How long does it take for vistaril to work?

PMC

To the Editor: In a given year, approximately 6 million American adults aged 18 years or older have panic disorder.1,2 To the best of our knowledge, this is the first report to document the successful treatment of acute exacerbation of panic disorder with hydroxyzine in a healthy adult.

Case report. Mr A, a 25-year-old man with a history of panic disorder, presented in 2010 to the emergency department complaining of chest pain, tachycardia, palpitations, hyperventilation, shortness of breath, sweating, nausea, and vomiting. Moreover, he reported derealization, a sense of doom, and constant fear of having another panic attack. Mr A stated that he had been having panic attacks about 3 or 4 times daily for the previous week. Myocardial infarction was ruled out. Blood workup was inconclusive for any other medical cause.

Mr A had been on venlafaxine 75 mg/d orally for the previous 6 months. He had taken paroxetine 40 mg/d orally with no improvement for the 6 months prior to starting venlafaxine. Past medical, surgical, and family histories were not significant for any major illnesses. He was employed and single and smoked half a pack of cigarettes daily, but had no history of alcohol or illegal drug use. The patient denied having any psychosocial stressors. Physical examination findings revealed no abnormalities.

Mr A was admitted to the acute psychiatry unit for observation. Upon admission to the unit, hydroxyzine 25 mg 3 times daily was started with no other changes in medication or therapy. The patient received prompt relief, and there were no further panic attacks during his 3-day admission or his 1-month follow-up.

To the best of our knowledge, there are no published cases of successful treatment of acute exacerbation of panic disorder with hydroxyzine in healthy adults. There has been clear evidence of the anxiolytic efficacy of hydroxyzine. In a controlled trial in generalized anxiety disorder patients, hydroxyzine demonstrated greater and more rapid cognitive improvement compared to lorazepam.3 Moreover, it has also shown a lack of organ toxicity and an absence of dependency.

As reported in our case, an acute exacerbation of panic disorder was effectively managed by hydroxyzine in a healthy adult. If practitioners recognize this association, extensive use of benzodiazepines may be prevented.

What is Atarax?

The dose medicines in this class will be different for different patients. Follow your doctor’s orders or the directions on the label. The following information includes only the average doses of these medicines. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

For use as an antihistamine:

    For azatadine

  • For oral dosage form (tablets):
    • Adults—1 to 2 milligrams (mg) every eight to twelve hours as needed.
    • Children 12 years of age and older—0.5 mg to 1 mg two times a day as needed.
    • Children 4 to 12 years of age—Use and dose must be determined by your doctor.
    • Children and infants up to 4 years of age—Use is not recommended .

    For brompheniramine

  • For regular (short-acting) oral dosage forms (capsules, tablets, or liquid):
    • Adults and teenagers—4 milligrams (mg) every four to six hours as needed.
    • Children 6 to 12 years of age—2 mg every four to six hours as needed.
    • Children 4 to 6 years of age—1 mg every four to six hours as needed.
    • Children and infants up to 4 years of age—Use is not recommended .
  • For injection dosage form:
    • Adults and teenagers—10 milligrams (mg) injected into a muscle, under the skin, or into a vein every eight to twelve hours.
    • Children 4 to 12 years of age—0.125 mg per kilogram (0.06 mg per pound) of body weight injected into a muscle, under the skin, or into a vein three or four times a day as needed.
    • Children and infants up to 4 years of age—Use is not recommended .

    For cetirizine

  • For oral dosage forms (syrup and tablets):
    • Adults—5 to 10 milligrams (mg) once a day.
    • Children 6 years of age and older—5 to 10 mg once a day.
    • Children 4 to 6 years of age—2.5 mg once a day, up to a maximum of 5 mg once a day or 2.5 mg twice a day.
    • Children and infants up to 4 years of age—Use is not recommended .

    For chlorpheniramine

  • For regular (short-acting) oral dosage forms (tablets or liquid):
    • Adults and teenagers—4 milligrams (mg) every four to six hours as needed.
    • Children 6 to 12 years of age—2 mg three or four times a day as needed.
    • Children 4 to 6 years of age—Use and dose must be determined by your doctor.
    • Children and infants up to 4 years of age—Use is not recommended .
  • For long-acting oral dosage forms (capsules or tablets):
    • Adults—8 or 12 milligrams (mg) every eight to twelve hours as needed.
    • Children 12 years of age and older—8 mg every twelve hours as needed.
    • Children 4 to 12 years of age—Use and dose must be determined by your doctor.
    • Children and infants up to 4 years of age—Use is not recommended .
  • For injection dosage form:
    • Adults—5 to 40 milligrams (mg) injected into a muscle, into a vein, or under the skin.
    • Children 4 years of age and older—0.0875 mg per kilogram (0.04 mg per pound) of body weight injected under the skin every six hours as needed.
    • Children and infants up to 4 years of age—Use is not recommended .

