If you or a loved one struggle with alcohol use, you may be curious about what drugs are used to help people with alcohol withdrawal syndrome, or AWS. One such medication is hydroxyzine. Hydroxyzine is the generic name of a medication that goes by the brand name Vistaril.

What Is Hydroxyzine Used For?

Hydroxyzine belongs to the antihistamine drug class. It is a prescription medicine that is used to treat allergic reactions. Your body produces histamine when it comes into contact with a substance it thinks may be harmful. When you take the drug, it binds to histamine receptors in your body to block them. In this way, the drug stops histamine from stimulating those cells. The drug also has sedative properties. It is typically prescribed for a few different reasons:

  • To relieve itching related to allergic reactions
  • To treat anxiety
  • To sedate you before or after surgery
  • To stop nausea and vomiting
  • In the past, it was used for symptoms of alcohol withdrawal

Is Hydroxyzine Helpful for Alcohol Withdrawal?

Hydroxyzine was one of the drugs often used to treat the symptoms of AWS until the late 1960s. Doctors did not know if any drug was better than the others in AWS because there were no major studies to compare the drugs. But in 1969, a study came out showing that the best drug to treat AWS was a drug called Librium, or chlordiazepoxide. Librium was shown to work much better than hydroxyzine in AWS patients. Librium is a benzodiazepine and has a chemical structure very different from hydroxyzine. Since then, benzodiazepines, including Librium, are now the top drugs of choice when a doctor is trying to help a person with AWS.

Hydroxyzine is not meant to be the main drug used for treating AWS. The medical guidelines for AWS do not recommend hydroxyzine for someone in AWS. Instead, they recommend benzodiazepines. Even when a patient is in recovery, guidelines recommend many other drugs and do not recommend hydroxyzine.

The main reason that hydroxyzine does not work well for AWS has to do with the reason AWS occurs in the first place. Two important chemicals in your brain are glutamate and gamma-Aminobutyric acid (GABA).

Glutamate excites the brain, while GABA calms it. Alcohol enhances the effects of GABA. When you drink a lot of alcohol, there is not a lot of glutamate going around. Therefore, your brain becomes very sensitive to glutamate. When you stop drinking all of a sudden, your brain is then overexcited from all the glutamate in your brain, because no GABA is blocking it. Drugs like benzodiazepines work because they fit the GABA receptors in your brain. Therefore, they can calm your brain down.

Hydroxyzine does not affect the GABA or glutamate receptors in your brain. Therefore, it is not able to counteract the effect of glutamate in your brain, which is the main cause of AWS symptoms. It is for this reason that hydroxyzine does not work well in AWS patients.

Cautions for Using Hydroxyzine for Alcohol Withdrawal

Hydroxyzine is no longer considered to be a first-line, or even a second-line, drug for AWS patients. For that reason, doctors are unlikely to use it in most patients. In addition, hydroxyzine should not be used in patients who:

  • Are allergic to antihistamines
  • Are in early pregnancy
  • Have a certain heart problem called “prolonged QT interval”

You should also avoid hydroxyzine if you are currently drinking alcohol. Because both hydroxyzine and alcohol depress the central nervous system, using them together can be dangerous.

Main Side Effects of Using Hydroxyzine

Hydroxyzine is thought to be a safe drug for most people. However, doctors try to avoid the drug, especially if you are 65 years old or older. You are at much higher risk of side effects if you are an older adult.

Side effects include:

  • Feeling sleepy
  • Dry mouth
  • Slow breathing (with very high doses)

Key Points: Withdrawal From Alcohol Using Hydroxyzine

Important points to remember about hydroxyzine and withdrawing from alcohol include:

  • Hydroxyzine used to be used for AWS but is no longer used because it does not work as well as other medications
  • Hydroxyzine has many uses, but treating AWS is not one of them
  • Benzodiazepine drugs are now the top choices for people managing AWS because they work very well
  • Alcohol and hydroxyzine should not be used together because they can depress your brain’s functioning

If you or someone you know struggles with addiction and wants to begin the recovery process, medically supervised detox in a reputable rehab center is an excellent first step. The Recovery Village can help. Reach out today for more information.

American Psychiatric Association. “Practice Guideline for the Pharmacological Treatment of Patients with Alcohol Use Disorder.” American Journal of Psychiatry, 2018. Accessed April 20, 2019.

World Health Organization. “Management of Alcohol Withdrawal.” 2012. Accessed April 20, 2019.

Kattimani Shivanand, Bharadwaj Balaji. “Clinical Management of Alcohol Withdrawal: A Systematic Review.” Industrial Psychiatry Journal, 2013. Accessed April 20, 2019.

U.S. National Library of Medicine. “Hydroxyzine.” February 4, 2019. Accessed April 20, 2019. 

Alcohol and Hydroxyzine
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