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Hydroxyzine vs. Gabapentin—A Detailed Comparison

Hydroxyzine vs. Gabapentin—A Detailed Comparison

If you’re wrestling with sleepless nights, specific medications may help break the cycle of sleeplessness. Among the numerous options, two drugs stand out—hydroxyzine and gabapentin.

Both medicines are considered viable options for treating sleep problems, particularly when combined with cognitive behavioral therapy for insomnia (CBT-i) coaching.  Learn about their mechanisms of action, potential side effects, and alternatives in this hydroxyzine vs. gabapentin comparison.

What Is Hydroxyzine?

Hydroxyzine—sold under brand names Atarax and Vistaril—is a first-generation antihistamine. It’s typically prescribed to relieve the symptoms of allergic reactions, such as:

  • Hives
  • Runny nose
  • Itching
  • Contact dermatitis

Hydroxyzine also has sedative properties—it induces a calming effect, making it helpful in managing stress and anxiety disorders as well as sleep problems.

The medication isn’t a controlled substance, but it’s only available with a prescription from a healthcare provider.

How Does Hydroxyzine Work?

Hydroxyzine works by blocking H1 receptors and suppressing the release of histamine, a chemical that causes the symptoms of allergic reactions. The drug also dampens activity in the subcortical area of the brain, slowing down the central nervous system (CNS). This action reduces nervous tension and anxiety, producing a calming effect that promotes sleep.

How To Take Hydroxyzine for Sleep

Hydroxyzine is available in four doses:

  1. 10 mg
  2. 25 mg
  3. 50 mg
  4. 100 mg

When taken for sleeplessness, hydroxyzine should be administered at least 60 minutes before going to bed. You should only take this medicine if you can set aside seven hours for sleep to let the effects subside naturally, allowing you to continue with daily activities without experiencing grogginess.

If you miss a dose, you should take it as soon as you remember, but don’t combine doses. In case the time for your next dose is near, skip the one you’ve missed. 

You should only take this medicine for the prescribed duration—typically a maximum of four months. Hydroxyzine isn’t addictive, but taking this drug longer than prescribed can lead to tolerance and psychological dependence.

Hydroxyzine for Sleep—Potential Side Effects


Hydroxyzine carries the risk of unwanted reactions, such as:

  • Drowsiness
  • Dry mouth
  • Headache
  • Dizziness

Most of these side effects are manageable and can be prevented by following your doctor's instructions.

Rare but serious adverse reactions may include:

  • Chest pain, discomfort, or tightness
  • Difficulty swallowing
  • Rapid heartbeat
  • Irregular or slow heart rate
  • Difficulty breathing

If you experience any of these unwanted reactions, seek medical attention immediately. 

What Is Gabapentin?

Gabapentin—brand names Neurontin and Horizant—is an anticonvulsant medication commonly used in treating the following conditions:

  • Partial seizures
  • Neuropathic pain
  • Restless legs syndrome
  • Hot flashes

This drug can only be obtained with a prescription from a healthcare provider. While gabapentin isn’t a controlled substance at the federal level, state laws vary. You can find the states that restrict gabapentin use in some way in the following table:

States Where Gabapentin Is a Controlled Substance

States That Allow Authorities To Monitor Misuse

  • Virginia

  • Alabama

  • Michigan

  • Kentucky

  • Tennessee

  • West Virginia

  • North Dakota

  • Kansas

  • Indiana

  • Connecticut

  • Minnesota

  • Nebraska

  • New Jersey

These lists aren't exhaustive. You should discuss the potential implications of using this medicine in your state with your healthcare provider.

How Does Gabapentin Work?

Gabapentin works by mimicking the activity of GABA, a natural substance in the brain. GABA is responsible for reducing neuronal excitability, leading to a calming effect on the nervous system. This helps manage conditions like neuropathic pain and seizures while promoting sleep. Gabapentin is effective for sleep problems stemming from nerve pain or restless legs syndrome.

While this medication can help induce sleep, it should only be used under the guidance of a healthcare provider.

How To Take Gabapentin for Sleep

Gabapentin is available in five doses:

  1. 100 mg
  2. 300 mg
  3. 400 mg
  4. 600 mg
  5. 800 mg

If you’re taking it for sleep, you should take a capsule of gabapentin once a day, at least two hours before bedtime. The medication kicks in within 2–3 hours, and the effects typically last between 6–8 hours. To benefit from the drug’s sedative effects, dedicate at least seven hours for sleep after taking the dose.

Follow your doctor’s instructions as they’ll recommend the accurate dosage based on your specific needs and condition.

Gabapentin for Sleep—Potential Side Effects

The common side effects of gabapentin include:

  • Dry mouth
  • Dizziness
  • Drowsiness
  • Swelling of the hands or feet

These unwanted reactions are generally mild and subside as the body adjusts to the medication.

Rare but serious side effects include:

  • Chest pain
  • Difficulty swallowing
  • Chills
  • Irregular heart rate
  • Breathing problems
  • Restlessness
  • Depression
  • A false sense of well-being

Patients who experience unusual physical or cognitive-behavioral changes should inform their doctors immediately. Consult your healthcare provider about the potential side effects before taking gabapentin. They can provide specific advice on how to use this drug safely and effectively. You shouldn’t take more than the prescribed dose because it increases the risk of side effects.

