Key takeaways:
Hydroxyzine (Vistaril) is a medication that treats itching and active symptoms of anxiety. You can take it up to 3 to 4 times per day as needed.
Mixing alcohol and hydroxyzine may worsen the risk of side effects, such as drowsiness and dizziness. It’s best to avoid the combination when possible.
It’s recommended to talk to your prescriber if you have anxiety and also drink alcohol. They can tell you about the safest and most effective ways to calm your symptoms. This often includes measures such as avoiding anxiety-inducing triggers and taking time to clear your head.
Save on related medications
It’s a normal urge to self-medicate feelings of anxiety with alcohol. After all, doing so may provide temporary relief. But it’s not the best move for your long-term health and happiness. If you’re living with an anxiety disorder, it’s important to know that there are recommended treatment options available to help manage these feelings.
Hydroxyzine (Vistaril) is one anxiety medication that many people benefit from. It doesn’t mix well with alcohol, though. While you’re taking hydroxyzine, it’s important to understand the possible risks of mixing it with alcohol.
What is hydroxyzine?
Hydroxyzine is an FDA-approved medication that’s used to treat anxiety and itching. Its two forms — hydroxyzine hydrochloride and hydroxyzine pamoate — treat active symptoms of anxiety the same way.
Hydroxyzine is available as a tablet, capsule, oral liquid, and injection into the muscle. It’s most often taken 3 or 4 times a day by mouth as needed. If it’s injected into the muscle, it’s usually given by a healthcare professional.
Can you drink alcohol while taking hydroxyzine?
In short, no. You should probably avoid the combination. Using alcohol and hydroxyzine at the same time can amplify alcohol’s negative effects. Alcohol could intensify hydroxyzine’s side effects, too.
Drinking alcohol can lead to symptoms such as drowsiness, coordination issues, and problems with impulse control, among other things. Drowsiness can become even more severe when combined with hydroxyzine.
The severity of this hydroxyzine-alcohol interaction can range from mild to serious depending on your health background and other medications that you take.
Is having 1 or 2 drinks OK?
There isn’t a lot of research available about how 1 or 2 drinks may affect you while taking hydroxyzine. Hydroxyzine’s prescribing information advises against combining it with alcohol as a precaution.
If you take hydroxyzine and drink alcohol, it’s recommended to talk to your prescriber to discuss your risks of combining the two. Each person may react differently to the combination’s effects. If your prescriber tells you that moderate amounts of alcohol are actually OK, they can also tell you how many drinks you should limit yourself to per outing.
How long after drinking can you take hydroxyzine?
Unfortunately, there’s no specific timeline for when alcohol can be safely consumed after stopping hydroxyzine. But you may want to at least wait a few days.
Good to know: It's not recommended to substitute hydroxyzine for alcohol. If hydroxyzine isn’t working for you or if it’s causing bothersome side effects, it’s recommended to talk to your prescriber about alternative treatment options.
How long does hydroxyzine stay in your system?
Hydroxyzine starts working quickly. Oral hydroxyzine usually begins working in as little as 15 to 30 minutes. But, even though it works quickly, it can linger in your body. It may take anywhere from 35 to 100 hours (roughly 1 to 4 days) for one dose to completely leave the body of an adult.
Certain medical conditions may extend the time that hydroxyzine stays in your body. Hydroxyzine is broken down and released by the liver and kidneys, so if either of these organs aren’t functioning as well as they could, it may stay in your system for longer.
How hydroxyzine works: If you’re taking hydroxyzine to treat anxiety or itchiness, keep these side effects and dosage guidelines in mind.
Does hydroxyzine cause sexual side effects? While it's not common for hydroxyzine to cause erectile dysfunction or low libido, these side effects are possible.
Interactions you should know about: Hydroxyzine can interact with a number of substances, including alcohol, opioids, and some antibiotics.
What are the typical side effects of hydroxyzine?
Hydroxyzine’s side effects are often mild and go away with time. Common hydroxyzine side effects include drowsiness, nausea, and dry mouth.
Although rare, hydroxyzine has the potential to cause more serious side effects. The most common symptom of too much hydroxyzine in your system is hypersedation — a form of extreme drowsiness. Other serious side effects can include:
Stupor, or a state of unresponsiveness
Convulsions
Excessive nausea and vomiting
Certain heart problems that cause fast, abnormal heartbeats
Adding alcohol into the mix can worsen the risk or severity of side effects — especially drowsiness.
