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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.
What are the risks of mixing hydroxyzine with alcohol?
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.
What is hydroxyzine (Vistaril)?
So, what exactly is hydroxyzine (brand name Vistaril, Atarax; see Important Safety Information)? 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).
What does anxiety feel like?
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).
Hydroxyzine side effects
The most common side effects of hydroxyzine include (National Library, 2020):
- Sedation (sleepiness and relaxation)
- Abnormal heart rhythm
- Dry mouth
- Dry eyes
In rare cases, there can also be severe side effects, such as:
- Trembling or shaking
Trouble sleeping: causes and what you can do
- 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; see Important Safety Information]), 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.
- Food and Drug Administration. (2014). VISTARIL® (hydroxyzine pamoate) Capsules and
Oral Suspension. Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/011459s048%2C011795s025lbl.pdf
- Garakani, A., Murrough, J. W., Freire, R. C., Thom, R. P., Larkin, K., Buono, F. D., & Iosifescu, D. V. (2020). Pharmacotherapy of anxiety disorders: Current and emerging treatment options. Frontiers in Psychiatry, 11, 595584. doi: 10.3389/fpsyt.2020.595584. Retrieved from https://pubmed.ncbi.nlm.nih.gov/33424664/
- Michigan Medicine. (2017). Hydroxyzine. University of Michigan Health. Retrieved from https://www.uofmhealth.org/health-library/d00907a1
- Pfizer. (2019). VISTARIL® (hydroxyzine pamoate). How supplied/storage and handling. Retrieved from https://www.pfizermedicalinformation.com/en-us/vistaril/storage-handling
- PubChem. (n.d.). Hydroxyzine. National Library of Medicine. Retrieved from https://pubchem.ncbi.nlm.nih.gov/compound/Hydroxyzine
- U.S. National Library of Medicine. (2020). DailyMed. Label: HYDROXYZINE HYDROCHLORIDE tablet. National Institutes of Health. Retrieved from https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=8e5fce17-936e-46ea-a969-518c952c2091
Dr. Steve Silvestro is a board-certified pediatrician and Senior Manager, Medical Content & Education at Ro.