Hydroxyzine pamoate (Vistaril) is an antihistamine. This medicine is used to treat allergy symptoms. It is also used to treat anxiety and tension. This medicine can be used with other medicines to induce sleep before surgery. It is slightly more popular than comparable drugs. It is available in multiple generic and brand versions. It is available in generic and brand versions. Generic hydroxyzine pamoate is covered by most Medicare and insurance plans, but some pharmacy coupons or cash prices may be lower.
Alprazolam (Xanax) is an inexpensive drug used to treat anxiety and panic attacks. This drug is more popular than comparable drugs. It is available in brand and generic versions. Generic alprazolam is covered by most Medicare and insurance plans, but some pharmacy coupons or cash prices may be lower.
What is the dosage of hydroxyzine pamoate vs. Xanax?
Hydroxyzine pamoate has its maximal effect about 30 to 60 minutes after it is taken. Its effects last for 4 to 6 hours.
- The recommended dose for treating itching (pruritus) is 25 mg given 3 or 4 times daily by mouth or by intramuscular injection.
- When used for sedation, the recommended dose is 50 to 100 mg orally or 25 to 100 mg by intramuscular injection.
- Anxiety and tension are managed with 50 to 100 mg in 4 divided doses or 50-100 mg intramuscular injection in 4 or 6 divided doses.
- Alcohol withdrawal is treated with a 50-100 mg injection and may be repeated every 4 to 6 hours as needed.
- The dose for nausea and vomiting is 25 to 100 mg by injection.
- Hydroxyzine can be taken with or without food.
- The starting dose for treating anxiety is 0.25-0.5 mg 3 to 4 times daily using immediate-release tablets. The dose may be increased every 3-4 days to a maximum dose of 4 mg daily.
- The starting dose for treating panic attacks is 0.5 mg 3 times daily. Doses can be increased every 3-4 days but by no more than 1 mg daily.
- The effective dose for preventing panic attacks may be as high as 10 mg daily for some patients. The starting dose when using extended-release tablets to treat panic disorder is 0.5 mg once daily and the average dose is 3-6 mg once daily.
- Alprazolam may be taken with or without food.
What drugs or supplements interact with hydroxyzine pamoate and Xanax?
Hydroxyzine adds to (exaggerates) the sedating effects of alcohol and other drugs that can cause sedation such as the benzodiazepine class of anti-anxiety drugs. These drugs include
- diazepam (Valium),
- lorazepam (Ativan),
- clonazepam (Klonopin), and
- alprazolam (Xanax).
Hydroxyzine also adds to the sedating effects the narcotic class of pain medications and its derivatives, for example
- oxycodone and acetaminophen (Percocet),
- hydrocodone/acetaminophen (Vicodin),
- hydromorphone (Dilaudid),
- codeine, and
- propoxyphene (Darvon).
Hydroxyzine also adds to the effects of the tricyclic class of antidepressants, for example
- amitriptyline (Elavil, Endep),
- imipramine (Tofranil), and
- desipramine (Norpramin).
Hydroxyzine also adds to the effects of certain antihypertensive medications, for example, clonidine (Catapres), and propranolol (Inderal). Hydroxyzine can also intensify the drying effects of other medications with anticholinergic properties, for example
- dicyclomine (Bentyl),
- bethanechol (Urecholine),
- amitriptyline (Elavil, Endep), and
- chlorpromazine (Thorazine).
When using these drugs, the dose of hydroxyzine may require reduction.
Ketoconazole (Nizoral), itraconazole (Sporanox), nefazodone (Serzone), cimetidine (Tagamet), and fluvoxamine (Luvox) increase concentrations in the blood of alprazolam and therefore may increase the side effects of alprazolam.
Alprazolam interacts with alcohol and medications (for example, barbiturates, and narcotics) that suppress activity in the brain by suppressing activity more and causing sedation.
Carbamazepine and rifampin reduce the effect of alprazolam by increasing metabolism and elimination of alprazolam in the liver. SEE: Buspirone vs Xanax: 10 Differences and Similarities
Are hydroxyzine pamoate and Xanax safe to use while pregnant and breastfeeding?
A limited number of studies of hydroxyzine pamoate in pregnant women suggests that there may be a relationship between its use in the first trimester of pregnancy and congenital abnormalities in the fetus. Therefore, hydroxyzine should be avoided during the first trimester of pregnancy. It is not known if hydroxyzine pamoate is excreted into breast milk. In general, antihistamines are not recommended for use during breastfeeding because they can cause stimulation or seizures in newborns.
Benzodiazepines, such as alprazolam, can cause fetal abnormalities and should not be used in pregnancy. Alprazolam is excreted in breast milk and it can affect nursing infants. Therefore, women who are should not take alprazolam while breastfeeding.
Is Hydroxyzine pamoate or Xanax more effective?
A double-blind, controlled clinical study compared the anxiolytic, sedative, amnesia, and safety effects of the ingredients of Hydroxyzine pamoate and Xanax on pre-procedural patients. This study found that Hydroxyzine pamoate produced essentially no effect on anxiety for these patients, compared to a moderate effect produced by Xanax. The two drugs were comparable in regards to effects in somnolence and memory, but the effects of hydroxyzine lead to a more pronounced decrease in blood pressure. While they are both effective pre-procedural drugs, Xanax may be preferred due to its more pronounced effect on anxiety and adverse event profile.
Only your doctor can decide which anxiety treatment is best for you. If you are experiencing anxiety or other symptoms of a mental health disorder, seek medical advice. Do not attempt to self-medicate or take over-the-counter medications.
Coverage and cost comparison of Hydroxyzine pamoate (Vistaril) vs. Xanax
Hydroxyzine pamoate is a prescription medication that is typically covered by both Medicare and commercial insurance plans. Brand name Vistaril can cost as much as $92 out-of-pocket. With a coupon, you could pay as little as $4 for a 30-day supply of the generic, hydroxyzine pamoate 25 mg.
Xanax is a prescription medication that is typically covered by commercial insurance plans. Medicare drug plans may or may not cover Xanax. It is excluded from some plans. The out-of-pocket price for Xanax is an average of about $63. With a coupon from, you could pay less than $10 for a 30-day supply of the 1 mg generic. SEE: Etizolam vs Xanax: 7 Similarities and Differences