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Finding a Hydroxyzine Equivalent—What You Need To Know

Finding a Hydroxyzine Equivalent—What You Need To Know

Hydroxyzine can provide much-needed relief for individuals experiencing sleep problems, but it’s not a one-size-fits-all solution. The medication carries the risk of side effects—like dizziness and dry mouth—and is contraindicated for patients with specific conditions or on particular treatments.

If the risks of using hydroxyzine outweigh the benefits for you, there are several viable alternatives you can try. Learn what some hydroxyzine equivalent options are, what their side effects may be, and when your doctor may recommend them.

Hydroxyzine for Sleep—Basic Facts

Hydroxyzine is an FDA-approved antihistamine. This prescription-only drug binds to histamine H1 receptors, suppressing the effects of histamine in the body and alleviating allergy symptoms like itching, hives, and contact dermatitis.

This medication is also used in the short-term treatment of anxiety and insomnia because it affects the serotonergic receptors (5HT2) in the brain and promotes the release of serotonin, a neurotransmitter that makes you feel calm. This substance also boosts the release of melatonin, a natural hormone that induces sleep.

Here are some basic details about hydroxyzine:



Active component 

Hydroxyzine dihydrochloride

Drug class


FDA approval


Primarily indicated for

Symptoms of allergic reactions


Tablet, capsule, liquid

Available doses

  • 10 mg

  • 25 mg

  • 50 mg

  • 100 mg

Suitable for pregnant women


Prescription or OTC


Side effects


Hydroxyzine kicks in within 30–60 minutes, and the sedative effects last 4–6 hours. If you take it for insomnia, allocate seven hours for sleep to ensure the drug wears off naturally.

Source: Eren Li

Why Seek Hydroxyzine Alternatives?

Each patient can react differently to any medication, including hydroxyzine. Before prescribing hydroxyzine, your healthcare provider should assess your health history and specific sleep issues. If your doctor determines that the risks of using this medicine outweigh the benefits, they may suggest other safe sleep aids.

The factors that may cause your healthcare provider to recommend hydroxyzine alternatives include:

  1. Side effects of hydroxyzine
  2. Potential hydroxyzine interactions

Side Effects of Hydroxyzine

Hydroxyzine carries the risk of undesired reactions. While most patients rarely experience these side effects, certain medical conditions or medications may increase the risks. Here are the common side effects of hydroxyzine and how they’re typically managed:

Side Effect

How To Manage It

Dry mouth

  • Drink plenty of fluids

  • Avoid tobacco and its derivatives

  • Limit caffeine intake as it can worsen the dry mouth effect

  • Chew sugar-free gum or suck on sugar-free hard candies

  • Try OTC saliva substitutes

Blurred vision

  • Avoid driving, climbing ladders, and other activities that require sharp focus

  • Inform your healthcare provider if this side effect persists


  • Rise slowly when getting up from sitting or lying positions

  • Ensure you can sleep for at least seven hours when taking this medication


  • Increase fiber intake by eating more leafy greens

  • Drink plenty of fluids

  • Consider using a fiber supplement

  • Use laxatives like MiraLAX or Glycolax (only if approved by your doctor)

Some of the severe but rare side effects of this medication may include:

  • Irregular heartbeat
  • Seizures
  • Unintentional trembling or shaking movements
  • Sedation
  • Fainting
  • Difficulty breathing
  • Swollen lips, eyes, face, tongue, or eyelids
  • Difficulty swallowing
  • Headaches
  • Difficulty passing urine

If you experience these side effects or other unexplained physical or cognitive-behavioral changes, consult your doctor. They will determine whether to adjust your dose or switch to another drug.

Potential Hydroxyzine Interactions

Hydroxyzine can also interact with other medications, enhancing its side effects or reducing its effectiveness for sleep.