    For clemastine

  • For oral dosage forms (tablets or liquid):
    • Adults and teenagers—1.34 milligrams (mg) two times a day or 2.68 mg one to three times a day as needed.
    • Children 6 to 12 years of age—0.67 to 1.34 mg two times a day.
    • Children 4 to 6 years of age—Use and dose must be determined by your doctor.
    • Children and infants up to 4 years of age—Use is not recommended .

    For cyproheptadine

  • For oral dosage forms (tablets or liquid):
    • Adults and children 14 years of age and older—4 milligrams (mg) every eight hours. The doctor may increase the dose if needed.
    • Children 6 to 14 years of age—4 mg every eight to twelve hours as needed
    • Children 4 to 6 years of age—2 mg every eight to twelve hours as needed
    • Children and infants up to 4 years of age—Use is not recommended .

    For desloratadine

  • For oral dosage form (tablets):
    • Adults and children 12 years of age and older—5 milligrams (mg) once a day.
    • Children 4 to 12 years of age—Use and dose must be determined by your doctor.
    • Children and infants up to 4 years of age—Use is not recommended .

    For dexchlorpheniramine

  • For regular (short-acting) oral dosage form (tablets or liquid):
    • Adults and teenagers—2 milligrams (mg) every four to six hours as needed.
    • Children 5 to 12 years of age—1 mg every four to six hours as needed.
    • Children 4 to 5 years of age—0.5 mg every four to six hours as needed.
    • Children and infants up to 4 years of age—Use is not recommended .
  • For long-acting oral dosage form (tablets):
    • Adults—4 or 6 milligrams (mg) every eight to twelve hours as needed.
    • Children 4 years of age and older—Use and dose must be determined by your doctor.
    • Children and infants up to 4 years of age—Use is not recommended .

    For diphenhydramine

  • For oral dosage forms (capsules, tablets, or liquid):
    • Adults and teenagers—25 to 50 milligrams (mg) every four to six hours as needed.
    • Children 6 to 12 years of age—12.5 to 25 mg every four to six hours.
    • Children 4 to 6 years of age—6.25 to 12.5 mg every four to six hours.
    • Children and infants up to 4 years of age—Use is not recommended .
  • For injection dosage form:
    • Adults—10 to 50 milligrams (mg) injected into a muscle or into a vein.
    • Children 4 years of age and older—1.25 mg per kg (0.6 mg per pound) of body weight injected into a muscle four times a day.
    • Children and infants up to 4 years of age—Use is not recommended .

    For doxylamine

  • For oral dosage form (tablets):
    • Adults and teenagers—12.5 to 25 milligrams (mg) every four to six hours as needed.
    • Children 6 to 12 years of age—6.25 to 12.5 mg every four to six hours as needed.
    • Children 4 to 6 years of age—Use and dose must be determined by your doctor.
    • Children and infants up to 4 years of age—Use is not recommended .

    For fexofenadine

  • For oral dosage form (capsules):
    • Adults and teenagers—60 milligrams (mg) two times a day as needed or 180 mg once a day.
    • Children 6 to 11 years of age—30 mg twice a day as needed.
    • Children 4 to 6 years of age—Use and dose must be determined by your doctor.
    • Children and infants up to 4 years of age—Use is not recommended .

    For loratadine

  • For oral dosage forms (tablets or liquid):
    • Adults and children 6 years of age and older—10 milligrams (mg) once a day.
    • Children 4 to 5 years of age—5 mg once a day.
    • Children and infants up to 4 years of age—Use is not recommended .

    For phenindamine

  • For oral dosage form (tablets):
    • Adults and teenagers—25 milligrams (mg) every four to six hours as needed.
    • Children 6 to 12 years of age—12.5 mg every four to six hours as needed.
    • Children 4 to 6 years of age—Use and dose must be determined by your doctor.
    • Children and infants up to 4 years of age—Use is not recommended .

