Lunesta vs. Hydroxyzine
See how Lunesta and Hydroxyzine compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Lunesta is FDA-approved specifically for insomnia, while hydroxyzine is approved for anxiety and itching and is only used for sleep off-label.
Both drugs can cause drowsiness and dry mouth, but Lunesta's signature side effect is an unpleasant taste while hydroxyzine's is weight gain.
Lunesta is a Schedule IV controlled substance with a boxed warning for complex sleep behaviors, while hydroxyzine carries no such controlled-substance restrictions.
Lunesta vs. Hydroxyzine Drug Summary
Lunesta
Lunesta (eszopiclone) is a nonbenzodiazepine sedative-hypnotic FDA-approved to treat insomnia in adults. It is taken as a single tablet by mouth right before bed, in 1 mg, 2 mg, or 3 mg strengths depending on response and other medications. It is a Schedule IV controlled substance due to its potential for dependence.
Hydroxyzine
Hydroxyzine is a first-generation antihistamine FDA-approved for short-term anxiety, itching from allergic skin conditions, and sedation before procedures. It is usually taken as an oral tablet, dosed at 50 to 100 mg up to four times a day for anxiety. It is sometimes used off-label at bedtime for sleep, which is not an FDA-approved use.
Lunesta vs. Hydroxyzine Side Effects
Lunesta
Hydroxyzine
Lunesta vs. Hydroxyzine Dosage
Lunesta
Hydroxyzine
| STAGE | DOSE | WHEN |
| Starting dose | 1 mg | At the start |
| Maximum dose | 3 mg | If needed |
| Dose changes | 2 increases | As tolerated |
| STAGE | DOSE | WHEN |
| Starting dose | 50-100 mg | At the start |
| Maximum dose | 50-100 mg | Same as starting |
| Dose changes | None | Fixed dose |
Lunesta
| STAGE | DOSE | WHEN |
| Starting dose | 1 mg | At the start |
| Maximum dose | 3 mg | If needed |
| Dose changes | 2 increases | As tolerated |
Hydroxyzine
| STAGE | DOSE | WHEN |
| Starting dose | 50-100 mg | At the start |
| Maximum dose | 50-100 mg | Same as starting |
| Dose changes | None | Fixed dose |
Lunesta vs. Hydroxyzine Indications
Lunesta
Lunesta is FDA-approved to treat insomnia in adults, helping people fall asleep faster and, at higher doses, stay asleep through the night. It is taken as one tablet right before getting into bed, only when a full night of sleep is possible. It is not approved for use in children.
Difficulty falling asleep
Difficulty staying asleep
For adults only, not children
Schedule IV controlled substance
Hydroxyzine
Hydroxyzine is FDA-approved for short-term relief of anxiety and tension, itching from allergic skin conditions, and sedation before or after medical procedures. It is not approved to treat insomnia, though its sedating effect leads some doctors to prescribe it off-label for occasional sleep trouble. Long-term anxiety use beyond four months has not been formally studied.
Short-term anxiety and tension
Itching from allergic skin conditions
Sedation before medical procedures
Off-label: occasional sleep trouble
Lunesta vs. Hydroxyzine Pros and Cons
Lunesta
Lunesta is purpose-built for insomnia, with dosing designed around a single nightly tablet rather than a schedule borrowed from another use. Like other sedative hypnotics, it carries a boxed warning for complex sleep behaviors such as sleepwalking or sleep-driving. Insurers often prefer the generic form, since brand pricing runs high.
Pros
FDA-approved specifically for insomnia, not off-label use
Only one dose needed at bedtime, no daytime dosing
Three strengths (1, 2, 3 mg) allow dose adjustment
Generic eszopiclone available at a fraction of brand cost
Cons
Schedule IV controlled substance with dependence potential
Boxed warning for complex sleep behaviors like sleepwalking
Unpleasant taste affects up to a quarter of users
Brand-name list price runs roughly $1,300 to $1,600 a month without insurance
Hydroxyzine
Hydroxyzine is not FDA-approved for sleep, so using it as a sleep aid relies on off-label judgment rather than insomnia-specific trial data. It is not a controlled substance, which means no special prescribing restrictions. Its anticholinergic effects, like dry mouth and weight gain, are more prominent than with hypnotics built specifically for sleep.
Pros
Not a controlled substance, no dependence monitoring required
Low-cost generic, commonly $10 to $40 a month without insurance
Also treats anxiety and itching, useful for overlapping conditions
No boxed warning for complex sleep behaviors
Cons
Not FDA-approved for insomnia; sleep use is off-label
Anticholinergic effects like dry mouth and weight gain are common
FDA dosing is four times daily, not designed for one nightly dose
Anxiety use beyond four months has not been formally studied
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