Key Takeaways
- Vistaril can help with anxiety quickly, usually working within 15 to 30 minutes.
- Vistaril is not for long-term use because its long-term effectiveness for anxiety is unknown.
- Avoid drinking alcohol with Vistaril, as it can make you more sleepy.
Vistaril (hydroxyzine pamoate) is a prescription drug used to relieve anxiety and tension. Although it is an antihistamine, Vistaril also has a sedative effect, reducing feelings of anxiousness by suppressing activity in subcortical regions of the brain—areas that are often more active in anxious individuals.
If you’ve been prescribed Vistaril for anxiety, it’s important to know how to use this drug safely. This includes understanding its potential side effects, precautions, drug interactions, and more.
Most Important Things to Know About Vistaril
- Vistaril is not recommended during early pregnancy or if you are nursing.
- Taking Vistaril with similar-acting medicines or other central nervous system depressants, including alcohol, can increase its sedative effects.
- If Vistaril overdose is suspected, immediate medical care is critical.
Uses for Vistaril
Vistaril is primarily used to reduce anxiety symptoms. Healthcare providers may prescribe it as an alternative to benzodiazepines, which can be addictive.
Vistaril often provides quick relief, with effects typically felt within 15 to 30 minutes. However, it is generally prescribed for short-term use as its long-term effectiveness for anxiety is not well established.
As an antihistamine, Vistaril is also approved for relieving itchy skin caused by conditions like chronic hives (urticaria) and allergies. It can be prescribed as a preoperative sedative as well.
Off-Label Uses
Healthcare providers might prescribe Vistaril off-label for nausea, vomiting, and sleep difficulties. Off-label use means that, while the drug may provide benefits for these issues, it has not been approved by the U.S. Food and Drug Administration (FDA) as being safe or effective for these purposes.
Care providers sometimes prescribe drugs off-label if there are no approved drugs for a specific condition or if other approved treatment options have been tried without any success.
Side Effects of Vistaril
Some people experience side effects when taking Vistaril. Typically, these side effects are mild and resolve within a few days of starting the medication. Although rare, serious side effects can occur.
Verywell / Jessica Olah
Common Side Effects
Common side effects of Vistaril include:
- Blurred vision
- Confusion
- Dizziness
- Drowsiness
- Dry mouth
- Fatigue
- Headache
- Irritability
- Urinary retention
If you experience any of these effects and they don’t go away or are bothersome, talk with your healthcare provider. They may change the Vistaril dosage to reduce its effects or switch you to one of the other anti-anxiety medications.
Severe Side Effects
Serious side effects are rare, but involuntary motor activity can occur with Vistaril, especially if taken in higher-than-recommended dosages. This may lead to tremors or convulsions.
Other rare but serious side effects of Vistaril include:
- Allergic reactions (difficulty breathing, hives, and/or swelling of face, lips, or tongue)
- Confusion
- Hallucinations
- Increased heart rate
- Priapism (erection lasting four hours or more)
- Skin rash
- Abnormal heartbeat
Contact your healthcare provider or seek immediate medical attention if you experience any of these severe side effects after taking Vistaril.
Long-Term Side Effects
It’s not entirely clear whether taking Vistaril long-term can result in lasting effects. However, some studies have found a connection between drugs with anticholinergic effects—of which Vistaril is one—and an elevated risk of certain health conditions later in life.
For instance, some research suggests a link between anticholinergics and dementia. Another study involving individuals aged 65 and older connected past use of anticholinergic drugs with an increased pneumonia risk.
Precautions and Interactions for Vistaril
Before taking Vistaril for anxiety, it’s important to understand its precautions and potential drug interactions.
Precautions
There have been limited studies on Vistaril usage in individuals aged 65 and older. Therefore, the FDA recommends that people in this age range start on a lower dosage of the drug. They should also be monitored closely to ensure that Vistaril’s sedative properties don’t lead to confusion or over-sedation.
Certain people should avoid taking Vistaril altogether. This includes anyone who:
- Has a hypersensitivity to hydroxyzine, Zyrtec (cetirizine), or Xyzal (levocetirizine)
- Is in the first trimester of pregnancy, close to going into labor, or breastfeeding as this drug can negatively affect the fetus or infant
- Has a heart condition with a long QT interval as this can lead to serious heart problems
Tell your healthcare provider if you have a history of heart disease or a slow or irregular heartbeat before taking Vistaril.
Because Vistaril can cause drowsiness, use caution if driving, operating dangerous machinery, or participating in hazardous activities. When first starting Vistaril, you may want to avoid these activities until you know how it will affect you.
