Hydroxyzine Addiction: The Dangers of Abuse And Treatment Options

Last Updated: July 22, 2021

Authored by Dr. Ahmed Zayed

Reviewed by Michael Espelin APRN

Hydroxyzine is available under the brand names of Vistaril and Atarax (discontinued) in the United States, and in 2018, it was ranked the 78th most commonly prescribed drug in the country. Although the Hydroxyzine drug class is antihistamine, this drug also has antiemetic and anxiolytic properties. So, aside from being a powerful and effective medication for allergic skin reactions with symptoms such as itching, it is also largely used by patients for combatting nausea and vomiting as well as relieving anxiety. It can also be used as a sedative and opioid potentiator. The use of Vistaril as a prescription drug has become a subject of endless debate in recent years. Researchers have been asking questions about Vistaril medication, especially its addictive potential and general safety. Despite the low potential for Hydroxyzine addiction and/or Hydroxyzine abuse and experiencing withdrawal symptoms, the risk still exists.

What Is Hydroxyzine?

Atarax/Vistaril is an H1 antagonist (piperazine subtype) of the antihistamine drug class. Its use diversity revolves around its ability to produce anxiolytic, sedative, and anticholinergic effects, thanks to its ability to decrease activity in the brain, or more specifically, suppress activity at subcortical levels. The aforementioned abilities make Vistaril feasible for use not only for the management of allergic reactions but also for insomnia treatment, anxiety and tension relief. When used as an antihistamine, the Hydroxyzine pill effectively helps overcome allergy symptoms by blocking the root cause of it all – the substance called histamine. Although Vistaril  is not a controlled substance, it is only available with a doctor’s prescription.

As for the most common side effects of Hydroxyzine drug class – antihistamine, they are usually mild and transitory. One may experience dry mouth, headache, and drowsiness, which usually disappears after a few days of continued therapy. However, patients taking a significantly higher dose of Hydroxyzine HCl than recommended may experience some involuntary motor activity and other undesirable side effects such as hallucination, pruritus, and rashes, among others.

What Is Hydroxyzine?

Hydroxyzine Brand Names

Two types of formulas are available for this drug. One formulation is of HCl (hydrochloride salts) or dihydrochloride, and the other one is of pamoate. They both help with managing allergies, but the HCl formulation is the type that’s prescribed more often for that. The pamoate formulation, on the other hand, is mostly used for help with sleep or insomnia and anxiety relief.

Below are the most common brand names available for this drug in the US. Please note that it cannot be bought without a prescription:

Hydrochloride form: sold under the brand name Atarax (manufactured by Pfizer). Other brands available are:

  • Orgatrax: Orgatrax is a discontinued trade name in the United States. It was made by Organon USA Inc.
  • Hy-Pam25: It is a registered trademark of the TEVA company. It is discontinued in the United States.

Pamoate form: It is generic for Vistaril (manufactured by Pfizer, known as the first manufacturer of this drug as an everyday treatment for anxiety and allergy disorders). Other brands available are:

  • Equipose
  • Masmoran
  • Paxistil

When it comes to the Hydroxyzine over-the-counter drug’s onset of action, it usually starts to work within 15 to 30 minutes after oral intake in healthy patients, and its effects usually last for around 4 to 6 hours. However, it must be noted that Hydroxyzine in injectable form has a faster onset of action than the Hydroxyzine pill. Also, the onset and duration of action of the Hydroxyzine medication as well as how long it stays in one’s system will of course vary from patient to patient as it depends on several individual factors. But for reference, its elimination half-life is around 20 hours in adults, 29 hours in the elderly, and 7.1 hours in children.

What Is Hydroxyzine Used For ?

Hydroxyzine HCl and Hydroxyzine pamoate are both antihistamines,  with the pamoate form being mostly used to treat nausea and anxiety. Atarax (Hydroxyzine HCl), on the other hand, is used for allergies and itching. One noticeable difference between the forms is that Hydroxyzine pamoate can penetrate the blood-brain barrier while Hydroxyzine HCl can’t. This, in turn, also means that they may produce different side effects.

This medication comes in two routes of administration: oral and parenteral. The hydrochloride form comes in solution, tablet, and intramuscular injection dosage forms with varying strengths. On the other hand, the pamoate form comes in capsules and suspensions.

