Hydroxyzine (Vistaril)


HALF-LIFE: 20 hours
STARTING DOSE: 50mg-100mg
TARGET DOSING RANGE: 50mg-100mg PO every 4-6 hours as needed
BEST TIME TO DOSE: Bedtime or when anxious
> No titration needed
> Initial 50mg-100mg PO every 4-6 hours as needed
> Intramuscular formulation available
PREGNANCY: Minimal data on safety.
BREASTFEEDNG: Minimal data on safety.
1) Anxiety and tention associated with neurosis
2) Adjust for anxiety from organic disease
3) Pruritus from allergic reactions
4) Histamine-mediated pruritus
5) Premedication sedation
6) Sedation following anesthesia
7) Acute hysteria
8) Alcohol withdrawal anxiety and DTs (IM formulation)
9) Nausea and vomiting (IM formulation)




  • Antihistamine
  • Reduces anxiety by blocking histamine (H-1) receptors (results in a general decrease in cortical activation)
  • A favorite “PRN” among nursing staff
  • Has some dopaminergic properties
  • Rapid absorption from GI tract
  • Not a good agent for chronic anxiety



  1. Cooper, J. R., Bloom, F. E., & Roth, R. H. (2003). The biochemical basis of neuropharmacology (8th ed.). New York, NY, US: Oxford University Press.
  2. Iversen, L. L., Iversen, S. D., Bloom, F. E., & Roth, R. H. (2009). Introduction to neuropsychopharmacology. Oxford: Oxford University Press.
  3. Puzantian, T., & Carlat, D. J. (2016). Medication fact book: for psychiatric practice. Newburyport, MA: Carlat Publishing, LLC.
  4. J. Ferrando, J. L. Levenson, & J. A. Owen (Eds.), Clinical manual of psychopharmacology in the medically ill(pp. 3-38). Arlington, VA, US: American Psychiatric Publishing, Inc.
  5. Schatzberg, A. F., & DeBattista, C. (2015). Manual of clinical psychopharmacology. Washington, DC: American Psychiatric Publishing.
  6. Schatzberg, A. F., & Nemeroff, C. B. (2017). The American Psychiatric Association Publishing textbook of psychopharmacology. Arlington, VA: American Psychiatric Association Publishing.
  7. Stahl, S. M. (2014). Stahl’s essential psychopharmacology: Prescriber’s guide (5th ed.). New York, NY, US: Cambridge University Press.
  8. Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY, US: Cambridge University Press.
  9. Whalen, K., Finkel, R., & Panavelil, T. A. (2015). Lippincotts illustrated reviews: pharmacology. Philadelphia, PA: Wolters Kluwer.

Access all content with a FREE membership!

  • Education and Training Resources
  • Psychopharmacology Review
  • Modules, Algorithms, and Clinical Tools
  • Practice Questions
  • And much much more!