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

Most common
Sedation (up to 15.9%)
Dizziness (up to 6.9%)
Weakness (up to 4.2%)
Unsteadiness (up to 3.4%)

Hydroxyzine

Most common
Drowsiness (up to 28%)
Dry mouth (up to 14%)
Weight gain (up to 12%)
Headache (up to 9%)

Ativan vs. Hydroxyzine Dosage

Ativan

Dosage
Dosage Table
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

Dosage
Dosage Table
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

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