Vistaril vs Xanax

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For patients dealing with anxiety disorders or other types of stress-related conditions, certain medications that influence the balance of chemicals in the brain known as neurotransmitters can assist in stabilizing mood and managing symptoms. Vistaril (hydroxyzine) and Xanax (alprazolam) are two such commonly prescribed medications for these conditions. Both impact different neurological pathways but aim to promote a calming effect.

Vistaril is classified as an antihistamine with sedative properties; it works by reducing activity in the central nervous system, thereby producing a calming effect. On the other hand, Xanax falls under the category of benzodiazepines affecting gamma-aminobutyric acid (GABA) receptors in your brain, which slows down brain activity to reduce feelings of fear or anxiety. It's important to understand their differences when considering treatment options.

What is Vistaril?

Hydroxyzine (the generic name for Vistaril) is a first-generation antihistamine that was approved by the FDA in 1956. It operates by suppressing activity in certain regions of the subcortical area of the central nervous system, making it helpful as an anti-anxiety medication or sedative. Vistaril inhibits histaminic edema and pruritus while also exhibiting significant analgesic effects.

On the other hand, alprazolam (Xanax) belongs to a class of medications called benzodiazepines which affect chemicals in the brain that may be unbalanced in people with anxiety. Xanax is frequently prescribed for panic disorders and anxiety conditions due to its fast-acting nature and efficacy.

While both drugs have similar uses, they function differently within the body. Hydroxyzine's effect on serotonin isn't significant, whereas Xanax influences gamma-aminobutyric acid (GABA), leading to potentially more severe side effects including dependency issues.

What conditions is Vistaril approved to treat?

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

  • Anxiety and tension associated with psychoneurosis (an obsolete term for a mental disorder that interferes with normal life but does not affect perception or intelligence)
  • Pruritus due to allergic conditions such as chronic urticaria
  • As an adjunctive therapy in organic disease states in which anxiety is manifested.

On the other hand, Xanax has been sanctioned for use in:

  • Management of anxiety disorders
  • Short-term relief of symptoms of anxiety
  • Panic disorders, with or without agoraphobia.

How does Vistaril help with these illnesses?

Vistaril assists in managing anxiety and tension by impacting activity in the central nervous system. It operates as an antihistamine, specifically targeting H1 receptors and exhibiting sedative properties. This results in a calming effect which helps mitigate symptoms of anxiety and stress. Histamines are chemicals that your body produces during allergic reactions, but they also play roles in your gut and act as neurotransmitters sending signals to your brain.

Xanax, on the other hand, works by enhancing the effects of a certain natural chemical (GABA) in the body which decreases abnormal excitement observed in individuals suffering from anxiety or panic disorders.

While both medications can help manage feelings of anxiety, it's important to note that Xanax is classified as a controlled substance due to its potential for addiction or dependency whereas Vistaril doesn't carry this risk but may cause more side effects such as dry mouth or drowsiness.

What is Xanax?

Xanax, also known by its generic name alprazolam, is a benzodiazepine that enhances the effect of gamma-aminobutyric acid (GABA) in the brain to produce sedative, anti-anxiety and muscle-relaxant effects. Xanax was first approved by the FDA in 1981. Unlike Vistaril which is an antihistamine with sedating properties used primarily for short-term treatment of anxiety and tension associated with certain disease states, Xanax directly increases inhibitory neurotransmission throughout all areas of the central nervous system. This difference means that Xanax's side-effect profile differs from that of Vistaril; it can cause drowsiness or lightheadedness but is less likely to result in dry mouth or constipation - common side effects seen with antihistamines like Vistaril. Dependence on and withdrawal from alprazolam are significant issues due to rapid development of tolerance (its effectiveness decreases over time), especially when used at higher doses over prolonged periods. Its calming effects on GABAergic inhibition can be advantageous for treating panic disorders as well as generalized anxiety disorder, particularly in patients who do not respond optimally to "typical" antianxiety medications such as Vistaril.

What conditions is Xanax approved to treat?

Xanax is approved for the treatment of:

  • Anxiety disorders
  • Panic disorder, with or without agoraphobia (fear of places and situations that might cause panic, helplessness, or embarrassment)

How does Xanax help with these illnesses?

Xanax, also known as alprazolam, is a medication often used to treat generalized anxiety disorder and panic disorders. It functions by enhancing the effects of GABA (gamma-aminobutyric acid), a neurotransmitter that inhibits or reduces the activity of nerve cells in the brain. Such action causes a calming effect on users, reducing feelings of anxiety and fear. Unlike Vistaril which has antihistamine properties and may cause drowsiness as a side effect, Xanax directly affects the central nervous system promoting relaxation and easing tension. Because it can produce significant changes in your mental state due to its potency, Xanax is typically prescribed when other less powerful medications like Vistaril don't yield satisfactory results for patients suffering from severe anxiety conditions.