Check out the table below for more details:

Medication Category

Interaction With Hydroxyzine


Opioids and CNS depressants

Can enhance the CNS depressant effects

Follow your doctor’s instructions—they may reduce the dosages of both drugs by 50%

Heart medication

Can enhance the risk of irregular heart rhythm

Use a hydroxyzine alternative

Blood pressure medication

Can contribute to low blood pressure

Consider a hydroxyzine equivalent if you’re taking medicines that lower blood pressure

Anti-seizure medication

Can enhance the risk of seizure

Consult your healthcare provider for personalized advice

Anti-HIV drugs

Can contribute to the risk of QT prolongation

Talk to your doctor for specific guidance

Infection medication

Can enhance the risk of irregular heart rhythm

Consider another sleep aid

Sleep or anxiety medication

Can enhance the sedative effects

Consult your doctor for more information

Muscle relaxants

Can contribute to drowsiness

Talk to your doctor about adjusting the dose to reduce the risk of sedation


Can cause additive effects

Talk to your healthcare provider for more details

Herbal supplements

Supplements like kratom and St. John’s Wort can contribute to drowsiness

Avoid combining hydroxyzine with herbal supplements without consulting your doctor

The list above isn’t exhaustive, so you should tell your healthcare provider about all substances you recently used before taking hydroxyzine. Patients with specific medical conditions or on particular treatments should avoid this medication, including the following:

  • Patients who recently took MAO inhibitors
  • Those with a history of long QT syndrome
  • Women who are pregnant, breastfeeding, or planning to get pregnant
  • Patients with low potassium levels in the blood
  • Individuals with heart disease
  • Those with glaucoma
  • People with blockage in the digestive tract
  • Patients with urination problems

This medicine may also interact with foods containing CYP3A4 inhibitors, such as grapefruit, so you should avoid them until you discontinue treatment.

Medicines Similar to Hydroxyzine

Depending on your sleep history and underlying health conditions, your healthcare provider may recommend hydroxyzine alternatives. Check out the details in the following table:



Treatment Duration

Common Side Effects


Treating primary insomnia

Up to 4 weeks

  • Dizziness

  • Headache

  • Somnolence


Treating insomnia caused by anxiety or stress

4 weeks maximum

  • Drowsiness

  • Dizziness

  • Unsteadiness


Treating sleep onset and sleep maintenance insomnia

1–2 weeks

  • Drowsiness

  • Strange dreams

  • Headache


Treating insomnia exacerbated by allergic reactions, nausea, and vomiting

Up to 2 weeks

  • Drowsiness

  • Headache 

  • Confusion in the elderly


Treating sleep issues accompanied by muscle pains

3 weeks maximum

  • Constipation

  • Drowsiness 

  • Dry mouth


Short-term treatment of secondary insomnia

2 weeks maximum

  • Blurred vision

  • Constipation

  • Dry mouth


Treating sleep issues due to nerve pain or restless leg syndrome

Both short- and long-term

  • Dry mouth

  • Dizziness

  • Drowsiness


Treating sleep disorders related to anxiety or tension

2–4 weeks maximum

  • Fatigue

  • Slurred speech

  • Digestive problems


Treating severe insomnia linked to anxiety

2 weeks maximum

  • Drowsiness

  • Constipation

  • Addiction 


Treating sleeplessness caused by anxiety, depression, or mood disorders

6–9 months maximum

  • Diarrhea

  • Dry mouth

  • Increased sweating


Treating occasional sleeplessness due to anxiety


  • Chest tightness

  • Cough producing mucus

  • Difficulty breathing


Treating sleep issues stemming from depressive disorders


  • Headache 

  • Dry mouth

  • Constipation


Used for muscle spasms and discomfort. May induce sleep due to its sedating properties


  • Dry mouth

  • Dizziness

  • Diarrhea

The list above isn’t exhaustive, so you should consult your doctor about the safest and most effective hydroxyzine alternatives for you if you can’t take any of these medications.

Non-Pharmaceutical Alternatives to Hydroxyzine

Source: Joshua Lim

Besides hydroxyzine and other sleep medications, you can try non-pharmaceutical methods to improve your sleep. Some of these methods are:

  1. Using natural sleep aids
  2. Making meaningful lifestyle changes

Using Natural Sleep Aids

Natural supplements may provide relief from both sleep onset and sleep maintenance insomnia. Most sleep aids work by promoting relaxation and regulating the sleep-wake cycle. 

Common natural products include:

  • Melatonin
  • Valerian root
  • Chamomile
  • Passionflower

Like their pharmaceutical alternatives, these supplements carry the risk of side effects. They don’t require FDA approval, so the risk of receiving inappropriate doses is higher. If you’re considering these supplements, consult your healthcare provider for more details on their effects and how to use them safely.

