Atarax vs Zyrtec

Listen to the article instead of reading through it.


For patients suffering from allergies or anxiety, certain medications can help manage symptoms by affecting specific substances within the body. Atarax (hydroxyzine) and Zyrtec (cetirizine) are two such drugs often prescribed for these conditions. Both impact histamine levels in the body, a chemical that triggers allergy symptoms like itching and sneezing but have different effects beyond this.

Atarax is an antihistamine with sedative properties used not only to treat allergic reactions but also used as a tranquilizer for short-term anxiety treatment. It inhibits activity in the central nervous system and induces calmness.

On the other hand, Zyrtec is mainly employed to counteract perennial or seasonal allergic rhinitis and hives resulting from chronic idiopathic urticaria. Unlike Atarax, it's less likely to cause drowsiness due its selective inhibition of peripheral H1-receptors.

What is Atarax?

Hydroxyzine (the generic name for Atarax) is a first-generation antihistamine that has been in use since the 1950s. It functions by blocking histamine, a substance produced by the body during an allergic reaction. Hydroxyzine is often prescribed to treat itching caused by allergies and also used as a sedative to treat anxiety and tension. Furthermore, it can be utilized pre- or post-surgery to help with nausea or vomiting.

On the other hand, Cetirizine (the generic name for Zyrtec) is a second-generation antihistamine approved by the FDA in 1995. It also works by blocking histamine but is less likely than first-generation antihistamines like Atarax to cause drowsiness or interfere with rapid eye movement sleep because it doesn't cross into brain tissue as easily due to its chemical structure. This means that Zyrtec may have fewer side effects compared to drugs like Atarax which have stronger effects on these areas.

What conditions is Atarax approved to treat?

Atarax is approved for the treatment of various conditions, including:

  • Pruritus caused by allergic conditions
  • Anxiety and tension associated with psychoneurosis (an outdated term referring to a range of mental disorders)
  • As an adjunctive therapy in organic disease states in which anxiety is manifested.

On the other hand, Zyrtec has approval for:

  • Indoor and outdoor allergies
  • Chronic urticaria or hives.

How does Atarax help with these illnesses?

Atarax, also known as hydroxyzine, helps to manage allergies by blocking the effects of histamine in the body. It does this by binding to H1 receptors on cells throughout the body which would usually be activated by histamine during an allergic reaction. Histamine is a compound that plays multiple roles in our bodies, including acting as a neurotransmitter and regulating physiological function in the gut; however, it's most well-known for its pivotal role in immune responses. When released during an allergy attack or exposure to allergens like pollen or pet dander, it triggers symptoms such as sneezing and itching. Therefore, by blocking histamine from binding to its receptors on cells all over your body, Atarax can limit these uncomfortable allergy symptoms.

On the other hand, Zyrtec (cetirizine) works similarly but with less sedating side effects compared to Atarax. This makes it a popular choice among patients who need anti-allergy medication but do not want their daily routines hampered due to sleepiness caused by antihistamines like Atarax.

What is Zyrtec?

Zyrtec, also known as cetirizine, is a second-generation antihistamine that selectively inhibits the peripheral H1 receptors. This means it opposes the activity of histamines in the body which are released during an allergic reaction. Especially useful for seasonal allergies, Zyrtec was first approved by the FDA in 1995. Being a second-generation antihistamine, Zyrtec does not cross into the brain from the blood and does not cause sedation or drowsiness when used at recommended doses. Its side-effect profile differs from first generation antihistamines like Atarax (hydroxyzine), as it causes less dry mouth and urinary retention symptoms due to its non-anticholinergic property. Because of these advantages, patients with allergies might respond better to Zyrtec than older traditional medications such as Atarax.

What conditions is Zyrtec approved to treat?

Zyrtec, known generically as cetirizine, has been approved for the treatment of:

  • Seasonal allergic rhinitis (commonly referred to as hay fever)
  • Perennial allergic rhinitis (year-round allergies)
  • Chronic urticaria or hives

These conditions manifest with symptoms such as a runny nose, sneezing, and itchy or watery eyes. Zyrtec is often favored due to its quick onset of action and 24-hour duration of effect.

How does Zyrtec help with these illnesses?

Histamine is a natural chemical in the body that can cause allergy symptoms such as sneezing, itching, watery eyes, and runny nose. Zyrtec works by blocking the action of histamine, thereby providing relief from these symptoms. It's classified as a second-generation antihistamine which means it’s less likely to cause drowsiness compared to first-generation antihistamines like Atarax. This makes Zyrtec an appealing choice for those who require symptom alleviation without significant sedation during their daily activities. Furthermore, unlike Atarax which is also used as a sedative to treat anxiety and tension, Zyrtec focuses on allergy relief making it more suitable for individuals primarily looking to manage allergies.

How effective are both Atarax and Zyrtec?