How effective are both Vistaril and Xanax?

Both hydroxyzine (Vistaril) and alprazolam (Xanax) have established histories of success in treating patients with anxiety, though they were initially approved by the FDA several decades apart. Since they act on different systems within the body, they may be prescribed under different circumstances. The effectiveness of Vistaril and Xanax in alleviating symptoms of anxiety was directly studied in a double-blind clinical trial; both drugs exhibited similar efficacy managing symptoms as well as similar safety profiles.

A review study indicated that hydroxyzine is effective in relieving symptoms of generalized anxiety disorder starting from one week of treatment, its side effect profile is generally favorable compared to benzodiazepines like Xanax, and it has been found to be well-tolerated even among elderly populations. This same study noted that although Vistaril isn't widely used for long-term management of anxiety disorders due to concerns about anticholinergic effects such as dry mouth or urinary retention, it's often utilized for acute exacerbations because it lacks potential for addiction.

On the other hand, a 2017 systematic review demonstrated that alprazolam seems more effective than placebo when treating panic disorder but comes with risks including dependency if used over prolonged periods due to its addictive nature. Alprazolam is typically considered a first-line treatment option meaning it is often picked before alternatives like SSRIs or SNRIs are tried out. However significant research involving Xanax co-prescribed alongside an SSRI suggests data confirming its efficacy as a stand-alone treatment remains limited compared to some other treatments available today. Nonetheless due to unique pharmacology characteristics alprazolam might offer optimal results particularly for individuals who didn't respond favorably towards initial treatment attempts using SSRIs or those who need immediate relief against extreme bouts of panic attack.

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 research has suggested that 25mg four times a day is sufficient for managing anxiety in most adults. Children and adolescents may be started on lower doses, typically between 15-50mg daily taken in divided doses. In either population, dosage can be increased after some weeks if there is inadequate response. However, the maximum dosage that should not be exceeded under any circumstance is 400 mg/day.

At what dose is Xanax typically prescribed?

Xanax therapy typically begins at a dosage of 0.25–0.5 mg taken three times a day. Depending on the patient's response, the dose may be increased every 3 to 4 days in increments of no more than 1 mg per day. The maximum daily dose is generally set at around 4 mg, divided into smaller doses that are spaced out throughout the day. If there is no significant improvement or if symptoms persist after several weeks, your healthcare professional might evaluate and adjust this dosage accordingly.

What are the most common side effects for Vistaril?

Comparative side effects of Vistaril and Xanax can include:

  • Drowsiness or sleepiness
  • Dry mouth
  • Headache
  • Feeling nervous, excited, or irritable
  • Tremors (unintentional trembling or shaking)
  • Nausea, vomiting, upset stomach
  • Skin rash
  • Blurred vision
  • Constipation
  • Decreased libido (sex drive)

In rare cases with both drugs, there may be instances of confusion and lack of coordination. If you experience any unusual symptoms while taking either medication, it is important to consult your healthcare professional immediately.

abstract image of a patient experiencing side effect

Are there any potential serious side effects for Vistaril?

While Vistaril is generally considered safe, it can produce certain side effects in rare cases. These include:

  • Thoughts about suicide or self-harm
  • Allergic reactions such as hives, difficulty breathing, and swelling of your face or throat
  • Severe skin reactions characterized by fever, sore throat, burning eyes, skin pain and a red or purple skin rash that blisters and peels
  • Changes in vision like blurred vision or seeing halos around lights
  • Cardiovascular irregularities including fast or pounding heartbeats, fluttering in your chest, shortness of breath and sudden dizziness which might make you feel like passing out
  • Symptoms indicating low sodium levels such as headache, confusion, slurred speech severe weakness, vomiting loss of coordination and unsteadiness -Severe nervous system reaction causing symptoms similar to serotonin syndrome such as very stiff (rigid) muscles high fever sweating confusion fast or uneven heartbeat tremors feeling faint agitation hallucinations shivering fast heart rate muscle stiffness twitching loss of coordination nausea vomiting diarrhea

If any of these side effects occur while using Vistaril discontinue its use immediately and consult with a healthcare professional.

What are the most common side effects for Xanax?

Xanax, a frequently prescribed benzodiazepine, may result in the following side effects:

  • Dry mouth or changes in salivation
  • Drowsiness, fatigue and possible dizziness
  • Changes in appetite leading to weight fluctuation
  • Difficulty with bowel movements such as constipation
  • Potential difficulty sleeping (insomnia)
  • Possible feelings of nervousness or anxiety paradoxically heightened despite Xanax being an anti-anxiety medication
  • Muscle weakness and potential joint discomfort. Remember though that these side effects do not occur for every individual who takes this medication; however, if you experience any negative symptoms while on Xanax it is crucial to contact your healthcare provider immediately.

