Key takeaways:
It’s not common for the antihistamine hydroxyzine (Vistaril) to cause sexual side effects such as erectile dysfunction (ED) or low libido (sex drive). But they are possible, and everyone’s experience with side effects is unique.
Hydroxyzine’s side effects usually only last for a few hours. So it’s unlikely that sexual side effects will persist. If your sexual issues with hydroxyzine are bothersome, contact your prescriber to discuss next steps.
Very rarely, men taking hydroxyzine have reported priapism. This is when an erection lasts too long, and it can cause permanent damage to the penis. Seek emergency medical care if you have an erection lasting longer than 4 hours.
Save on related medications
Erectile dysfunction (ED) is a possible side effect of certain antihistamines. But not all antihistamines are created equal. Some have more side effects than others.
But how common are sexual side effects with hydroxyzine (Vistaril)? Thankfully, they don’t happen frequently. But they are possible.
Does hydroxyzine cause sexual side effects?
It’s unlikely that hydroxyzine will cause sexual side effects. Sexual problems, such as ED and low libido (sex drive), aren’t listed as side effects in hydroxyzine’s labeling. But everyone’s experience is different.
We know that other first-generation (older) antihistamines, such as diphenhydramine (Benadryl), can cause sexual problems. However, there aren’t many studies on whether sexual side effects happen with hydroxyzine. So it’s possible that hydroxyzine may cause sexual problems. But based on the information we have, it’s likely rare.
Good to know: Some research suggests that people with allergies and allergic conditions may be more likely to have sexual problems. So the sexual difficulties you’re having could be linked to allergies (a reason some people take hydroxyzine).
Sexual side effects of hydroxyzine for men
It’s very rare for anyone to have sexual side effects while taking hydroxyzine. But men could potentially have:
Trouble maintaining an erection
Priapism (an erection that lasts too long) — more on this rare but serious side effect later
Sexual side effects of hydroxyzine for women
There are no known reports of women experiencing sexual side effects while taking hydroxyzine.
However, fatigue and drowsiness are common hydroxyzine side effects. These side effects can make it more difficult to do a number of regular activities. If you believe fatigue may be contributing to your sexual issues, let your prescriber know. They may suggest lowering your dosage to help relieve side effects.
How common are sexual side effects with hydroxyzine?
As mentioned above, sexual side effects are probably rare with hydroxyzine. Only a small number of people have reported these issues to the FDA’s Adverse Event Reporting System (FAERS).
FAERS is the FDA’s database for tracking problems people have when taking a medication. It can help the FDA identify safety concerns that weren’t seen during clinical trials. A medication may not have caused a reaction in the FAERS database. But if a large number of people report similar problems, the FDA may look into it further.
Do sexual side effects from hydroxyzine go away?
As discussed, people taking hydroxyzine don't usually experience sexual side effects. So we don’t know for sure how long these issues might last should they happen to you.
However, hydroxyzine’s effects don’t last very long in the body. The medication may start wearing off in as little as 4 hours. Typically, side effects don’t last very long either. If sexual side effects happen, they’re likely to go away on their own after the medication wears off too.
What to expect: Read about hydroxyzine’s side effects — from drowsiness to dry mouth — and how to manage them.
When it takes effect: Hydroxyzine takes about 15 to 30 minutes to start working. Get answers to other commonly asked questions about this antihistamine.
Other erectile dysfunction causes: Antihistamines are one of several medications that can cause erectile dysfunction.
How can you manage sexual side effects from hydroxyzine?
Talk with your prescriber if you’re having sexual problems while taking hydroxyzine. Your prescriber will likely want to evaluate you for a cause and discuss potential treatment options. Together, you can put together an action plan that works best for you.
If your prescriber determines hydroxyzine is the reason for your sexual problems, they may suggest an alternative medication for your symptoms. Many other medications can manage allergies, itching, or anxiety (common reasons people take hydroxyzine).
When to seek emergency care for sexual side effects
There are rare reports of men experiencing priapism after taking hydroxyzine. Priapism is a painful erection that lasts for more than 4 hours. It’s a medical emergency that can result in permanent damage to the penis. Fortunately, it’s very rare with hydroxyzine, and there have only been a few reported cases since the medication’s initial FDA approval.
If you experience an erection that’s painful or lasts for 4 hours or longer, seek emergency medical care.
Is hydroxyzine more likely to cause sexual side effects than other antihistamines?
We don’t know if hydroxyzine is more or less likely than other antihistamines to cause sexual side effects. This type of comparison hasn’t been well studied due to how rarely hydroxyzine causes sexual side effects.
However, we do know that it’s possible for all antihistamines to cause ED. This is likely because the chemical histamine plays a role in achieving and maintaining erections. And antihistamines, such as hydroxyzine, block histamine’s actions in the body.
The bottom line
Hydroxyzine (Vistaril) doesn’t typically cause sexual side effects, such as erectile dysfunction (ED) or low libido (sex drive). But everyone’s experience is different, so these issues are possible. Side effects of hydroxyzine should go away as the medication wears off — usually within a few hours.
Very rarely, men taking hydroxyzine have experienced priapism. This is when an erection lasts too long and can cause permanent damage to the penis. Seek emergency medical help if you have an erection that’s painful or lasts for 4 hours or longer.
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References
Chiang, T. Y., et al. (2023). The relationship between allergic disease and sexual dysfunction: A scoping review. International Archives of Allergy and Immunology.
Elfessi, Z., et al. (2023). Priapism associated with the addition of hydroxyzine to risperidone: A case report. Journal of Pharmacy Practice.
Heidelbaugh, J. J. (2010). Management of erectile dysfunction. American Family Physician.
Kiyohara, K., et al. (2022). Involvement of histamine H3 receptor agonism in premature ejaculation found by studies in rats. International Journal of Molecular Sciences.
NuCare Pharmaceuticals, Inc. (2024). Hydroxyzine pamoate - hydroxyzine pamoate capsule [package insert].
Olson, C., et al. (2021). Hydroxyzine-induced priapism. American Journal of Emergency Medicine.
Stratton, K. L., et al. (2023). Drugs that may cause erection problems. MedlinePlus.
U.S. Food and Drug Administration. (2023). FDA adverse event reporting system (FAERS) public dashboard.