Both hydroxyzine (Atarax) and cetirizine (Zyrtec) are antihistamines with a history of successfully treating allergy-related symptoms. Hydroxyzine was approved by the FDA in the 1950s, while cetirizine became available over two decades later. These medications are prescribed under different circumstances due to their unique pharmacological properties.

A direct comparison study between hydroxyzine and cetirizine found that both drugs had similar efficacy in managing symptoms of chronic urticaria, a condition characterized by hives or skin rash with itchiness[1]. In this double-blind clinical trial conducted in 1995, there were no significant differences across various metrics for measuring efficacy in treating chronic urticaria between patients receiving either drug.

Findings from a meta-analysis report published in 2012 showed that cetirizine has been effective at alleviating allergy symptoms from the first day of treatment. It has an acceptable side effect profile compared to other antihistamines and is generally well-tolerated amongst most populations including elderly patients [2].

Hydroxyzine, on the other hand, provides fast-acting relief but may lead to more pronounced sedative effects than newer second-generation antihistamines like Zyrtec. This makes it useful as an addition to primary treatments when needed for its sedating properties because it can help patients sleep through periods of severe itching or allergic reactions [3]. Nonetheless, due to its unique pharmacology, hydroxyzin could be an optimal treatment for those who need rapid symptomatic relief and do not respond well enough to less-sedating alternatives such as Zyrtec.

[1] [2] [3]

abstract image of a researcher studying a bottle of drug.

At what dose is Atarax typically prescribed?

Oral dosages of Atarax range from 25–100 mg/day, but studies have indicated that 25 mg/day is sufficient for treating anxiety and tension in most adults. Children over the age of six may be started on a dosage calculated by their weight (0.6 mg/kg). In either population, dosage can be increased after a few weeks if there is no response. The maximum dosage that should not be exceeded in any case is 100 mg/day.

On the other hand, Zyrtec's recommended dose for adults and children over six years old is typically 10mg once daily. For younger kids aged two to five years, it's generally advised to take 2.5mg (half a tablet) once daily - although this can be increased to twice daily if advised by your doctor.

As always, these are general guidelines and you should consult with your healthcare provider before making changes to medication or dosages.

Find Top Clinical Trials

Choose from over 30,000 active clinical trials.

At what dose is Zyrtec typically prescribed?

Zyrtec treatment is typically initiated at a dosage of 10 mg/day for adults and children over the age of 6 years. The dose can be halved to 5 mg/day for those who have mild symptoms, or for small children between the ages of 2-6 years. Higher doses should not be used unless advised by a physician due to potential side effects such as drowsiness. Dosage adjustments are not usually needed beyond this range, as Zyrtec's efficacy plateaus after reaching the initial recommended daily dose. For most individuals, relief from allergy symptoms occurs within an hour and lasts up to 24 hours, providing full-day relief with just one daily dose.

What are the most common side effects for Atarax?

Here are the common side effects that can be experienced when taking Atarax and Zyrtec:

  • Drowsiness or sleepiness
  • Dry mouth
  • Headache
  • Fatigue (general weakness)
  • Nausea, constipation or diarrhea
  • Stomach pain (discomfort in the digestive tract)
  • Dizziness
  • Changes in vision For Atarax specifically:
    • Tremors (unintentional trembling or shaking)
    • Confusion

For Zyrtec specifically:

  • Cough, sore throat (potential signs of pharyngitis)

It's important to note that not everyone experiences these side effects. However, if any of these persist or worsen over time, it is recommended to seek medical attention immediately.

abstract image of a patient experiencing side effect

Are there any potential serious side effects for Atarax?

While Atarax and Zyrtec are both antihistamines used to treat symptoms of allergies, their side effects can vary. For Atarax (hydroxyzine), some serious but rare side effects may include:

  • Signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat
  • Involuntary motor activity such as tremor or convulsions
  • Fast or pounding heartbeats
  • Confusion and hallucinations
  • Uncontrollable shaking in a part of the body
  • Seizures

For Zyrtec (cetirizine), potential severe reactions could be:

  • Allergic reactions like skin rash, itching or hives, swelling in your face or hands, swelling or tingling in your mouth or throat; chest tightness; trouble breathing
  • Rapid heartbeat
  • Sleepiness that is so severe you cannot function normally during the day

Please note these lists do not cover all potential side effects. If any unexpected symptoms occur while taking either medication, consult a healthcare provider immediately.

What are the most common side effects for Zyrtec?

Zyrtec, also known as cetirizine, can lead to different side effects compared to Atarax. Some of the common ones include:

  • Dry mouth and throat
  • Nausea or stomach upset
  • Fatigue, drowsiness or a feeling of lethargy
  • Dizziness and headache
  • A faster than usual heartbeat
  • Unusual feelings of nervousness or restlessness
  • Occasional constipation problems or urinary retention
  • Muscle pain is uncommon but can occur in some individuals.

