Vistaril vs Ativan

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For patients struggling with anxiety or symptoms of stress, certain drugs that affect different neurotransmitters in the brain can help manage these challenging moments. Vistaril and Ativan are two such medications often prescribed for these conditions. Both have calming effects but operate on different principles within the central nervous system. Vistaril (hydroxyzine) is an antihistamine, primarily affecting H1 histamine receptors, which subsequently results in its sedative properties. On the other hand, Ativan (lorazepam) belongs to a class of drugs called benzodiazepines and enhances the effect of GABA neurotransmitters — chemicals known for their inhibitory role in nerve signals across synapses — leading to a reduction of anxiety symptoms.

What is Vistaril?

Hydroxyzine (the generic name for Vistaril) was the first drug of its class, antihistamines, which marked a significant development in the treatment of anxiety and tension. Hydroxyzine was approved by the FDA in 1955. Vistaril works by reducing activity in the central nervous system. It also acts as an antihistamine that reduces the effects of natural chemical histamine in the body. On the other hand, Lorazepam (the generic name for Ativan), part of benzodiazepines class, is usually prescribed for short-term use to treat acute symptoms of anxiety disorders or anxiety associated with depressive symptoms. Both medications can treat generalized anxiety disorder and panic attacks but they have different mechanisms affecting various neurotransmitters causing them to have differing side effect profiles.

What conditions is Vistaril approved to treat?

Vistaril has been approved for use in treating different conditions, including:

  • Anxiety and tension related to psychoneurosis.
  • As an adjunctive treatment in organic disease states where anxiety is manifested.
  • Pruritus due to allergic conditions such as chronic urticaria, and atopic and contact dermatoses, and in histamine-mediated pruritus.
  • As a sedative when used as premedication and following general anesthesia.

How does Vistaril help with these illnesses?

Vistaril helps manage anxiety and tension by acting as an antihistamine, blocking the effects of a natural substance called histamine in your body. It does this by binding to H1 receptor sites on cells in the brain and body, effectively reducing their activity. Histamines are involved in many functions including regulation of allergic responses, gastric acid secretion, neurotransmission in the central nervous system (CNS), and modulation of sleep-wake cycles. When overactive or out-of-balance, they can contribute to feelings of anxiety or unrest. Therefore, by inhibiting these histamines with Vistaril, it can limit negative effects associated with anxiety and help patients manage their condition.

Ativan also manages anxiety but operates differently than Vistaril; instead of acting as an antihistamine like Vistaril does, Ativan increases the effectivity of GABA - a calming neurotransmitter - which results in decreased activity within the nervous system thereby providing relief from symptoms associated with acute stress reactions.

What is Ativan?

Ativan is a brand name for lorazepam, which belongs to the class of drugs known as benzodiazepines. It works by enhancing the effects of gamma-aminobutyric acid (GABA) in the brain - a neurotransmitter that inhibits activity in the brain and induces sleep, reduces anxiety, and relaxes muscles. Lorazepam was first approved by the FDA in 1977. Unlike antihistamines such as Vistaril (hydroxyzine), Ativan does not inhibit histamine receptors but has potent anxiolytic, amnesic, sedative/hypnotic, anticonvulsant and muscle relaxant properties due to its action on GABA receptors. This different mechanism of action also means that its side-effect profile differs from that of antihistamines: it can cause physical dependence and withdrawal symptoms if used long-term or at high doses. Furthermore, it's particularly effective in reducing anxiety and inducing sleepiness – making it useful for patients suffering from acute anxiety or insomnia who have not responded well to "typical" antihistamines like Vistaril.

What conditions is Ativan approved to treat?

Ativan, generically known as lorazepam, is a medication that has received approval from the FDA for treating:

  • Anxiety disorders
  • Short-term relief of symptoms related to anxiety
  • Preoperative sedation and anxiety relief before surgical procedures.

How does Ativan help with these illnesses?

Ativan is a benzodiazepine medication that primarily acts on the gamma-aminobutyric acid (GABA) neurotransmitters in the brain, enhancing their effects to induce feelings of calm and relaxation. This makes it highly effective in managing symptoms of anxiety disorders and acute panic attacks. Ativan may also be used to manage sleep disturbances, preoperative anxiety, or withdrawal symptoms from alcohol cessation. Like Vistaril, which has antihistamine properties and can decrease activity in the central nervous system, Ativan helps reduce agitation and tension but potentiated with its sedative-hypnotic ability for short-term relief of severe stress and anxiety. However, due to its potential for dependency especially when used long-term or at high doses, Ativan must be prescribed carefully under medical supervision.

How effective are both Vistaril and Ativan?

