Vistaril (Hydroxyzine Pamoate) for Anxiety

Whether this drug is excreted in human milk is not known. Don't take Vistaril if you are breastfeeding.

What Is Vistaril?

Vistaril (hydroxyzine pamoate) is a prescription drug that a healthcare provider might give you for anxiety, itching, or hives, or to help sedate you before a surgical procedure. It belongs to these classes:

  • Antiemetic agents
  • Antihistamines, first generation
  • Antihistamines
  • Piperazine derivatives

It comes in 25 mg two-tone green capsules, 50 mg green and white capsules, and 10, 25, and 50 mg tablets.

Drug Facts

Generic name: Hydroxyzine pamoate

Brand name: Vistaril

Drug availability: Prescription

Therapeutic classification: Antiemetic agent; antihistamine, first-generation; antihistamine; piperazine derivative

Available generically: Yes

Controlled substance: No

Administration route: Orally or by intramuscular injection

Active ingredient: Hydroxyzine pamoate

Dosage forms: Tablet, capsule

Uses

Vistaril is used as a short-term treatment of anxiety symptoms and as an alternative to habit-forming anxiety medications, such as benzodiazepines. Vistaril is also prescribed as an antihistamine to treat skin allergies and, therefore, can be a good choice for combined allergies and anxiety. Sometimes, healthcare providers use it as a preoperative sedative.

How to Take Vistaril

You don't have to take this drug with food, but you may if it upsets your stomach. Follow your doctor's instructions to either take it every day at regular times or only as needed.

If you're taking the liquid form, shake it well and measure it with a measuring spoon, oral syringe, or medicine cup, not an ordinary household spoon. Swallow tablets or capsules whole. Don't break, crush, or chew them.

Take this medicine only as directed by your doctor. Don't take more of it, more often, or for a longer time than your doctor ordered. Store capsules and tablets below 86 F, and liquid at room temperature.

Off-Label Uses

Healthcare providers might administer Vistaril by intramuscular injection to help control nausea and vomiting.

Vistaril Side Effects

You might experience several side effects or none at all when taking this drug. Always consult your doctor if you're concerned about how you feel while taking this medication.

This is not a complete list of side effects and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your pharmacist or a medical professional. You may report side effects to the FDA at www.fda.gov/medwatch or 800-FDA-1088.

Common Side Effects

Common side effects of Vistaril include dry mouth and drowsiness. However, these effects are usually mild and short-lived. Older adults might experience constipation or confusion. Dizziness and headache have also been reported.

side effects of vistaril

Verywell / Jessica Olah

Severe Side Effects

Rarely, tremor or convulsions can develop, usually with high dosages. Call your doctor immediately if you experience trembling or seizures. Stop taking Vistaril immediately and call your doctor if you develop a rash, pus-filled sores, swelling, or fever.

Long-Term Side Effects

You should not be prescribed Vistaril for more than four months; researchers have not systematically studied its effectiveness over the long term.

Some research suggests a link between long-term use and dementia, particularly in older adults. Many other alternatives are available to treat your anxiety long-term.

Dosage

A typical adult dose for anxiety is 50 to 100 mg up to four times a day.

All listed dosages are according to the drug manufacturer. Check your prescription and talk to your doctor to make sure you are taking the right dose for you.

Modifications

Vistaril may be combined with other medications, such as antidepressants, depending on your symptoms. Your healthcare provider also may combine it with other treatments, such as psychotherapy.

The general dosage for children younger than 6 years is 2 mg per kg per day in divided dosages, not to exceed 50 mg per day. As in adults, Vistaril may be used in children as both an anti-anxiety treatment and an antihistamine.

Missed Dose

If you forget to take a dose, 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

The risk of overdose of Vistaril is low, with the result generally being extreme sedation. Other symptoms of an overdose include stupor, dizziness, nausea, vomiting, and seizures. Contact a poison control center or 911. Usually, they will instruct you to induce vomiting if it hasn't occurred already.

Precautions

Don't drink alcohol or use recreational drugs while taking Vistaril. Use caution if driving, operating dangerous machinery, or participating in hazardous activities.

If you're undergoing medical testing, tell laboratory staff and all of your healthcare providers that you're taking Vistaril; it can affect the results.

Reasons Not to Take Vistaril

You should not take Vistaril if you have a hypersensitivity to hydroxyzine, Zyrtec (cetirizine), or Xyzal (levocetirizine). It is not recommended if you are pregnant or breastfeeding; it is not known whether the medicine passes into breast milk, or causes birth defects or other harm to a fetus.

Don't take Vistaril if you have a heart condition with a long QT interval; it can lead to serious heart problems. Discuss any history of heart disease or a slow or irregular heartbeat with a healthcare provider.

Vistaril is not a good choice for long-term treatment of anxiety, as it has not been shown to be effective for this use.

Interactions

Vistaril can interact with several medications including narcotics, antihistamines, analgesics, and barbiturates. It also can increase the effect of alcohol.

Don't use Vistaril with antihistamine creams or sprays such as diphenhydramine; increased side effects may result. Use caution if you're taking Vistaril with any other medications that can cause drowsiness.

Be sure to tell your doctor about any nonprescription or prescription drugs you are taking or plan to take. Your dosages may need to be adjusted, or you may need to be monitored for side effects.

Similar Medications

Vistaril is similar to cetirizine and levocetirizine; don't take either of these while taking Vistaril.

Staying Healthy While Taking Vistaril

Follow all of your healthcare provider's directions carefully and call with any questions or concerns. If you're being treated for anxiety, also look into additional therapies and strategies such as counseling, meditation, yoga, and deep breathing exercises. As always, try to get enough sleep, eat healthfully, drink plenty of water, exercise, and get fresh air.

A Word From Verywell

If you have been prescribed Vistaril by your doctor, be sure to follow the instructions for dosage. If you find that this medication does not help your anxiety, talk with your doctor about other medication or treatment alternatives.

Frequently Asked Questions

  • How long does Vistaril last?

    Vistaril can start working in as little as 15 minutes after you take it. You'll feel its peak effects at 30 to 60 minutes, which will wane in four to six hours. One dose takes between one and four days to leave an adult body completely.

  • How long does Vistaril stay in your system?

    Vistaril's effects wear off in four to six hours, but a single dose of the drug lingers in your body for one to four days.

3 Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. U.S. Food and Drug Administration. Vistaril (hydroxyzine pamoate).

  2. Cai X, Campbell N, Khan B, Callahan C, Boustani M. Long-term anticholinergic use and the aging brainAlzheimers Dement. 2013;9(4):377-385. doi:10.1016/j.jalz.2012.02.005

  3. Schlit AF, Delaunois A, Colomar A, et al. Risk of QT prolongation and torsade de pointes associated with exposure to hydroxyzine: Re-evaluation of an established drugPharmacol Res Perspect. 2017;5(3):e00309. doi:10.1002/prp2.309

Additional Reading

By Arlin Cuncic
Arlin Cuncic, MA, is the author of "Therapy in Focus: What to Expect from CBT for Social Anxiety Disorder" and "7 Weeks to Reduce Anxiety."