Understanding the Fundamental Differences Between Xanax and Atarax
While both Xanax (alprazolam) and Atarax (hydroxyzine) are prescribed to manage anxiety, they are not the same medication [1.2.2]. They belong to entirely different drug classes, work in the body through different mechanisms, have different approved uses, and carry significantly different risk profiles, particularly concerning dependence and addiction [1.2.3, 1.2.5]. Understanding these distinctions is crucial for safe and effective treatment.
What is Xanax (Alprazolam)?
Xanax is the brand name for alprazolam, a potent medication belonging to the benzodiazepine class [1.3.5].
Mechanism of Action Benzodiazepines work by enhancing the effects of a natural chemical in the brain called gamma-aminobutyric acid (GABA) [1.3.2]. GABA is the primary inhibitory neurotransmitter, meaning it slows down brain activity. By boosting GABA's effects, Xanax produces a calming, sedative effect on the central nervous system [1.3.1, 1.3.2]. Its effects are typically felt within 30 minutes to an hour and last for about six hours [1.2.2, 1.3.4].
Approved Uses and Controlled Status Xanax is FDA-approved for the management of anxiety disorders and the short-term treatment of panic disorder, with or without agoraphobia [1.8.2, 1.8.4]. Due to its mechanism and potential for misuse, Xanax is classified as a Schedule IV controlled substance by the DEA [1.5.1, 1.5.2]. This classification signifies that it has a known potential for abuse and physical or psychological dependence [1.5.4]. Long-term use is generally discouraged due to the high risk of tolerance, dependence, and difficult withdrawal symptoms [1.2.5, 1.8.3].
What is Atarax (Hydroxyzine)?
Atarax is a brand name for hydroxyzine, which is a first-generation antihistamine [1.4.1]. While its primary class is associated with allergy treatment, it has sedative properties that make it useful for anxiety.
Mechanism of Action Unlike Xanax, Atarax does not primarily act on GABA receptors [1.4.3]. Its main mechanism is blocking histamine H1 receptors in the brain [1.4.1, 1.4.3]. This action reduces activity in key regions of the central nervous system, leading to a sedative and anti-anxiety effect [1.4.3]. It also has an effect on serotonin receptors, which may contribute to its anxiolytic properties [1.4.5]. Its effects begin quickly, often within 15 to 30 minutes [1.2.2, 1.4.1].
Approved Uses and Controlled Status Hydroxyzine is FDA-approved for the symptomatic relief of anxiety and tension, as well as for itching (pruritus) caused by allergies and as a sedative before and after general anesthesia [1.7.1, 1.7.3]. A key difference from Xanax is that Atarax is not a controlled substance [1.2.4, 1.6.1]. It is not considered to be habit-forming in the same way as benzodiazepines, which makes it a preferred option for individuals with a history of substance abuse or when long-term treatment is considered [1.2.1, 1.2.5].
Side-by-Side Comparison: Xanax vs. Atarax
To clarify the differences, here is a direct comparison table:
| Feature | Xanax (Alprazolam) | Atarax (Hydroxyzine) |
|---|---|---|
| Drug Class | Benzodiazepine [1.3.5] | Antihistamine [1.4.1] |
| Mechanism | Enhances GABA activity [1.3.2] | Blocks histamine H1 receptors [1.4.3] |
| Primary Uses | Anxiety disorders, Panic disorder [1.8.2] | Anxiety, Itching/Allergies, Sedation [1.7.1] |
| Controlled? | Yes, Schedule IV [1.5.2] | No [1.6.1] |
| Addiction Risk | High potential for dependence and abuse [1.2.5] | Does not cause physical addiction [1.2.5, 1.6.3] |
| Onset of Action | ~30-60 minutes [1.2.2, 1.3.4] | ~15-30 minutes [1.2.2, 1.4.1] |
| Common Side Effects | Drowsiness, dizziness, memory problems, coordination issues [1.8.2, 1.11.2] | Drowsiness, dry mouth, confusion (especially in older adults), headache [1.7.3, 1.11.1] |
Drug Interactions and Taking Them Together
Both medications are central nervous system depressants, and combining them can amplify side effects like drowsiness, dizziness, confusion, and impaired judgment and motor coordination [1.10.1]. Taking Xanax and Atarax together is generally not recommended unless specifically directed and monitored by a healthcare professional [1.10.2, 1.10.4]. Similarly, combining either drug with other CNS depressants like alcohol or opioids significantly increases the risk of severe side effects, including life-threatening respiratory depression [1.8.3, 1.10.3].
Conclusion
In summary, Xanax and Atarax are profoundly different medications. Xanax is a potent, federally controlled benzodiazepine with a high risk of dependence, best suited for severe, acute anxiety or panic disorders on a short-term basis [1.2.5, 1.8.2]. Atarax is a non-controlled antihistamine with sedative properties, used for milder anxiety, allergies, and sedation, and it carries a much lower risk of addiction [1.2.5, 1.6.1]. The choice between these medications depends entirely on the specific clinical situation, the severity of symptoms, and a patient's medical history. Always consult a healthcare provider to determine the most appropriate treatment. Find out more about medication safety from the FDA.