Are there any potential serious side effects for Xanax?

While Xanax is generally well-tolerated, it can sometimes cause serious side effects. These may include:

  • Allergic reactions such as swelling of the face, lips or throat; hives; difficulty breathing
  • Severe mood changes including suicidal thoughts and increased anxiety
  • Uncontrollable muscle movements, tremors or convulsions
  • Confusion and hallucinations
  • Vision problems like blurred vision or seeing halos around lights
  • Heart-related issues including palpitations or irregular heartbeats
  • Symptoms indicative of a manic episode: these could involve racing thoughts, drastic increase in energy levels, impulsive behavior, feeling overly happy or irritable without reason, talking more than usual and severe sleep disturbances.

If you experience any of these symptoms while taking Xanax, seek immediate medical attention.

Contraindications for Vistaril and Xanax?

Both Vistaril and Xanax, along with most other anti-anxiety medications, may exacerbate symptoms of anxiety in some people. If you notice worsening anxiety or panic attacks, or an increase in depressive thoughts or behaviors after starting these medications, please seek immediate medical attention.

Neither Vistaril nor Xanax should be taken if you are taking or have recently stopped using opioid medication, sedatives (including alcohol), or other drugs that slow brain activity. Always inform your physician about all the medications and substances you are consuming; opioids and similar substances will require a period of time to clear from the system to prevent dangerous interactions with Vistaril and Xanax. Moreover, it is important to note that both these drugs can cause physical dependence if used for long periods and withdrawal symptoms can occur if they are abruptly discontinued.

How much do Vistaril and Xanax cost?

For the brand name versions of these drugs:

  • The price of 60 tablets of Vistaril (25 mg) averages around $260, which works out to approximately $8.66 per day, depending on your dose.
  • The price of 30 tablets of Xanax (0.5 mg) averages around $280, working out to roughly $9.33 per day.

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

For the generic versions:

  • Hydroxyzine Pamoate (Vistaril's generic form) costs about $15 for 30 capsules at a typical dosage strength (25 mg). Depending on dosages and frequency this can work out to between about $.50 and $1 per day.
  • Alprazolam (Xanax's generic form) costs start from as low as $.70 for one tablet at common prescription doses (.25 mg up to .5 mg), with the cost increasing substantially dependent upon both quantity and dosage strength required.

Popularity of Vistaril and Xanax

Hydroxyzine, in its brand form Vistaril, was estimated to have been prescribed to about 4 million people in the US in 2020. Hydroxyzine accounted for just over 9% of antihistamine prescriptions that are commonly used as anxiolytics or sedatives. It's a first-generation H1 receptor antagonist which has shown consistent utility since its approval.

Alprazolam, including brand versions such as Xanax, was prescribed to approximately 20 million people in the USA in 2020. In the US, alprazolam accounts for around 17% of all benzodiazepine prescriptions and is one of the most-prescribed psychiatric medications overall due to its quick onset and potent effects on anxiety and panic disorders. However, it also carries significant risks such as dependency and withdrawal issues if not managed properly. The prevalence of alprazolam continues to raise some concerns among health professionals due to these associated risks.


Both Vistaril (hydroxyzine) and Xanax (alprazolam) have a long-standing history of use in patients with anxiety, and they are backed by numerous clinical studies indicating that they are more effective than placebo treatments. While both drugs can be used to manage symptoms of anxiety, their mechanisms of action differ significantly. Vistaril is an antihistamine that works by reducing the activity in the central nervous system, while Xanax is a benzodiazepine that enhances the effects of GABA, a neurotransmitter associated with calming nerves.

In some cases, these drugs may be used together under careful supervision by a healthcare professional due to potential interactions. Typically, however, each would usually be prescribed under different circumstances: for example, Vistaril might often be chosen when treating patients who need help managing pruritus or nausea and vomiting related to certain conditions; whereas Xanax would typically be utilized in cases where immediate relief from acute symptoms of panic disorder or generalized anxiety disorder is required.

Both medications are available generically which represents significant cost savings especially for those paying out-of-pocket. With regards to side effects profile - both drugs are generally well-tolerated but do come with their own set of side-effects. Drowsiness tends to occur more commonly with Vistaril use compared to Xanax while dependence issues tend to arise more frequently with prolonged use of Xanax given its potential for abuse as it belongs to Schedule IV controlled substances.

As always when starting treatment on either drug – close monitoring especially during initial stages should take place and medical assistance must immediately ensue if worsening symptoms occur or suicidal thoughts begin manifesting.