Atarax (Hydroxyzine HCl) 10 mg / 25 mg / 50 mg / 100 mg Tablets: Prescription Sedating Antihistamine and Anxiolytic for Allergic Pruritus, Urticaria, and Anxiety — Vistaril (Pamoate) Also Available

Information last reviewed: May 2026 — for educational purposes only.

Atarax is a brand name for hydroxyzine hydrochloride, a first-generation antihistamine with sedating properties. It belongs to the piperazine class of antihistamines and is used primarily to relieve itching caused by allergic skin reactions, chronic urticaria (hives), and atopic dermatitis. Hydroxyzine also has anxiolytic properties and may be prescribed off-label for short-term anxiety management. Unlike second-generation antihistamines, hydroxyzine readily crosses the blood-brain barrier, which contributes to its sedating effect.

What Is Hydroxyzine?

Hydroxyzine acts on H₁ histamine receptors and also has anticholinergic and central nervous system depressant activity. This triple action makes it effective for itch relief but also means it causes more noticeable drowsiness than non-sedating alternatives like fexofenadine or loratadine. The sedating effect can be clinically useful when itch-related sleep disruption is a concern, but patients should be cautioned about driving or operating machinery.

The drug is metabolised in the liver to its active metabolite cetirizine — the same compound found in Zyrtec — meaning part of its antihistamine effect is actually attributable to cetirizine.

Prescription-Only Status

Hydroxyzine is not available over the counter in most countries. In the United States, the United Kingdom, Canada, and the European Union, it requires a valid prescription from a licensed healthcare provider. This restriction reflects its sedating profile, potential for misuse as a sleep aid, and clinically relevant drug interactions with other CNS depressants.

Patients seeking antihistamine relief for mild seasonal hay fever without sedation may be directed toward OTC options such as fexofenadine, loratadine, or cetirizine. Hydroxyzine is generally reserved for more complex presentations, including dermatological itch that has not responded adequately to first-line OTC treatments.

Tablet Strengths and Forms

Hydroxyzine is available in several forms under the Atarax and Vistaril brands, and as generic hydroxyzine hydrochloride or hydroxyzine pamoate:

• 10 mg tablets — typically used for children and as a starting dose in adults
• 25 mg tablets — standard adult dose for allergy-related itch
• 50 mg tablets — higher dose; may be prescribed for more severe urticaria or pre-operative anxiety
• Syrup (10 mg/5 ml) — for paediatric use; measured doses administered with a calibrated oral syringe
• Injection (hydroxyzine HCl) — hospital use for sedation or anxiety prior to procedures

Hydroxyzine pamoate (brand name Vistaril) is a different salt of the same active compound, available in capsule form and commonly used for anxiety. Both salts are considered therapeutically equivalent on a milligram-for-milligram basis.

Price and Cost Considerations

Because hydroxyzine requires a prescription, its cost depends on the prescriber’s consultation, the pharmacy, and any applicable insurance or health plan coverage. Generic hydroxyzine tablets are among the more affordable prescription antihistamines, and many pharmacy discount programmes significantly reduce out-of-pocket costs. The syrup formulation for children may be priced differently from solid oral forms. Patients are advised to compare prices across pharmacy benefit managers and check for applicable manufacturer savings programmes.

Frequently Asked Questions

Can I get hydroxyzine without a prescription?

No. Hydroxyzine is a prescription-only medicine in the US, UK, Canada, and most of Europe. An online or in-person consultation with a licensed prescriber is required before a pharmacy can dispense it.

How long does hydroxyzine take to work for itching?

Hydroxyzine typically begins to reduce itch within 15 to 30 minutes of an oral dose. Peak plasma concentration is reached within approximately two hours. The sedating effect generally parallels the antihistamine effect; both taper over four to six hours.

Is hydroxyzine the same as cetirizine (Zyrtec)?

They are related but not identical. Cetirizine is a metabolite of hydroxyzine and is itself a second-generation, non-sedating antihistamine. Hydroxyzine has additional anticholinergic and anxiolytic activity that cetirizine does not share. The two are prescribed in different clinical contexts.

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