Hydroxyzine: What it does and how to use it

Hydroxyzine is an antihistamine you’ve probably heard of for allergies and itching. But it also helps with anxiety, sleep before procedures, and nausea in some cases. It works fast to reduce itching and calm the nervous system, and doctors prescribe it when a stronger sedative or benzodiazepine isn’t ideal.

How hydroxyzine is used

People take hydroxyzine for a few common reasons: allergy symptoms (hives, itching), short-term anxiety relief, trouble sleeping, and as a premedication before surgery. It comes as tablets, syrup, and in hospitals it may be given by injection. The two main forms are hydroxyzine hydrochloride (often for allergies) and hydroxyzine pamoate (commonly used for anxiety/sedation).

Typical adult doses vary by use: for itching or allergy, doctors often prescribe 25–100 mg a day divided into several doses; for anxiety or sleep, single doses of 25–50 mg at bedtime are common. Kids get much lower doses based on weight. Always follow your prescriber — these numbers are a guide, not a prescription.

Safety, side effects, and interactions

Most people notice drowsiness, dry mouth, and sometimes dizziness. Because it sedates, avoid driving or operating heavy machinery until you know how it affects you. Older adults are more likely to feel confused or faint because of the sedating and anticholinergic effects.

Hydroxyzine can add to the sedation from alcohol, opioids, sleep medicines, and some antidepressants — don’t mix them without medical advice. There’s also a risk of QT prolongation (a heart rhythm change) at high doses or when combined with other QT drugs, so tell your doctor about any heart meds or irregular heartbeat.

If you’re pregnant or breastfeeding, talk to your clinician. Hydroxyzine is usually avoided late in pregnancy because it can affect newborn breathing and muscle tone. For kids, dosing must be precise — ask your pediatrician.

One interesting note: early lab research found that some antihistamines, including hydroxyzine, showed activity against certain viruses in cell tests. That’s lab work, not a reason to start taking the drug for infections. Always stick to approved uses unless your doctor recommends otherwise.

Practical tips: take hydroxyzine with food if it upsets your stomach, store it at room temperature, and don’t stop suddenly if your doctor prescribed it for anxiety without checking first. If you notice fast heartbeat, severe dizziness, allergic reaction, or fainting, seek medical help right away.

Questions for your provider: is this the best option for my anxiety or sleep problem? Could it interact with my other meds? What dose is safest given my age and heart history? A short chat with your clinician clears up these points and keeps you safe while getting the relief you need.