Side Effects of Hydroxyzine Pamoate

Published on: 08 Sep 2023
Clinically Reviewed by Bisma Anwar, LMHC
Side Effects of Hydroxyzine Pamoate

Mental health treatment includes many options today, including the medication Hydroxyzine Pamoate (Vistaril). While this antihistamine drug is commonly used to treat itching related to allergies, it’s also FDA-approved to manage symptoms of anxiety and is sometimes used off-label for insomnia

According to the American Psychiatric Association, an estimated 30% of adults will deal with an anxiety disorder, like social anxiety, at some point in life. If your doctor has suggested you consider getting Hydroxyzine online for generalized anxiety disorder (GAD) or insomnia, it’s essential to explore the various side effects you may experience while on the drug. 

Hydroxyzine side effects can vary from mild to severe and depend on frequency, dose, and condition. Your doctor can provide detailed information on hydroxyzine side effects so you know what to expect, but you can continue reading to learn even more.

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Common Side Effects of Hydroxyzine

According to research, hydroxyzine can help you deal with anxiety by altering serotonin levels in the brain. The path to learning to manage symptoms of anxiety can seem daunting though, especially when you’re faced with medication side effects. Knowing what to expect can help.

If you’re taking hydroxyzine, you might experience the following:

  • Drowsiness or fatigue — This could affect your daily routine and productivity levels.
  • Dry mouth — You may need to drink more water than usual.
  • Headache — Mild discomfort in the head region can occur but generally doesn’t persist for extended periods.
  • Nausea or vomiting — Monitor this side effect closely, as it could impact nutrient intake and your overall health status if severe or prolonged.

“The notable side effects of hydroxyzine are dry mouth, tremors, and sedation. Sedation is the most common side effect I hear from patients and is often transient.”

Talkspace psychiatrist Dr. Dion Metzger

Occasionally — though not often — hydroxyzine can cause trembling or shaking in the legs, hands, feet, or arms. Let your doctor or healthcare provider know if you experience this side effect. 

Serious Side Effects of Hydroxyzine

This medication is generally well-tolerated. That said, hydroxyzine side effects can be serious in some cases. Being aware of the potential outcomes of taking this drug is critical. 

Chest pain or discomfort

Hydroxyzine pamoate side effects might include chest pain or discomfort. This could indicate heart-related issues due to the drug. Do not ignore any symptoms related to a change in heart rate after starting hydroxyzine. Seek immediate medical advice, attention, or go to the ER.

Dizziness and fainting

Dizziness and fainting might occur when starting on hydroxyzine. To ensure safety while your body adjusts, avoid tasks requiring high alertness, like driving, until you understand how the medicine affects you personally.

How Long Do Hydroxyzine Side Effects Last?

The duration of hydroxyzine (Vistaril) side effects is not the same for everyone. Factors like your overall health, age, weight, condition, and the length of time you’ve been on the drug can affect how long its side effects last.

Mild hydroxyzine pamoate side effects, like drowsiness or dry mouth, often fade within a few days to a week. Contact your healthcare provider immediately if these side effects persist beyond a week or begin to worsen.

The serious reactions are less frequent but require immediate attention. If you experience symptoms like difficulty breathing or an irregular or fast heartbeat while using hydroxyzine, don’t hesitate to seek emergency medical care immediately.

How to Manage Hydroxyzine Side Effects

Navigating the potential adverse effects of hydroxyzine can be challenging at first, but there are ways to manage them effectively.

1. Communicate with your healthcare provider

Consulting your healthcare provider should be your initial step when addressing drug-related matters for medical advice. They have an in-depth understanding of how medications like hydroxyzine work, common drug interactions, and can guide you through managing potential impacts on your body. They can help answer common questions like: how long does it take for hydroxyzine to work, and how much hydroxyzine is without insurance?

If mild side effects continue or if a severe reaction occurs, it’s crucial not only to report these symptoms but also to discuss possible adjustments in dosage or even alternative treatment options due to possible drug interactions.  

2. Implement lifestyle changes to address mild side effects

Certain lifestyle modifications might be effective against milder side effects of hydroxyzine, like dry mouth, headache, or drowsiness.

  • Stay hydrated — Monitoring hydration levels throughout the day can combat oral dryness associated with this medication.
  • Tweak the timing of intake — Taking this medicine closer to bedtime might mitigate daytime or drowsiness.

3. Seek immediate medical attention for serious reactions

In case of a severe allergic reaction — including skin rash, chest discomfort, or difficulty breathing — immediate medical intervention becomes paramount.

“The best way to manage side effects is to wait because they are often temporary. If the side effects persist or are too severe, lowering the dose of hydroxyzine may help the side effects to improve.”

Talkspace psychiatrist Dr. Dion Metzger

See If Hydroxyzine Is Right for You 

Deciding to incorporate hydroxyzine into your treatment plan isn’t something you should rush into. This is where Talkspace online psychiatry and the team of licensed professionals, can help.

Hydroxyzine (Vistaril) side effects may present as mild or severe, but these are variables that Talkspace’s experts can help you understand and manage. Talkspace provides an avenue for open discussions about this or any medication related to your mental health. You and your Talkspace provider can work together to assess whether a drug aligns well with your specific condition and needs, or if a better alternative should be considered.

Reach out to Talkspace today to learn more. 


  1. Vistaril® – Food and Drug Administration. Accessed July 24, 2023.,011795s025lbl.pdf.
  2. Burgazli CR, Rana KB, Brown JN, Tillman F. Efficacy and safety of hydroxyzine for sleep in adults: Systematic Review. Human Psychopharmacology: Clinical and Experimental. 2023;38(2). doi:10.1002/hup.2864. Accessed July 24, 2023.
  3. What are anxiety disorders? – What are Anxiety Disorders? Accessed July 24, 2023.  
  4. Guaiana G, Barbui C, Cipriani A. Hydroxyzine for generalised anxiety disorder. Cochrane Database of Systematic Reviews. Published online 2010. doi:10.1002/14651858.cd006815.pub2. Accessed July 24, 2023. 

Talkspace articles are written by experienced mental health-wellness contributors; they are grounded in scientific research and evidence-based practices. Articles are extensively reviewed by our team of clinical experts (therapists and psychiatrists of various specialties) to ensure content is accurate and on par with current industry standards.

Our goal at Talkspace is to provide the most up-to-date, valuable, and objective information on mental health-related topics in order to help readers make informed decisions.

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