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Hydroxyzine for Sleep—Off-Label but Efficient

Hydroxyzine for Sleep—Off-Label but Efficient

We’ve all been there—tossing and turning, watching the hours slip away in the dead of night. Whether it’s due to the never-ending to-do list, the mind’s relentless chatter, or life’s unexpected challenges, sleeplessness can hit us all, affecting our mood, focus, and overall well-being.

Once we’ve exhausted counting sheep and smelling lavender before bed, sleep medication may be the only way to overcome insomnia. 

With various options available, getting the best drug is challenging. Besides traditional medicines like Ambien or Belsomra, hydroxyzine for sleep proved to be an effective solution, especially combined with cognitive behavioral therapy for insomnia (CBT-I) best practices. Learn how this drug can help with sleeping issues. 

What Is Hydroxyzine?

Hydroxyzine is not the first drug to come to mind when treating insomnia. It’s an antihistamine medication that belongs to a class of medicines called sedating antihistamines. It was approved for sale in the U.S. in 1957 and is primarily prescribed to treat allergic skin reactions, including itching and contact dermatitis.

Due to its efficiency in calming the mind and reducing restlessness, hydroxyzine has become a popular aid for those grappling with mild sleep disturbances. Hydroxyzine is an off-label prescription for insomnia—the FDA has approved it for other conditions, but it’s safe and legal to use when treating sleep issues and anxiety. The medication can be taken orally or administered through intramuscular injection.

You can check out the details in the following table:

Drug Characteristics


Active component

Hydroxyzine dihydrochloride

Drug classification

Histamine H1 antagonist

Date of FDA approval


Drug form

Tablets, capsules, liquid

Average dose

50 mg per day

Maximum dose

400 mg per day 

Suitable for children

Yes (only for treating other conditions; don’t use it to get a child to sleep)

Suitable for pregnant women


How Does Hydroxyzine Work?

Hydroxyzine reduces the effects of histamine, a natural chemical in the body released during allergic reactions as an inflammatory mediator. The substance binds to H1 receptors, resulting in further release of pro-inflammatory cytokines, or in layman’s terms, emphasizing your response to a specific allergen. Hydroxyzine dampens the activity of H1 receptors, thus alleviating symptoms such as hives, sneezing, or skin irritations. 

However, hydroxyzine also reduces the central nervous system’s activity, so it helps you relax. According to various clinical studies, the drug is effective in treating insomnia in adults, especially as a short-term option. 

Hydroxyzine for Sleep—Dosage

Hydroxyzine comes in three main forms:

  1. Liquid (oral syrup and intramuscular injection)
  2. Oral tablet
  3. Oral capsule

You can find a detailed breakdown of the available doses for each form in the table below:


Available doses

Oral syrup

10 mg

Oral tablet

10 mg

25 mg

50 mg

Oral capsule

25 mg

50 mg

100 mg

Intramuscular injection

25 mg

50 mg

The oral tablet is the most popular option for patients with sleep disorders. The average daily dose for adults with insomnia is 50 mg, but the dosage is lower for patients older than 65 since they are more likely to experience the side effects of the drug.

Your doctor will determine the appropriate dosage for you and adjust it if necessary. Following their instructions is vital to prevent potential risks associated with overdoses and to avoid adverse reactions to the medication.

How Do You Take Hydroxyzine for Sleeplessness?

You should take hydroxyzine 30 minutes before your planned bedtime. Stick to the dose prescribed by your doctor, and allocate at least seven hours of sleep for the drug to work effectively.

The medication’s sedating effects will wear out during that time, leaving you re-energized for the day ahead. Avoid operating heavy machinery, driving, or doing similar activities that require intense focus at least one hour after waking up to ensure the drowsiness subsides. 

The drug is a mild sedative and should be used for a maximum of four months. If you experience sleeplessness one week after starting your medication, inform your doctor. They’ll re-evaluate your progress and recommend an alternative.

How Long Does It Take for Hydroxyzine To Work?

Hydroxyzine’s sedating effects take around 30 minutes to kick in. If you take the drug after a meal, expect it to start working a bit later—typically 1–2 hours after eating. The effects of the drug last between 4–6 hours, allowing you to get a good night’s rest without disturbances.

How Long Does Hydroxyzine Stay in Your System?

Source: Bruce Mars

How long hydroxyzine stays in your system can vary depending on your metabolism and the dose you’ve taken. The medication has a half-life of about 20 hours, meaning it takes approximately 20 hours for 50% of the dose you took to leave your body.

Typically, your body eliminates hydroxyzine after 4–5 half-lives, translating into 3–5 days. The medication’s long half-life means some patients may feel the effects long after their last dose. 

Patients who feel drowsy for more than five days after treatment discontinuation should inform their doctor. The doctor will help determine if the drug is the reason for feeling groggy or if there’s a different cause that needs addressing.