When should I get medical attention?
You should call 911 or go to the nearest ER right away if you’re experiencing any of the following symptoms — which alcohol may worsen:
Severe drowsiness
Hallucinations or unusual behavior
Difficulty breathing
A rapid or pounding heartbeat
Symptoms of a severe allergic reaction, including difficulty breathing, hives, or facial swelling
Are certain people more at risk when combining alcohol and hydroxyzine?
Everyone’s experiences with alcohol are different. But, certain groups of people may be more affected by this combination than others. Specifically, older adults and people taking other medications that affect the central nervous system (CNS) are at a higher risk of complications.
Older adults
As you get older, your body may have a lower alcohol tolerance. Older adults — typically considered as people who are 60 or older — tend to feel the effects of alcohol more intensely and quickly than younger adults.
Because of this, it may be more dangerous for older adults to drink alcohol and take hydroxyzine. The combination raises the risk of severe drowsiness. Alcohol use can also worsen certain health problems that are common among older adults, including diabetes, high blood pressure, and memory problems.
What else should you avoid with hydroxyzine?
Hydroxyzine affects the CNS. When taken at the same time as alcohol and other CNS-focused medications, the risk of side effects for all substances goes up.
There are many example medications that fall under this category, such as:
Narcotic medications: Also known as opioids, these medications treat moderate-to-severe pain. Examples include morphine (Duramorph PF, MS Contin, others), hydromorphone (Dilaudid), and oxycodone (OxyContin, Roxicodone, others).
Barbiturates: These medications are often used as sedatives. Examples include butalbital and phenobarbital.
Benzodiazepines: These medications treat conditions such as anxiety and insomnia. Examples include diazepam (Diastat, Valium, others), clonazepam (Klonopin), and alprazolam (Xanax).
Non-benzodiazepine sedatives: These medications are most often used to treat insomnia. Examples include zolpidem (Ambien, Edluar), eszopiclone (Lunesta), and zaleplon (Sonata).
Taking hydroxyzine and other CNS medications can worsen the risk of side effects. But the combination isn’t technically prohibited. If you take two or more of these medications together, your prescriber may want to adjust one or more of your medication dosages to ensure the combination is safe.
Which anxiety medications aren’t affected by alcohol?
Everybody responds differently to medications. If hydroxyzine isn’t working for you, other options are available. Antidepressants, buspirone, and benzodiazepines are three of the most common types of anti-anxiety medications. But alcohol impacts all of them in one way or another.
Aside from medications and therapy, other options can help calm anxiety symptoms. These consist of practices that you can try to incorporate into your everyday life, and they include:
Learning your triggers: If a specific location or activity makes you anxious, try to limit your exposure to that trigger. Everyone has different triggers.
Taking time to clear your head: This can be through practices such as listening to music, meditating, or utilizing other relaxation techniques.
Being especially mindful of your nutrition and diet: There are certain foods and drinks that you may want to carefully consider consuming or limiting. It can be helpful to limit caffeine use, and well-balanced meals tend to be beneficial.
Talking to a familiar face. Professional resources are important for managing various health conditions. But, sometimes, it’s helpful to simply talk to a trusted friend or family member about what you’re going through.
The bottom line
Anxiety is a common mental health condition that has many possible treatment options, hydroxyzine (Vistaril) being one. People may also use alcohol — either occasionally or chronically — to help relieve feelings of anxiety. Mixing hydroxyzine and alcohol may be an unsafe choice because the combination can worsen the risk of side effects like drowsiness. It’s best to avoid alcohol if you take hydroxyzine.
Why trust our experts?
References
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Eunice Kennedy Shriver National Institute of Child Health and Human Development. (2018). What are the parts of the nervous system?
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Li, M., et al. (2017). Drug-induced QT prolongation and torsades de pointes. Pharmacy and Therapeutics.
Maiese, K. (2022). Stupor and coma. Merck Manual Consumer Version.
MedlinePlus. (2023). Hydroxyzine overdose.
National Alliance on Mental Illness. (2024). Hydroxyzine (vistaril).
National Institute on Alcohol Abuse and Alcoholism. (n.d.). Older adults.
National Institute on Alcohol Abuse and Alcoholism. (2023). Understanding the dangers of alcohol overdose.
