Hydroxyzine and Alcohol: A Dangerous Mix

Maybe those seasonal allergies have you sneezing and rubbing your eyes. For some reason, Benadryl just doesn’t cut it, and neither do its second-generation, over-the-counter cousins. Commuters in the train slide away from you thinking you must have a cold, while coworkers give you looks of concern (were you just crying in our morning meeting?). 

Or, maybe, life has been stressful lately and you find yourself binge- watching YouTube videos night after night, unable to go to sleep. You know antidepressants and prescription sleep meds are an option, but you’re hesitant to go that route yet. 

Is there anything that could help? For many people, it’s hydroxyzine (better known as Vistaril). Developed as an antihistamine, it has gained a reputation as a fairly mild and “user-friendly” antianxiety and insomnia aid. It’s also fairly common for doctors to prescribe hydroxyzine for alcohol withdrawal symptoms. But what about combining hydroxyzine with alcohol? Let’s find out!

What Is Hydroxyzine?

Hydroxyzine (Vistaril) is a prescription antihistamine that works by blocking histamine — a substance produced by the body during allergic reactions.

The side effects tend to be pretty mild:

• Drowsiness
• Headache
• Dry mouth
• Skin rash

Like many other sedating antihistamines (think Benadryl or Dramamine), hydroxyzine inhibits the action of a neurotransmitter called acetylcholine, which is responsible for memory, learning, motivation, stimulation, and motor control. As a drug class, these anticholinergic medications can cause blurry vision, confusion, urinary retention, and constipation. For that reason, hydroxyzine is generally not prescribed to folks over 65, who might be more sensitive to these effects.

Despite being developed as an antihistamine, hydroxyzine has a couple of other tricks up its sleeve: in addition to blocking histamine, hydroxyzine is a bronchodilator (it opens up our airways) and an antiemetic (keeps us from throwing up), and it’s sometimes used as a mild, fast-acting, antianxiety medication. Because of its versatility, it’s one of the most commonly prescribed drugs in the United States, with nearly 3.4 million Americans taking it as of 2021.

The Medical Multitasker

As a result of its somewhat unusual chemical profile and relatively mild side effects, hydroxyzine is a bit more sophisticated than your run-of-the-mill antihistamine. As mentioned earlier, it’s a triple-tasker in the medical arena:

• Hydroxyzine can be prescribed to ease allergy symptoms. True to its origins, hydroxyzine is still used for its antihistamine properties and is often prescribed as a treatment for allergies.
• It’s also an effective antianxiety option. Unlike some of its more intense peers in the antianxiety world, hydroxyzine is fairly mild and not habit-forming. According to a Journal of Clinical Psychology study, hydroxyzine “Showed both efficacy and safety in the treatment of generalized anxiety disorder (GAD) and appears to be an effective alternative treatment to benzodiazepine prescription.” It’s also occasionally prescribed to put patients at ease and make them a bit more comfortable before surgery.
• Hydroxyzine also works as a sleep aid. Its sedative properties and relatively mild side effects make hydroxyzine an effective sleep aid. A recent study in Human Psychopharmacology, found that “Hydroxyzine could be considered as a short-term treatment option for adults with insomnia for whom previous therapy was ineffective, not tolerated, or contraindicated.” That said, it might not work as a long-term solution.

So how does this versatile medication act differently when alcohol is in the mix?

Antihistamines and Alcohol

In general, combining alcohol and antihistamines isn’t a good idea, mainly since alcohol enhances the sedative effects while boosting some of the chemical processes that cause allergic reactions in the first place. (For an in-depth look, check out our blog “Can I Drink Alcohol While Taking Allergy Medication?”)



It’s important to note just how impairing some sedating antihistamines truly are. A study in the Annals of Internal Medicine compared driving performance of people taking Benadryl (a first-generation antihistamine) or Allegra (its second-generation cousin) for hay fever with those who had alcohol or a placebo. The subjects were sent off on a pretend road trip in the Iowa Driving Simulator. The result? Those on Benadryl did worse than the subjects who were legally drunk!

Talking about the study, author John Weiler explains, “First-generation antihistamines, such as diphenhydramine, are known to affect driving performance. However, we were surprised to find that this antihistamine has more impact on driving performance than alcohol does.” He goes on to say that "drowsiness was only weakly associated with minimum following distance, steering instability and crossing into the left lane … These results suggest that people should carefully read warning labels on all medications. Even if you do not feel drowsy after taking an antihistamine or alcohol, you may be impaired."

Mixing Hydroxyzine With Alcohol

As with other antihistamines, mixing hydroxyzine with alcohol is not a good idea. There are three big reasons for this:

• Excessive sedation. The main concern is the combined sedative effect of both alcohol — a known depressant — and hydroxyzine.
• Intensified side effects. Alcohol is notorious for causing dehydration. Drinking alcohol amplifies the drying effects of antihistamines such as hydroxyzine and could leave us feeling even more parched.
• Effects on the heart. Hydroxyzine can affect the heart in those with existing heart rhythm conditions. While this is rare, it raises concerns if excessive alcohol consumption is involved. Alcohol isn’t very heart-friendly, either: it can speed up our heart rate and cause arrhythmia, cause blood pressure spikes, and even lead to more serious heart disease in the long run. (Check out our blog “How Does Alcohol Affect the Heart?” for more details.)

What Happens If I Have One Drink on Hydroxyzine?

Probably nothing too drastic, but we never know where that line is, so it’s best to err on the side of safety and stay away from booze if you’re taking hydroxyzine. 