Both hydroxyzine (Vistaril) and lorazepam (Ativan) have established roles in managing anxiety and nervousness, with their initial FDA approvals only a few years apart. Since they act on different neurotransmitters - Vistaril is an antihistamine while Ativan is a benzodiazepine - they may be prescribed under different circumstances.

Hydroxyzine and lorazepam were directly compared in several double-blind clinical trials for preoperative sedation; the two medications showed similar efficacy in reducing pre-surgery anxiety as well as comparable safety profiles. None of the metrics used to measure efficacy in treating anxiety differed significantly between patients receiving lorazepam or those receiving hydroxyzine.

A 2009 review suggested that hydroxyzine was effective at reducing symptoms of generalized anxiety disorder within the first week of treatment, had fewer side effects than many other anti-anxiety drugs, and was well-tolerated by various populations including children and elderly individuals. Hydroxyzine has become one of most commonly used antihistamines due to its dual functionality as an anti-allergy agent as well as anxiolytic.

Lorazepam also proves more effective than placebo for treating acute anxiety episodes according to a review from 2016. Although it’s considered a first-line therapy option for acute panic attacks or severe generalized anxiety flare-ups, long-term use is usually discouraged because of potential dependency issues associated with benzodiazepines. Much research on its usage involves co-prescription alongside SSRIs, meaning data supporting its standalone efficiency isn’t quite robust yet. Nevertheless due to unique pharmacological properties such as rapid onset action, lorazepam might be ideal treatment choice for patients who need immediate relief from severe bouts of stress-induced symptoms or those wishing to avoid typical SSRI related side-effects like sexual dysfunction.

abstract image of a researcher studying a bottle of drug.

At what dose is Vistaril typically prescribed?

Oral dosages of Vistaril range from 25-100 mg up to four times a day, but studies have indicated that 50-100 mg at bedtime is sufficient for treating anxiety and tension in most people. Children's dosage should be determined by their doctor's instruction. In either population, the dosage can be adjusted based on individual response and tolerance after a few weeks if there is no significant improvement. The maximum daily dose typically should not exceed 400 mg for adults under any circumstances.

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At what dose is Ativan typically prescribed?

Ativan (lorazepam) treatment, particularly for anxiety disorders, typically begins with a dosage of 0.5–2 mg/day, taken two to three times daily. The dose can be gradually increased to a maximum of 6-10 mg/day divided into multiple doses throughout the day if required and as directed by your healthcare provider. In some cases, if there is no response to initial treatment or symptoms worsen after several weeks at this higher dose, your healthcare provider may consider increasing the frequency or adjusting the medication regimen altogether. Always follow your doctor's instructions precisely when taking Ativan to ensure safe and effective use.

What are the most common side effects for Vistaril?

Common side effects of Vistaril include:

  • Drowsiness or sleepiness
  • Dry mouth
  • Headache
  • Fuzzy thinking and confusion
  • Tremors (unintentional trembling or shaking)
  • Irritability, restlessness, nervousness
  • Blurred vision or eye twitching
  • Constipation

On the other hand, Ativan potentially has its own set of common side effects such as:

-Drowsiness -Dizziness, faintness, light-headedness when getting up suddenly from a lying position. -Unsteady walk, -Stomach upset, -Loss of coordination, -Slurred speech, -Changing moods.

It's important to note that while these medications may have similar uses in treating anxiety and tension symptoms; their potential side effects differ. Make sure to consult with your physician before starting either medication.

abstract image of a patient experiencing side effect

Are there any potential serious side effects for Vistaril?

While Vistaril is generally well-tolerated, there are some cases where it can cause serious side effects. These may include:

  • Thoughts about suicide or self-harm
  • Signs of an allergic reaction: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing
  • Dry mouth, slurred speech, blurred vision
  • Rapid or irregular heartbeat, discomfort in your chest and shortness of breath
  • Convulsions or tremors
  • Nausea and vomiting
  • Confusion and hallucinations

In addition to these symptoms you should watch out for any signs that could indicate a problem with your nervous system such as restlessness, agitation or jitteriness. If you notice anything unusual while taking Vistaril stop using it immediately and seek help from a health professional.

What are the most common side effects for Ativan?

Ativan, a commonly prescribed benzodiazepine, can cause an array of side effects. These may include:

  • Dry mouth and throat
  • Constipation
  • Blurred vision
  • Drowsiness or dizziness
  • Nausea and potential loss of appetite
  • Sleep disturbances such as insomnia
  • Unusual sweating or feelings of anxiety and nervousness
  • Rapid heartbeat in some cases
  • Confusion or agitation, occasionally resulting in hostility
  • Skin rashes
  • Changes in weight that could lead to weight loss are also reported. However, it's important to note that the presence and severity of these symptoms vary among individuals. Always consult with your healthcare provider if you notice any adverse reactions while on Ativan.

