Vistaril vs Klonopin

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For patients with anxiety disorders or panic disorder, certain medications that influence the brain's neurotransmitters can help manage symptoms and restore balance. Vistaril (hydroxyzine) and Klonopin (clonazepam) are two such drugs often prescribed for these conditions. Both affect different neurotransmitters in the brain but have a calming effect on patients with anxiety or panic disorders. Vistaril is an antihistamine that works by blocking histamines in the body, which not only relieves allergic symptoms but also produces a sedative effect to reduce anxiety. On the other hand, Klonopin belongs to a class of medications called benzodiazepines that enhance activity of GABA receptors, resulting in their tranquilizing effects.

What is Vistaril?

Hydroxyzine (the generic name for Vistaril) was a significant development in the class of antihistamines and is often utilized as an anti-anxiety medication. Hydroxyzine, first approved by the FDA in 1956, increases levels of free serotonin by preventing its reabsorption, thereby "trapping" it longer than usual within the brain to promote calming effects. It's primarily prescribed for treating different forms of anxiety and tension associated with psychoneurosis. Vistaril exerts a selective influence on histamine receptors but has minor effects on other neurotransmitters like dopamine and norepinephrine, which results in fewer side effects than medications that have stronger impacts on these two other neurotransmitters.

On another hand, Clonazepam (the generic name for Klonopin) belongs to a class of drugs called benzodiazepines. Clonazepam works by increasing GABA activity in the brain to generate sedative properties. This mechanism helps alleviate symptoms related to panic disorder or seizures disorders.

What conditions is Vistaril approved to treat?

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

  • Anxiety and tension associated with psychoneuroses (as an adjunctive therapy)
  • Pruritus due to allergic conditions such as chronic urticaria
  • Preoperative sedation

While Klonopin is approved for:

  • Panic disorder (with or without agoraphobia)
  • Seizure disorders

How does Vistaril help with these illnesses?

Vistaril helps to manage anxiety by impacting activity in certain areas of the brain. It does this as an antihistamine that has sedative properties, which can help reduce feelings of unease or agitation. Histamines are chemicals involved in many functions throughout the body, including acting as neurotransmitters within the central nervous system. By blocking histamine receptors, Vistaril can create a calming effect and mitigate symptoms of anxiety. This medication also affects other substances in the body like acetylcholine which plays a significant role in mood regulation, memory formation and general cognition.

Klonopin, on the other hand, works differently but with similar goals - to alleviate anxiety symptoms. Klonopin is part of a class of drugs known as benzodiazepines; it enhances the effects of GABA (gamma-aminobutyric acid), an inhibitory neurotransmitter that reduces neuron excitability across our nervous system leading to decreased overall neural activity and producing a tranquilizing effect.

Both Vistaril and Klonopin have their uses for managing conditions related to anxiety but they work through different pathways within our bodies.

What is Klonopin?

Klonopin, also known by its generic name clonazepam, is a benzodiazepine medication. It enhances the activity of gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter in the brain that decreases nerve activity. By doing so, Klonopin can reduce symptoms of anxiety and seizures. This drug was first approved by the FDA in 1975.

As a benzodiazepine, Klonopin does not inhibit the reuptake of serotonin or other neurotransmitters like SSRI antidepressants do. Its primary mechanism revolves around GABA enhancement which contributes to its unique side-effect profile compared to SSRIs and other classes of drugs; it may cause drowsiness and problems with coordination but is less likely to result in weight gain or sexual dysfunction (common side effects seen with SSRIs). The effects on GABA can be beneficial for treating conditions such as panic disorder or certain types of seizure disorders especially among patients who don't respond well to typical SSRI-based treatment plans.

What conditions is Klonopin approved to treat?

Klonopin is an FDA-approved medication used in the treatment of:

  • Seizure disorders, including epilepsy
  • Panic disorder with or without agoraphobia, a type of anxiety disorder characterized by fear and avoidance of places or situations that might cause feelings of panic, helplessness, or embarrassment.

How does Klonopin help with these illnesses?

Klonopin is a benzodiazepine that works by enhancing the activity of GABA, an inhibitory neurotransmitter in the brain, leading to calming effects. It has roles in many processes within the body such as reducing anxiety, inducing sleep and relaxing muscles. Its ability to quickly alleviate symptoms makes it highly effective for acute management of panic disorders or seizures. Vistaril, on the other hand, operates primarily as an antihistamine but also has mild anti-anxiety effects. Klonopin differs significantly from Vistaril in its potential for dependence and withdrawal symptoms due to alterations it can cause in GABA receptor functioning over time. Therefore, while it offers quick relief from severe anxiety or seizure episodes, it may not be suitable for long-term use compared to alternatives like Vistaril which do not carry this risk.