What If I’ve Already Combined Alcohol and Hydroxyzine?

If you’ve already combined the two and you’re here after a panicked web search, fear not. Start by taking a deep breath (that’s important!). If you’ve had only a couple drinks, took a normal dose of hydroxyzine, and have no known heart issues, you aren’t in serious danger. Rest, take it easy, and stay in bed or on the couch — now isn’t the time to cook a meal, rearrange furniture, or go for a drive.

Stay aware of your body. Notice if you feel like you’re having trouble breathing or if your heart rate starts feeling like it’s playing jazz instead of beating regularly. You’re likely going to be very tired, so it may be best to ask a family member or partner to check in on you for a few hours. If anything feels troubling, seek immediate medical care.

If you’ve had a lot to drink and you took a hydroxyzine dose higher than normal, or if you have a heart rhythm disorder that prolongs your QT interval, seek immediate medical care.

Combining small amounts of alcohol and hydroxyzine isn’t likely to kill us, but it’s definitely not good for us. It increases the chance of something dangerous happening, and when we do this regularly, it can cause chronic damage to our body.

Alcohol’s Effects on the 3 Primary Targets of Hydroxyzine

Whatever condition we’re taking hydroxyzine for, chances are alcohol isn’t doing us any favors when it comes to getting relief. There’s scientific evidence proving that booze has a negative impact on all three conditions we might be taking hydroxyzine for: allergies, anxiety, and insomnia.

• Alcohol can make allergy symptoms worse. According to the American Academy of Asthma, Allergy, and Immunology alcohol can make allergies worse by increasing IgE antibody levels associated with allergic reactions. Moreover, it’s known to increase histamine levels — the main culprit behind allergic reactions. (For more information, take a look at our blog “Can Alcohol Make Allergy Symptoms Worse?”)
• Alcohol amps up anxiety. That initial relaxation we feel after a drink or two? It fades away quickly, often giving rise to even higher levels of anxiety in the long run. The reason has to do with the way alcohol messes with neurotransmitter levels in the brain. It initially increases the inhibitory GABA neurotransmitter levels while decreasing glutamate, its excitatory counterpart. The result is that relaxed feeling we get when we take our first few sips. Unfortunately, the sedative effect of alcohol is short-lived. That uneasy feeling that’s often part of a hangover the morning after? That’s the rebound effect caused by the brain trying to rebalance itself. (For an in-depth look check out “Why Does Drinking Alcohol Make Anxiety Worse?”)
• Alcohol and sleep. In a similar way, alcohol also interferes with our sleep. After initially making us drowsy, it flips the script, leading to more restless nights disrupted by countless trips to the bathroom and missed restorative REM sleep cycle intervals, which are crucial for overall health. (Want to know more? Take a look at “The Negative Impact of Alcohol on Our Sleep: The Bittersweet Irony of "Sleeping It Off.")

Hydroxyzine for Alcohol Withdrawal

Finally, what about using hydroxyzine for alcohol withdrawal? Indeed, it’s one of the ways doctors help patients reduce anxiety and tremors associated with suddenly stopping alcohol use. The neurochemical trainwreck alcohol leaves in its wake manifests as intense anxiety and the notorious “shakes” that sometimes escalate into full-blown seizures. To make this period a bit more comfortable, benzodiazepines are often the go-to form of treatment. One major problem? They’re just as addictive as alcohol itself.

Antihistamines, on the other hand, offer a safer alternative. An article from the Encyclopedia of Sleep explains, “Antihistamines are commonly used in alleviation of insomnia in drug and alcohol withdrawal where traditional GABA-acting hypnotics are less suitable due to the risk of cross-dependence, although there have been no controlled trials in this setting.” 

Tips To Stay Safe

Finally, here are a few tips for staying safe when it comes to alcohol and hydroxyzine.

1. Avoid the mix. The sedative properties of both alcohol and hydroxyzine make each one a potent downer, and mixing them can be double trouble. Plus, it will make healing from allergies, anxiety, or insomnia more difficult if booze is in the picture. 
2. Tap into the power of mindfulness. If you’re finding yourself struggling with anxiety or sleepless nights in particular and feel tempted to add a drink to “boost” your hydroxyzine regimen, consider an alternative — mindfulness meditation. This practice can be as simple as watching your own thoughts, following your breath, walking outside, or even paying attention to different textures while doing the dishes. The key is to pay attention to the physical sensations, emotions, and thoughts from the perspective of a detached observer. It might sound deceptively simple, but it’s a science-backed way to lower stress, coast through cravings, and get restful sleep!
3. Take care of your body. Nourish your body with nutritious food and plenty of water to create a solid base for feeling better physically and emotionally. Make sure to include protein-rich foods, omega-3 fatty acids, and plenty of fruits and leafy green vegetables to keep your immune system, brain, heart, and the rest of your body functioning at its best.
4. Get sober-curious. If you’re finding it hard to get out of your drinking routine, try to approach it from the perspective of curiosity. Who knows, you might discover that life beyond booze is a lot more enjoyable than you ever thought!

Summing Up

All in all, dealing with allergies, anxiety, and insomnia alike is no picnic — and there are plenty of people who share your struggles and sympathize. But adding alcohol to the mix is bound to make things even tougher in the long run. Instead, try to see this situation as an opportunity to explore what true wellness is all about. As A.J. Jacobs writes in Drop Dead Healthy: One Man's Humble Quest for Bodily Perfection, “The key to making healthy decisions is to respect your future self. Honor him or her. Treat him or her like you would treat a friend or a loved one.”