As mentioned earlier, this antihistamine medication is and may be prescribed for uses other than relieving allergy symptoms.

Its use is most commonly seen to help manage the following:

Hydroxyzine HCL For Anxiety This drug is quite versatile as far as the treatment of different types of anxiety is concerned. Most doctors, however, prescribe Atarax for anxiety for the management of Generalized Anxiety Disorder (GAD) as the medication showed both safety and efficacy in the treatment of the disorder, therefore proving to be an effective alternative to benzodiazepines. GAD is one of the most widely diagnosed types of anxiety. People with anxiety disorders usually have increased 5-HT activity. Vistaril inhibits the activity of these receptors, thus allowing for the reduction of anxiety in the user. 5-HT, ordinarily, combined with serotonin, which may heighten the tension. It is also due to this ability that doctors prescribe Vistaril for panic attacks. Many anxiety drugs have to be taken regularly, and that is another way Atarax differs from the rest, such as the case in Vistaril vs. Benadryl. Vistaril also can’t be used for a long period of time and in high doses as it will induce unpleasant adverse reactions.
Hydroxyzine For Sleep The ability to cross the blood-brain barrier makes the use of Vistaril for insomnia a good idea since it is an effective sedative. Having a soothing effect is a common property of most antihistamines. There are instances when doctors prescribe Atarax/Vistaril alongside other drugs for the treatment of insomnia. A study has also found that it helps with sleep disorders and reduces nightmares in patients suffering from PTSD. Physicians find it easy to prescribe Vistaril for sleep alongside other medicines because the interaction usually has no adverse effects, and excessive drowsiness only adds to the cause.
Hydroxyzine For Allergies And Symptoms Such As Itching Atarax suppresses activities of histamine in the key regions of the subcortical area of the CNS (central nervous system). It is known to be effective for use in relieving allergic symptoms and managing histamine-mediated pruritus (itching) and allergic conditions like atopic and contact dermatoses as well as chronic urticaria. It is also largely used for other symptoms such as nausea and tension.

Hydroxyzine Dosage Forms And Strengths

This drug’s dosage varies depending on some factors. For example, doctors prescribe Vistaril for anxiety differently for each patient. The number of doses, frequency of drug administration, and time intervals between each dose solemnly depend on an individual’s medical problem, reaction to treatment, the severity of side effects, etc. For this reason, patients should not neglect the instructions given by a doctor or try to imitate someone’s prescription.

Atarax/Vistaril Comes In Several Dosage Forms and Strengths, With the Following Being the Most Commonly Prescribed Ones:

Form Dose/Strength Type (Tablet/Capsule) Description (color, shape, etc.) Imprint Code
Hydroxyzine hydrochloride 10mg Tablet White, round, film-coated 75 on one side, A on the other
25mg Tablet White, round, film-coated 71 on one side, AN on the other
50mg Tablet White, round, film-coated 77 on one side, AN on the other
Hydroxyzine pamoate 25mg Capsule Two-tone green (opaque dark green cap, opaque light green body); filled with yellow powder IX on the cap, 657 on the body
50mg Capsule Green and white (opaque dark green cap, opaque white body); filled with yellow powder IX on the cap, 658 on the body

In addition to these, Hydroxyzine hydrochloride is also available in 10mg/5mL solutions, 100 mg tablets, and 25 mg/mL and 50 mg/mL injections strictly for intramuscular use. Meanwhile, Hydroxyzine pamoate is available in capsules equivalent to 100 mg of its hydrochloride form and suspensions equivalent to 25mg/mL of the same.

Is Hydroxyzine Addictive?

Atarax and/or Vistaril are not necessarily addictive and are unlikely to cause Hydroxyzine addiction. However, due to their anti-anxiety properties and sedative effects that make people feel relaxed, some tend to misuse them. Misuse, in some cases, leads to dependence and Hydroxyzine abuse. Atarax is particularly appealing to people suffering from anxiety. It is not habit-forming like the usual anti-anxiety drugs – benzodiazepines.