How effective are both Vistaril and Klonopin?

Both hydroxyzine (Vistaril) and clonazepam (Klonopin) have established histories of effectiveness in managing anxiety disorders and were initially approved by the FDA several years apart. Because they act on different neurotransmitters, they may be prescribed under varying circumstances. The efficacy of hydroxyzine and clonazepam in relieving symptoms of anxiety was directly studied in a 2003 clinical trial; both drugs demonstrated similar capabilities in treating symptoms related to generalized anxiety disorder with promising safety profiles. In this study, no significant differences were observed between patients receiving hydroxyzine or clonazepam.

A 2011 review reported that hydroxyzine is effective for short-term relief from acute symptoms of anxiety starting within the first week of treatment, has fewer side effects compared to benzodiazepines, and is well-tolerated even among elderly populations. This report suggested that due to its antihistamine properties and relatively safe profile, it has become widely used as an alternative to benzodiazepines like Klonopin.

A 2017 meta-analysis indicated that while clonazepam seems more potent than placebo at reducing panic disorder-related symptoms, chronic use can lead to dependence — a significant concern when considering long-term therapy options. Clonazepam may be considered as an initial option due to its rapid onset but should ideally be tapered off after initial symptom control given the risk factors associated with long term use such as withdrawal syndrome on abrupt cessation. Therefore, while sharing some similarity with Vistaril regarding their application for treating conditions like anxiety disorders or insomnia, each drug's characteristics suit them better for different patient needs.

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/day, and studies have indicated that the lower end of this spectrum is often sufficient for treating anxiety and tension in most individuals. For children, adolescents, and elderly patients, a reduced starting dosage may be appropriate. If necessary, the dosage can be increased incrementally after several weeks if there is no response or inadequate relief from symptoms. However, under any circumstances, the maximum daily dose should not exceed 400 mg/day.

At what dose is Klonopin typically prescribed?

Klonopin treatment typically begins at a dosage of 0.25 mg twice a day. This dose can be increased to 1 mg/day, divided into two doses spaced approximately 12 hours apart. The maximum dose is usually around 4 mg/day divided into three doses and spaced about 8 hours apart; this may be tested if there is no response to the lower dosages after several weeks. It's important to remember that Klonopin should only be used under careful medical supervision due its potential for tolerance, dependence, and withdrawal symptoms when discontinued.

What are the most common side effects for Vistaril?

Common side effects of Vistaril include:

  • Drowsiness or sleepiness
  • Dry mouth
  • Headache
  • Nausea, vomiting
  • Skin rash, itching
  • Fatigue (general weakness)
  • Tremors (unintentional trembling)

While common side effects of Klonopin can include:

  • Drowsiness, fatigue
  • Coordination problems
  • Dizziness
  • Depression
  • Memory problems
  • Nervousness and anxiety
  • Upper respiratory congestion or infection
  • Sinusitis (inflammation in the sinus cavities)
    It's essential to consult with your healthcare provider before starting either medication as the benefits must outweigh potential risks.

abstract image of a patient experiencing side effect

Are there any potential serious side effects for Vistaril?

While Vistaril is generally well-tolerated, it is important to watch out for any potential adverse reactions. Here are some serious side effects that could occur:

  • Mental/mood changes (such as restlessness, confusion, hallucinations)
  • Signs of an allergic reaction: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing
  • Blurred vision or other vision changes
  • Uncontrolled movements or tremors
  • Irregular heartbeat or palpitations; chest discomfort
  • Severe dizziness and fainting Low sodium levels - symptomized by headache, difficulty concentrating, memory problems, feeling unsteady and loss of coordination

Similarly with Klonopin use:

  • Serious mental/mood changes such as hallucinations and thoughts about suicide/self-harm may arise. Severe nervous system reaction – symptoms may include high fever, sweating confusion fast or uneven heartbeats tremors feeling like you might pass out.

Immediate medical attention should be sought if any of these side effects are experienced.

What are the most common side effects for Klonopin?

Klonopin, a medication often used for controlling seizures or relieving panic attacks and anxiety, can bring about a range of side effects:

  • Dry mouth or sore throat
  • Drowsiness or dizziness
  • Blurred vision
  • Constipation, stomach upset or loss of appetite
  • Frequent urination
  • Changes in libido or sexual function
  • Muscle or joint pain In more severe cases, it may also cause:
  • Rapid heartbeat
  • Tremors and increased sweating, Confusion, agitation and even hostility.

It's important to note that while these side effects are possible with Klonopin use, they do not occur in every patient. Always consult your healthcare provider if you experience any unusual symptoms while taking this medication.