Vistaril is not a long-term anxiety treatment due to a lack of research on whether it is effective when taken for longer than four months. If your anxiety persists, your healthcare provider may explore other options, such as different medications or various types of therapy known to help anxiety disorders.
Drug Interactions
Vistaril can interact with several medications. That’s why it’s important to tell your care provider about any prescription and nonprescription drugs you are taking or plan to take. Your Vistaril dosage may need to be adjusted or you may need to be more closely monitored for side effects.
Drugs that can interact with Vistaril include those with similar properties to this drug, potentially increasing its effects. Among them are:
- Other antihistamines, including Benadryl (diphenhydramine), Zyrtec (cetirizine), and Xyzal (levocetirizine)
- Other anticholinergics, like Cogentin (benztropine)
- Other medications that increase drowsiness, such as the sleep medication Ambien (zolpidem)
- Other medications prescribed to increase the QT interval of the heart, including Elavil (amitriptyline), Celexa (citalopram), and methadone
If you are taking any other central nervous system depressants—which includes narcotics, analgesics, or barbiturates—you want to let your healthcare provider know as your Vistaril dosage should be lowered. Vistaril can also increase the effects of alcohol, so it is recommended that you avoid drinking when taking this drug.
Dosage of Vistaril
Vistaril comes in both capsule and oral suspension (liquid) forms. The capsules are available in two different dosages: 25 mg capsules that are two-tone green and 50 mg capsules that are green and white.
When prescribed for anxiety, the typical adult dose is 50 mg to 100 mg, up to four times a day. However, your healthcare provider will determine the proper dosage for you based on your specific condition, its level of severity (whether you are experiencing mild or severe anxiety, for instance), and its symptoms.
Take this medicine only as directed by your care provider. Don’t take more of it, take it more often, or use it for a longer time than your physician has ordered.
Modifications
Vistaril may be prescribed for children with anxiety, allergies, or as a presurgical medication. However, the dosage recommendations are lower than those indicated for adults.
In children younger than 6 years of age, the maximum recommended dosage for anxiety or allergy conditions is 50 mg per day and it should be taken in divided doses. When prescribed as a presurgical sedative, the recommended dosage is 0.6 mg per kg of body weight.
Missed Dose
If you forget to take Vistaril at your normal time, take it as soon as you remember it—unless it’s almost time for your next dose. In that case, skip it and resume your regular schedule with the next dose.
Overdose
If too much Vistaril is taken, it can result in extreme sedation. Other drug overdose symptoms associated with Vistaril include:
- Convulsions
- Nausea
- Stupor
- Vomiting
In cases of Vistaril overdose, induced vomiting or pumping of the stomach is recommended. Other substances may be used to counteract the medicine’s depressant effects and, during recovery, the individual’s vital signs should be closely monitored.
If an overdose is suspected, contact a poison control center immediately, call 911, or go to the nearest emergency room.
How to Take Vistaril
You don’t have to take this drug with food, but you may if it upsets your stomach. Follow your physician’s instructions to either take Vistaril at regular times daily or to only use it as needed, such as when feelings of anxiousness or tension are increased.
Swallow the capsules whole. Don’t break, crush, or chew them. If you’re taking Vistaril in liquid form, shake it well and measure it with a measuring spoon, oral syringe, or medicine cup—not an ordinary household spoon.
Store capsules below 86 F and liquid Vistaril at room temperature. As with all medications, keep your prescription someplace where it is not accessible to children.
How Long Does Vistaril Last?
Vistaril can start working in as little as 15 minutes with its peak effects occurring at two hours, then waning over the next four to six hours. One dose of Vistaril can last up to four days before leaving the body completely.
Discontinuing Vistaril
Vistaril is a short-term anxiety treatment, generally four months or less. Your healthcare provider should regularly reassess whether it is providing the intended effect (reduced anxiety) or if another treatment option should be pursued instead.
Since Vistaril is not addictive or habit-forming, you should not experience withdrawal symptoms when discontinuing this drug. Still, it’s important to work with your healthcare provider and follow their advice when stopping Vistaril use.
Staying Healthy While Taking Vistaril
When taking Vistaril for anxiety, it’s important to keep an open line of communication with your healthcare provider. Speak with them about any questions or concerns you may have about taking this drug.
Depending on your symptoms, Vistaril may be combined with other medications, such as antidepressants. Your healthcare provider also may combine this drug with other forms of anxiety treatments, such as counseling or psychotherapy.
There are a few additional actions you can take to help improve your health and wellness when being treated for anxiety. Additional strategies to consider include:
If you struggle with anxiety, it can also be beneficial to spend time outdoors. Go for a walk, take a hike, or simply sit in a park and take in the world around you. There are many mental health benefits associated with spending time in nature, with a reduction of anxiety symptoms being one.
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