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
Vistaril
Ativan vs. Vistaril Dosage
Ativan
Vistaril
| 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 |
| 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
| 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
| 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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