Hydroxyzine and Alcohol: Interactions and Avoidance

By Craig Sorkin, DNP, APN
Medically reviewed checkmarkMedically reviewed
June 21, 2022

Hydroxyzine is a common antihistamine medication that is prescribed for anxiety disorders.

It is sold as a generic or under the brand name Vistaril.

More than 30% of adults in the United States will experience anxiety at some time throughout their lives.

While not everyone ends up taking an anti-anxiety medication, it is important to understand how to safely take one when you do.

Alcohol use is common, and for many people, it can provide a temporary release from tension or stress.

But using alcohol to address anxiety is not recommended.

This article explores the risks of pairing alcohol with hydroxyzine, including potentially serious side effects that may occur.

It will also discuss symptoms to monitor and how to know when you should see a doctor.

Hydroxyzine and Alcohol Risks

Most prescription medications come with warnings to avoid mixing them with alcohol.

Hydroxyzine is no different.

This is because alcohol has the potential to magnify and increase hydroxyzine’s side effects.

This is known as having an additive effect.

There is not a lot of research to identify whether it is fine to have the occasional alcoholic beverage while taking hydroxyzine, though the information from the medication insert says to avoid combining the two.

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Common Side Effects

The side effects of hydroxyzine can be similar to the side effects of alcohol.

When they are mixed, this can lead to increased severity of side effects.

Common side effects of hydroxyzine include:

Alcohol can magnify the effects of hydroxyzine or worsen them.

Alcohol can also cause drowsiness on its own, can worsen coordination, and can even cause headache or nausea.

Depending on the dose of hydroxyzine, and the amount of alcohol consumed, the side effects could become severe.

Hydroxyzine’s side effects are typically short-lived.

The peak effect of the drug is felt within 2 hours of taking, and most noticeable anxiety effects are gone within 4-6 hours.

However, because the half-life of hydroxyzine is 16-24 hours, it remains in your system much longer than you may even notice the benefits.

For older adults or people who have kidney or liver problems, the half-life is longer.

More Serious Side Effects

Less commonly, hydroxyzine can cause more serious side effects.

Alcohol could make these severe.

If you are taking hydroxyzine and experience any of the following side effects, seek emergency medical attention and discontinue hydroxyzine right away.

More serious side effects of hydroxyzine may include:

  • Seizures
  • Unintentional tremoring, trembling, or shaking
  • Fever
  • Rash or redness of the skin
  • Pus-filled or blister-like sores

If you consume alcohol with or around the time you take hydroxyzine, it may make it harder to know whether you are having severe effects from the medication or not.

It may also increase the odds of experiencing a serious adverse reaction.

What to Avoid

It is always important to follow your prescription instructions. In this case, avoiding alcohol while you take hydroxyzine is not about a minor symptom increase, rather a potentially deadly interaction.

It is not always possible to know how someone will respond to certain medications.

Adding alcohol to the mix creates more potential for serious reactions.

This is especially true for people with liver or kidney problems, older adults, and others who have conditions or take medications that affect the central nervous system (CNS).

Alcohol has a depressant effect on the CNS.

When paired with the sedative effects of hydroxyzine, it can lead to severe drowsiness or other CNS complications.

Alcohol use can also independently worsen other conditions, like heart disease, blood pressure, diabetes, cancer risk, and more.

Hydroxyzine and alcohol are not the only combination to avoid.

There are certain situations or health conditions that are contraindicated for hydroxyzine.

  • Avoid hydroxyzine if you have a prolonged QT interval (abnormal electrical activity of the heart) or if you have a history of heart attack, heart failure, heart disease, or other heart problems. Hydroxyzine in these situations can lead to severe complications.
  • Older people who are over age 65 should be cautious with hydroxyzine. They are at higher risk for stronger side effects. There are safer medications for anxiety or allergic skin conditions in older adults.
  • Do not take hydroxyzine with illegal drugs. Much like alcohol, this combination can increase the risk of serious adverse effects.
  • Use of hydroxyzine is not safe for anyone who is pregnant or could become pregnant. It is also not safe for breastfeeding. Hydroxyzine increases the risk of fetal harm and comes with an increased risk of birth defects. It may pass to the infant through breast milk.
  • Do not take hydroxyzine if you are allergic to any of its ingredients.
  • Hydroxyzine can cause serious side effects in people who have low blood levels of magnesium or potassium. Alcohol can also deplete important electrolytes, worsening this effect.
  • Overdose with hydroxyzine is possible and can be life-threatening. Pairing it with alcohol can increase the risk of magnified side effects and risks.

Symptoms to Monitor

Patients respond differently to hydroxyzine.

If you are taking it for anxiety, seek medical attention right away if you notice the following symptoms:

  • Problems breathing
  • Rapid heart rate
  • Hallucinations or seeing things that are not there
  • Severe drowsiness or inability to wake
  • Hives or facial swelling

Alcohol can worsen any of the more serious effects of hydroxyzine and lead to unwanted side effects.

Anxiety and Alcohol

For some who have anxiety, alcohol can sometimes provide a relief from symptoms by inducing feelings of relief or relaxation.

However, the desire to self-medicate with alcohol to alleviate anxiety is risky.

You should keep your healthcare provider apprised of your symptoms, and be honest about when and how often you consume alcoholic beverages.

Long-term, alcohol can have many serious effects on the body, including increasing the risk for heart and liver problems.

It can also play a role in the development of certain types of cancer and can weaken the immune system.

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When to See a Doctor

If you deal with anxiety and want to find relief from symptoms, your healthcare provider can discuss medication or alternative treatment plans with you.

While it may not feel easy to discuss questions about alcohol consumption with a medical provider, it is important to honestly and openly communicate your habits so that they can safely prescribe medication and make recommendations.

If you take hydroxyzine and want to know about alcohol intake, let a healthcare provider know.

If anxiety is a long-term condition that is being treated, it can feel overwhelming to consider giving up alcohol forever.

But your medical provider can give you personalized guidance and recommendations.

Nothing replaces professional medical advice when it comes to your individual circumstances.

If you’re having a mental health emergency, call 911 or go to the nearest emergency room. You can also get free 24/7 support from a suicide and crisis expert by calling or texting 988. If you’d prefer to chat online, you can chat with a suicide and crisis expert by visiting the Lifeline Chat.

How K Health Can Help

Think you might need a prescription for Vistaril (hydroxyzine)?

K Health has clinicians standing by 24/7 to evaluate your symptoms and determine if hydroxyzine is right for you.

Get started with our free assessment, which will tell you in minutes if treatment could be a good fit. If yes, we’ll connect you right to a clinician who can prescribe medication and have it shipped right to your door.

Frequently Asked Questions

Can you drink alcohol while taking hydroxyzine?
Combining hydroxyzine with alcohol is not recommended. Alcohol can magnify and increase the side effects of hydroxyzine, which can have serious results in some cases. If you want to drink alcohol while taking hydroxyzine, speak to your medical provider and be honest about symptoms and planned intake. In most cases, healthcare providers will recommend avoiding the combination all together to decrease the chance for serious adverse effects or interactions.

K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

Craig Sorkin, DNP, APN

Craig Sorkin, DNP, APN is a board certified Family Nurse Practitioner with over 15 years experience. He received his Undergraduate and Graduate degrees from William Paterson University and his doctoral degree from Drexel University. He has spent his career working in the Emergency Room and Primary Care. The last 6 years of his career have been dedicated to the field of digital medicine. He has created departments geared towards this specialized practice as well as written blogs and a book about the topic.

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