Gabapentin vs. Hydroxyzine—Which One Is Better for Sleep?

Hydroxyzine and gabapentin are both viable options for treating sleep issues, but the most effective treatment depends on your age, lifestyle, health history, and specific type of insomnia. Sleeplessness can stem from several complex factors and requires an all-encompassing approach that combines effective medications, meaningful lifestyle changes, and treating the potential underlying health issues.

The best course of action is to visit a sleep specialist, but since they’re scarce in the U.S., getting an appointment with one can be complicated and time-consuming. The good news is that with the development of telemedicine, you can get help from a sleep expert almost immediately. Kick, an online performance clinic, has helped many patients get restful nights in no time, which is evidenced by numerous positive reviews on Trustpilot:

“The process was so simple, delivery was fast. And my event was so smooth, I can’t believe I’ve been playing on hard mode my whole life.”

Jennifer, L., U.S.

Kick—Restful Nights, Healthful Days

Source: Polina Kovaleva

Designed by a Stanford sleep expert, Dr. Alex Dimitriu, Kick’s sleep program entails personalized treatment based on your sleep problems, lifestyle, and medical history.

Our sleep specialist will prescribe two gentle trial medications that you’ll rotate to reduce the risks of dependence and tolerance. Your doctor will also offer tips on sleep hygiene to maximize the treatment efficiency.

Kick’s specialist will monitor your progress and adjust the treatment if necessary. In case our team decides Kick doesn’t have the best treatment for you, they’ll refer you to your healthcare provider for further consultation. In that case, you won’t pay for the initial consultation as per our Doctor Guarantee.

Getting Started With Kick

Kick’s sleep program is easy to join:

  1. Navigate to our Sleep Visit page to begin your 15-minute consultation 
  2. Fill us in on your sleep issues, health status, and lifestyle to help us design a treatment plan tailored to your case
  3. Enter your shipping address and payment details

Your prescribed medications will be delivered to your local pharmacy or directly to your doorstep, making the process discreet and convenient.

Source: Vika Glitter

Gabapentin vs. Hydroxyzine for Sleep—Who Should and Shouldn’t Use These Drugs?

Hydroxyzine and gabapentin can be beneficial to adults dealing with occasional sleeplessness. Older adults (65+) typically take lower doses to reduce the risk of unwanted reactions.

Pregnant women should avoid hydroxyzine since it carries the risk of birth defects, especially in the first trimester. They should also consult their doctors before taking gabapentin.

Check out the table below for more information on who shouldn’t use these medications:

Who Shouldn’t Use Hydroxyzine?

Who Shouldn’t Use Gabapentin?

  • Patients with a history of long QT syndrome

  • Those experiencing blockage in the digestive tract

  • People with bladder obstruction or other urination problems

  • Patients with a history of epilepsy or seizures

  • Those with glaucoma

  • Individuals with heart disease

  • People with electrolyte imbalance

  • Breastfeeding women

  • Patients allergic to gabapentin

  • Those with a history of misuse or addiction to any medicine

  • Women who are pregnant or planning to get pregnant

  • Patients with kidney disease

  • People on a sodium-or-potassium-controlled diet 

The lists above aren’t exhaustive. You should inform your healthcare provider if you have other conditions or you recently underwent a medical procedure.

Alternatives to Hydroxyzine and Gabapentin

If your doctor decides hydroxyzine and gabapentin aren’t suitable or effective for you based on your lifestyle, sleep issues, or medical history, they may recommend other options. These include:

Hydroxyzine vs. Gabapentin—A Short Overview 

Source: Artem Podrez

Check out this side-by-side comparison of hydroxyzine and gabapentin:




Drug class



Mechanism of action

Blocks H1 receptors, dampens activity in the subcortical region of the CNS

Mimics the activity of GABA, reduces neuronal excitability

Primarily indicated for

Allergic reactions, itching, anxiety, tension

Partial seizures, neuropathic pain, restless leg syndrome, hot flashes

FDA approval date




Tablet, capsule, liquid

Tablet, capsules, oral solution

Available doses

10 mg, 25 mg, 50 mg, 100 mg

100 mg, 300 mg, 400 mg, 600 mg, 800 mg

Major considerations

Sedative effects, potential for drowsiness

Calming effect on the CNS, potential for drowsiness

Pregnancy category

C (risks can’t be ruled out)

B (not enough information to claim it’s safe for unborn babies)

Suitable for children

Yes (only for approved conditions—you shouldn’t use it to treat insomnia in children)

Yes (only for other conditions—don’t use it to treat sleeplessness in children)



Controlled in some states (consult your doctor)

How to get it



Treatment duration

3–4 months

Long-term (consult your healthcare provider)

Warnings and precautions

Avoid driving and operating heavy machinery until the sedative effects subside

Caution when driving or operating heavy machinery

You should consult your healthcare provider for more details on these drugs, including their potential interactions with grapefruit juice, caffeine, alcohol, and other medications.

Featured image source: Kampus Production