Making Meaningful Lifestyle Changes

Lifestyle changes involve addressing the behavioral or environmental factors that contribute to your sleep issues, helping you get all-encompassing treatment. Some of the healthy habits that may help you overcome insomnia are:

  • Regular exercise
  • Maintaining a consistent sleep schedule
  • Reducing caffeine intake 
  • Creating a sleep-friendly environment

While you can implement most of these changes yourself, sleeplessness typically stems from complex issues that only an expert can help you identify. To get comprehensive treatment, you should see a sleep specialist. However, this can be challenging due to the shortage of doctors specializing in sleep medicine in the U.S.

Telehealth platforms like Kick are a convenient solution. Designed by a Stanford sleep expert, Dr. Alex Dimitriu, Kick’s sleep program can connect you with an experienced specialist within 24 hours of signing up.

Source: Ketut Subiyanto

Kick—Sleep Solutions Rooted in Science

Kick’s sleep program combines cognitive behavioral therapy for insomnia (CBT-i) with gentle yet effective sleep medications like hydroxyzine. After your first consultation, our specialist will handpick two trial medications that you’ll rotate to reduce the risk of dependency.

Our expert will monitor your progress regularly and adjust the doses until you develop a consistent, healthy sleep pattern. Your doctor will offer practical tips on healthy sleep hygiene and help you address the specific underlying factors exacerbating your sleep issues.

The process is discreet and convenient—you’ll consult our experts from the comfort of your home and have the medications shipped to your doorstep or local pharmacy.

Getting Started With Kick

To begin your journey towards restorative sleep with Kick, follow these simple steps:

  1. Navigate to our signup page to start your 15-minute consultation
  2. Fill out the intake form to help us understand your specific condition
  3. Provide your payment and shipping details

Depending on your specific sleep issue and medical history, our specialist will prescribe two trial medications from the following list:

  1. Hydroxyzine
  2. Trazodone
  3. Cyclobenzaprine
  4. Doxylamine
  5. Ramelteon
  6. Gabapentin

If our team decides you’re not the best candidate for the program, you’ll be directed to your primary healthcare provider. In that case, you won’t be charged for the initial consultation, according to Kick’s Doctor Guarantee.

Fantastic reviews on Trustpilot are a testament to how Kick’s sleep program has changed the lives of many patients. Sign up now to experience the benefits of this innovative program first-hand.

Is Hydroxyzine Safe To Take Regularly?

Source: Ron Lach

You can take hydroxyzine regularly if your healthcare provider approves it, but the treatment typically lasts up to a maximum of 3–4 months. While this medicine isn’t physically addictive, the risk of psychological dependence can’t be ruled out.

You should only take the prescribed dose and for the recommended time. Overdosing on hydroxyzine carries the risk of serious undesired reactions, such as:

  • Vomiting
  • Severe drowsiness
  • Reduced awareness or responsiveness
  • Nausea
  • Seizure

Patients who take more than the prescribed dose may develop tolerance, so sticking to your doctor’s instructions is essential.

What Happens When You Stop Taking Hydroxyzine?

Even though hydroxyzine isn’t addictive, discontinuing it abruptly may cause discomfort in rare cases. Some patients may experience symptoms of insomnia relapse, such as:

  • Agitation
  • Insomnia
  • Seizures
  • Anxiety
  • Irritability
  • Nausea
  • Headache

Psychological dependence can contribute to distress after stopping hydroxyzine treatment, so you should consult your doctor before getting off the drug.

Safety Guidelines for Switching Sleep Medications

If you’ve been taking a particular sleep drug with no results, you can switch to its alternatives while making sure to:

  1. Inform your doctor—They can help you identify the best alternative based on your medical history
  2. Understand the risks—Ask your healthcare provider about the potential interactions and side effects of the alternatives
  3. Stick to the prescribed dosage—Always follow the recommended dosage to reduce the risk of unwanted reactions
  4. Monitor your symptoms—Keep track of your sleep patterns and physical or cognitive changes after switching sleep aids and notify your doctor if necessary

These are general guidelines, and your healthcare provider may recommend a different approach based on your specific case.

Featured image source: Polina Kovaleva