Hydroxyzine vs. Serax

See how Hydroxyzine and Serax compare on approved uses, dosing, side effects, and cost.

Key Takeaways

  • Hydroxyzine is a non-addictive antihistamine used short-term for anxiety and itching, while Serax is a benzodiazepine with a boxed warning for dependence and misuse.

  • Both drugs commonly cause drowsiness, but hydroxyzine is also linked to dry mouth and weight gain, while Serax carries the added risks of its benzodiazepine class.

  • Serax is FDA-approved for alcohol withdrawal, a use hydroxyzine does not have, but hydroxyzine typically costs less per month without insurance.

Hydroxyzine vs. Serax Drug Summary

Hydroxyzine

Hydroxyzine is a first-generation antihistamine used for short-term relief of anxiety and tension, as well as itching from allergic skin conditions. It is taken by mouth, usually four times a day, and is not a controlled substance.

Serax

Serax (oxazepam) is a benzodiazepine used to manage anxiety disorders and ease symptoms of alcohol withdrawal. It is taken by mouth several times a day and, as a controlled substance, carries boxed warnings for dependence and misuse.

Hydroxyzine vs. Serax Side Effects

Hydroxyzine

Most common
drowsiness (up to 28%)
dry mouth (up to 14%)
weight gain (up to 12%)
trouble concentrating (up to 9%)

Serax

Most common
drowsiness (commonly seen, first days of therapy)
dizziness (occurs in few instances)
vertigo (occurs in few instances)
headache (occurs in few instances)

Hydroxyzine vs. Serax Dosage

Hydroxyzine

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 50-100 mg At the start
Maximum dose 50-100 mg Same as starting
Dose changes None Fixed dose

Serax

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 10-15 mg 3-4x daily At the start
Maximum dose 15-30 mg 3-4x daily If needed
Dose changes 1 increase As tolerated

Hydroxyzine vs. Serax Indications

Hydroxyzine

Hydroxyzine treats short-term anxiety and tension linked to psychoneurosis, and it relieves itching from allergic skin conditions like hives and eczema. It is also used as a sedative before and after surgery. Some clinicians use it off-label for insomnia, though this is not an FDA-approved use.

  • Short-term anxiety and tension in psychoneurosis

  • Itching from allergic skin conditions like hives

  • Sedation before and after surgery

  • Off-label: sometimes used for insomnia

Serax

Serax treats anxiety disorders and the short-term symptoms of anxiety, and it is FDA-approved to ease symptoms of alcohol withdrawal. Some clinicians use it off-label for insomnia, though this is not an FDA-approved use.

  • Management of anxiety disorders

  • Short-term relief of anxiety symptoms

  • Relief of alcohol withdrawal symptoms

  • Off-label: sometimes used for insomnia

Hydroxyzine vs. Serax Pros and Cons

Hydroxyzine

Hydroxyzine is not a controlled substance and carries no known risk of physical dependence, which sets it apart from benzodiazepine options. It also treats itching, giving it a use beyond anxiety alone. It generally costs less out of pocket than Serax.

Pros

  • Not a controlled substance, no known abuse risk

  • Also treats itching from allergic skin conditions

  • Onset of action within 15 to 30 minutes

  • Lower cost, roughly $15 to $40 per month generic

Cons

  • Strong anticholinergic effects like dry mouth

  • Not FDA-approved for alcohol withdrawal

  • Not established for use beyond 4 months

Serax

Serax is a benzodiazepine with a short half-life and no active metabolites, which can make it easier to dose in older adults or those with liver problems. It carries FDA boxed warnings for abuse, dependence, and dangerous opioid interactions. It typically costs more than non-controlled alternatives like hydroxyzine.

Pros

  • FDA-approved for alcohol withdrawal too

  • Short half-life with no active metabolites

  • Often preferred in elderly or liver disease

  • Less anticholinergic burden than antihistamines

Cons

  • Schedule IV controlled substance, abuse risk

  • Boxed warnings for dependence and opioid risk

  • Costs roughly $90 to $145 per month

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