Hydroxyzine vs. Valium

  • 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. Valium: What's the difference?

What are hydroxyzine and Valium?

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

Valium (diazepam) is a benzodiazepine used to treat anxiety. Valium is also used to treat agitation, tremors, delirium, seizures, and hallucinations resulting from alcohol withdrawal, and to treat seizures, for relief of muscle spasms in some neurological diseases, and for sedation during surgery. Other benzodiazepines include Xanax (alprazolam), Klonopin (clonazepam), Ativan (lorazepam), and Dalmane (flurazepam).

What are the side effects of hydroxyzine and Valium?

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.

Valium

The most common side effects of Valium are:

Other important side effects include:

  • Paradoxical reactions with excitability
  • Muscle spasm
  • Lack of sleep
  • Rage
  • Confusion
  • Speech problems
  • Double vision

Possible serious side effects:

What is the dosage of hydroxyzine vs. Valium?

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 injection 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.

Valium

  • Diazepam may be taken with or without food.
  • Diazepam is disposed of by the liver and excreted mainly by the kidney. Dosages of diazepam may need to be lowered in patients with abnormal kidney function.
  • The usual oral diazepam dose for anxiety or seizures is 2 to 10 mg given 2 to 4 times daily.
  • The usual rectal dose is 0.2 to 0.5 mg/kg and depends on the age of the patient.

What drugs interact with hydroxyzine and Valium?

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.

Valium

Alcohol or medications that cause sedation may add to the sedative effects of Valium. Patients taking benzodiazepines should avoid such combinations.

The following drugs may prolong the effects of Valium by inhibiting liver enzymes that eliminate it:

Dosages may need to be decreased when these drugs are used with Valium.

Conversely, carbamazepine (Tegretol), rifampin (Rifadin), and St. John's Wort promote the production of liver enzymes that break down Valium, thereby reducing its effectiveness.

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Are hydroxyzine and Valium 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.

Valium

  • Benzodiazepines, including Valium, can cause fetal abnormalities and should not be used during pregnancy.
  • Valium is excreted in breast milk and can affect nursing infants, so it should not be used by women who are nursing.

Summary

Hydroxyzine (Vistaril) is an antihistamine with sedative and anticholinergic (drying) properties used to treat allergies, anxiety, and alcohol withdrawal. Valium (diazepam) is a benzodiazepine used to treat anxiety, alcohol withdrawal, and seizures.

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Medically Reviewed on 5/6/2019
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