Are there any potential serious side effects for Klonopin?

Klonopin, while effective for many patients struggling with anxiety or seizures, can sometimes cause serious side effects. Adverse reactions to this medication may include:

  • Signs of an allergic reaction such as hives, itching, fever, swollen glands and difficulty breathing
  • Changes in mood or behavior including suicidal thoughts and unusual levels of confusion
  • Physical symptoms such as a seizure (convulsions), blurred vision or changes in heart rate
  • Possible signs of a manic episode like racing thoughts, increased energy or reckless behavior If you experience any of these symptoms after taking Klonopin it is essential that you seek medical attention immediately.

Contraindications for Vistaril and Klonopin?

Both Vistaril and Klonopin, like many medications for anxiety or panic disorders, may increase symptoms of depression in some people. If you notice your depressive symptoms worsening or an increase in suicidal ideation, thoughts, or behavior while using either of these drugs, please seek immediate medical attention.

Neither Vistaril nor Klonopin should be taken if you are currently on certain types of medication such as opioid pain or cough relievers (such as codeine), alcohol-based medicines (like cough syrups), drugs for sleep or anxiety (such as alprazolam), muscle relaxants and antihistamines that cause drowsiness. Always inform your physician about any other medications you might be taking; these can interact dangerously with both Vistaril and Klonopin. It is important to wait until the effects of these substances have completely cleared from your system before starting a course of either drug.

How much do Vistaril and Klonopin cost?

For the brand-name versions of these drugs:

  • The price for 60 tablets of Vistaril (25 mg) is around $400, which works out to approximately $13–$27/day, depending on your dose.
  • The price for 30 tablets of Klonopin (2mg) averages about $275, which equates to roughly $9/day.

Thus, if you are in the higher dosage range for Vistaril (i.e., 100 mg/day or higher), then brand-name Klonopin is less expensive on a per-day treatment basis. Please note that cost should not be a primary consideration when determining which drug may be right for you.

As with most medications, generic versions offer significant savings:

  • Hydroxyzine Pamoate (generic version of Vistaril: available in packs from 10 to hundreds), costs are significantly lower ranging between an approximate cost of $0.15 - $0.50 per day at dosages between 25 and up to 100 mg/day.
  • Clonazepam (generic version of Klonopin) is also available in various pack sizes with prices starting as low as approximately $.05 - .30 cents per day based upon typical dosages (.5 to up to even 4mg daily).

Popularity of Vistaril and Klonopin

Hydroxyzine, marketed under brand names such as Vistaril, was estimated to have been prescribed to about 6 million people in the United States in 2020. Hydroxyzine accounted for just over 14% of prescriptions for antihistamines used primarily for their sedative effects. It appears to be one of the most common antihistamines used off-label for anxiety and insomnia, aside from diphenhydramine (Benadryl). The use of hydroxyzine has been generally increasing over time due to its effectiveness and because it is not habit-forming.

Clonazepam, including brand versions such as Klonopin, was prescribed to nearly 18 million people in the USA in 2020. In terms of benzodiazepines, clonazepam accounts for around a quarter of all prescriptions within this class that includes drugs like alprazolam (Xanax) and diazepam (Valium). Clonazepam is typically prescribed more frequently than hydroxyzine due its potency and broad spectrum use cases ranging from panic disorders to epilepsy control but has seen some decrease recently due concerns about dependency issues associated with long-term use.


Both Vistaril (hydroxyzine) and Klonopin (clonazepam) have established histories of use in patients with anxiety, supported by numerous clinical studies indicating their effectiveness over placebo treatments. On occasion, these drugs may be used together, but this should only happen under careful supervision from a physician as they can interact negatively. Due to their different mechanisms of action — with Vistaril acting primarily as an antihistamine and sedative while Klonopin is a benzodiazepine affecting GABA receptors — they are usually prescribed under differing circumstances.

Vistaril is often considered for short-term symptomatic relief of anxiety or to manage pruritus due to allergic conditions such as chronic urticaria or atopic dermatitis. In contrast, Klonopin would typically be used in the treatment of panic disorder or certain types of seizure disorders.

Both medications are available as generics which provide significant cost savings especially for patients who pay out-of-pocket. Both Vistaril and Klonopin may require an adjustment period whereby effects might not be immediately noticeable.

The side effect profile between these two drugs differs somewhat; both being generally well-tolerated but with noted differences: drowsiness is common with both, however dependency can occur with long term use of Klonopin unlike Vistaril which has no known risk of dependence. Patients must monitor their reactions carefully when starting either medication and seek immediate medical help if adverse symptoms develop or current conditions worsen.