Hydroxyzine and alcohol: risks and side effects

Hydroxyzine is unique among antihistamines (common allergy medications). It’s the only one that the FDA also approves to treat anxiety because it can make you feel sleepy and relaxed. While that’s a double whammy if you regularly deal with allergies and anxiety, those effects can spell trouble if you take hydroxyzine with alcohol or many other drugs.

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Hydroxyzine shouldn’t be taken together with alcohol, since using the two substances together can worsen the side effects of both:

• Drinking alcohol can increase the central nervous system (CNS) side effects of hydroxyzine, such as sleepiness, dizziness, and difficulty concentrating.

• Hydroxyzine, in turn, can worsen the side effects of alcohol, including drowsiness, impaired thinking and judgement, and problems with impulse control.

So, what exactly is hydroxyzine (brand name Vistaril, Atarax)? It’s an antihistamine (a class of drugs usually used for treating allergy symptoms). It’s the only antihistamine that the FDA also approves for anxiety. Hydroxyzine is available only by prescription. Unlike many other antihistamines, you can’t buy it over-the-counter (OTC) (Garakani, 2020; FDA, 2014).           

As the name suggests, antihistamines work by blocking the effects of histamines in your body—histamines are what cause an allergic response to certain substances. Unlike other antihistamines, hydroxyzine doesn’t only affect the body’s histamines; it also affects levels of serotonin, a neurotransmitter in your brain involved in mood. It’s not clear how hydroxyzine works to relieve anxiety, but it may work similarly to antidepressants that affect serotonin levels, such as selective serotonin reuptake inhibitors (SSRIs).

The most common side effects of hydroxyzine include (National Library, 2020):

• Sedation (sleepiness and relaxation)

• Abnormal heart rhythm

• Dry mouth

• Dry eyes

• Constipation

• Headache

In rare cases, there can also be severe side effects, such as:

• Trembling or shaking

• Seizures

• Hydroxyzine has more drug interactions than OTC antihistamines. It can interact with many different types of drugs. In addition to alcohol, hydroxyzine can also increase the effects of other medications that affect the CNS, including sleeping pills (such as Ambien), narcotics and opioids, muscle relaxers, antidepressant medications (such as Lexapro [generic name escitalopram]), antiseizure drugs, and other anti-anxiety drugs (such as Xanax and Valium) (Michigan Medicine, 2017).

• Hydroxyzine can cause serious heart problems, especially if you use certain medicines at the same time, including antibiotics, antidepressants, heart rhythm drugs, antipsychotic drugs, and drugs to treat cancer, malaria, HIV, or AIDS (National Library, 2020; PubChem, n.d.; Pfizer, 2019).

• Avoid driving a car or operating machinery after taking hydroxyzine until you know how it affects you, especially if you’ve drunk alcohol or taken any other drugs that affect the CNS.

Because hydroxyzine interacts with hundreds of different drugs, seek medical advice from your healthcare provider about taking any other drugs or supplements with hydroxyzine.

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Every article on Health Guide goes through rigorous fact-checking by our team of medical reviewers. Our reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the writer.

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Current version

November 17, 2021

Written by

Alison Dalton

Fact checked by

Steve Silvestro, MD

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About the medical reviewer

Steve Silvestro, MD, Ro

Dr. Steve Silvestro is a board-certified pediatrician and Associate Director, Clinical Content & Education at Ro.