In rare cases, the sedative effects of hydroxyzine may wear off from the body, but traces of the drug remain detectable for a longer period. 

If a patient undergoes medical tests or procedures within 30–90 days after the last medication, they should inform healthcare professionals about recent hydroxyzine use to ensure its presence is taken into consideration.

Who Can Take Hydroxyzine?

Source: Maeghan Smulders

Hydroxyzine is a versatile medication. Adults with sleep disturbances stemming from stress and anxiety can typically take hydroxyzine to relax and improve their sleep quality. The drug is also often prescribed to adults and children suffering from allergic reactions or nausea from motion sickness and other factors.

How Can You Get Hydroxyzine?

Hydroxyzine is a prescription-only drug, so you can’t buy it over the counter. While hydroxyzine proved effective in treating sleep problems, it’s not a go-to solution for primary healthcare providers who focus on generic sleeping drugs like Ambien, Belsomra, or Sonata. Still, hydroxyzine can be better suited for some patients despite being an off-label option. 

The primary challenge individuals with sleep disorders face when seeking help is the shortage of sleep specialists. Patients often have to wait for 3–6 months before meeting a psychiatrist, an agonizing delay that can negatively impact their productivity and quality of life.

Enter Kick, a performance medicine clinic that provides a range of solutions, including CBT-I and non-standard yet efficient prescriptions like hydroxyzine to help you enjoy restful nights and improve your overall well-being. 

Kick—Sleep Science at Your Fingertips

Kick offers a unique and convenient approach to resolving sleep issues. 

Traditional healthcare appointments can be time-consuming and frustrating, so Kick provides a platform that allows you to connect with a sleep medicine specialist promptly. Led by Dr. Alex Dimitriu, our team has extensive experience and expertise to ensure you receive top-notch care and guidance.

Kick’s offers you a tailored and science-based approach to overcoming sleeplessness.

The program entails a selection of off-label sleep medications with two trial options carefully chosen by our doctors to match your unique circumstances.

The encompassing approach includes tips on cognitive behavioral therapy for insomnia (CBT-I) best practices from sleep experts. With their guidance, you can adopt healthier sleep habits as a long-term solution for insomnia.

How Kick Works

Source: Slaapwijsheid

To embark on your journey with Kick, follow these three straightforward steps:

  1. Visit our signup page for a quick 15-minute sleep visit
  2. Fill out the form with your sleep history and the relevant medical details
  3. Select between pharmacy pickup and doorstep delivery and provide the relevant details

Our sleep specialists will evaluate your case and create a tailored plan with two trial drugs. The medication will be delivered to the address you provided, and the specialist will guide you and monitor your progress. If necessary, they’ll recommend adjustments to optimize the treatment.

If Kick isn’t the best solution for your sleep problems, we won’t charge you for the initial consultation as part of our Doctor Guarantee. Our specialist will refer you to your primary healthcare provider for further evaluation. 

We get a shower of positive compliments on Trustpilot for a good reason. Register for Kick for sleep solutions rooted in science. 

Is Hydroxyzine Addictive?

Hydroxyzine is not classified as a controlled substance. It doesn’t carry the risk of addiction and withdrawal symptoms associated with other sedatives. Still, misusing any medication can lead to psychological dependence, so you should consult your doctor before using this drug. 

You should also use hydroxyzine as directed to ensure that it’s safe and effective.

Patients who experience signs of misuse, which include cravings, tolerance, or withdrawal symptoms, should seek immediate professional help.

What Are Hydroxyzine’s Side Effects?

While hydroxyzine is effective in treating sleep disturbance and other conditions, it carries the risk of side effects, so sticking to the prescribed dose and doctor’s instructions is essential.

Common Side Effects of Hydroxyzine

The common side effects of Hydroxyzine may include:

  • Dry mouth—The most frequent side effect. It can be bothersome, but it’s generally manageable. Staying well-hydrated and using sugarless candy or gum may help alleviate the discomfort
  • Constipation—Common in older adults. Maintaining a fiber-rich diet, staying active, and, if necessary, taking a laxative can help manage this issue
  • Confusion—Common in older adults. It’s crucial to report any cognitive or behavioral changes to your healthcare provider because they can evaluate whether the medication is the cause and recommend necessary adjustments
  • Dizziness—Often exacerbated by getting up quickly from a sitting or lying position. To reduce the risk of falls, patients are advised to rise slowly and maintain their balance

Rare Side Effects of Hydroxyzine

The rare side effects of hydroxyzine may include:

  • Headaches—They occur occasionally. Over-the-counter pain relievers or other aids recommended by a healthcare provider can provide relief for this discomfort
  • Unintentional trembling or shaking movements—If this occurs, it’s essential to contact a healthcare provider promptly, as this could be a sign of a more serious issue
  • Seizures—While rare, seizures have been reported as a side effect of hydroxyzine. If an individual experiences seizures while taking this medication, immediate medical attention is needed

Not everyone will experience the side effects, and most individuals tolerate hydroxyzine without significant problems. If adverse reactions are severe, persistent, or cause concern, patients should consult their healthcare provider and discuss whether to adjust the dose or seek alternative treatment options.