Please note that although these side effects are possible with Zyrtec use, they do not affect everyone who takes this medication. Additionally, many people taking Zyrtec experience no noticeable adverse reactions at all.

Are there any potential serious side effects for Zyrtec?

While Zyrtec is typically well-tolerated, there are certain side effects that you should be aware of. If any of the following occur after taking Zyrtec, seek immediate medical attention:

  • Troubled breathing or swallowing
  • Swelling in your face, throat or tongue
  • Hives and itching which could indicate an allergic reaction
  • Severe dizziness or confusion; changes in mood such as restlessness or nervousness
  • Problems with vision including blurred sight or eye pain
  • Rapid heartbeat These symptoms can potentially indicate serious conditions like severe allergic reactions, central nervous system problems, cardiovascular issues and ocular complications. As always if you experience unusual changes in behavior such as agitation, irritability or insomnia do not hesitate to contact a healthcare professional for advice.

Contraindications for Atarax and Zyrtec?

Both Atarax and Zyrtec, along with most other antihistamine medications, may worsen symptoms of drowsiness in some people. If you notice your fatigue increasing or an increase in cognitive impairment, please seek immediate medical attention.

Neither Atarax nor Zyrtec should be taken if you are taking, or have been taking monoamine oxidase (MAO) inhibitors (MAOIs). Always inform your physician which medications you are taking; MAOIs will require a period of about 2 weeks to clear from the system to prevent dangerous interactions with Atarax and Zyrtec. Additionally, both these drugs can interact negatively with certain sleep aids, muscle relaxants and narcotic pain relievers. Be sure to provide detailed information about all current medication use to your doctor before beginning treatment with either drug.

How much do Atarax and Zyrtec cost?

For brand name versions of these drugs:

  • The price of 60 tablets of Zyrtec (10 mg) averages around $33, which works out to approximately $0.55 per day.
  • The price for the same quantity of Atarax (25 mg), on the other hand, is about $200, translating into roughly $3.33 per day.

Hence, if you are taking a single daily dose, then brand-name Zyrtec is considerably less expensive than Atarax on a per-day basis. Remember that cost should not be your primary consideration in choosing between these two medications; instead focus on their effectiveness and side-effects.

The generic versions - cetirizine (Zyrtec) and hydroxyzine (Atarax), offer significantly more affordable options:

  • Cetirizine can be found in packs ranging from 14 to 365 tablets with costs starting as low as $0.04/day up to about $0.20/day.
  • Hydroxyzine comes typically in packages from 30 to 100 pills with prices varying between approximately $0.40 and $.90 per day depending on dosage and package size you choose.

Keep in mind that prices may vary based on location, pharmacy choice or insurance coverage among others factors.

Popularity of Atarax and Zyrtec

Hydroxyzine, in both its generic form and under the brand name Atarax, was prescribed to about 3.6 million people in the US in 2020. Hydroxyzine made up just over 7% of antihistamine prescriptions and is widely used for its sedative properties as well as treating itching caused by allergies.

Cetirizine, including brand versions such as Zyrtec, was prescribed to around 10 million people in the USA during the same period. Cetirizine accounted for approximately 20% of all antihistamine prescriptions within this timeframe. It's primarily used to treat hay fever symptoms and hives but does not have significant sedative effects due to it being a second-generation antihistamine that doesn't cross blood-brain barrier extensively.

While cetirizine's use has remained relatively stable over the last decade, hydroxyzine’s usage saw an increase which can be attributed partially to its off-label uses such as anxiety relief or sleep aid due to its sedating properties.


Both Atarax (hydroxyzine) and Zyrtec (cetirizine) are antihistamines used in the treatment of allergies, itching and hives. They both work by blocking histamine H1 receptors, thus preventing or reducing allergy symptoms. While they have similar mechanisms of action, they differ in terms of their sedative properties and indications.

Atarax is a first-generation antihistamine that crosses the blood-brain barrier more readily than Zyrtec, resulting in greater sedation effects. It's often prescribed for its tranquilizing effect to manage anxiety or as a preoperative medication to reduce anxiety before surgery.

Zyrtec, on the other hand, belongs to the second generation of antihistamines which were designed to be less sedating while remaining effective against allergy symptoms. It is available over-the-counter without prescription making it an easily accessible option for many people with mild-to-moderate allergies.

While both drugs come with potential side effects such as dry mouth and drowsiness, these tend to occur more frequently with Atarax due to its higher degree of central nervous system penetration. Like any medications you should remain attentive when starting treatment particularly if you experience severe side effects such as difficulty breathing or swelling around your face.

It's also important noting that although hydroxyzine has been used longer than cetirizine there’s plenty evidence supporting efficacy and safety profile for both agents based on clinical studies conducted over years. As always consult your doctor about what might work best given your personal medical history and current condition before deciding between these two treatments options.