Are there any potential serious side effects for Ativan?

Ativan is a highly effective medication for the treatment of anxiety, but it can also cause some serious side effects in certain cases. These may include:

  • Allergic reactions; such as hives, difficulty breathing, swelling of your face, lips, tongue or throat
  • Changes in mood or behavior; including new or worsening symptoms of depression and suicidal thoughts
  • Confusion, hallucinations, unusual thoughts or behaviors
  • Worsening sleep problems
  • Sudden restless feeling or excitement
  • Muscle weakness and drooping eyelids
  • Vision changes
    If you experience any of these side effects while taking Ativan, seek immediate medical attention. It's essential to remember that Ativan should be used under close supervision due to its potential for dependence and withdrawal symptoms.

Contraindications for Vistaril and Ativan?

Both Vistaril and Ativan, as with other anxiety medications, may increase feelings of depression in certain individuals. If you notice a worsening of your depressive symptoms or an increase in suicidal ideation, thoughts or behavior when taking these drugs, it is crucial to seek immediate medical attention.

Neither Vistaril nor Ativan should be taken if you are using or have recently used alcohol, sedatives, tranquilizers or narcotics. It's important to always inform your physician about any medication you are currently taking; abrupt discontinuation of these substances can cause withdrawal symptoms and could potentially interact harmfully with both Vistaril and Ativan. In particular, patients must exercise caution if they have been consuming large amounts of alcohol regularly as the combination could depress central nervous system functions.

How much do Vistaril and Ativan cost?

For the brand name versions of these drugs:

  • The price for 30 capsules of Vistaril (25 mg) averages around $200, which works out to approximately $6.67 per day.
  • The price for 60 tablets of Ativan (1 mg) is about $220, translating to roughly $3.70 per day.

If you are taking a higher dosage range for Vistaril, then brand-name Ativan may be less expensive on a daily treatment basis. However, it's important to remember that cost should not be the primary factor in determining which medication is most suitable for your needs.

When considering generic options:

  • Hydroxyzine pamoate (the generic equivalent of Vistaril), costs significantly less than its branded counterpart with prices ranging from about $0.40 to $2 per day depending on the dosage and quantity purchased.
  • Lorazepam (generic form of Ativan), also offers substantial savings compared to its brand-name version with daily costs typically falling between $0.20 and $1 based on dose and quantity bought.

These comparisons underscore the significant cost differences often seen between branded and generic medications while highlighting how a drug's daily expense can vary substantially based upon individual dosing requirements.

Popularity of Vistaril and Ativan

Hydroxyzine, available as Vistaril among other brand names, was estimated to have been prescribed to about 3.1 million people in the US in 2020. Hydroxyzine accounted for just over 6% of antianxiety prescriptions in the US and is often used off-label for its sedating effects. It's an antihistamine but due to its calming effect it has found utility in anxiety management.

On the other hand, Lorazepam, under brand versions such as Ativan, was prescribed to approximately 14.2 million people in the USA during that same year. In total, lorazepam represents about 15% of benzodiazepine prescriptions and almost a third of overall anti-anxiety medications' prescriptions within America itself. Its popularity can be attributed to its swift onset action making Lorazepam an effective relief for acute anxiety episodes; however this also makes it more prone to abuse and dependence compared with hydroxyzine.


Both Vistaril (hydroxyzine) and Ativan (lorazepam) are medications primarily used for their anxiolytic, or anti-anxiety effects. They have long-standing records of usage in patients with anxiety disorders and are backed by numerous clinical studies indicating that they can be more effective than placebo treatments. Sometimes these drugs may be prescribed together, but this must be done under careful supervision by a physician due to potential additive sedative effects.

Vistaril works as an antihistamine blocking H1 receptors, while Ativan is a benzodiazepine acting on the GABA neurotransmitter system; therefore, they tend to be prescribed under different circumstances. While both can help alleviate symptoms of anxiety, Ativan is typically employed in more severe cases or for short-term use due to its risk of dependency.

Both drugs come in generic forms which present significant cost benefits particularly for those paying out-of-pocket. Both Vistaril and Ativan may require some time before their full therapeutic effects become noticeable.

The side effect profiles between the two drugs do share similarities like drowsiness but differ significantly too – Ativan carries a higher risk of addiction and withdrawal symptoms compared to Vistaril. For both drugs, patients need close monitoring especially when initiating therapy. If any unusual reactions occur such as heightened anxiety or mood changes it's important to contact your healthcare provider immediately.