Hydroxyzine
Vistaril
First-Generation AntihistamineGeneric available
Clinical Pharmacology Hydroxyzine is unrelated chemically to the phenothiazines, reserpine, meprobamate or the benzodiazepines. Hydroxyzine is not a cortical depressant, but its action may be due to a suppression of activity in certain key regions of the subcortical area of the central nervous system. Bronchodilator activity, antihistaminic and analgesic effects have been demonstrated experimentally and confirmed clinically.
Compare Hydroxyzine →FDA-Approved Indications
- Anxiety and tension (psychoneurosis or organic disease; adults; pediatric)
- Pruritus — chronic urticaria, atopic/contact dermatoses (adults; pediatric)
- Sedation — premedication and post-anesthesia (adults; pediatric)
Common Off-Label Uses
- Insomnia
- Pruritus (dermatologic)
- Nausea/vomiting
What Sets This Drug Apart
- H1 antihistamine with anxiolytic properties; rapid onset (15-30 min) makes it useful for acute anxiety episodes without benzodiazepine dependence risk
- QTc prolongation risk — FDA warning; baseline ECG recommended especially at doses above 4 mg/kg/day or with other QT-prolonging drugs
- Significant sedation (H1-related) and anticholinergic effects; limiting in elderly and cognitive populations
- No abuse potential or dependence — advantage over benzodiazepines for patients with substance use history
- Available as pamoate (Vistaril, preferred for anxiety) and hydrochloride (Atarax, preferred for pruritus/antihistamine effect)