Still, the medication’s anxiolytic effects, in addition to its fast-acting nature, are the most common cause of Hydroxyzine abuse or misuse. If talking about Hydroxyzine addiction in a physical sense, though, it’s just not possible. Psychological addiction is basically what could potentially be formed as there are no physical side effects or withdrawal symptoms to be expected when one abruptly stops taking the medication.

Is Hydroxyzine Addictive?

Hydroxyzine Abuse Statistics

The statistical data on Vistaril abuse is quite scarce. In 2015, at least 166,000 people (aged 12 and older) misused the Vistaril. At the same time, the number of written prescriptions for the drug is steadily growing each year. This, however, doesn’t mean that there is a mass dependence on the drug. It is also noteworthy that a higher prescription rate running into millions of individuals every year means Atarax/Vistaril is a drug in high demand.

Signs Of Hydroxyzine Addiction

While abuse of non-habit-forming drugs (in the physical sense) like Hydroxyzine may not be very hazardous, once patients become tolerant to it, addiction sets in. Signs of Hydroxyzine abuse are similar to signs of overdose, and the same goes for Hydroxyzine addiction.

Physical Signs Of Hydroxyzine Abuse Include The Following:

  • Extreme sedation
  • Dizziness
  • Seizures
  • Nausea and vomiting
  • Fever
  • Serious skin reactions, such as:
    • Rashes
    • Swelling and redness on the skin
    • Lesions
  • Restlessness and coordination problems
  • Trembling or shaking

Signs of Hydroxyzine Addiction or Abuse in the Psychological Sense, On the Other Hand, Are As Follows:

  • Confusion or disorientation
  • Excitation
  • Agitation
  • Impatience
  • Tolerance
  • Intentional abuse to cultivate ‘good feeling’

The interaction of alcohol, anesthetics, central nervous system (CNS) depressants such as analgesics or opiates, barbiturates, or other sedatives may be potentiated if taken with the Hydroxyzine over-the-counter drug. Therefore, abuse of Hydroxyzine medication with the said substances and drugs must be approached with caution as it can cause excessive sedation, and hypersedation is the most common characteristic of overdose from Hydroxyzine pill. This is why medical and health experts recommend that if it were to be taken with a CNS depressant, the dosage of the latter should be decreased by up to 50%. Note that aside from hypersedation, an overdose may also manifest as nausea, vomiting, convulsions, and stupor.

Who is Most at Risk of Hydroxyzine Addiction And Abuse?

According to the National Institute on Drug Abuse, people who lacked parental supervision and/or presented aggressive behavior in their childhood are more at risk of Hydroxyzine abuse or addiction and drug addiction in general. Having low peer refusal skills, being exposed to community poverty, and interest in drug experimentation or history of addiction to other substances (including alcohol) are also among the most common risk factors that may lead to addiction and abuse. When it comes to drug use with age groups considered, data from the National Center for Drug Abuse Statistics shows the highest percentage of 39% in people aged 18 to 25, followed by 35% in those aged 26 to 29. It has also shown that more men (22%) than women (17%) abused prescription drugs such as Atarax.

Evading The Hydroxyzine Abuse

Antihistamine addiction is a serious problem that may cause a hip of medical and health consequences for the abuser. Abuse of antihistamine drugs can slowly develop into drug addiction. It then becomes a case of drug dependence one cannot overcome without professional treatment and medical/health counseling. At a rehab facility, patients go through a wide range of drug therapies and medical counseling processes modeled to help individuals recover faster and overcome drug abuse. All of the recovery programs are based around the patient’s needs; thus, it allows for customization of one’s individual treatment plan.

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Published on: March 11th, 2020

Updated on: July 22nd, 2021

About Author

Dr. Ahmed Zayed

Dr. Ahmed Zayed is a Bachelor of Medicine and Surgery. He is graduated from the University of Alexandria, Egypt. Dr. Ahmed Zayed has a passion for writing medical and health care articles and focuses on providing engaging and trustworthy information to readers.

Medically Reviewed by

Michael Espelin APRN

8 years of nursing experience in wide variety of behavioral and addition settings that include adult inpatient and outpatient mental health services with substance use disorders, and geriatric long-term care and hospice care.  He has a particular interest in psychopharmacology, nutritional psychiatry, and alternative treatment options involving particular vitamins, dietary supplements, and administering auricular acupuncture.