For nausea, vomiting, and vertigo (only dimenhydrinate and diphenhydramine are used for vertigo):

    For dimenhydrinate

  • For regular (short-acting) oral dosage forms (tablets or liquid):
    • Adults and teenagers—50 to 100 milligrams (mg) every four to six hours as needed.
    • Children 6 to 12 years of age—25 to 50 mg every six to eight hours as needed.
    • Children 4 to 6 years of age—12.5 to 25 mg every six to eight hours as needed.
    • Children and infants up to 4 years of age—Use is not recommended .
  • For long-acting oral dosage forms (capsules):
    • Adults—1 capsule (contains 25 milligrams for immediate action and 50 mg for long action) every twelve hours.
    • Children 4 years of age and older—Use and dose must be determined by your doctor.
    • Children and infants up to 4 years of age—Use is not recommended .
  • For injection dosage form:
    • Adults—50 milligrams (mg) injected into a muscle or into a vein every four hours as needed.
    • Children 2 years of age and older—1.25 mg per kg (0.6 mg per pound) of body weight injected into a muscle or into a vein every six hours as needed.
    • Children and infants up to 4 years of age—Use is not recommended .
  • For suppository dosage form:
    • Adults—50 to 100 milligrams (mg) inserted into the rectum every six to eight hours as needed.
    • Children 12 years of age and older—50 mg inserted into the rectum every eight to twelve hours as needed.
    • Children 8 to 12 years of age—25 to 50 mg inserted into the rectum every eight to twelve hours as needed.
    • Children 6 to 8 years of age—12.5 to 25 mg inserted into the rectum every eight to twelve hours as needed.
    • Children 4 to 6 years of age—Use and dose must be determined by your doctor.
    • Children and infants up to 4 years of age—Use is not recommended .

    For diphenhydramine

  • For oral dosage forms (capsules, tablets, or liquid):
    • Adults—25 to 50 milligrams (mg) every four to six hours as needed.
    • Children 4 years of age and older—1 to 1.5 mg per kg (0.45 to 0.7 mg per pound) of body weight every four to six hours as needed.
    • Children and infants up to 4 years of age—Use is not recommended .
  • For injection dosage form:
    • Adults—10 milligrams (mg) injected into a muscle or into a vein. Dose may be increased to 25 to 50 mg every two to three hours.
    • Children 4 years of age and older—1 to 1.5 mg per kg (0.45 to 0.68 mg per pound) of body weight injected into a muscle every six hours.
    • Children and infants up to 4 years of age—Use is not recommended .

    For hydroxyzine

  • For oral dosage forms (capsules, tablets, or liquid):
    • Adults—25 to 100 milligrams (mg) three or four times a day as needed.
    • Children 6 years of age and older—12.5 to 25 mg every six hours as needed.
    • Children 4 to 6 years of age—12.5 mg every six hours as needed.
    • Children and infants up to 4 years of age—Use is not recommended .
  • For injection dosage form:
    • Adults—25 to 100 milligrams (mg) injected into a muscle.
    • Children 4 years of age and older—1 mg per kg (0.45 mg per pound) of body weight injected into a muscle.
    • Children and infants up to 4 years of age—Use is not recommended .

For Parkinson’s disease:

    For diphenhydramine

  • For oral dosage forms (capsules, tablets, or liquid):
    • Adults—25 milligrams (mg) three times a day when starting treatment. Your doctor may increase the dose gradually later if needed.
  • For injection dosage form:
    • Adults—10 to 50 milligrams (mg) injected into a muscle or into a vein.
    • Children—1.25 mg per kg (0.6 mg per pound) of body weight four times a day injected into a muscle.

For use as a sedative (to help sleep):

    For diphenhydramine

  • For oral dosage forms (capsules, tablets, or liquid):
    • Adults—50 milligrams (mg) twenty to thirty minutes before bedtime if needed.

    For doxylamine

  • For oral dosage form (tablets):
    • Adults—25 milligrams (mg) thirty minutes before bedtime if needed.
    • Children 4 years of age and older—Use and dose must be determined by your doctor.
    • Children and infants up to 4 years of age—Use is not recommended .

    For hydroxyzine

  • For oral dosage forms (capsules, tablets, or liquid):
    • Adults—50 to 100 milligrams (mg).
    • Children 4 years of age and older—0.6 mg per kg (0.3 mg per pound) of body weight.
    • Children and infants up to 4 years of age—Use is not recommended .
  • For injection dosage form:
    • Adults—50 milligrams (mg) injected into a muscle.

