Hydroxyzine and Alcohol: Risks and Side Effects

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July 5, 2023

Hydroxyzine is an antihistamine, which is a type of common allergy medications.

It's unique compared to other antihistamines in that it's the only one that the FDA also approves to treat anxiety because it can make you feel sleepy and relaxed. While that’s very helpful if you regularly deal with allergies and anxiety, Hydroxyzine can lead to dangerous side effects when taken with alcohol or many other drugs.

The Short Answer.

  • Hydroxyzine (Atarax, Vistaril) is a medication that can treat itching and active symptoms of anxiety.
  • Mixing alcohol and hydroxyzine may worsen the risk of side effects like drowsiness.
  • It’s recommended to talk to your healthcare provider if you have anxiety and also drink alcohol.

What are the risks of mixing hydroxyzine with alcohol?

Hydroxyzine shouldn’t be taken together with alcohol, since using the two substances together can worsen the side effects of both:

  • Drinking alcohol can increase the central nervous system (CNS) side effects of hydroxyzine, such as sleepiness, dizziness, and difficulty concentrating.
  • Hydroxyzine, in turn, can worsen the side effects of alcohol, including drowsiness, impaired thinking and judgement, and problems with impulse control.

Can I drink alcohol while taking hydroxyzine?

In short, no — you should probably avoid the combination. Using them at the same time can worsen alcohol’s side effects, and hydroxyzine’s side effects can also be made worse by alcohol — more on this below. 

Is having one or two drinks OK?

Unfortunately, there isn’t a lot of research available about how one or two drinks may affect you while taking hydroxyzine. Hydroxyzine’s prescribing information advises against combining it with alcohol.

If you take hydroxyzine and drink alcohol, it’s recommended to talk to your healthcare provider to discuss your risks of combining the two. Each person may react differently to the combination’s effects.

What is hydroxyzine (Vistaril)?

So, what exactly is hydroxyzine (brand names Vistaril, Atarax)? It’s an antihistamine (a class of drugs usually used for treating allergy symptoms). It’s the only antihistamine that the FDA also approves for anxiety. Hydroxyzine is available only by prescription. Unlike many other antihistamines, you can’t buy it over-the-counter (OTC) (Garakani, 2020; FDA, 2014).

As the name suggests, antihistamines work by blocking the effects of histamines in your body—histamines are what cause an allergic response to certain substances. Unlike other antihistamines, hydroxyzine doesn’t only affect the body’s histamines; it also affects levels of serotonin, a neurotransmitter in your brain involved in mood. It’s not clear how hydroxyzine works to relieve anxiety, but it may work similarly to antidepressants that affect serotonin levels, such as selective serotonin reuptake inhibitors (SSRIs).

Hydroxyzine side effects

The most common side effects of hydroxyzine include (National Library, 2020):

  • Sedation (sleepiness and relaxation)
  • Abnormal heart rhythm
  • Dry mouth
  • Dry eyes
  • Constipation
  • Headache

In rare cases, there can also be severe side effects, such as:

  • Trembling or shaking
  • Seizures, convulsions
  • Stupor, or a state of unresponsiveness
  • Excessive nausea and vomiting
  • Certain heart problems that cause fast, abnormal heartbeats

Hydroxyzine warnings

  • Hydroxyzine has more drug interactions than OTC antihistamines. It can interact with many different types of drugs. In addition to alcohol, hydroxyzine can also increase the effects of other medications that affect the CNS, including sleeping pills (such as Ambien), narcotics and opioids, muscle relaxers, antidepressant medications (such as Lexapro [generic name escitalopram; see Important Safety Information]), antiseizure drugs, and other anti-anxiety drugs (such as Xanax and Valium) (Michigan Medicine, 2017).
  • Hydroxyzine can cause serious heart problems, especially if you use certain medicines at the same time, including antibiotics, antidepressants, heart rhythm drugs, antipsychotic drugs, and drugs to treat cancer, malaria, HIV, or AIDS (National Library, 2020; PubChem, n.d.Pfizer, 2019).
  • Avoid driving a car or operating machinery after taking hydroxyzine until you know how it affects you, especially if you’ve drunk alcohol or taken any other drugs that affect the CNS.

Because hydroxyzine interacts with hundreds of different drugs, seek medical advice from your healthcare provider about taking any other drugs or supplements with hydroxyzine.


  1. Food and Drug Administration. (2014). VISTARIL® (hydroxyzine pamoate) Capsules and
    Oral Suspension. https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/011459s048%2C011795s025lbl.pdf
  2. Garakani, A., Murrough, J. W., Freire, R. C., Thom, R. P., Larkin, K., Buono, F. D., & Iosifescu, D. V. (2020). Pharmacotherapy of anxiety disorders: Current and emerging treatment options. Frontiers in Psychiatry11, 595584. doi: 10.3389/fpsyt.2020.595584. https://pubmed.ncbi.nlm.nih.gov/33424664/
  3. Michigan Medicine. (2017). Hydroxyzine. University of Michigan Health. https://www.uofmhealth.org/health-library/d00907a1
  4. Pfizer. (2019). VISTARIL® (hydroxyzine pamoate). How supplied/storage and handling. https://www.pfizermedicalinformation.com/en-us/vistaril/storage-handling
  5. PubChem. (n.d.). Hydroxyzine. National Library of Medicine. https://pubchem.ncbi.nlm.nih.gov/compound/Hydroxyzine
  6. U.S. National Library of Medicine.  (2020). DailyMed. Label: HYDROXYZINE HYDROCHLORIDE tablet. National Institutes of Health. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=8e5fce17-936e-46ea-a969-

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