Hydroxyzine (Vistaril) vs. buspirone (Buspar)

  • Medical Editor: John P. Cunha, DO, FACOEP
    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.

Hydroxyzine vs. buspirone: What's the difference?

What are hydroxyzine and buspirone?

Hydroxyzine is an antihistamine with anticholinergic (drying) and sedative properties used to treat itching caused by various allergic reactions. Hydroxyzine is also used to treat anxiety and tension, and for inducing sedation prior to or after anesthesia. Hydroxyzine also is used to treat nausea and vomiting, and alcohol withdrawal.

Buspirone is used to manage anxiety disorders or for short-term relief of the symptoms of anxiety. However, buspirone is not effective in treating severe anxiety, panic disorders, or obsessive-compulsive disorders. Buspirone may also help improve symptoms of depression in patients with generalized anxiety disorder. Research shows that buspirone may work on the neurotransmitters serotonin and dopamine. Buspirone is an azapirone anti-anxiety medication that does not cause sedation like anxiety medications in the benzodiazepine class, such as diazepam (Valium), lorazepam (Ativan), alprazolam (Xanax), and clonazepam (Klonopin).

QUESTION

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What are the side effects of hydroxyzine and buspirone?

Hydroxyzine

Common side effects of hydroxyzine are:

  • Sedation
  • Tiredness
  • Sleepiness
  • Dizziness
  • Disturbed coordination
  • Drying and thickening of oral and other respiratory secretions
  • Stomach distress

Other important side effects include:

Hydroxyzine should be used with caution (if at all) in persons with narrow-angle glaucoma, prostatic hypertrophy (enlarged prostate gland), hyperthyroidism, cardiovascular disease, hypertension, and asthma.

Buspirone

The most common side effects associated with buspirone are:

Other important but less frequent side effects include:

  • Unsteady gait
  • Diarrhea
  • Excitement
  • Weakness
  • Hostility
  • Skin rash
  • Tremors

What is the dosage of hydroxyzine vs. buspirone?

Hydroxyzine

  • Hydroxyzine has its maximal effect about 30 to 60 minutes after it is taken. Its effects last for 4 to 6 hours.
  • The recommended dose for treating itching (pruritus) is 25 mg given 3 or 4 times daily by mouth or by intramuscular injection.
  • When used for sedation, the recommended dose is 50 to 100 mg orally or 25 to 100 mg by intramuscular injection.
  • Anxiety and tension are managed with 50 to 100 mg in 4 divided doses or 50 to 100 mg intramuscular injections in 4 or 6 divided doses.
  • Alcohol withdrawal is treated with a 50 to 100 mg injection and may be repeated every 4 to 6 hours as needed.
  • The dose for nausea and vomiting is 25 to 100 mg by injection.
  • Hydroxyzine can be taken with or without food.

Buspirone

  • The usual starting adult dose is 10 to 15 mg daily given in 2 or 3 doses.
  • The dose may be increased by 5 mg every 2 to 4 days until an effective dose is found.
  • The maximum adult dose is 60 mg daily, but most patients respond to 15 to 30 mg daily.
  • Although food increases the amount of buspirone that is absorbed, the importance of this effect is not clear.
  • Buspirone can be taken with or without food but preferably on a consistent basis.

SLIDESHOW

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What drugs interact with hydroxyzine and buspirone?

Hydroxyzine

Hydroxyzine adds to (exaggerates) the sedating effects of alcohol and other drugs that can cause sedation such as the benzodiazepine class of anti-anxiety drugs. These drugs include:

  • diazepam (Valium)
  • lorazepam (Ativan)
  • clonazepam (Klonopin)
  • alprazolam (Xanax)

Hydroxyzine also adds to the sedating effects the narcotic class of pain medications and its derivatives, for example:

Hydroxyzine also adds to the effects of the tricyclic class of antidepressants, for example:

Hydroxyzine also adds to the effects of certain antihypertensive medications, for example:

Hydroxyzine can also intensify the drying effects of other medications with anticholinergic properties, for example:

When using these drugs, the dose of hydroxyzine may require reduction.

Busprione

Buspirone may interact with drugs called monoamine oxidase (MAO) inhibitors -- such as isocarboxazid (Marplan), phenelzine (Nardil), tranylcypromine (Parnate), and procarbazine (Matulane) -- which are used in psychiatric disorders. The use of buspirone with these drugs can cause increased blood pressure. A similar reaction may occur if buspirone is combined with linezolid (Zyvox), an antibiotic that is also an MAO inhibitor. The combination of buspirone and trazodone (Desyrel), an antidepressant, may cause abnormal liver enzymes in the blood.

The combination of buspirone and warfarin (Coumadin), a blood thinner, may accentuate the effects of warfarin and increase the risk of bleeding. Patients taking buspirone should not drink grapefruit juice, since the juice (even well after a dose of buspirone is taken) can increase the amount of buspirone in the blood, possibly leading to side effects.

Inactivation and removal of buspirone is mediated by liver enzymes. Drugs that inhibit these liver enzymes -- for example, erythromycin, itraconazole (Sporanox), and nefazodone (Serzone) -- increase blood concentrations of buspirone. Drugs that enhance these enzymes -- for example, rifampin -- decrease blood concentrations of buspirone. Increased blood concentrations may increase side effects, while decreased blood concentrations may reduce efficacy.

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Are hydroxyzine and buspirone safe to use while pregnant or breastfeeding?

Hydroxyzine

  • A limited number of studies of hydroxyzine in pregnant women suggests that there may be a relationship between its use in the first trimester of pregnancy and congenital abnormalities in the fetus. Therefore, hydroxyzine should be avoided during the first trimester of pregnancy.
  • It is not known whether hydroxyzine is excreted into breast milk. In general, antihistamines are not recommended for use during breastfeeding because they can cause stimulation or seizures in newborns.

Buspirone

  • There are no adequate studies of buspirone in pregnant women.
  • It is not known whether buspirone is secreted in human breast milk. Because buspirone is secreted in the breast milk of animals, however, it should not be used by women who are nursing infants.

Summary

Hydroxyzine (Vistaril) and buspirone (Buspar) are used to treat anxiety. An antihistamine with anticholinergic and sedative properties, hydroxyzine is also used to treat itching caused by allergies, to provide sedation prior to anesthesia, and to treat nausea, vomiting, and alcohol withdrawal. An azapirone anti-anxiety medication that does not cause sedation like benzodiazepines, buspirone is used to provide short-term relief of anxiety symptoms and improve symptoms of depression in patients with generalized anxiety disorder.

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Medically Reviewed on 5/3/2019
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