For anxiety:

    For hydroxyzine

  • For oral dosage forms (capsules, tablets, or liquid):
    • Adults—50 to 100 milligrams (mg).
    • Children 4 years of age and older—0.6 mg per kg (0.3 mg per pound) of body weight.
    • Children and infants up to 4 years of age—Use is not recommended .
  • For injection dosage form:
    • Adults—50 to 100 milligrams (mg) injected into a muscle every four to six hours as needed.
    • Children 4 years of age and older—1 mg per kilogram (0.45 mg per pound) of body weight injected into a muscle.
    • Children and infants up to 4 years of age—Use is not recommended .

Vistaril

Medical Editor: John P. Cunha, DO, FACOEP

Last reviewed on RxList 7/17/2017

Vistaril (hydroxyzine pamoate) is an antihistamine with anticholinergic (drying) and sedative properties used as a sedative to treat anxiety and tension. Vistaril is also used together with other medications given for anesthesia. Vistaril may also be used to control nausea and vomiting, or to treat allergic skin reactions such as hives or contact dermatitis. Vistaril is available in generic form. Common side effects of Vistaril include:

  • dizziness,
  • drowsiness,
  • blurred vision,
  • dry mouth,
  • stomach upset,
  • or headache.

Tell your doctor if you experience serious side effects of Vistaril including:

The recommended dose of Vistaril for treating itch (pruritus) is 25 mg, 3 or 4 times daily. For sedation, the recommended dose is 50 to 100 mg. The dose to treat anxiety and tension is 50 to 100 mg 4 times daily. Vistaril may interact with other medicines that make you sleepy (such as cold or allergy medicine, sedatives, narcotic pain medicine, sleeping pills, muscle relaxers, and medicine for seizures, depression, or anxiety). Tell your doctor all prescription and over-the-counter medications and supplements you use. Vistaril is not recommended for use during pregnancy. It could harm the fetus. Discuss birth control with your doctor. It is unknown if this medication passes into breast milk or if it could harm a nursing baby. Consult your doctor before breastfeeding.

Our Vistaril (hydroxyzine pamoate) Side Effects Drug Center provides a comprehensive view of available drug information on the potential side effects when taking this medication.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Which anti-anxiety medication is right for me?

What are anxiety disorders?

Anxiety disorders affect 31.9 percent of people between the ages of 13 and 18, and women are twice as likely to develop an anxiety disorder as men. Common examples of anxiety disorders include generalized anxiety disorder, panic disorder, social anxiety disorder, substance-induced anxiety disorder and specific phobias.

“An anxiety disorder does more than make you anxious. They can affect your entire life. Plus, untreated anxiety can lead to other mental health disorders and physical conditions,” Alonzo said. “We have no way of predicting what will cause someone to develop an anxiety disorder. However, you can take steps to reduce the impact of symptoms such as getting help from a health care professional early and avoiding the use of non-prescribed drugs and alcohol.”

Do I have an anxiety disorder?

Common signs and symptoms of anxiety include nervousness, restlessness or tenseness, a sense of impending danger or doom, increased heart rate, breathing rapidly, sweating, trembling, feeling weak or tired, trouble concentrating or sleeping, stomach aches and headaches and the urge to avoid things that trigger anxiety.

Anxiety disorders often develop from a complex set of risk factors. The risk factors may include exposure to trauma, certain medical problems like thyroid disease or heart disease, stress due to a severe illness and other mental health disorders like depression. The use or misuse of drugs and alcohol can worsen symptoms of anxiety.

“Anxiety disorders are best treated with a combination of therapy and medication,” Alonzo said. “It takes time to find the perfect combination for your symptoms. Your primary care provider is the best place to start that journey.”

Benzodiazepines for anxiety

“For years, providers have prescribed benzodiazepines to treat symptoms of acute anxiety,” Alonzo said. Benzodiazepines also treat severe muscle spasms, tremors and acute seizures.

Benzodiazepines, such as Xanax and Klonopin, provide rapid relief from a panic attack. Providers may also prescribe them to prevent cases of acute anxiety like those stemming from a plane ride, for those with a fear of flying, or the moments leading up to a surgery.

Unlike other anti-anxiety medications, benzodiazepines are controlled substances. You can develop a tolerance to benzodiazepines and a dependence to them over time. Additionally, trying to suddenly stop taking a benzodiazepine can cause life-threatening withdrawal that may include seizures. For these reasons, providers typically prescribe benzodiazepines at low doses for limited amounts of time.

Buspirone for anxiety

“Another common medication used to treat anxiety is buspirone, which is also known under the brand name Buspar,” Alonzo said. “It interacts with certain neuroreceptors in the brain that control mood which can decrease anxiety symptoms.”

Buspirone may help patients think more clearly and relax with less worry. It may also help anxiety symptoms like irritableness, sweating and trouble sleeping.

