Ativan vs. Vistaril

See how Ativan and Vistaril compare on approved uses, dosing, side effects, and cost.

Key Takeaways

  • Ativan is a benzodiazepine that works quickly for acute anxiety but carries boxed warnings for abuse, dependence, and dangerous interactions with opioids.

  • Vistaril is an antihistamine with no abuse potential or boxed warning, but it is generally considered less potent for severe anxiety and must be dosed several times a day.

  • Ativan is a controlled substance meant mainly for short-term use, while Vistaril can also treat allergic itching and is sometimes used longer term.

Ativan vs. Vistaril Drug Summary

Ativan

Ativan (lorazepam) is a benzodiazepine used to manage anxiety disorders and short-term anxiety symptoms, and it is also given by injection for sedation before anesthesia. It comes as an oral tablet, an oral liquid concentrate, and an injectable form, and it is generally intended for short-term use.

Vistaril

Vistaril (hydroxyzine pamoate) is an antihistamine used for anxiety and tension linked to psychoneurosis, as well as for itching from allergic skin conditions. It is taken as an oral capsule or liquid suspension, usually multiple times a day.

Ativan vs. Vistaril 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%)

Vistaril

Most common
drowsiness (frequency not specified)
dry mouth (frequency not specified)
pruritus (frequency not specified)
rash (frequency not specified)

Ativan vs. Vistaril Dosage

Ativan

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 0.05 mg/kg IM At the start
Maximum dose 1 to 10 mg/day If needed
Dose changes 2 increases As tolerated

Vistaril

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 50-100 mg 4 times daily At the start
Maximum dose 50-100 mg daily divided If needed
Dose changes 2 increases As tolerated

Ativan vs. Vistaril Indications

Ativan

Ativan is FDA-approved for anxiety disorders, short-term relief of anxiety symptoms, anxiety with depressive features, and preanesthetic sedation by injection. It is also used off-label for status epilepticus and insomnia caused by anxiety or stress.

  • Management of anxiety disorders

  • Short-term relief of anxiety symptoms

  • Anxiety associated with depressive symptoms

  • Preanesthetic sedation (injection)

Vistaril

Vistaril is FDA-approved for anxiety and tension tied to psychoneurosis and as an adjunct in medical conditions with anxiety components. It also treats itching from allergic skin conditions and provides sedation around general anesthesia.

  • Anxiety and tension with psychoneurosis

  • Adjunct in organic disease-related anxiety

  • Pruritus from allergic skin conditions

  • Sedation before and after anesthesia

Ativan vs. Vistaril Pros and Cons

Ativan

Ativan acts quickly and is well suited for short bursts of severe anxiety, with an injectable option for urgent or procedural sedation. Its benzodiazepine class means real risks around dependence and interactions that require careful use.

Pros

  • Fast-acting for acute anxiety symptoms

  • Available as IV/IM injection for urgent use

  • Extended-release option for once-daily dosing

  • Lower typical cost, roughly $10 to $40 per month

Cons

  • Boxed warnings for abuse, misuse, and addiction

  • Boxed warning for dependence and withdrawal risk

  • Dangerous with opioids: sedation, respiratory depression

  • Not studied for use beyond about 4 months

Vistaril

Vistaril has no abuse potential and no boxed warning, making it an option for people who want to avoid controlled substances. It tends to be less potent for severe anxiety and needs more frequent dosing throughout the day.

Pros

  • Not a controlled substance, no known abuse risk

  • No boxed warning unlike many sedating anxiety drugs

  • Also treats allergic itching, a dual-purpose use

  • Considered appropriate for longer-term use

Cons

  • Generally less potent for severe acute anxiety

  • Requires dosing multiple times per day

  • Contraindicated with prolonged QT interval

  • Cost varies widely, roughly $25 to $330 per month

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