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Medically Reviewed

What is the Difference Between Hydroxyzine and Xanax?

- 6 sections

Medically Verified: 2/1/24

Medical Reviewer:

Sahil Talwar, PA-C, MBA


All of the information on this page has been reviewed and verified by a certified addiction professional.

Over 40 million adults in the United States struggle with symptoms of an anxiety or panic disorder.[1] Many people take medications to help them manage their symptoms and improve functioning.

This article will explore two medications used to treat anxiety: hydroxyzine and Xanax (alprazolam).

What you will learn:

  • How hydroxyzine and Xanax work
  • What these medications treat
  • The differences between hydroxyzine and Xanax
  • How to recognize hydroxyzine and Xanax abuse and addiction
  • Where to find substance use disorder treatment

Contact the specialists at the Carolina Center for Recovery to learn about our comprehensive substance abuse treatment programs. You may also schedule an intake assessment.

What is Hydroxyzine?

Hydroxyzine pamoate is an FDA-approved drug distributed under the names Atarax, Qiana, and Vistaril.[2] The most common dosage of hydroxyzine is a 0.25 mg tablet. Doctors who prescribe medication will determine the correct dosage for each person based on weight and other factors.

Doctors prescribe hydroxyzine to treat several conditions, including:

  • Insomnia
  • Anxiety
  • Opioid withdrawal symptoms
  • Allergies
  • Eczema

Some reported side effects of hydroxyzine include:

  • Blurred vision
  • Drowsiness
  • Dizziness
  • Constipation

People may also experience other more severe side effects, including:

  • Mood changes
  • Restlessness
  • Confusion
  • Hallucinations
  • Difficulty with urination
  • Tremors

Medical experts believe hydroxyzine is safe to use as prescribed. However, drug interactions with alcohol, opioids, sedatives, and other medications pose a risk of long-term complications.

Some people who use hydroxyzine may develop psychological dependence on the drug. While most health experts agree that the risk of abuse and addiction is low, it is essential to be aware of the signs of abuse and seek treatment when needed.

What is Xanax?

Xanax is the most commonly prescribed benzodiazepine drug in the United States. Doctors prescribe Xanax to patients with anxiety, panic, and sleep disorders.[3] Taking Xanax can help people experience fewer symptoms of these conditions.

Xanax and other benzodiazepines produce calming effects. People may feel relaxed or sedated while using Xanax. Xanax can provide quick, short-term relief of symptoms. The drug begins working as soon as 15 to 30 minutes after people take it.

The pleasurable effects of Xanax can make people want to misuse this drug. Xanax is a controlled substance with a high potential for abuse and addiction.

Xanax misuse includes:

  • Taking a larger dose of Xanax than prescribed
  • Using Xanax more often than prescribed
  • Taking Xanax for a longer period than prescribed
  • Using Xanax recreationally (without a prescription)

Xanax abuse can lead to physical dependence. In many cases, they are prescribed for short-term use to reduce the risk of addiction.

Understanding the Difference Between Hydroxyzine and Xanax

Xanax (alprazolam) and hydroxyzine are both prescription medications that can be used to treat anxiety and panic disorder.

However, these drugs work differently in the body. Xanax increases the amount of a neurotransmitter called gamma-aminobutyric acid (GABA).[4] Increased GABA levels can calm the central nervous system. This reduces symptoms of anxiety and tension.

Hydroxyzine works by suppressing activity in the subcortical region of the brain.[2] This can produce a sedative effect, making the drug effective in the treatment of anxiety.

Doctors initially began using hydroxyzine to treat allergy symptoms, including itching. The drug’s sedative effects make it an effective anti-anxiety drug. Benzodiazepines like Xanax are primarily used for their calming effects.

Hydroxyzine vs Xanax: Risk of Abuse and Addiction

Medical experts believe hydroxyzine has a low risk of abuse or addiction. People who take hydroxyzine may like the drug’s sedative effects and misuse it. Hydroxyzine abuse may include taking larger doses or taking it for a longer period than prescribed.

People may develop a psychological dependence on hydroxyzine. They may believe they require the drug to function normally. They may take larger doses and build a tolerance to it.

Some signs of hydroxyzine abuse include:

  • Extreme sedation
  • Cravings for hydroxyzine
  • Nausea and vomiting
  • Severe skin reactions
  • Seizures
  • Confusion or disorientation
  • Insomnia
  • Anxiety
  • Abdominal pain
  • Blurry vision
  • Constipation
  • Dry eyes
  • Fatigue

It is crucial to watch for signs of hydroxyzine abuse and seek treatment when necessary. However, the risk of hydroxyzine addiction is much lower than opioids, benzodiazepines, or other drugs.

Xanax and other benzodiazepines are highly addictive. People who misuse Xanax may quickly develop tolerance (needing more to get the effects) or addiction. Signs of Xanax abuse and addiction include:

  • Experiencing cravings for Xanax
  • Taking Xanax is risky or inappropriate situations, like at work or while driving
  • Using Xanax without a prescription
  • Having multiple prescriptions for Xanax from different doctors (doctor shopping)
  • Stealing Xanax or buying it illegally
  • Misuse that leads to withdrawal symptoms when you stop taking it
  • Wanting to stop using it but finding it’s impossible

People who abuse Xanax are at increased risk of overdose. Symptoms of a Xanax overdose include:

  • Slurring
  • Slow or shallow breathing
  • Confusion
  • Loss of consciousness
  • Altered mental status
  • Loss of muscle control

A Xanax overdose can be life-threatening. If you or someone near you exhibits symptoms of an overdose, you must call 911 right away. Wait with the person until help arrives.

Get Treatment Now

If you or someone you love struggles with hydroxyzine or Xanax abuse, you are not alone. Contact the Carolina Center for Recovery specialists to explore our comprehensive treatment programs or schedule an intake assessment.


  1. Forbes Health: Anxiety Statistics And Facts
  2. Science Direct: Hydroxyzine
  3. National Institute of Health (NIH): A Review of Alprazolam Use, Misuse, and Withdrawal
  4. William’s University: Positive Neuromodulation of GABAa Receptors: Tranquilizers