Vistaril (hydroxyzine) vs Xanax (alprazolam): Comparing medications

If you’ve been diagnosed with anxiety and are considering medication to treat your symptoms, two names you may have come across are Vistaril and Xanax. What’s the difference? Both are FDA-approved to treat anxiety in the short-term, but they are very different drugs that work in different ways.

In this article we’ll explain how each of them works, their benefits and disadvantages, as well as other anxiety medications.

Differences between Vistaril and Xanax

Vistaril is the brand name for the hydroxyzine and Xanax is the brand name for alprazolam. Vistaril and Xanax are both different types of medications that come in different forms and dosages. Another key difference is that Xanax has a higher risk of misuse than Vistaril and is classified as a controlled substance.

The chart below outlines some of the key distinctions between these drugs for easy reference, but read on for a detailed explanation of their side effects and their relative efficacy, as well as a list of other anxiety medications.  

What conditions do they treat?

Both Vistaril and Xanax are prescribed to treat anxiety, but they do so in different ways.  

Vistaril is a brand name of hydroxyzine pamoate, an antihistamine. This drug is an antihistamine, which means it manages the levels of a chemical called histamine that is produced by your immune system. It's not completely clear how hydroxyzine directly improves anxiety, but it possibly increases serotonin to help with mood and it's antihistamine properties contribute to sedation. Hydroxyzine is FDA-approved to treat several different types of anxiety disorders, as well as allergies. It’s also prescribed off-label for insomnia. (Off-label means an unapproved use of a drug, for which it can still be effective based on scientific evidence.)

Xanax is a brand name for alprazolam, which is a benzodiazepine. Xanax works by binding to specific receptors in the brain that are sensitive to a neurotransmitter called GABA that helps calm down the activity of neurons, which can prevent feelings of anxiety. Xanax enhances GABA’s effect on these receptors. Xanax is FDA-approved for the treatment of generalized anxiety disorders (GAD) and panic disorders (PD).  

Related article: Can you take Xanax for sleep?

How quickly do they work?

Vistaril and Xanax differ in their chemical composition, but both medications can potentially start improving symptoms within 15 minutes. But it's important to choose which medication might be a better fit for you with your doctor.

It’s important to note that individual responses to these medications can vary. Some people may experience quicker or slower onset of action, and the effectiveness of the drugs may depend on factors such as dosage, metabolism, and the severity of the anxiety or panic symptoms being treated. Always follow your doctor’s guidance regarding the use of these medications, and report any concerns or unusual reactions.

Learn more about how long Vistaril (hydroxyzine) takes to work

Is hydroxyzine as effective as Xanax?

Both medications have shown clinical improvement for anxiety. It's important to discuss which medication might be a better fit based upon your current symptoms with your doctor.  However Xanax, it might not be the best choice of anxiety treatment for everyone, in part because of its side effects and habit-forming potential. Xanax is a controlled substance and has a potential for physical dependence so it isn’t right in some circumstances, especially if you have struggled with substance use in the past.  

If you’re pregnant or breastfeeding, Vistaril and Xanax should both be used with caution. Talk with your psychiatrist or OB/GYN for more information to see what you should do in your situation.

What are the side effects?

Common side effects of hydroxyzine include:

• Sedation  
• Dry mouth  
• Tremor  

Meanwhile, some common side effects of Xanax include:

• Sedation
• Fatigue
• Depression  
• Dizziness  
• Slurred speech
• Weakness
• Forgetfulness
• Confusion
• Mania

Some people don’t want to take Xanax because of these side effects and because, as a benzodiazepine, it can be habit-forming and cause withdrawal symptoms if you stop taking it.  

Both medications are not typically recommended for long term use due to their potential increased risk of developing dementia in the elderly population.

They also have the potential to build a tolerance which means that a higher dosage may be necessary to treat symptoms with time, but only Xanax has the addiction potential. Here are some other alternative to Xanax to consider.  

When you discuss potentially taking either of these medications with your psychiatrist, one thing to keep in mind is potential drug interactions. Because both Xanax and hydroxyzine have a sedative effect, it’s not recommended to take them at the same time as any opioids, or any substance that might cause sleepiness or drowsiness, like sleeping aids or alcohol. Doing so can be very dangerous. Be sure to tell your doctor about any other medications you’re taking to ensure that the combination is safe for you.

Other treatment options for anxiety  

Xanax and Vistaril are by no means the only methods available for treating anxiety. Many other options exist, both prescription and non-prescription medication.  

Medication alternatives to Xanax and Vistaril include:

• Other benzodiazepines, such as Klonopin (clonazepam), Ativan (lorazepam), and Valium (diazepam). Like Xanax, they can be very effective and quick, but also like Xanax, they carry the risk of dependence.  
• SSRIs, or selective serotonin reuptake inhibitors. Patients typically don’t build up a tolerance to SSRIs like they can with hydroxyzine, and they are not habit-forming like benzodiazepines are. Some commonly prescribed SSRIs antidepressants include sertraline (Zoloft), citalopram (Celexa), escitalopram (Lexapro), and fluoxetine (Prozac).  
• SNRIs, or serotonin-norepinephrine reuptake inhibitors. SNRIs that might be prescribed for anxiety include duloxetine (Cymbalta) and venlafaxine (Effexor).

Non-prescription options for treating anxiety include:

• Regular exercise is a highly effective non-medical solution to preventing and treating anxiety and improving overall mental well-being. Whether it’s going for a walk, hitting the gym, or practicing yoga, finding activities that you enjoy and can sustain over time can have significant benefits for managing anxiety symptoms.

• Good sleep hygiene is essential for overall well-being, including mental health, and plays a significant role in managing anxiety. Sleep hygiene refers to a set of practices and habits that promote healthy and restful sleep. Some easy ways to practice good sleep hygiene include going to bed at a consistent time every day, creating a relaxing bedtime routine, and trying to limit screen exposure for an hour or two before bedtime.  

• Therapy, including cognitive behavioral therapy (CBT), is often considered a cornerstone of treatment for anxiety disorders, either as a standalone approach or in conjunction with medication. It offers a holistic and personalized approach to treating anxiety, addressing not only the symptoms but also the underlying factors contributing to anxiety disorders. It can be a valuable resource for individuals seeking lasting relief from anxiety and improving their quality of life.

If you’re interested in getting help for anxiety, you can take Talkiatry’s online assessment to get matched with one of our doctors.  We’re a national psychiatry practice that provides in-network virtual care.

FAQ

Here are more answers to your questions.

What is hydroxyzine?

Hydroxyzine is an antihistamine medication used to relieve symptoms of anxiety and tension, as well as to treat itching due to allergic reactions. It works by blocking the effects of histamine in the body, leading to sedation and relaxation. You might encounter it under the brand name Vistaril.  

What is Xanax?  

Xanax is a benzodiazepine medication primarily prescribed for the treatment of anxiety disorders and panic disorders, but comes with negative consequences, like the potential for addiction and misuse. It works by enhancing the effects of a neurotransmitter called gamma-aminobutyric acid (GABA) in the brain, resulting in calming effects on the central nervous system.  

Which one is better for anxiety?

Whether hydroxyzine or Xanax is better for treating anxiety depends on your circumstances and preferences. If you’re interested in trying one of these drugs, you should discuss it with a mental health professional.  

The information in this article is for education and informational purposes only and should never be substituted for medical advice, diagnoses, or treatment. If you or someone you know may be in danger, call 911 or the National Suicide and Crisis Lifeline at 988 right away.