Users should note any unusual or unexpected reactions besides these and inform their healthcare provider to ensure the safe and effective use of hydroxyzine.

Who Shouldn’t Use Hydroxyzine?

Although hydroxyzine is recommended for patients of different age groups and conditions, some cases require more caution. 

Adults over 65 can be more sensitive to the drug, making them more prone to side effects like confusion, dizziness, and constipation. Older adults often have various chronic conditions and take multiple medications, which can increase the risk of drug interactions. It’s best to work closely with your healthcare provider to determine the correct dosage and monitor your reaction to hydroxyzine.

Individuals with a history of seizures or epilepsy should use hydroxyzine with caution as it is a rare side effect of the medication. Discuss the risks and benefits with your healthcare provider before starting treatment. A medical professional will consider your seizure history and overall health to determine if hydroxyzine is appropriate for your condition. 

Hydroxyzine is not recommended for pregnant women or women planning to get pregnant. It’s best to consider alternative treatment, such as CBT-I, in such cases.

Individuals with chronic medical conditions should exercise caution when using hydroxyzine. These conditions include:

  • Heart disease
  • Glaucoma
  • Urinary retention

Hydroxyzine is not suitable for children with insomnia. Parents or caregivers of children with sleeping issues should discuss potential treatments with medical professionals.

Inform Your Doctor if You Have Allergies

While allergic reactions to hydroxyzine are rare, individuals with allergies should use the drug with caution. The key ingredients of the medication include the following:

  • Polysorbate
  • Hypromellose
  • Titanium dioxide
  • Crospovidone
  • Microcrystalline cellulose
  • Magnesium stearate
  • Polyethylene glycol
  • Anhydrous lactose
  • Colloidal silicon dioxide

If you’re hypersensitive to cetirizine and levocetirizine, avoid taking hydroxyzine.

Always inform your healthcare provider of known allergies—whether to these ingredients or other medications.

Which Medications Interact With Hydroxyzine?

If you’re taking other medications, such as sedatives and CNS depressants, it’s best to inform your healthcare provider before taking hydroxyzine. The healthcare professional will assess potential drug interactions and suggest the best option for mitigating the risks of taking multiple drugs together.

Here’s a list of medications that interact with hydroxyzine:

Medication category


Opioids and CNS depressants

  • Oxycodone

  • Hydrocodone

  • Benzodiazepines

Heart medication

  • Metoprolol

  • Amiodarone

  • Amlodipine

Blood pressure medication

  • Doxazosin

  • Amlodipine

Anti-seizure medication

  • Phenytoin

  • Carbamazepine

  • Valproate

Anti-HIV drugs

  • Ritonavir

  • Efavirenz

  • Tenofovir

Infection medications

  • Erythromycin

  • Ketoconazole

  • Fluconazole

Sleep or anxiety medications

  • Lorazepam

  • Zolpidem

  • Buspirone

Muscle relaxants

  • Cyclobenzaprine

  • Methocarbamol

  • Baclofen


  • Diphenhydramine

  • Cetirizine

  • Loratadine

Herbal supplements

  • St. John’s Wort

  • Ginkgo Biloba

  • Ginseng

This list is not exhaustive, so you should inform your doctor about all medicines or supplements you currently use or have used recently. 

You shouldn’t mix hydroxyzine with alcohol. Alcohol can elevate histamine levels in the body, reducing hydroxyzine’s effectiveness or increasing the risks of side effects.

What Are Alternatives to Hydroxyzine?

Source: Alan KO

When considering alternatives to hydroxyzine for managing shuteye-related issues, your doctor may suggest the following:

Doctors may recommend an alternative based on your case to tailor the treatment to your needs, address the underlying conditions causing insomnia, or minimize the potential side effects of hydroxyzine.

Your healthcare provider may also suggest you explore over-the-counter options, such as:

  • Melatonin 
  • Valerian root
  • Lavender

Know that hydroxyzine and its alternatives are not permanent solutions to shuteye problems. In clinical trials of hydroxyzine, participants were observed for only three months. If you have chronic insomnia and need a long-term solution, your healthcare provider may recommend a comprehensive approach to addressing the problem. 

Combining medication with healthy sleep habits and psychotherapy is the only way to a long-lasting solution for sleeplessness. 

Featured image source: Bruce Mars