Hydroxyzine vs. Valium

• Hydroxyzine and Valium (diazepam) are used to treat anxiety and alcohol withdrawal.
• Hydroxyzine is also used to treat itching caused by various allergic reactions, to induce sedation prior to or after anesthesia, and to treat nausea and vomiting.
• Valium is also used to treat seizures, for relief of muscle spasms in some neurological diseases, and for sedation during surgery.
• A brand name for hydroxyzine is Vistaril.
• Valium is a brand name for diazepam.
• Hydroxyzine and Valium belong to different drug classes. Hydroxyzine is an antihistamine with anticholinergic (drying) and sedative properties, and Valium is an anti-anxiety medication in the benzodiazepine class.
• Side effects of hydroxyzine and Valium that are similar include drowsiness, tiredness/fatigue, confusion, and blurred or double vision.
• Side effects of hydroxyzine that are different from Valium include sleepiness, dizziness, problems with coordination, drying and thickening of oral and other respiratory secretions, upset stomach, dry mouth, nervousness, irritability, tremors, seizures, loss of appetite, and nausea.
• Side effects of Valium that are different from hydroxyzine include diarrhea, rash, euphoria, loss of balance, excitability, muscle spasm, lack of sleep, rage, and speech problems.
• Suddenly stopping Valium after prolonged use can lead to withdrawal symptoms including insomnia, headaches, nausea, vomiting, lightheadedness, sweating, anxiety, fatigue, and seizures (in severe cases).

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).

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:

• Confusion
• Dry mouth
• Nervousness
• Irritability
• Blurred vision
• Double vision
• Tremor
• Seizure
• Loss of appetite
• Nausea

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:

• Drowsiness
• Fatigue
• Diarrhea
• Rash
• Euphoria
• Ataxia (loss of balance)

Other important side effects include:

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

Possible serious side effects:

• Respiratory depression
• Neutropenia
• Depression

• 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.

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:

• oxycodone and acetaminophen (Percocet)
• hydrocodone/acetaminophen (Vicodin)
• hydromorphone (Dilaudid)
• codeine
• propoxyphene (Darvon)

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

• amitriptyline (Elavil, Endep)
• imipramine (Tofranil)
• desipramine (Norpramin)

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

• clonidine (Catapres)
• propranolol (Inderal)

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

• dicyclomine (Bentyl)
• bethanechol (Urecholine)
• propantheline (Pro-Banthine)
• amitriptyline (Elavil, Endep)
• chlorpromazine (Thorazine)

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:

• cimetidine (Tagamet)
• ketoconazole (Nizoral)
• itraconazole (Sporanox)
• omeprazole (Prilosec, Rapinex)
• erythromycin
• clarithromycin (Biaxin)
• darunavir (Prezista)
• fluvoxamine (Luvox)
• fluoxetine (Prozac)

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.

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.