Alonzo cautions about consuming alcohol and grapefruit or grapefruit juice when taking buspirone. “Tell your health care provider or pharmacist about other medications, vitamins and herbal supplements you take, as well as if you drink alcohol, smoke, vape or use illegal substances,” Alonzo said. Common side effects of buspirone may include dizziness, nervousness, drowsiness and lightheadedness. “Avoiding anything that might make these side effects worse is a good strategy.”

Hydroxyzine for anxiety

Hydroxyzine, also known under the brand names Atarax and Vistaril, is an antihistamine that has an effect on regulating the chemicals in your brain, which helps control anxiety on a short-term basis. These medications have a calming effect on the brain, and providers may prescribe it prior to a surgery to ease nerves and help sleep.

“Hydroxyzine can cause drowsiness and decreased alertness,” Alonzo said. “It is important that patients take precautions not to drive and to be careful around the home, so they do not fall.”

The effects of hydroxyzine can happen quickly, unlike buspirone, which may take time to become effective. Hydroxyzine and buspirone are not controlled substances. They also do not cause tolerance, dependence or withdrawal.

Meclizine for anxiety

Meclizine, also an antihistamine, is most often used to treat motion sickness and dizziness. The drug, sold under the brand name Antivert, can also treat nausea and dizziness during panic attacks. However, there is no evidence that meclizine decreases anxiety long term.

“Meclizine may take up to an hour to become effective. It can help with nausea and dizziness associated with panic attacks,” Alonzo said. “Those with a specific anxiety trigger like air travel may take it before a flight, as the effects will last between eight and 24 hours.”

What are SSRIs and SNRIs?

Selective serotonin reuptake inhibitors (SSRIs) like Zoloft and Prozac, and serotonin and norepinephrine reuptake inhibitors (SNRIs) like Effexor and Pristiq are antidepressant medications, but they can help with anxiety symptoms as well. For this reason, many providers will prescribe an SSRI or SNRI if you have a combination of depression and anxiety.

“SSRIs and SNRIs are not an instant fix for symptoms associated with an anxiety disorder, nor do they even provide immediate relief,” Alonzo said. “They work by interacting with the neurotransmitters and receptors in your brain, which can help regulate mood, sleep and energy levels. It is important for patients to understand that these medications may take four to six weeks for full effect.”

Some patients may respond better to one of these medications than others. If after taking the medication for two weeks and symptoms have not improved, talk to your provider to have your medication regimen adjusted. Treatment trials with more than one medication are not uncommon.

Combining anti-anxiety medications, opioids and alcohol

More than 30 percent of overdoses involving opioids also involve anti-anxiety medications. Alonzo said. “Benzodiazepines and opioids both cause sedation and suppress breathing. Alcohol plays a role in decreasing consciousness and cognitive ability. These substances together can be incredibly dangerous, even fatal.”

Alonzo, an integral part of the Texas A&M Health Science Center Opioid Task Force, works to educate the community about the risks of opioid misuse. “The opioid crisis is an incredibly complex problem with many driving factors,” she said. “We need strategies to better educate both prescribers and patients alike on the dangers of certain prescription medications, especially when taken in combination and with alcohol.”

Patients who misuse prescription medications might believe that these substances are safer than illicit substances, which is not the case. Any patient under treatment with a prescription medication for a mental health disorder should discuss the use of alcohol, over-the-counter medications and other substances with their pharmacist or provider.

Are anti-anxiety medications safe when pregnant or breastfeeding?

“Before taking any prescription medication, you should always speak with your health care provider or pharmacist if you are pregnant or plan to become pregnant,” Alonzo said. “Certain medications like SSRIs and SNRIs have not been adequately studied in pregnancy. Everyone needs to have an open conversation about those risks.”

Generally, providers do not recommend benzodiazepines during pregnancy or during breastfeeding because they can get into breast milk. The nursing infant has the potential to experience symptoms like sedation, feeding difficulties and weight loss.

You and your health care team should evaluate the benefits of breastfeeding with the risk of potential infant drug exposure and an untreated or inadequately treated mental health disorder in the mother.

Which anti-anxiety medication is best?

Anxiety disorders are treated differently depending on the person. “Mental health disorder treatments are not a one-size-fits-all approach. You need to include your primary care practitioner, therapist and pharmacist to find which treatment works best for you,” Alonzo said. “It may take time to find the right treatment. However, there is hope for your recovery and you are worth it.”

If you are having trouble managing your anxiety, then speak with a health care provider about your options.

— Mary Leigh Meyer

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