroxyzine pamoate and the brand name medication, Vistaril.
Cost of a 30-Day Supply of Vistaril Compared to Hydroxyzine Pamoate




Hydroxyzine Pamoate

25 mg capsules



50 mg capsules




Hydroxyzine pamoate is a multi-purpose drug with many benefits. Because hydroxyzine pamoate comes in many forms and strengths and is produced by a large number of manufacturers, it is generally very affordable, even for uninsured and underinsured patients. Because hydroxyzine pamoate can be used to treat a variety of conditions, patients who take the medication to help manage their anxiety may also find that the drug has the added benefit of reducing the symptoms of your seasonal allergies as well. Hydroxyzine pamoate is considered safe and effective and is generally well-tolerated and can be used on patients of all ages under appropriate supervision. It can be taken with or without food, at regular times, or as needed, depending on the condition being treated. 


Hydroxyzine pamoate comes in a wide variety of forms and strengths, each of which is well-suited to treatment of a particular condition. Hydroxyzine pamoate tablets come in 5 mg, 25 mg, and 50 mg doses, while capsules are manufactured in 25 mg, 50 mg, and 100 mg strengths. Hydroxyzine pamoate also comes in the form of a syrup/oral suspension at a strength of 10 mg/5 mL, and in an injectable solution at strengths of 25 mg/5 mL and 50 mg/5 ml. Hydroxyzine pamoate reaches its maximum effect approximately 30 to 60 minutes after it is taken, and adverse effects last for approximately 4 to 6 hours.
Your health care professional will choose the appropriate dose of hydroxyzine pamoate for your depending on a number of factors, including the condition being treated, the severity of the condition, and your age, weight, and gender. In some cases, your doctor may prescribe a dosage “range” depending on the severity of your symptoms on a given day. For example, you may be instructed to take 25 mg - 50 mg (1 to 2 capsules) per day depending on the severity of chronic hives (urticaria) managed by hydroxyzine pamoate. Hydroxyzine pamoate is considered safe for long term use, but most patients take it for four months or less, depending on the condition being treated.

Side Effects

Hydroxyzine pamoate has side effects similar to those of other antihistamines, such as over the counter allergy medications like Benadryl or Zyrtec. If you have taken allergy medication before,  you’re likely already familiar with some of the common side effects of hydroxyzine pamoate, which include:

  • Drowsiness
  • Headache
  • Dry mouth
  • Skin rash

Involuntary motor activity (tremor or convulsions) - generally observed when doses are taken that are higher than recommended

  • Urinary retention
  • Irritability 
  • Stomach distress

Other serious side effects associated with hydroxyzine pamoate can include:

  • Allergic reactions
  • Hallucinations
  • Itching
  • Hives
  • Increased heart rate
  • Unsafe heart beat
  • Confusion 
  • Nervousness
  • Double vision
  • Blurred vision
  • Loss of appetite

Ironically enough, it is possible to have an allergic reaction to a medication designed to treat allergic reactions. Although allergic reactions to hydroxyzine pamoate are uncommon, they are possible. If you experience signs of an allergic reaction to hydroxyzine pamoate, such as hives, difficulty breathing, or swelling of your face, lips, tongue, or throat, you should seek medical attention immediately.

Precautions for Pregnant and Nursing Women

While hydroxyzine pamoate is generally safe and well-tolerated for most people, women who are pregnant or thinking about becoming pregnant, should talk to their doctors before taking the medication. Studies performed on mice and rats have shown that use of hydroxyzine pamoate during pregnancy corresponded to an increased risk of birth defects. Because of uncertainty surrounding the impacts of hydroxyzine pamoate on fetuses in the first trimester, the medication is not recommended for use during this period of pregnancy. Despite the dangers of using hydroxyzine pamoate in the first trimester of pregnancy, the medication is considered to be safe for use in the second and third trimester at the current time. However, use of the medication should be stopped prior to labor, as use of hydroxyzine pamoate during or immediately preceding  labor may cause a drop in fetal heart rate, increase the risk of seizures in infants, and increase short-term and long-term side effects when used in conjunction with narcotics.
Hydroxyzine pamoate can be transmitted through breast milk to infants, so use of the medication while breastfeeding is not recommended. Infants who are exposed to antihistamines can experience drowsiness, irritability, or unexpectedly high levels of excitement; additionally, hydroxyzine pamoate can lower milk production in breastfeeding mothers.

People Who Should Avoid Hydroxyzine Pamoate

Hydroxyzine pamoate should not be used by women who are in their first trimester of pregnancy, are about to deliver a baby, or are breastfeeding. Because hydroxyzine pamoate produces a calming effect, you should talk to your doctor about taking this medication to avoid negative drug interactions if you are also taking sleeping pills, narcotic pain medicine, muscle relaxers, or medicine for anxiety, depression, or seizures. Hydroxyzine pamoate should not be used when under the influence of alcohol or narcotic drugs due to its sedative effect. Individuals taking hydroxyzine pamoate should avoid driving or operating dangerous machinery until they know how the medication affects them.
Hydroxyzine pamoate can cause heart problems, especially when combined with certain other medications. Make sure to tell your doctor about all medications you are taking, including prescription drugs, over-the-counter medicines, vitamins, and herbal products. Individuals with narrow-angle glaucoma, an enlarged prostate gland, hyperthyroidism, cardiovascular disease, hypertension, and asthma should use hydroxyzine hydrochloride with caution, if at all.

Deciding to Take Hydroxyzine Pamoate

Only your doctor can prescribe hydroxyzine pamoate, so the first step in seeking treatment is to talk to your healthcare provider about symptoms you are experiencing. Your doctor will evaluate your medical history, your list of current medications, and talk to you about your lifestyle prior to prescribing hydroxyzine pamoate.

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