Ativan vs. Hydroxyzine
See how Ativan and Hydroxyzine compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Ativan is a fast-acting benzodiazepine best for short-term, acute anxiety, while hydroxyzine is a non-addictive antihistamine that can be used longer term but works less predictably for anxiety relief.
Both drugs can cause drowsiness, but Ativan carries a boxed warning for dependence and dangerous interactions with opioids, while hydroxyzine carries no abuse risk but needs dosing up to four times a day.
Ativan is a Schedule IV controlled substance requiring closer prescribing oversight, whereas hydroxyzine is not controlled and is also FDA-approved to treat itching from allergies.
Ativan vs. Hydroxyzine Drug Summary
Ativan
Ativan (lorazepam) is a benzodiazepine used to manage anxiety disorders and short-term anxiety symptoms, including anxiety tied to depression. It comes as an oral tablet, an oral liquid concentrate, and an injection used for preanesthetic sedation.
Hydroxyzine
Hydroxyzine is a first-generation antihistamine used to treat anxiety and tension linked to psychoneurosis, alongside its original use for allergy itching. It's taken as an oral tablet, capsule, or liquid, usually several times a day, or given by injection for sedation around surgery.
Ativan vs. Hydroxyzine Side Effects
Ativan
Hydroxyzine
Ativan vs. Hydroxyzine Dosage
Ativan
Hydroxyzine
| STAGE | DOSE | WHEN |
| Starting dose | 2 to 6 mg/day | At the start |
| Maximum dose | 0.05 mg/kg IM | If needed |
| Dose changes | 2 increases | As tolerated |
| STAGE | DOSE | WHEN |
| Starting dose | 50 to 100 mg | At the start |
| Maximum dose | 25 to 100 mg IM | If needed |
| Dose changes | 2 increases | As tolerated |
Ativan
| STAGE | DOSE | WHEN |
| Starting dose | 2 to 6 mg/day | At the start |
| Maximum dose | 0.05 mg/kg IM | If needed |
| Dose changes | 2 increases | As tolerated |
Hydroxyzine
| STAGE | DOSE | WHEN |
| Starting dose | 50 to 100 mg | At the start |
| Maximum dose | 25 to 100 mg IM | If needed |
| Dose changes | 2 increases | As tolerated |
Ativan vs. Hydroxyzine Indications
Ativan
Ativan (lorazepam) is FDA-approved to manage anxiety disorders and provide short-term relief of anxiety symptoms, including anxiety tied to depression. It's also used as a preanesthetic sedative given by injection before certain procedures. Doctors sometimes prescribe it off-label for status epilepticus or for insomnia driven by anxiety.
Generalized anxiety disorder
Short-term anxiety symptom relief
Anxiety with depressive symptoms
Preanesthetic sedation (injection)
Off-label: status epilepticus, insomnia
Hydroxyzine
Hydroxyzine is FDA-approved for anxiety and tension linked to psychoneurosis, and as an add-on treatment when anxiety accompanies a physical illness. It's also approved to relieve itching from allergic skin conditions and for sedation before or after anesthesia. Some clinicians use it off-label for insomnia or nausea.
Anxiety and tension (psychoneurosis)
Anxiety linked to physical illness
Itching from allergic skin conditions
Sedation before or after anesthesia
Off-label: insomnia, nausea
Ativan vs. Hydroxyzine Pros and Cons
Ativan
Ativan works within minutes for acute anxiety, but it's a Schedule IV controlled substance, so refills are tightly regulated and monitored. As a decades-old generic, insurance plans almost always cover it without special approval.
Pros
Works within 15 to 30 minutes for anxiety
Available as once-daily extended-release
Injectable option for urgent sedation
Decades of clinical use since 1977
Cons
Schedule IV controlled substance
Boxed warning for dependence, withdrawal
Dangerous if combined with opioids
Not studied for use beyond 4 months
Hydroxyzine
Hydroxyzine is not a controlled substance, so it carries no federal refill restrictions and no dependence risk, though its anxiety relief tends to be milder and slower. It's also a long-established generic that insurance plans typically cover with ease.
Pros
Not a controlled substance, no misuse flag
No withdrawal symptoms after stopping
Also treats itching and allergy symptoms
Can be used for longer stretches of time
Cons
Requires dosing up to 4 times daily
More anticholinergic effects like dry mouth
Slower onset than benzodiazepines
Carries its own QT prolongation warning
Common Symptoms and Related Diseases You Can Explore
Explore a range of common symptoms the Doctronic Symptom Checker can help you understand.